You mean to say that back pain has its benefits. Really? Yes.
At Alpine Physical Therapy we’ve treated over 4,000 Missoulians with it.
Strangely, the main goal of PT isn’t merely pain freedom. Why? Because many folks tend to feel better after first time back pain within 6 weeks no matter what they do or don’t do.
But that’s not a good reason to go it alone.
Actually, back patients at Alpine get big benefits such as:
1. Learning about their condition and why their back isn’t working right.
2. Gaining strategies to protect their back for the long haul.
3. Learning ways to strengthen their back and core so they can get out and work and play hard.
4. Discovering how to transition from back exercises to full body, fat burning, muscle building exercises to improve health, wellbeing, and longevity.
If you have back pain, don’t wait to get better. Instead, discover the benefits that await you at Alpine Physical Therapy.
For more information on our approaches to helping people with back pain, click here.
Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.
The incidence of “slipping a disc” in your low back or herniating an intervertebral lumbar disc, in the medical vernacular, while attempting to move that heavy filing cabinet is not uncommon. The ensuing low back pain and often accompanying radiating leg or buttock pain from a bulging disc putting pressure on your spinal nerves is also unfortunately, quite common. Dr. Jon Lurie and a collaborative team of researchers based out of Dartmouth’s Department of Medicine, Orthopedics, Health Policy and Clinical Practice set forth to assess the data of 8-years of outcome research from operative versus non-operative treatment for this debilitating back issue.
Decompression surgery to relieve disc-related spine pain is a well-researched and a highly-accepted indication for spine surgery. While in the throws of an episode of raging low back pain, the quick fix of going under the knife seems like a logical decision, but spine surgery comes with plenty of costs and risks. The questions Dr. Lurie’s team set to answer was: why does the rate of surgery vary so greatly geographically in the U.S, if the surgical option is more effective and faster to provide relief? They also aimed to add to the body of knowledge of high-quality, multiple-testing sites, with randomized controlled trials of prospective surgical (or conservatively managed) effects on patients over the long term.
This study was considered a ‘concurrent prospective randomized and observational cohort study’, as each of the 1,991 eligible participants chose either a route into randomized study (surgery vs nonsurgery) at one of 13 spine clinics participating in this Spine Patient Outcomes Research Trial (SPORT) or the observational group. The observational group got to choose their not-so-random, treatment route of surgery vs nonsurgery. There was plenty of lenience in the eight-year study for either group to opt in or crossover to the other group as their back issue and provider deemed necessary. The nonoperative group was tracked over the course of the study and received the “usual care” recommendations. These treatments were customized to the individual and included at least: physical therapy, back pain education and counseling, and medication management.
All of the enrolled participants received thorough screenings and imaging tests for eligibility (such as >6 weeks of radiating low back pain with a confirmatory MRI), outcome measures and assessments on a regular basis (6 weeks, 3 months, and 6 months, and annually thereafter). Most surgical participants had the standard bulge trimming or ‘open discectomy’ and exam of their pinched nerve root. The study gets highly complicated statistically, as the analyses were multifactorial and convoluted to best capture the longitudinal comparisons of the randomized and observational groups. Lurie et al. provided plentiful and excellent flow diagrams cited in the original paper for those that want to peruse the detailed statistical intricacies behind such analyses as “intent-to-treat” versus “as-treated” groupings.
The results reiterated the hypothesis that usually, effective and selective surgery relieves radiating low back pain. Over the course of this 8-year study, more measurable improvements were “clinically significant” in all of the main outcome measures (ie. bodily pain, physical function, perceived disability) for the surgical group than those who remained nonoperative. However, both groups experienced heavy amounts of statistically challenging “crossover”, as humans tend to change their mind on the question of: Should I Get My Sciatica Relieved Surgically, Or Should I Wait? The common exception for both groups was neither returned to prior work status. Or once you ‘blow a disc’ hoisting that filing cabinet up the stairwell, you’re less likely to return to moving heavy office equipment regardless of choosing surgery or conservative care for your back. The study goes on to throw the conclusive bone to those deliberating this costly surgery, that “even among patients with strong surgical indications, many (34%) remained in the nonoperative group out to 8 years”. Take comfort in conservative rehabilitative care and do your core stabilization exercises and spine stretches if surgery doesn’t sound like your calling, as improvements in “sciatica bothersomeness” happened in both groups.
Jon O. Lurie, MD, MS, et al. Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation – Eight-Year Results for the Spine Patient Outcomes Research Trial. In Spine. 2014, Volume 39, Number 1. Pp. 3-16.
For more information, visit our patient guide on this topic by clicking here.
Special thanks to star Alpine physical therapist Brace Hayden, DPT, for providing this write up on a recent article from Spine.
There is no arguing that low back pain is an illness that burdens a large percentage of Americans. Sadly, centuries of folk cures and decades of research have fallen short predict reduce the prevalence of low back pain. Modern medicine has dramatically improved the health and livelihood in many arenas, but back pain remains an age-old, expensive, debilitating and frustrating… pain.
The average person with back pain and the American health care reform analyst are equally interested in sorting the worthwhile from the worthless treatments for reducing the duration and frequency of back pain episodes. Comparative effectiveness research hopes to shed light on what services should be recommended and reimbursed by insurance carriers. For example, the Cochrane Collaboration, another meta-analysis think tank, in 2010 looked at fifty studies on chiropractic treatments on low back pain and found muddled results across years of research.
. . . there is . . no evidence to support or refute that combined chiropractic interventions provide a clinically meaningful advantage over other treatments for pain or disability in . . . low back pain Future research is very likely to change the estimate of (the) effect and our confidence in the results.
Double doctor, J. Michael Menke, a doctor of chiropractic and PhD academic out of the International Medical University in Kuala Lumpur, Malaysia, found very little supportive evidence in his meta-analyses on comparative effectiveness of various manual therapies in his review of the existing literature. “A comparative effectiveness meta-analysis” was performed to compare the relative effectiveness of various spinal manipulation treatments (from the ancient bonesetter to the modern back cracker), medical management (READ: drugs, injections, etc), physical therapy, and exercise for acute (less than a month) and chronic (more than 3 months) nonsurgical management of low back pain.
The good news is most pain originating from the muscles and joint in the human body is ‘self-limiting’, meaning slowing down, protecting your injury, and letting the body heal will often suffice. Research supports the notion that sixty to seventy percent of acute low back pain settles in six weeks without any medical treatment. Chronic low back pain sufferers get better in a year without treatment 40 to 70 percent of the time. Pain whether short-term or long-term is indubitably unpleasant, so why suffer any longer than you have to if effective treatment is available.
This study looked at 56 spinal manipulation studies published between 1974 and 2010 and classified them into six different treatment categories. The categories included: 95 spinal manipulation studies, 31 exercise studies, 51 physical therapy/physiotherapy modalities (for example, ultrasound, electrical stimulation, and hot packs) studies, 40 usual medical care studies, and 40 control group studies of subjects that received no treatment. The results found a 96 percent relative improvement in the first 6 weeks across acute back pain studies was unrelated to treatment. Thus the “carry on with your life” control group and the various treatment groups were nearly equal in settling their acute pain. The chronic pain comparison analyses found that 32 percent of the various treatment studies could claim improved outcomes. The balance of the percentage of claimed improvement in the chronic pain comparison analyses can be attributed to everything else (letting the injury run its course). Looking at the printed boxplots of the 6 treatment categories effect sizes attributable to the passage of time alone, the three largest effect sizes were in the exercise group, then the spinal manipulation group, then the modality group.
This study also examined which spinal manipulation treatment provider did the best job for improving chronic back pain. It was determined in the comparison that getting your spine manipulated in the first 6 weeks has little influence on the outcome of shortening the duration of your acute pain. Five types of spinal manipulation providers (osteopaths, physical therapists, chiropractors, allopathic medical physicians, and bonesetters) were compared. Spinal manipulation by a physical therapist was found to be most effective, and most variable, in treating both acute and chronic back pain.
In the 36 years and 8,400 patients subjected to comparative spinal manipulation studies research cost from $32 to $80 million. Menke’s comparative analysis makes the bold assertion that ‘equivocal outcomes are unacceptable for this investment’, and funding more research on the topic should be stopped. It stands to reason, that inadequate analytics and methodology throughout the studies could be part of the problem. The take home message was that all of the compared treatments for acute and chronic low back pain are hard to quantify when looking at their relative effectiveness versus letting the injury run its course.
J. Michael Menke, DC, PhD. Do manual therapies help low back Pain? A comparative effectiveness meta-analysis. Spine. April 1, 2014. Volume 39 , Number 7. pp. e463-e472.
Back pain is now the number one cause of disability . . . in the WORLD, according to a recent article in Annals of the Rheumatic Diseases.
Notably, “The risk of low back pain was nearly four times higher for people working in agriculture, animal husbandry, forestry, fishing and hunting compared to other professions,” reported a team led by Dr. Tim Driscoll of the University of Sydney.
While the write up included advice on steps to take in the event a person ends up having typical back pain, they did emphasize that keeping in shape and attaining good flexibility and core strength are the best steps people can take to ward off an episode of back pain.
Our 14 PTs at Alpine Physical Therapy use advanced training in their efforts to treat over 3,000 Missoulians with back pain. Our tools and approaches are offered within the Spine Clinic at Alpine. For more information on our Spine Clinic, click here.
Here’s the article that announced the recent study on the worldwide stats on back pain.
Low back pain leading case of disability worldwide: Study
"Low back pain causes more disability than nearly 300 other conditions worldwide, according to new research, and nearly one in 10 people across the globe suffers from an aching lower back."
For the rest of this article, click here.
3/9/2014 0 Comments
Alpine Physical Therapy is again hosting two free presentations with Dr. Hammerstein of Northern Rockies Orthopedics. The upcoming presentations will be presented at the both locations of the Peak Health & Wellness Center. Our upcoming topic is titled “Back Talk: A Surgeon and PT Perspective.” Get key information on the relationship of back and leg pain . . . and what your options are for treating leg pain that originates in the back.
Each presentation will include helpful information and insights by Dr. Hammerstein and by Alpine’s PTs. Following each seminar, participants are invited to consult with one or both presenters and to have the opportunity for an orthopedic assessment.
For questions or for more information, call Alpine PT at 406-251-2323.
An article was recently published on the popular NPR Health Blog entitled “Doctors Increasingly Ignore Evidence in Treating Back Pain.” This article was posted and reposted on social media sites. Why the interest? It is simple – because millions of American live with back pain. Many of them just take it and think that back pain is part of their life. Some report it to their primary care physician. If they are lucky, their physician reads about and more importantly acts based on the evidence for treating back pain. Unfortunately, this is not often the case. More often than not, the patient is given medications to mask the pain or sent for a costly MRI or CT scan.
While use of the weaker over the counter pain killers has decreased, prescriptions for OxyContin have significantly increased. Add that to the fact that many of the individuals receiving these prescriptions for strong Opiods have a history of substance abuse, and we are faced with a terrible health care disaster.
Often a costly scan, such as an MRI or CT scan will be ordered in attempt to find the ‘cause’ of the back pain but more often than not these scans are inconclusive.
At the conclusion of the article posted by NPR is perhaps is the most disturbing ‘fact’. “Doctors should cut a little slack,” a journal commentary accompanying this study says, “because guidelines have been conflicted on back pain treatment until recently, and it takes 17 years, on average, for new treatment standards to be widely adopted.”
17 years. Does it really have to take that long? The evidence on the effectiveness of physical therapy in the treatment of back pain has become increasingly strong over the past decade. It is such a simple choice. Do you give someone with an addictive personality more drugs or send them to a place where perhaps they can be taught to care for themselves. As a patient do you just accept that back pain is a part of your life. Do you give up on physical therapy because it did not work for you 5 or 10 years ago?
I encourage you to be an active participant in health care decisions and your recovery. It’s important that when possible these medications be limited and ensure sound scientific evidence is used in the decisions that determine our health and wellness.
For more information on Alpine’s approach to spine care, we encourage you to visit our clinic website by clicking here.
3/24/2013 0 Comments
Two of Alpine’s physical therapists headed to Phoenix last month, not to work on their tans but to hone in their manual therapy skills for mobilizing and manipulating the spine. Jamie Terry and
Techniques were used to assess and improve mobility at different levels of the spine. When a particular spine segment is stiff or painful, it prevents other areas of the spine system to move correctly. Doing so leads to restrictions and limitations in normal activities and movements.
By understanding how to properly assess and change the segments that are stiff or painful, therapists with MAPS training have a greater advantage when helping patients get back to fun stuff like skiing, running, and living . . . again faster!
A core component of our approach at Alpine is to encourage all of our physical therapists to seek out these types of courses. Our vision is to continually take the manual skills of our therapists to the highest level in a way that synergizes with our approach toward training patients in corrective movement.
For more information on our leadership in the area of spine care in Missoula, visit the “Spine Clinic” page of our website by clicking here.
Many thanks to Samantha Schmidt, one of our star physical therapists at Alpine Physical Therapy, for recounting this fantastic story of success experienced by one of her patients who was previously hampered by years and years of low back pain.
When Tami first came to Alpine Physical Therapy in April 2010, she had been a member at the Peak Health and Wellness Center for quite some time. Yet she wasn’t using her membership because her body hurt, especially her low back. She had a 20-year battle with intermittent low back pain, and it seemed that every time she tried to get a fresh start with exercise, her back pain would limit her progress and foil her commitment. Tami related how her low back pain not only limited her exercise but led to increased weight gain over the years. She came to Alpine with the goal of getting control of her low back pain and learning how to safely return to fitness.
Over a span of six months, Tami was able to resume mat Pilates classes at the Peak, started in a yoga classes, and got vigilant about watching her daily calorie intake. By the time she returned to her doctor for her annual physical, she’d lost 40 pounds, was half an inch taller, and dropped three pant sizes. Best of all, she’d gotten her back pain under control!
Tami now attends a group fitness class at the Peak at least four times a week, sees a massage therapists at the Spa at the Peak without guilt, and enjoys the benefits of investing in semi-private Pilates reformer classes at the Peak Studio. Tami still returns to Alpine Physical Therapy for a tune up now and then, but she knows it’s what she needs to do to keep on a steady track to a healthier young life.
Tami’s success is a testament that back pain needn’t halt your dream to get back to a healthier you in 2012.
For more information on how the physical therapists at Alpine Physical Therapy can help you, visit our clinic website by clicking here.
It’s common to think about a chiropractic or osteopathic physician when considering spinal manipulation. Yet physical therapists have been performing spinal manipulation in the US since the very foundation of the Physical Therapy Association in 1921.
Several of the physical therapists at Alpine have advanced certification in manipulative medicine. Using spinal manipulation on a daily basis, they get stellar results with patients suffering with neck pain, back pain, and headaches–to name a few.
Take a few moments to watch as Brent Dodge of Alpine is interviewed by Dr. Randale Sechrest of the Montana Spine and Pain Center.
For more information, be sure to visit our website by clicking here.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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