Back pain is one of the major disabling health conditions among older adults aged 60 years and older. Many causes of lower back pain are age-related with physical and psychosocial changes. There is a distinct lack of awareness, especially in older adults to the causes and effects of back pain and pain management.
Existing evidence suggests that prevalence rates of severe and chronic low back pain increase with older age. As compared to working-age adults, older adults are more likely to develop lower back pain like osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis
The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” So what’s this concept of “wellness” all about? Well, wellness is basically healthiness… It’s the active process of becoming more aware of your health and making positive changes towards leading a healthier, more fulfilling life.
What is wellness?
The concept of “wellness” can often be a dirty word in healthcare circles, as it has long been associated with antiscientific or pseudoscientific ideas… But that depends on what wellness means to you. To us, wellness is health. It’s living a healthy and fulfilling life, and taking responsibility for your own health. We’re taking ownership of the word wellness and are going to strive to clean up its reputation!
Go on then, how?
As an evidence based clinic, we rely heavily on what research tells us is effective for managing conditions or symptoms, and as such the treatment protocols that we utilise can vary quite dramatically depending on what the latest high quality research says is effective. We don’t sell long treatment plans, and you shouldn’t buy into one either- it’s impossible to know that someone will need 12 treatments to get you better when they first start seeing you- instead, a short course of treatment should be proposed and that should definitely include a review appointment where you discuss your progress and determine if you should be discharged from care. We collect patient reported outcome measures to ensure that we do not over or under-treat our patients, and this provides us with an opportunity to identify how effective the treatment is that we’ve provided,
(P.S. We monitor how many treatments our patients receive on average- it’s just 5 appointments over a 3 month period!)
We promise you that as an ethical healthcare clinic we will never offer you ineffective, unnecessary treatment.
Why does wellness matter?
If you were lucky enough to be born in the UK, chances are you’ll have encountered the NHS once or twice. The NHS is a fantastic system for taking care of us, but it is overstretched, overburdened and not coping. When it was established in 1948, life expectancy for men was 66 years old, and for women, 71. Today those figures are 77.2 and 81.5. Over the past 60 years, the proportion of all deaths caused by cancer has risen, from 16.9 to 27 per cent. It took 50 years for the UK population to increase from 40 to 50
million between 1898 and 1948, but in just 24 years the population will increase by 10 million – and hit 70 million in 2029, according to the Office for National Statistics. Simply put, there’s more of us, we’re living longer, with more diseases and more complex health needs than ever before. Our poor NHS can’t cut it.
The NHS will always be there for us when we get sick- but how about we work a little harder to stop ourselves needing it in the first place?
More and more people are recognising a need to take responsibility for their own health and are striving to lead a healthier lifestyle. This can be through small steps, such as reducing your alcohol intake, not smoking, regularly exercising or you might take it a little further, with bespoke nutritional programmes, chiropractic care to optimise performance and move well, in addition to regular care to address the stresses and strains we put our body through on a daily basis.
An holistic approach to health
Ahh, “holistic”. Another dirty word. Or is it? Philosophically, holism is described as “the belief that the parts of something are intimately interconnected and explicable only by reference to the whole.” From a medical perspective, it’s characterised by “the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.” Doesn’t sound so bad to me- as humans we do need to consider the person as a whole. Someone with back pain doesn’t just have back pain- they have a problem that’s preventing them from going to work (social issue), that’s causing them anxiety (psychological issue), that’s limiting their ability to walk (physical issue) and no doubt a whole host of other problems. So it would be churlish to only consider the physical issues- that’s probably not going to get them truly better, particularly for those with high anxiety levels as there’s a whole host of research that tells us they need more specific management to help with their back pain. We need to acknowledge their
needs as a whole. We need to ensure we address all these aspects in order for them to recovery.
We also need to consider the why behind their pain. For example, a smoker will report higher levels of pain perception than a non-smoker. That’s an environmental issue. So an holistic approach would aim to tackle the smoking also (not least for the hundreds of health benefits you see from being a non-smoker) and encourage you to take active steps towards leading a healthier lifestyle (there’s that wellness
definition popping up again!)
This is what we aim to provide for our patients- not just addressing the physical symptoms but ensuring that all your health needs are met.
So when we talk about taking an holistic approach to wellness, that suddenly doesn’t sound like such a bad thing, does it?
It may or may not surprise you to find out there’s a lot of misleading information about back pain out there- more specifically, about what to do when back pain strikes and how to prevent it from recurring. This has not only over-simplified how to treat back pain but also lead to some weird and wonderful rehabilitation strategies.
Let’s bust a few of these back pain misconceptions.
1. Sit-ups will help improve your spinal health
Did you know that the average sit-up causes compression of the lower back that almost exceeds the safe limits set by the National Institute for Occupational Safety and Health (the unified set of manual lifting recommendations based on the convergence of medical, scientific, and engineering points of view which helps determine safe work practices)
Physical fitness does have an impact on our spinal health, but it is more important that we are getting fit in the right way. Studies have shown that increasing abdominal strength through sit-ups causes stress on the discs in our back and compresses the lumbar spine- enough for researchers to conclude that sit-ups may cause problems in almost anyone.
2. “Lift with your knees, not your back”
Have you ever tried to do this? Ever tried to do it all day long? It’s almost impossible to do this every single time we go to lift something. Forget the old squat technique, instead, the way you lift should depend on what you’re lifting, where you’re moving it to, your own build, how many items you have to lift and so on.
For more information on how to lift correctly (and give your knees a break) click here.
3. Strong muscles, strong back
Not so, my friends. Muscle strength doesn’t help us predict who will or won’t get back problems, and focusing too much on strength instead of stability will be sure to cause problems. Instead, focus on muscular endurance (i.e. how long your muscles can sustain an activity for). Remember, muscles have three main properties: flexibility, strength and endurance. Any issues that results in a lack of flexibility, strength or endurance will be enough to stimulate the nerves within your muscles and start telling your brain that something’s wrong. What’s the end result of that? Pain.
4. Tight hamstrings and unequal leg lengths cause back problems.
These types of issues are often given as easy diagnoses to simplify the cause of a patients’ complaint. Don’t be fooled. Some studies have shown that in athletes with ‘tight’ hamstrings, these muscles function almost like springs, to help jump higher or run faster. It rather appears that tight hamstrings aren’t the issue, it’s how well these tight hamstrings can cope with stretching that determines whether or not you’ll have back pain. Studies have found that people with chronic back pain tend to use their hamstrings instead of their gluteal muscles to extend the hip, which can increase the amount of force on the spine during squatting- correcting this is going to be a fundamental aspect of care.
Interestingly, back pain also wasn’t found to be definitively linked with leg length discrepancies even in cases where the difference in length was 5cm!
5. Scoliosis= A lifetime of back issues?
Not true! We see so many adults who were abruptly diagnosed with a ‘scoliosis’ after being
asked to bend forwards and touch their toes by the school nurse back in the 1970’s. The difficulty with this is that
the tests for assessing scoliosis have a false positive rate of at least 60%, and the statistical risk of having a scoliosis that requires treatment is only 0.2%. Why are we telling you this? Because once we’re told we have a “condition” it becomes ingrained in us. Part of who we are. So time and time again we see adults who tell us they have a “scoliosis”, and have been plagued by a lifetime of avoiding activities because of their diagnosis, when mild scoliosis (less than 30 degrees deviation) may simply be monitored and treated with exercise.
6. Knees to chest- the ultimate back stretch
Sure, it feels good, lying on the floor pulling your knees into your chest. Depending on your diagnosis, it might even be the right exercise for you, but if you’re one of the many patients I see who doesn’t cope well with forward bending, this exercise isn’t ideal. Why? Because pulling the knees to the chest gives you the perception of relief from your lower back pain (because the stretch receptors in your erector spinae muscles are stimulated) but this type of exercises causes more cumulative damage to the discs, leading to increased pain and stiffness the next day. As practitioners, we know to eliminate these type of exercises and prescribe ones appropriate for your needs- in fact this bespoke rehabilitation plan is one of the main benefits of coming to see a chiropractor.
So where do we go from here?
As you can see, misleading information and advice regarding back pain can lead to us performing the very movements that worsen our back pain in our attempts to get it better. Ensuring you have an accurate diagnosis, treatment plan and rehabilitation strategy is vital to recovery.No treatment plan can be truly successful without incorporating spinal rehabilitation exercises that work to remove the faulty movement patterns that cause back pain problems. We have to work with our clients to ensure that we incorporate exercises that help you build the capacity of the muscles in your back to cope with the tasks you ask of it each day. As you can imagine, each persons’ day is different, and so your treatment plan will be too.
We (as a society) throw huge amounts of money at back pain. There’s new gadgets, research, more effective drugs, better surgeries and dozens more practitioners out there all touting to be the next big thing in curing back pain, yet back pain remains as prevalent as it ever was. In fact, it seems to be getting worse.
So why is it that back pain is still such an issue?
Everyone is different. Gosh, wasn’t that a groundbreaking statement. Yes, well, forgive me for stating the obvious but, it’s true. If we treated your back pain the same way we treat everyone else’s, we’re not going to get very far, as unfortunately everyone’s backs behave differently (and misbehave differently!) That’s why all of these treatment that work for everyone else don’t necessarily work for you- because your back is different to theirs and you need to find the approach that works for you! P.S. This is why whenever someone asks me if I get bored “cracking backs all day” I can answer with a resounding NO! a) Because I don’t “crack backs” and b) because I have to not only work out what’s going on and diagnose it correctly but also work out how best to treat it based on what’s happening and what you want! It’s not quite as simple as handing over a pill and sending you out the door. Blimey, how boring would that be!
We’re treating it far too literally.
This is the big one! So many treatments out there focus on treating the area of pain as though that’s the cause of the pain. Pain in the lower back, treat the lower back. Monkey see, monkey do. Do you follow? Well, there’s two problems there. Firstly, if it was that simple to treat back pain, it wouldn’t be such a massive problem. Secondly, if we isolate our treatment and just focus on the spine, we are ignoring everything the spine connects to (and you don’t need a genius to tell you that the spine connects to everything!) As such, treating just one thing in the giant jigsaw that is your back pain is going to end up in tears and a lot of wasted time (and money). Of course we need to treat the site of pain (duh, that’s where it hurts!) but pain in itself only tells us there’s a problem, not where the problem is or what it is. Treating the site of the pain is lazy- we need to look at everything inside your body that impacts on the area of pain and could, as a result, be affecting it. Then, we need to look at everything outside your body (like your job, hobbies, environment) and see if that’s having an impact too!
As a really simple demonstration of this, do me a favour- Google “Cervicogenic headache.” Done it? What does it say? That it’s pain referred to the head from structures (i.e. soft tissues and joints) in the neck. So as you see, you could take a paracetamol or sit with an icepack on your forehead but as this isn’t the source of the pain, it’s not going to do much good in the long term. A good clinician needs to look further afield to find out what’s actually causing that pain.
Have a look at the image below- see how forward head carriage can cause dysfunction in your back and thoracic extensors?! What a waste of time it would be just treating the back and not addressing the forward head carriage (i.e. the issue that’s actually causing the pain!)
So if back pain is really so tricky to treat, what can we really do about it? Here’s two super simple tips.
1) Get in touch with mother nature. No, we don’t mean making skirts out of hemp and running naked through the wilderness (although feel free, if that’s your thing). We mean take your shoes and socks off and feel the ground.
The nerves in your lower back run all the way down to your feet for a reason! Your feet provide feedback to your brain that not only tells your brain where you are in space, but they also provide invaluable feedback to help stabilise your body. Stick some bulky trainers on to stop your feet from being able to feel the ground and those feedback signals sent to your brain get confused, which leads to instability. When the brain feels unsafe, or unstable, it’s going to make things hurt and reduce the amount of movement in the area.
(While we’re on the subject, where most people go wrong is that at this point, right when they have less movement, they strain against it to push the body beyond that threshold. As soon as you go beyond where your body is happy to go, the body has a habit of going into shutdown- it tenses up and produces pain to stop you from doing it again!)
Simply put- the more skin in touch with the ground, the more sensory input your brain gets, which it in turn feeds forward to your spine, giving you more stability and in turn reducing pain.
You’d think, given it’s something you’ve been doing your whole life, that you’d know how to breathe by now. But I bet you don’t! Do yourself a favour- for the next 24 hours, try and pay attention to how you’re breathing when you’re moving. My bet is that you hold your breath when you’re performing dynamic movements. Why? Read on, dear friends and all shall be made clear.
Breathing is closely related to spinal stability. If you think of your body as a barrel, the diaphragm is the top, and the pelvic floor the bottom. The diaphragm regulates our intra-abdominal pressure and contributes massively to our spinal stability. So when our spine is unstable and weak, we hold our breath to perform movements. This is an ill-informed attempt by our brain to increase our intra-adnominal pressure and maintain spinal stability because it’s worried that if we don’t, we’ll become unstable and get injured. Pull that belly button in towards your spine and breathe OUT as you perform dynamic movements- this will engage the good ol’ core musculature and take the pressure of your diaphragm and stop relying on the diaphragm alone to provide spinal stability. 24 hours, focusing on your breathing, that’s all I ask. Being mindful and aware is key to changing your habits.
In a nutshell, part of your treatment programme is going to involve teaching you how to breathe!
So there you have it!
Now you understand why back pain can be such a nuisance to treat. Fortunately, you’ve got those two simple steps to reducing your back pain. Doesn’t that sound like a great catchphrase?! Honestly though, if I could give one (okay, two) pieces of advice to every person I see in clinic, it would be those. Create some healthy habits to help your spine and I guarantee you’ll see an improvement.
Here it is, the oh-so-predictable New Year’s Resolution post about a “New Year, New You.” We’re going to bypass that this year in favour of something far more important. Whilst New Year’s Resolutions which centre around going to the gym, getting fitter or putting more of an emphasis on our health are fantastic, we want you to spare a thought for your joints before you start a new exercise regime. Search online for “getting fit quotes” and the words that pop up most frequently are “pain”, “hurt”, “sore”, “skinny” or “burn”. Whilst some pain is normal and to be expected, this has given rise to a worrying influx in the number of sport-related injuries we’ve seen from athletes “training through the pain”.
Most sporting injuries occur from what we call the Terrible Toos- doing too much, too soon. After not working out for months or years, people come in and try to run 5 miles or lift 200 lbs at their first session. Their deconditioned, unprepared muscles can’t cope with the action and so injury occurs. We then have to recover from the injury by which point our motivation for our New Year’s resolution is gone. You won’t become Batman (or Catwoman) in one workout session, so please please please train properly and spare a thought for injury prevention this year.
So how does injury occur?
Injury, particularly sports injury, occurs through direct or indirect trauma to muscles, ligaments, and joint capsules. Injury takes two forms- direct and indirect. Direct trauma or injury occurs through blunt trauma or a sudden overload- so dropping a weight on your foot would be a direct trauma (HINT: Don’t do it!)
Indirect trauma or injury occurs from repeated submaximal loading. (When we refer to joint loading, what we mean is the force that is put on a load-bearing or weight-bearing joint during exercise.) This could be therefore be repetitive injury to your elbows when lifting, or your knee when running. Indirect trauma can therefore occur through repetitive lifting of weights, running, or any activity that “loads” a joint.
Regardless of direct or indirect trauma, the end result is still the same- tissue dysfunction that is characterised through pain, inflammation, and internal tissue stress. This can lead to what is known as “functional disability”, where you’re able to go about your day-to-day life largely without issue, but your training or exercise regime is impaired. Not what you want when you’re motivated to get to the gym!
Why does injury occur?
Whilst some sports injury occurs through direct trauma- such as a rugby tackle, overuse injuries are more common in sports than acute injuries. These are subtle and occur over time, hence why early detection and diagnosis is key. Faulty movement patterns, joint restriction or muscle dysfunction can be detected by your chiropractor which can help to identify those who are at risk of an overuse injury and provide advice on injury prevention, modification of exercises, adaptations to technique or treatment if appropriate.
Researchers have reported that impact forces of up to 550% the normal force load are transmitted to our joints when running, with impact forces between 4 to 8 times higher than those during normal walking. Much as you wouldn’t lift a heavy weight without putting some thought into it first (if you even decided to lift it at all!) we need to put some thought into how well equipped our bodies are to cope with these additional stresses and strains before we hit the gym. This is why launching into a fitness regime without putting some thought into how you’re going to do it and how you’re going to protect yourself whilst doing it can be crucial.
Coping with this degree of stress can be challenging enough even for joints that are well-adapted to this degree of stress, but if you are starting a new exercise regime or perhaps picking up a new activity, your joints need some time to adapt to the new activity. They also need to be ready and able to cope with this degree of stress. This is where chiropractic comes in.
How does chiropractic help?
Chiropractors are primary healthcare professionals who are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints and muscles), as well as the effects these can have on the nervous system and general health.
Chiropractors are often thought to only “crack backs” and only treat back pain. Much like your GP wouldn’t prescribe the same pill for an ear infection as they would for high blood pressure, so a chiropractor doesn’t just perform spinal manipulation for a bad back. It entirely depends on the nature of the injury, the level of pain, and most importantly, your personal preferences (it all comes down to teamwork!) Chiropractors have a vast array of treatment options they can offer and chiropractic care can be crucial in injury prevention because chiropractic emphasises the correct functioning of all joints, muscles, tendons and ligaments in your body to ensure you are performing at your very best. Whether you are an elite athlete, a gym newbie, or perhaps a keen sportsperson returning from injury, chiropractic can be crucial in identifying dysfunction prior to an injury occurring.
A crucial part of treatment at Acorn Health is helping you to develop a firm understanding of how your body works, how pain and problems can occur and how to prevent it. We work with you to develop a new fitness routine and training programme with appropriate exercises that will enable you to strengthen and stabilise your joints whilst reducing your risk of picking up an injury.
So whilst you’re dusting off your trainers and wrangling your way into your sports kit, spare a thought for your joints, and spare a thought for injury prevention.
If you would like to receive our “Injury for Runners” resource, detailing the most common types of running injuries, the mechanism of injury, preventative measures and more useful information, please complete your details below.