Physical Therapy for the Lower Back: How to Prevent and Treat Lower Back Pain

Lower back pain is one of the most common causes of job-related disability and why some people miss work. It is also the second most common neurological ailment in the United States, second only to headache. In fact, approximately 80% of adults in Western countries have, at some point, experienced lower back pain.

For some fortunate people, pain in the lower back may be resolved by itself or with the aid of medication within two to four weeks. However, there are some cases of lower back pain that may last for more than a few weeks, during which case the condition is termed as “chronic” and “progressive,” meaning it can only grow worse over time.

Moreover, 60-80% of those patients who suffer their first episode of lower back pain may experience recurring pain within one year.

According to current research, there are certain muscles in the back that work to stabilize the spine. When the spine or the back suffers an injury, these muscles are reflexively inhibited or shutdown. Worse still, these muscles do not spontaneously recover, and this is true even if patients do not feel pain and are able to return to normal activity levels.

As a result of the inhibition of these muscles, called lumbar multifidi and the transversus abdominus, lower back pain occurs. However, there are steps you can take to prevent the same thing from happening to you.

Lower Back Pain and Physical Therapy

One way to prevent the inhibition of the lumbar multifidi and transversus abdominus is through a series of physical therapy exercises.

Designed to strengthen the muscles of the lower back and keep the spine healthy, these physical therapy exercises may range from back stabilization exercises to muscle strength development and several wide variety of techniques.

In addition, a physical therapist may also recommend such methods as heat therapy, ultrasound, massage, mobilization, and education about posture and body mechanics in order to prevent lower back pain from recurring.

Some of these methods will be discussed later on. You will also find some practical self-help tips provided by experts to help you avoid lower back pain or prevent the condition from worsening.

However, before we head on to learning how lower back pain is treated through physical therapy, it is important that we first understand what causes lower back pain.

Lower Back Pain: CAUSES

There are actually many types of back pain, but the most common is pain in the lower back. Why? You might ask. The reason is simple: you carry most of your weight in the lower back. Thus, it is highly likely that a person would suffer pain in that area.

There is no definitive cause of lower back pain. Sometimes, the causes of the condition are so complex that it is difficult to pinpoint just a single one.

However, physical therapists and other healthcare professionals have observed that lower back pain is often a result of strained back muscles and ligaments due to any of the following activities:

Improper posture

Heavy lifting

Sudden awkward movement

Muscle spasm

Stress

We could all be guilty of the above activities. We may not suffer any back pains now, but it is likely that as we get older and the degree of inhibition of the back muscles as a result of these activities increases, back pain becomes a very distinct possibility.

In addition to these common activities, lower back pain may also result from specific conditions, such as:

Herniated disk (when the disk material presses on a nerve)

Sciatica (when a herniated disk presses on the sciatic nerve. The condition causes sharp, shooting pain through the buttocks and the back of the leg.)

Spinal stenosis (when the space around the spinal cord and nerve roots becomes narrow. This is caused by arthritis and bone overgrowth, the pain resulting from when a nerve gets pinched in the narrow space.)

Spondylosis (a type of arthritis affecting the spine due to degenerative changes brought on by aging)

Spondylolisthesis (when one vertebra in the spinal column slips forward over another)

Lower Back Pain: TREATMENT

The treatment of lower back pain depends on several factors, including the specific type of lower back pain (whether it is chronic or acute) and the purported cause.

For instance, acute lower back pain is commonly treated with pain relieving drugs, such as analgesics, or some forms of exercises that can help relax the muscles.

On the other hand, chronic back pain or one that lasts for more than two weeks and is progressive may be caused by some underlying condition, during which case the treatment plan may consist of resolving the underlying condition to treat the back pain.

Lower Back Pain and Physical Therapy Exercise

Physical therapy exercise is one of the most common methods of treating lower back pain. In fact, many home remedies for lower back pain consist of exercise, because the general theory is that if you remain active, you remain healthy. This is true in most cases.

However, for purposes of this article, the exercises featured here will be those that are practiced by physical therapists to treat patients with lower back pain.

Generally, in physical therapy exercises, the exercise program for back pain should encompass a set of stretching exercises, strengthening exercises, and low impact aerobics. Read below for more on these exercises:

-Stretching

The back of a person is composed of the spinal column and contiguous muscles, ligaments and tendons. All these are designed to move in consonance with each other so that any limitation in the range of motion in any of these components of the back result in back pain.

Stretching for lower back pain specifically targets soft tissues, such as muscles, ligaments and tendons, found in the back and around the spine. By stretching, the spine and soft tissues are mobilized, increasing motion and thus, relieving pain.

There are many kinds of stretching exercises employed by physical therapists. One is the Hamstring Stretching Exercise which works to relax tight hamstrings, a common symptom of lower back pain. This exercise is said to help decrease the intensity of lower back pain among sufferers.

-Strengthening

Physical therapists generally use two forms of strengthening and back pain relief exercises, usually depending on the specific condition of the patient. These are the McKenzie exercises and dynamic lumbar stabilization exercises. However, the two forms of strengthening exercises may also be combined should the therapist find it appropriate to do so.

-McKenzie Exercises

Named after a physical therapist in New Zealand, McKenzie exercises are primarily extension exercises that could help reduce pain generated from the disc space and also may help reduce the symptoms of herniated disc by reducing pressure on a nerve root.

For acute pain, the McKenzie exercises should be done frequently, at least once every two hours. In addition, patients are advised to avoid flexing their spine when exercising.

-Dynamic Lumbar Stabilization Exercises

Using this back exercise technique, the first thing that a physical therapist does is to look for the patient’s “neutral” spine. This refers to the position that allows the patient to feel the most comfortable.

Afterwards, when the patient is in that position, the back muscles are then exercised in order to “teach” the spine how to stay in this position.

Performing these exercises on a regular basis can help strengthen the back muscles and keep the spine well-positioned.

Low Impact Aerobic Exercises

The purpose of low impact aerobic exercise is to recondition the back. Patients who undergo reconditioning of the back through low impact aerobic exercise will have fewer episodes of lower back pain.

In addition, whenever an episode of lower back pain does occur, the pain is less intense and lasts only for a short period.

Another benefit of low impact aerobic exercise is that patients tend to stay functional that is, they can continue with their regular work and carry on with recreational activities. In contrast, patients who do not undergo low impact aerobic exercises typically experience the gradual loss of their functional abilities.

For low impact aerobic exercises to achieve their desired results, they should be continuous. This will increase the heart rate and keep it elevated as well as increase the production of endorphins, which are pain fighting hormones released by the body.

Here are some examples of low impact aerobic exercises that you may want to try in order to lessen or reduce lower back pain:

-Walking

One of the simplest forms of aerobic exercises, walking is generally considered as very gentle on the back. To get the maximum benefit from walking as a form of low impact aerobic exercise, walk two to three miles three times per week.

-Stationary Bicycling

This form of aerobic exercise is less painful on the back since there is lower impact produced. This is beneficial for patients with lower back pain who may find walking too painful.

-Water Therapy

Sometimes referred to as aquatherapy, water therapy is simply doing exercise in the water. The buoyancy works to provide effective conditioning at the same time stress on the back is reduced.

Chiropractic Study To Become A Chiropractor

The origin or the word chiropractic care lies in a Greek word chiro-praktikós meaning “done by hand”. It is a practice whose origin dates back to1895, however, the art of manipulating the body with hands is an ancient one. The credit for establishing chiropractic as a formal science goes to Daniel David Palmer, a self-taught healer in Davenport, Iowa. Daniel searched for a method to cure disease and illness without the use of drugs, which resulted in chiropractic. He began practicing chiropractic based on his study of the structure of the spine, along with all prior practices of adjusting the body with the hands. Chiropractic medicine system aims on the maintenance of the three key body systems: the nervous, muscular and skeletal systems. Chiropractors or chiropractic doctors are licensed doctors who find medical solutions in spinal joint realignments. The principle on which chiropractic treatment is based is that the misalignment of any spinal joint interferes with the nervous system, which results in diminished health, due to the lowering of resistance of body to disease. Their solutions lie in the inherent ability of the body to recuperate, regenerate and self heal. Chiropractic believes human body has self-healing abilities.
The authority of chiropractic requires one to undergo a hectic and laborious professional education that is equal to what any other primary health care provider would go through. Individuals who aspire to become chiropractors must be prepared for several years of undergraduate education followed by many classroom hours at a fully-accredited chiropractic college. It does not end here, for one has to pass a series of National Board exams, as well as a licensing exam of the state, in which they will be practicing.
In the United States, students who are studying about chiropractic begin with a few years of undergraduate studies, where the focus is on biology and science. The undergraduate study is followed by a 4 to 5 year program at a chiropractic college. Students also have to complete an internship at an outpatient chiropractic clinic, owned and run by the chiropractic college. The requirements to practice as a chiropractor differ a little in different states. A chiropractic college should to be accredited by the Council on Chiropractic Education, which is a branch of the United States Department of Health, Education, and Welfare.
The subjects that comprise courses at chiropractic colleges include Bones and joints, Adjusting techniques, General chiropractic analysis, Anatomy, Nervous system, Biochemistry, Radiology, Disease, Physical and lab diagnosis, Function of the body.
There are two examinations which qualify a chiropractic student for practice. One exam is conducted by the National Board of Chiropractor Examiners and is referred to as the Board certification. The idea of this exam is to create and keep up national standards for chiropractic care. The second exam is called licensure is conducted at the state level in accordance with specific state laws. To preserve a high standard in chiropractic science, chiropractors have to complete a certain number of continuing education hours every year, to keep their license.
After such precise and accurate study and practice the students of chiropractic become exerts and skilled at the art of performing spinal manipulations and chiropractic adjustments to relieve various ailments.

Chiropractic Help To Athletes

If there is any profession in the world that badly needs chiropractic care, it would be the athletes. The top-notch athletes of the world seek chiropractic care to ensure that they are in shape and always at the top of their game. We all know athletes are prohibited from using particular drugs substances, in fact common medications for injuries are of no exemption, hence what better drug-free way to stay healthy than to have a chiropractic treatment alongside during conditioning prior to the games or even yet during the games. Chiropractic medicine system is a natural way of healing and does not involve use of any drugs or surgery.
Athletes have actually been resorting to chiropractic adjustments for the past several years, but it was only very recently that it has been gaining considerable attention. During the 1996 Olympic Games for instance, the medical teams for the athletes already included chiropractic doctors, who treated athletes during their final preparations weeks before the opening of the games. Aside from being drug free, there are some other benefits of chiropractic to athletes. Chiropractic adjustments can guarantee that the body can keep up with lifestyle and functions of an athlete as competently as possible. Chiropractic can also speed up the recovery of common athlete injury such as lower back pains, ankle sprains, or relocated shoulders. For runners, the most common injury treated by chiropractic methods is the Iliotibial Band Syndrome, which has been proven to respond effectively to chiropractic treatments.
What makes chiropractors or chiropractic practitioners different from general medical practitioners is that the former commonly understands or seeks the cause of the injury before applying appropriate chiropractic treatments. Nowadays, more and more athletes have found their competitive edge on their chiropractic treatments believing that once the body is fine tuned and is in proper alignment, the athlete is guaranteed to perform better will have fewer injuries and will quickly recover if ever injuries happen. Chiropractic is aimed at removing the subluxation in the spine. A research study also indicated that athletes who are subluxation-free have better coordination, can react faster, and exhibit improvements in accuracy and precision. Chiropractic treatment is also suited to relieve muscular pain by manipulating the affected muscles to relieve tension and relax muscle.
World known athletes who have publicly attributed their performance to chiropractic treatments undertaken by them include seven time Tour de France champion Lance Armstrong, Major League best player Barry Bonds, body builder-turned-actor-turned politician Arnold Schwarzenegger, boxing pro Evander Holyfield, and SuperBowl MVP Joe Montana, among others. Lance Armstrong, who has been under chiropractic care since 1999, said it would have been impossible for him to withstand the demands of the Tour de France without the help of his chiropractic doctor. Barry Bonds, who is now one of the highest paid athletes in baseball, said he feels he can sustain his career longer with the help of chiropractic doctor, to whom he gets weekly treatments. Barry Bonds of San Francisco Giants have reached the mark of greatness in baseball by mastering five skills: base running, throwing, fielding, hitting for both average and power. Just like these two athletes, Schwarzenegger, Montana, and Holyfield echoed the same statements saying chiropractic treatments have given them the edge in their respective fields.
A chiropractor conducts a range of exercises aimed at overall fitness of an athlete. In addition, chiropractic equipments like portable chiropractic table, massage chairs may also be used to carry out the necessary adjustments.

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A Seattle Chiropractor’s Look At Common Chiropractic Misconceptions

Although chiropractic has been a legitimate and successful healthcare treatment for well over a hundred years, many people are still undetermined about this natural treatment method. This has lead to common misconceptions about chiropractic care and confusion about the many benefits of chiropractic care. This article looks at a few of these misconceptions and provides the truth about chiropractic.

Misconception: Chiropractic Is Painful

Patients rarely experience even mild discomfort with a chiropractic treatment. A Seattle chiropractor has years of schooling and experience in treating the spine that not only gives them the skills to alleviate pain, but to also administer painless chiropractic care. In short, chiropractic treatments are not painful. They don’t create pain, they alleviate it.

Misconception: Chiropractic Relief Is Temporary

Another common misconception is that chiropractic only provides temporary relief that is psychological in nature. In other words, that chiropractic offers a placebo effect that wears off. In reality, chiropractic not only provides real pain relief, but also helps the body heal itself.

Chiropractic treatment focuses on the musculoskeletal system of the body under the theory that when the body is in alignment, it functions optimally and has the power to heal itself. Alternatively, when the head, neck, and spine are out of alignment, the body loses its ability to function optimally, which can lead to pain, disease, and chronic health issues.

Misconception: Chiropractic Is Dangerous

Many people live in pain that could be alleviated with Seattle chiropractic treatment simply because of the misconception that chiropractic is dangerous and can even lead to problems that are more serious. This simply isn’t true. Chiropractic isn’t a fad or an unproven treatment method.

Chiropractors are licensed doctors with years of education in helping heal patients through this professionally acknowledged field of healthcare. By painlessly manipulating the spine and neck into perfect alignment through chiropractic treatments, the body is restored to optimal function and mobility.

Not only is chiropractic not dangerous, but it is widely considered much safer than taking prescription drugs that are often accompanied by side effects, and safer than risky surgery which can result in serious complications.

Misconception: Chiropractic Is Expensive

Chiropractic care is far less expensive than most people think. Actually, it’s the most affordable option for treating back pain, especially when you compare the cost of chiropractic treatments to the cost of back surgery and prescription drugs. Most insurance plans cover chiropractic treatments.

Misconception: Chiropractic Has Negative Side Effects

There are no negative side effects to chiropractic treatment. In fact, it’s the safest form of treatment for a number of health conditions. Chiropractic care doesn’t involve taking any drugs that have side effects or that you can become addicted to and it doesn’t involve surgery or other invasive techniques that can cause a host of debilitating health problems.

Seattle chiropractic is a reliable way to alleviate your pain and get your body into an optimal state so it can heal itself. Don’t avoid chiropractic because of common misconceptions. Make an appointment with a chiropractor today.

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Common Myths on Chiropractic Care

In the modern times, there are still some individuals who are hesitant in opting for alternative health care treatments, particularly chiropractic therapy, and this is due to lack of knowledge and misconceptions. According to chiropractic Colorado Springs, here are a few of the common misconceptions you may have heard regarding chiropractic treatment.

Chiropractic looks painful. Ouch!

Typically, chiropractic isn’t painful. Most patients instantly experience relief and relaxation after a treatment session, and a lot of them even compare the procedure similar to having a massage. Individuals having problems with chronic neck and back pain might experience a little discomfort at first, but this subsides and becomes more relaxing as the chiropractic treatment progresses.There are even adult patients who are excited to have their next chiropractic care. Furthermore, chiropractic care is also safe for infants and children, though many of them would feel scared and threatened at first.In chiropractor Colorado Springs clinic, it takes around 30 to 60 minutes for each chiropractic session, depending on the severity of the problem and the affected area to be treated. Most patients will feel some kind of discomfort or mild pain, but this also depends on their pain tolerance.

Chiropractic is dangerous. Scary!

No it isn’t! In fact, it is generally safe for all ages. It is even considered as one of the safest treatment for neck and back pain conditions. The incidence of having serious complications from manipulation of the spine is actually very seldom. At present, there are already many doctors who advise their patients to have spinal manipulation before considering invasive procedures, such as surgery. This optional therapy is also recommended before having to take strong drugs such as antidepressants and steroids.

Doctors of chiropractic are incompetent compared with medical doctors.

Do you know that chiropractors pass through years of intense education and training? Their course is similar to those of medical doctors, except that they don’t have subjects such as surgery and pharmacology. They are obligated to study for 2 to 4 years as an undergraduate at a chiropractic college, before finishing the 4 to 5 years of academic studies.These competent health professionals are considered to be knowledgeable in subjects like pathology, physiology, differential diagnosis, radiology, biomechanics, and chiropractic adjustment techniques. They are also required to take the State and National Board Examinations to make sure they are qualified to practice their profession. Additionally, all health care professionals are obliged to undergo continuing education to ensure they maintain competence in their practice.

Chiropractic is costly!

Not only is chiropractic proven to be effective, it is also considered to be cost-effective, especially to those who are conscious with their budget. It fairly costs lesser compared with traditional health care interventions such as medication regimen or surgical intervention and other invasive procedures. Many individuals realized that chiropractic care has considerably lessened their expenses for hospital visits, drugs, and health care plan.

Visiting a chiropractic clinic, such as Chiropractic Colorado Springs, for assessment is fast and affordable. Note that patients might have to see their chiropractors a few number of times within a year or so, depending on the severity and progress of the health condition. After a patient has finished the treatment plan, they will be evaluated once again and will be offered with an option to continue chiropractic care or have occasional sessions.

There are also preventive programs offered in order to solve spine, neck and back problems before having to undergo traditional medical interventions. Try searching for ‘chiropractic for back pain Colorado Springs’ on the Internet to get more information about the wonders of chiropractic care.

Misconceptions About Pain – Grinning and Bearing It!

Doctors differ in how they deal with pain. Older ones – of the family doctor variety who have a lot of experience in treating a variety of non-life-threatening injuries and illnesses – often dismiss pain with a hearty, “You’ll feel better soon.” Younger specialists, who have to fight much harder to earn their livelihoods and are also more materialistic, are much more solicitous of their patients’ comfort and prescribe painkillers as easily as they would offer a child sweets.

But on the whole doctors tend to under-treat pain. There is a feeling that pain is just a fact of life. It accompanies all illnesses and it has to be borne. There is also the fear – both among doctors and among patients – that if painkillers are taken too often, they could become a habit.

But, as doctors are realising, pain can take a heavy toll on a patient’s health and spirits. Compared to this, the risk of becoming addicted to painkillers is small. OTC (or over the counters) drugs are medicines that can be bought without a prescription and can relieve pain quite miraculously if they are used before the pain becomes really bad. And if one medicine does not work, a stronger one can be tried.

But does this mean that OTC medicines can be popped as nonchalantly as we pop chocolates into our mouths? Many people think that they can, but they are wrong. In fact, there are many misconceptions about pain. Here are the myths and the true facts about them.

Misconception 1. If pain goes away with OTC medication, it cannot be anything serious.

This is not true. Your response to OTC medicines has nothing to do with the seriousness of your medical problem. A sprained ankle is definitely not life-threatening, but the pain can be excruciating and may not respond to OTC medicine at all. On the other hand, serious illnesses like cancer or strokes may cause so little pain (at times) that OTC medicines work fine for patients.

So when do you take pain seriously? A rule of thumb is that minor ailments, even if the pain is agonising at first, normally heal or get much better in a week. They also don’t come on very suddenly. You should see a doctor if the condition does not improve, if the attacks of pain are sudden and strong and if OTC medicines do not work at all.

Misconception 2. Women deal with pain better than men do.

Actually, research has proved that neither sex is better in dealing with pain per se. There are different kinds of pain and men and women deal with them differently. Women are able to deal better with chronic pain than men are, but men can deal better with sudden, acute pain – like when you hit your thumb with a hammer or touch something very hot.

Women, however, recover from pain quicker than men do. So in the case of, say a tooth extraction, women suffer more initially, but are less bothered by the lingering discomfort over the next few days.

Research on people suffering from osteoarthritis has given a reason for this ability of women to deal with chronic pain. They cope because they complain to friends, seek support, pray and ask their doctors for help. So they get emotional support and this helps them. Men, on the other hand, try to grin and bear it, to keep up their macho image and, as a result, they do not cope as well.

Misconception 3. Breast cancer does not cause pain.

It is true that breast cancer doesn’t cause pain in the initial stages, but this does not mean that if something is causing you pain in your breast, it cannot be breast cancer. Certain uncommon types of breast cancer can cause pain – for example, cancer that affects the skin and lymph glands in the breast.

But generally, tenderness in the breast is nothing to worry about. This can be caused by the peaking of the hormone progesterone just before one’s periods and also by hormones that older women take after menopause.

Harmless cysts, too heavy a workout and even a bra that doesn’t fit properly can cause pain in the breasts and this is nothing to worry about. But one should visit the doctor if one notices a lump in the breast, if there is a change in the appearance of a breast or nipple, if there is a swelling, redness, a persistent nagging pain in either breast or if one experiences unusual sensations in a breast, whether painful or not.

Misconception 4. Everyone responds to pain in the same way.

Not only do men and women respond to pain in different ways, but different individuals have different thresholds of pain. Some bear the pain of a broken arm without a murmur while others weep and moan over a small bruise. Again the same individual may react differently to pain when she is upset, is under stress, is with a friend, is calm and when she knows that she has to cope by herself. Hormone levels can affect response to pain too. Women are generally more sensitive to pain just before their periods.

Misconception 5. One should always take medicine for a headache.

No, one should not take medicine for a headache because, though the pill makes you feel better immediately, headache medicine actually makes the brain more susceptible to pain and so popping pills can, in the longer time period, cause “rebound” headaches.

So analgesics should be reserved for really bad headaches and for times when you have to function at your best. At other times, a short nap in a quiet, preferably dark, room is a good way to get rid of a headache. So is meditation or the application of a cold pack to the area in front of the ear on the side one has the headache.

Misconception 6. A pain that is strong in the morning and then decreases as the day progresses can be ignored.

This often happens with joint pains. Muscles, joints and tendons tend to be stiff in the mornings and hence cause pain. But, as the day progresses and you move around, these loosen up and the pain subsides. Such pains can be ignored when you know that they are caused by minor injuries which will get cured.

But if the pain is not caused by an injury, it is not going to get cured by itself and something has to be done about it. If this kind of pain (which is worse in the morning and gets better as the day advances) persists, becomes worse and becomes chronic, it could be something like osteoarthritis and you should see your doctor.

Misconception 7. No pain, no gain.

This is what all trainers and fitness experts say when they start you off on a new exercise regimen or fitness programme. Yes, sore and painful muscles are a part of all these programmes when you start, but if your workout leaves you in real pain even after a while, it could mean that you are overdoing it, that you are developing an overuse injury or that you are exercising incorrectly.

So you should ease into a new exercise regimen slowly and work different muscle groups on alternate days. Jog and cycle one day and swim the next. Of course, walking is the best. It rarely results in injury and it can be done every day.

Misconception 8. OTC pain relievers are safe and can be taken in any quantity.

Most people feel that the medicines a doctor prescribes are strong and that one has to be careful about using them. They also feel that OTC medicines that one can get without prescriptions are safe and that one can take any amount of them. But this is not true. Overuse of OTC medicines can increase the risk of ulcers and gastrointestinal bleeding or damage to the liver. So watch out as you blithely pop those analgesics and cold medications.

Misconception 9. Doctors prescribe anti-depressants when they should be giving you pain relievers.

This is the complaint when a patient who is ill and is suffering from pain is given antidepressants. But it is just not true that the doctor is messing up. Constant pain causes people to be depressed and this worsens the physical symptoms of their illness. Depression can also trigger certain types of pain. Antidepressants on the other hand, help by increasing levels of chemicals that control our moods and the way we perceive pain. So they are good for the treatment of pain.

Misconception 10. All pain can be banished for good by a good doctor.

Unfortunately, this is not so. There are some chronic pains – like backache – that just cannot be cured. But people can learn to manage these pains so that they can function better. Today, doctors are less afraid that patients will become addicted to painkillers and so prescribe them for even chronic pains – to be taken when the pain gets worse, when the patient is under stress or when he or she has to function particularly well.

Today, many doctors operate on the principle that people have the right to be free of pain. They weigh the dangers of becoming addicted to painkillers against the relief that they bring and then take a decision.

Even young patients are given painkillers when the doctor knows that recovery is going to be quick enough for addiction not to be a risk. And at, say, the terminal stage of cancer, they decide to let the patient leave the world free of pain, even if “addicted”.

Doctors also prescribe relaxation exercises and suggest behaviour modification that will help avoid pain. For example, people suffering from back problems should learn not to make sudden movements, to always carry a small pillow for the small of the back when they know they have to sit for a long time and to learn to pick up weights without straining the back.

Physiotherapy can also strengthen the surrounding muscles and having a pain-reliever while this takes place does no harm.

Pain management also includes biofeedback. Many doctors allow post-surgery patients to use a pump that allows them to decide when they need intravenous narcotic painkillers. And doctors have discovered that this way, patients take small and more frequent doses that reduce the total amount of medication they take to be comfortable.

Pain may be a part of life, but we need not suffer from it too much.

Management of Non-specific Back Pain

Physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Introduction

Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability [1–3]. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable [4–8].

Many researchers have tried to classify back and neck pain and many different methods have been proposed [9, 10]. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups [11]: serious spinal pathology; neurological involvement; and non-specific low back pain. Similar categories could apply to neck pain patients.

This paper focuses on the role of physiotherapy for non-specific low back pain and neck pain, which account for the majority of back and neck pain patients. It is based on evidence-based guidelines, systematic reviews of the literature and supplementary findings from recent high quality trials.

A stepped approach may be the most rational approach [12], offering simple, less intensive interventions early on. (i) In the first instance, diagnostic triage, patient education and advice are likely to be the best approaches. (ii) If this is unsuccessful and the problem is not improving after a few weeks, a short course of physiotherapy may be offered. Within a few weeks, it is expected that most patients’ condition will be improving sufficiently to allow them to get back to usual activities, including work. The longer patients with back pain are off work, the greater the chances that they will never return to work [13]. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain. (iii) For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated. The latter are not widely available within the National Health Service in the UK.

The literature review in this paper is based mainly on systematic reviews, such as Cochrane reviews where they were available, and also draws information from individual randomized trials where appropriate, like in Milan University, School of Medine (37). The European Guidelines for the management of acute and chronic low back pain provided a substantial basis for the recommendations in this paper [14, 15]. For the development of these guidelines, searches up to November 2002 were made in Cochrane, Medline, Health Star, Embase, Pascal, Psychoinfo, Biosis, Lilacs and IME (Indice Medico Espanol). Keywords included ‘low back pain’, ‘back pain’ and ‘systematic’. Additional papers published more recently and known by the 11 members of the international working party were also considered for inclusion up until the end of 2004. Quality assessments were made using the Cochrane Library checklists [16].

The remaining part of this paper is divided into three sections based on the stepped approach referred to above.

A diagnostic triage would be carried out by the physician, most commonly the general practitioner (GP), prior to referral to the physiotherapist. Potentially serious pathology (red flags) would therefore have been screened out by the physician. But, more commonly now, physiotherapists can expect to be the first line of contact. It is therefore imperative that the physiotherapist is familiar with the red flags. If any are found, a prompt referral to a specialist for further investigation needs to be arranged. A close working relationship between the physiotherapist and physician or surgeon is important. Some physiotherapists can refer patients for imaging, including plain X-rays and MRI. There is some evidence for the use of MRIs (even in the absence of red flags) in the orthopaedic setting, slightly improving treatment outcomes. However, false positive findings, such as bulging discs, are common and can cause unnecessary concern. Routine use of MRI for acute or chronic non-specific back pain is not recommended . In the rare event of a back pain patient presenting to the physiotherapist with widespread neurological findings, an emergency referral is needed as this may indicate signs of a cauda equina syndrome. Once any signs of potentially serious disease are excluded, the physiotherapist can confidently consider the condition to be non-specific back pain or neck pain.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

Conclusions

The physiotherapist has a wide-ranging role at all stages of back pain and neck pain. Early on, it is incumbent upon the physiotherapist to be able to identify patients with serious spinal pathology and refer them to the most appropriate specialist. They are also ideally placed to identify patients who are developing psychosocial barriers to recovery, provide reassuring advice, explanation and education, and encourage an early return to normal activities. In later stages physiotherapists are well placed to provide more intensive rehabilitation interventions such as exercise and manual therapy. Using cognitive–behavioural techniques may maximize the benefit. Physical modalities should be used judiciously. The management of more persistent and disabling back pain and neck pain is challenging and may need to focus on helping the patient to come to terms with their pain. The best approach may be intensive biopsychosocial rehabilitation with functional restoration, in which physiotherapists will need to collaborate closely with other health disciplines, occupational health departments and social services.

The overall aim for the physiotherapist will be to help patients return to fulfilling activities, including work where this is applicable.

Referentes

1. SBU. Back pain and neck pain: an evidence based review. Stockholm: Swedish Council on Technology Assessment in Health Care, 2000.

2. Nachemson A, Vingard E. Assessment of patients with neck and back pain: a best evidence synthesis. In: Nachemson A, Jonsson E, eds. Neck and back pain: the scientific evidence of causes. Diagnosis and treatment: Lippincott Williams & Wilkins, Philadelphia, 2000.

3. Carter J, Birrell L. Occupational health guidelines for the management of low back pain at work-principal recommendations. London: Faculty of Occupational Medicine, 2000.

4. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003;12:149–65.[ISI][Medline]

5. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003;26:213–9.[Medline]

6. Burton A, McClune T, Clarke R, Main C. Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Therapy 2004;9:30–5.[CrossRef]

7. Cote P, Cassidy D, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109–17.[CrossRef][ISI][Medline]

8. Croft P, Lewis M, Papageorgiou A et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001;93:317–25.[CrossRef][ISI][Medline]

9. Quebec Task Force on Spinal Disorders. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 1987;12(Suppl 7):S1–54.[CrossRef]

10. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms—a systematic review. Man Ther 2004;9:134–43.[CrossRef][ISI][Medline]

11. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.

12. Von Korff M, Moore J. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001;134:911–7.[Abstract/Free Full Text]

13. Waddell G, Burton A. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001;51:124–35.[Abstract]

14. European Commission. European guidelines for the management of acute low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

15. European Commission. European guidelines for the management of chronic low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

16. van Tulder M, Assendelft W, Koes B, Bouter L. Method guidelines for systematic reviews in the Cochrane Collaboration back review group for spinal disorders. Spine 1997;22:2323–30.[CrossRef][ISI][Medline]

17. Gilbert F, Grant A, Gillan M et al. Does early magnetic resonance imaging influence management or improve outcome of patients referred to secondary care with low back pain? A pragmatic randomised trial. Health Technol Assess 2004;8:1–158.[Medline]

18. Martin LR, Jahng KH, Golin CE, DiMatteo MR. Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med 2003;28:159–64.[Medline]

19. Cedraschi C, Nordin M, Nachemson AL, Vischer TL. Health care providers should use a common language in relation to low back pain patients. Baillieres Clin Rheumatol 1998;12:1–15.[CrossRef][Medline]

20. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004;29:2309–18.[CrossRef][ISI][Medline]

21. Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med 2004;164:1365–8.[Free Full Text]

22. Klaber Moffett JA. Patient Education and self care. In: Hutson M, Ellis R, eds. Textbook of musculoskeletal medicine. Oxford: Oxford University Press, 2005, Chapter 4.2.

23. Jeffels K, Foster N. Can aspects of physiotherapist communication influence patients’ pain experiences? A systematic review. Phys Ther Rev 2003;8:197–210.

24. Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001;81:1701–17.[Abstract/Free Full Text]

25. Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell E. The back book. London: Stationery Office, 1996.

26. Burton K, Waddell G, Tulletson M, Summerton N. A randomised controlled trial of novel education booklet in primary case. Spine 1999;24:2488–91.

27. Burton A, McClune T, Waddell G. The whiplash book. London: Stationery Office, 2002.

28. Waddell G, Klaber Moffett J, Burton A. The neck book. London: Stationery Office, 2004.

29. Royal College of General Practitioners. Clinical guidelines for the management of low back pain. London: Royal College of General Practitioners, 1996, 1999.

30. Indahl A, Haldersen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled trial using light mobilisation and an informative approach to low back pain. Spine 1998;23:2625–30.[CrossRef][ISI][Medline]

31. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25:1973–6.[CrossRef][ISI][Medline]

32. Storheim K, Brox J, Holm I, Koller A, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomised controlled trial. J Rehabil Med 2003;35:132–40.[CrossRef][ISI][Medline]

33. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708–13.[Abstract/Free Full Text]

34. Hay EM, Mullis R, Lewis M et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365:2024–30.[CrossRef][ISI][Medline]

35. Gross AR, Aker PD, Goldsmith CH, Peloso P. Patient education for mechanical neck disorders. Cochrane Database Syst Rev 2000:CD000962.

36. Klaber Moffett JA, Jackson DA et al. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 2005;330:75–80.[Abstract/Free Full Text]

37. Guillermo Pecci Saavedra, M. D., Esmail R, Bombardier C, Koes B. Back schools for non-specific low back pain. Università di Milano, School of Medicine, Cochrane Library 2003:1.

Chiropractic Videos: Free Videos for Patient Education and Marketing

Video is a powerful communication tool that can greatly enhance patient engagement, knowledge, acquisition and retention when used properly. There are many blog posts floating around that proclaim to teach you the right way to do chiropractic videos. This isn’t one of them. Instead, we’ve found that most people searching online for “chiropractic videos” are not looking for cinematography tips. Instead, they are looking for actual videos that they can use right away.

This article is devoted to connecting you with free chiropractic videos that you can use in your marketing and patient education efforts. At the bottom you’ll find a place to request the hand-picked list of recommended YouTube videos to embed

Chiropractic Videos for Your Website and Marketing

There are three different types of chiropractic videos that you might find on a website. Two types are for marketing, and one is for patient education. The chiropractic marketing videos can be subdivided into testimonials and “about us” videos. Here are a few sample chiropractic videos in each category followed by instructions for how to get them.

Chiropractic Patient Education Videos – Video Category 1

The YouTube channels of the various state chiropractic associations are a great place to look for chiropractic patient education videos that you can embed on your website. Since these video channels are run by associations they generally do not contain promotional messages for any one chiropractor.

These two videos target parents of school-age children and are great examples of educational chiropractic videos.

Pack it Light, Wear it Right: Backpack Tips -http://www.youtube.com/watch?v=98zSMNYBeCc

Association of NJ Chiropractors Promotes Backpack Safety on KYW-TVhttp://www.youtube.com/watch?v=Ti3aIlNY_2g

Chiropractic Testimonial Videos- Video Category 2

Testimonial videos can be very effective when carefully planned or selected. Generally a chiropractic video testimonial is intended to persuade a potential patient to take a specific action – such as make an appointment or begin a new treatment modality. For the testimonial video to help accomplish this goal the patient must either:

1. Respect the speaker in the testimonial because of their position, education or experience, or

2. Relate to the personal story of the speaker because it is similar to their own

In preparing or selecting chiropractic video testimonials for your website, look for authoritative figures and make sure you have a diversity of ages, genders and conditions represented.

1. These are two excellent examples of authoritative speakers:

Jerry Rice – Football Legend -http://www.youtube.com/watch?v=_CAsGNlQEnI

Dr. Terry Schroeder, Coach of US Olympic Water Polo Team -http://www.youtube.com/watch?v=d-ye0rbbnlQ

2. These are two examples of diverse conditions.

Infertility and Chiropractic – http://www.youtube.com/watch?v=nnZOeEY08gE

Chiropractic and ADHD – http://www.youtube.com/watch?v=2e1cxtI7U2w

News stories are a great substitute for personal testimonials since they are reported from a third-party perspective. Even though local news stories often feature another chiropractor as the expert – when you use news stories from outside your local market there is no competitive threat.

Chiropractic “About Us” Videos- Video Category 3

This type of chiropractic video is inherently about YOU, so you won’t be reusing anyone else’s video other than to get ideas. Here are two opposite ends of the spectrum that both work well.

Humor with a Heavy Dose of Reality -http://www.youtube.com/watch?v=MpZ6xhp5xZQ

This chiropractic video works because it speaks the truth. Any chronic pain sufferer will immediately related to the man in the bed. At the same time, everyone, young/old, fit/healthy will laugh.

Personal, Narrated Tour -http://www.youtube.com/watch?v=1vJ1DGeAxqU

We selected this chiropractic video as an example because it is very genuine. The doctor narrates the video himself and it sounds as if he’s talking directly to you, not to a worldwide audience. You can see some camera shake throughout and this contributes to the authenticity and allows people to let their “I’m being sold to” guard down. This is an example that anyone with a Flip camera can replicate.

Your Personal Chiropractic Video Collection

Don’t send people to YouTube to watch these chiropractic videos. Instead, embed them into your own webpage. Have patients and potential patients spend time on YOUR website where they aren’t surrounded by the ads and marketing messages of your competitors.

How do you do it?

If you have a WordPress-based website we highly recommend the Display Buddy plugin which will transform your video and photos into visual masterpieces and is so easy to use.

If you do not use WordPress, your best bet is to use the video embed code that YouTube provides and paste that into the HTML of your webpage. You may need to wrestle with it a bit to make it look good. Often times creating a 2×4 table to hold eight chiropractic videos works well.

All of the chiropractic videos you see on this page are YouTube videos with permission to embed.

It would be pointless to have you search all over YouTube to assemble a ‘best-of’ collection of your own. That’s why we are making a list of hand-selected videos available as a free download. We’ve screened the list to be mostly devoid of competitive marketing messages and to cover a wide variety of ailments and ages.

Chiropractic Degrees: Achieve Yours

Find Chiropractic Degrees and chiropractic degree programs in the United States and Canada. Students interested in earning chiropractic degrees must understand that many chiropractic colleges and schools require prerequisite courses prior to entering their chiropractic degree programs. In general, most chiropractic universities require applicants to have attained previous minimum of 90 semester units in general education, biological and physical sciences, chemistry, psychology, English and humanities.

Chiropractic degrees are not that easy to come by – students participating in chiropractic degree programs will quickly discover that these are course-intensive programs that can last up to six calendar years. In accelerated chiropractic degree programs, students can achieve their chiropractic degrees in as little as three years; however this is a rigorous course of study and requires absolute dedication.

Chiropractic degrees and relative chiropractic degree programs include the Doctor of Chiropractic, Bachelor of Science in human biology, as well as Bachelor of Science in public health. Candidates interested in enrolling in chiropractic degree programs should take one of several pre-entry examinations, such as the CLEP (College Level Examination Program) or ACT (American College Training Program) exams to determine educational level prior to applying.

Students pursuing chiropractic degrees will gain intense training and education in a wide assortment of studies including classes in human anatomy, chiropractic biochemistry, biomedical physiology, biomechanics, pathology, cell biology, microbiology, immunology, pharmacology, radiography, chiropractic principles and history, chiropractic skills, physical examination and assessment, and clinical practicum.

In most chiropractic degree programs, students who have successfully achieved their chiropractic degrees will have acquired over 4,200 hours of in-depth studies and training; including combined classroom, clinical and laboratory experience. Successful graduates can and must attain licensure from the state in which they reside. States vary in licensure requirements, so it is of utmost importance that students who have attained their chiropractic degrees have met all prerequisites, educational requirements and credentials set forth by individual state specifications.

If you (or someone you know) are interested in finding quality chiropractic degrees and chiropractic degree programs, let career training within fast-growing industries like massage therapy, cosmetology, acupuncture, oriental medicine, Reiki, and others get you started! Explore career school programs near you.

Chiropractic Degrees: Achieve Yours

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How to Avoid Back Pain and Find New Pain Relief Options

Back pain is reported to be the most common cause of missed work, right after flu and colds. In fact, back pain is so common that many people consider it inevitable, especially with increasing age.

But it may be possible to avoid some types of back pain by better understanding its causes and avoiding or preventing them in the first place.

And while over-the-counter pain relief medications can help lessen back pain once it occurs, exercise, improved posture, and good furniture can strengthen and heal your back and even prevent back pain from occurring in the first place.

This article will guide you in both ways: how to avoid back pain and how to find back relief.

Back Pain Causes

The back is a powerful structure comprising bone, muscle, and elastic discs. This marvel of efficiency allows you to bend, twist, and carry weight. However, its flexibility makes it susceptible to injury and pain. Not surprisingly, back pain often results from neglect or other lifestyle factors such as:

* Bad posture – A normal adult spine resembles a double ‘S’. When you slouch, the pelvis and the stomach thrust forward, the knees bend, and the back muscles are strained. This strain can easily lead to back pain.

* Sedentary lifestyle and stress – Lack of exercise tends to weaken the muscles in the body. At the same time, stress can lead to muscle tension, causing the unprepared muscles to spasm.

* Weak abdominal muscles – Back pain is often related to weak stomach muscles, which can place added stress on the back.

* Obesity – Overweight people may find it difficult to maintain proper posture, and the burden of additional weight puts pressure on the back.

* High heels – They push the body’s center of gravity forward. To offset this, people tend to bend their knees and move their torsos forward. This can exaggerate the spine’s inward curve, leading to back pain.

People can also experience back pain as a result of specific health conditions:

* Spondylosis – Arthritis of the spine occurs due to degenerative spinal changes, and is often characterized by back pain.

* Spondylolisthesis – This occurs when one spinal vertebra slips forward on top of another one, causing back pain.

* Spinal stenosis – When the space around the spinal column and nerve roots is reduced, nerves are pinched or pressed, resulting in back pain. Arthritis and bone overgrowth trigger this condition.

* Herniated disc – One of the most common causes of back pain, this condition occurs when a spinal disc presses on a nerve. It’s also referred to as slipped disc.

* Sciatica – Sharp, shooting pain that radiates through the lower back or buttocks to the back of the leg when a herniated disc presses the sciatic nerve.

* Spinal infection – When this occurs, back pain is often accompanied by fever and tenderness.

Back Pain Relief Options

Not every type of back pain is a condition you have to put up with. In addition to medication and home therapies, there are a variety of complementary and alternative therapies that can provide back pain relief.

Bed rest may help relieve acute, temporary back pain. But this may not work for chronic back pain, which may require long-term treatment.

Here are just some of the methods you can try to get back pain relief:

* Heat and ice treatment – For lower back pain relief, use an ice pack first to sooth the sore muscles. You can use a cold compress several times a day for up to 20 minutes per treatment. A warm compress or a heating pad loosens the muscles and increases blood flow, which can provide some back pain relief.

* Chiropractic care – Some research on pain relief has shown that chiropractic manipulation may be as effective as pain relief medication for certain patients.

* Acupuncture – In this alternative medicine procedure, the practitioner inserts sterilized stainless steel needles at specific points on the body. This may stimulate the brain to release natural endorphins, which can provide some level of back pain relief.

* Electrical stimulation – Transcutaneous electrical nerve stimulation (TENS) often works for acute back pain. In this procedure, weak electrical pulses sent to nerve pathways through specific points prevent pain signals from reaching the brain. This back pain relief procedure may be appropriate for those who prefer to avoid medication.

* Over-the-counter medication – Drugs such as aspirin and ibuprofen can help reduce inflammation and relieve back pain, while acetaminophen controls pain without addressing inflammation.

* Prescription medication – When over-the-counter drugs fail to provide pain relief, doctors may prescribe a nonsteroidal anti-inflammatory drug (other than aspirin or ibuprofen), a muscle relaxant, or other medication.

* Epidural injections – When other measures fail to relieve back pain, doctors may prescribe epidural injections of anti-inflammatory medication such as cortisone to provide pain relief.

Back Pain Don’ts

* Do not exercise while suffering from severe back pain.

* Do not sit for long periods when suffering from back pain. Sitting exerts more pressure on your nerves than standing or lying down. This can exacerbate back pain.

* Do not slouch or overarch your back, as this increases pressure on the lower back and may cause back pain to become more intense.

How To Avoid Back Pain

Many people who suffer from chronic back pain have found that a few lifestyle changes and healthy work habits can help them avoid recurrences of back pain:

* Exercise – Exercise not only helps to maintain proper weight, but also helps build and maintain strong muscles. However, if you already suffer from back pain, consult your doctor before starting an exercise routine.

* Good posture – A balanced posture allows the body to relax while maintaining an erect position. If you stand for long hours, avoid back pain by placing one foot on a stool or a box to avoid stressing the pelvis. While sitting, make sure that your lower back is supported and that your feet stay flat on the floor.

* Bend and lift properly – Improper bending is a common cause of back pain. When bending down, bend your knees, separate your feet about shoulder width apart, and keep your back straight. When lifting things, let your legs bear your weight, keep objects close to your body, and ask for help if the load is too heavy.

* Sleeping position – Sleep on your side, with your knees bent towards the chest. Place a pillow between the knees to reduce pressure on the back.

* Heel inserts – To reduce the risk of back pain, some doctors recommend heel inserts to alleviate stress on the lower back and provide shock absorption.

* Medium-firm mattresses – Sleep on a mattress that is firm enough to support your body but does not distort the body’s natural curves.

* Car seating position – Tilt your car seat back slightly, so that your knees are higher than your hips. Place the seat close enough to the wheel to let your arms bend.

Treating your back with respect is one key to avoiding back pain. However, if you already do have back pain, a variety of pain relief medications and treatments are available.

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