All Posts tagged Back Pain treatment

Back Pain : Prevent it with good lifting technique

Back Pain : Prevent it with good lifting technique

If there is one thing worth mastering to avoid injury it is the art of lifting. Setting yourself up correctly before attempting to lift something will keep you injury free. To achieve this it is best to practice the movements as an exercise to train the body so that correct posture and execution become second nature. The suitability of the pick up options below will depend on your physical condition so it is important to pick the right technique for the right situation.

The Golf pickup for lifting

Suitable for light items that can be picked up with one hand only. Saves on the effort of a squat for picking up something small like a pencil. Be sure to use your leg to counter
balance your weight. This technique is great for those who have some degree of stability and flexibility. Using a prop such as a chair, wall or table to stabilise yourself is also a good idea.
The Squat for lifting

A squat is something we often do without paying much notice to how well it is being performed. For those who lift items as part of their job, the squat is an integral part of manual handling duties.
As an exercise it is particularly good for your legs and one of the best to develop leg strength, working the kinetic link from the ankles all the way up to the hip. Stronger legs also offer greater support for the back, as performing better squat technique helps maintain correct spinal control.
So as well as strengthening our legs the squat exercise is also working our spine. As such the back should stay straight whilst the hips do the bending.
To performing a correct squat it is important to have the correct equal bend though our hip and our knees, making sure that the level of our knees is in line with but behind the level of our toes. Lowering yourself enough to create a ninety degree angle through both hip and knee, sticking the bottom down and back, plus maintaining a neutral position through the back is essential.

The Lunge for lifting

Whereas the squat offers a wide base of support and a higher power output for lifting, the lunge in contrast requires greater balance and is better for lifting smaller items.
The lunge is more like a variation of the squat. It works the same muscles but in a different way, challenging balance and control with an uneven load. Rather than both legs taking an equal load the front leg is working a lot harder to keep the body stable. The same posture principles of a squat apply, so ensure that there is an equal ninety degree bend through the hip and the knee whilst keeping your back straight. Remember when lunging it is important for the front knee not to go past the level of the front foot toes. In order to get down far enough the back heel will need to come up. When completing the lunge be sure to go down as far as is comfortable.
Remember that the co-ordination involved in performing these techniques for lifting and the use of momentum will lessen the need for isolated muscular strength and aid injury prevention. Also by switching on your core stabilising muscles on before doing any of these movements you will have greater control over the movement.

By doing a mixture of squats, lunges and golf lifts you will benefit from working a variety of muscles in different ways. Also if you happen to acquire an injury then having options as to how you pick something up will better enable you to rely on other muscles whilst the injured area recovers.

Incorporating these exercises into a routine and performing them correctly, will ensure that when you do need to use them in a practical manner throughout the day, that you are moving correctly.

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Drugs for Acute Low Back Pain: Do they work?

Drugs for Acute Low Back Pain: Do they work?

Among patients with acute, low back pain presenting to an emergency department, neither the nonsteroidal anti-inflammatory drug (NSAID) naproxen combined with oxycodone/acetaminophen or the muscle relaxant cyclobenzaprine provided better pain relief or improvement in functional outcomes than naproxen combined with placebo, according to a study in the October 20 issue of JAMA.

Low back pain (LBP) is responsible for 2.4 percent of visits to U.S. emergency departments, resulting in more than 2.5 million visits annually. These patients are usually treated with NSAIDs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination. Pain outcomes for these patients are generally poor.

Benjamin W. Friedman, M.D., M.S., of the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y., and colleagues randomly assigned 323 patients who presented to an emergency department with nontraumatic, nonradicular LBP of 2 weeks’ duration or less to receive a 10-day course of naproxen + placebo (n = 107); naproxen + cyclobenzaprine (5 mg) (n = 108); or naproxen + oxycodone, 5 mg/acetaminophen, 325 mg (n = 108). Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP; naproxen, 500 mg, was to be taken twice a day. Patients also received a standardized 10-minute LBP educational session prior to discharge.

The researchers found that neither naproxen combined with oxycodone/acetaminophen nor naproxen combined with cyclobenzaprine provided better pain relief or better improvement in functional outcomes than naproxen combined with placebo. Measures of pain, functional impairment, and use of health care resources were not different between the study groups at 7 days or at 3 months after the emergency department visit.

Regardless of allocation, nearly two-thirds of patients demonstrated clinically significant improvement in LBP and function 1 week later. However, 40 percent of the cohort reported moderate or severe pain, half reported functionally impairing LBP, and nearly 60 percent were still using medication for their LBP 1 week later. By 3-month follow-up, nearly one-fourth of the cohort reported moderate or severe pain and use of medications for LBP. Three months after the emergency department visit, regardless of study group, opioid use for LBP was uncommon, with fewer than 3 percent of patients reporting use of an opioid within the previous 72 hours.

“These findings do not support the use of these additional medications in this setting,” the authors write.

Journal Reference:
1.Benjamin W. Friedman, Andrew A. Dym, Michelle Davitt, Lynne Holden, Clemencia Solorzano, David Esses, Polly E. Bijur, E. John Gallagher. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. JAMA, 2015; 314 (15): 1572 DOI: 10.1001/jama.2015.13043

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Got Neck or Back Pain? Try Physio

Got Neck or Back Pain? Try Physio

The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine – with back and neck pain being the top reasons for treatment.

Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine.

According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.

For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.

“This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today’s challenging economic environment,” according to the study’s lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. “The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.”

Walker’s study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.

Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.

Sample exercises to relieve neck pain can be found on the APTA Web site, http://www.apta.org/consumer.

Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002) and cost effectiveness (Kothals-de Bos et al, 2003) than general practitioner care.
Journal References:
1.Hoving et al. Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients With Neck Pain. Ann Intern Med, 2002;136 DOI: (10):713-722

2.Bos et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial * Commentary: Bootstrapping simplifies appreciation of statistical inferences. BMJ, 2003; 326 (7395): 911 DOI: 10.1136/bmj.326.7395.911

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Back Pain: Educated exercise is best (JAMA).

A review of medical literature suggests that exercise, alone or in combination with education, may reduce the risk of low back pain, according to an article published online by JAMA Internal Medicine.

Daniel Steffens, Ph.D., of the University of Sydney, Australia, and coauthors identified 23 published reports (on 21 different randomized clinical trials including 30,850 participants) that met their inclusion criteria.

The authors report that moderate-quality evidence suggests exercise combined with education reduces the risk of an episode of low back pain and low- to very low-quality evidence suggests exercise alone may reduce the risk of both a low back pain episode and the use of sick leave. Other interventions, including education alone, back belts and shoe inserts do not appear to be associated with the prevention of low back pain.

“Although our review found evidence for both exercise alone (35 percent risk reduction for an LBP [low back pain] episode and 78 percent risk reduction for sick leave) and for exercise and education (45 percent risk reduction for an LBP episode) for the prevention of LBP up to one year, we also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year). This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required,” the study concludes.
Journal Reference:
1.Mark J. Hancock, PhD et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, January 2016 DOI: 10.1001/jamainternmed.2015.7431

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