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chronic pain

Exercise for Chronic Pain

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For years research has been conducted into the benefits of exercise for chronic low back and neck pain. Even though we know exercise is good for us, we don’t really know a lot about how it is prescribed in real-life situations (practice).  Recently, a large survey was done of 2700 people who reported having chronic neck or low back pain. The results are published in an article in Arthritis & Rheumatism.

Of these 2700 people, 48% had been prescribed exercise after visiting a physical therapist, chiropractor of family doctor in the past year. 33% of all people who visited a chiropractor were prescribed exercise for their pain, compared to 64% of PT patients and 14% of MD patients. Overall, the type of provider, as opposed to any characteristics of the patient was the greatest predictor of exercise prescription.

With chiropractic specifically in this instance, the rate of exercise prescription seemed to increase with number of visits. This supports the common practice pattern of reducing pain and increasing function before commencing rehabilitation.

This is a huge wake up call to all health care providers – exercise was prescribed to less than half the patients with chronic back pain, even though we know it is one of the most effective forms of treatment. We need to make sure we are getting our patients active, and helping them to stay that way!

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Exercises for Knee Arthritis

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Osteoarthritis is the most common type of joint problem worldwide, with knee arthritis being the most prevalent. The chances of getting knee arthritis increase with age, weight, previous injury or heredity. There is mixed evidence to support various types of knee rehabilitation for osteoarthritis sufferers. A study in the Journal of Back and Musculoskeletal Rehabilitation set out to compare strength training to balance training in managing knee arthritis.

At the beginning of the study, there were no differences between the 2 groups of participants. One group performed only strength training exercises, while the other group performed a combination of strength and balance exercises. Based on various outcome measures such as pain, disability, stiffness, depression and physical function; the balance group performed significantly better after one year.

This study suggests that it is important to ensure that any rehabilitation program for knee arthritis should include simple balance exercises. Some of the exercises used in the study are as follows:

  • 25 m backwards walk
  • 25 m heel walk
  • 25 m toe walk
  • 25 m eyes closed walk
  • 30-second one-legged stand (with leaning in all directions with eyes open and closed)

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Easing Chronic Muscle Pain – What works?

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Myofascial Pain Syndrome can be defined as chronic muscle pain. This pain originates around certain points of pain and sensitivity in your muscles called trigger points. A recent study was published in the Journal of Manipulative and Physiological Therapeutics that sought to identify and review the most common treatments for myofascial pain syndrome.

This study identified many different types of treatment used, and some of them are as follows:

  • Spray and Stretch – vapo-coolant spray followed by muscle stretch
  • Soft Tissue Massage
  • Ischemic Compression – compressing the trigger point in the muscle
  • Occipital Release Exercises – a form of massage and mobilization for the occiput (base of skull)
  • Strain/Counter-strain – stretching a muscle and then having the patient contract that muscle
  • Myofascial Release – compressing and tensioning the trigger point while stretching the muscle through its full range
  • Chiropractic Spinal Adjustments

Immediate (after treatment) benefits were demonstrated with the chiropractic adjustments, spray and stretch, compression, massage and strain/counter-strain. The authors therefore concluded that there is moderately strong evidence to support the use of these manual therapies for the treatment of trigger point pain. These treatments, however, didn’t show as strong benefits as long term solutions.

Recommendations for other types of treatment for trigger points and myofascial pain syndrome can be drawn from this review.  They are as follows:

  • There is strong evidence that laser therapy is effective.
  • There is moderately strong evidence that electrical therapy is effective on a short term basis.
  • There is moderately strong evidence that acupuncture is effective for up to 3 months after treatment.
  • There is limited evidence for modalities such as muscle stimulation, interferential current, an other such stims.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Alexander Technique Can Help

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As a Comox Valley Chiropractor who’s practice is mainly comprised of back pain, neck pain, headaches and other limb pain, I often hear of people’s adventures with other forms of treatment.  Many of these techniques are “named techniques”, or in other words they are named after the person who invented them. One of the techniques I hear about from time to time is the Alexander technique, and I dind’t give it much thought until this article appeared in the British Medical Journal.

In this study, 579 patients were randomly assigned into 4 different groups, and each intervention was applied with and without general exercise prescription:

  1. Normal care from a GP
  2. 6 massage therapy treatments
  3. 6 lessons of Alexander technique
  4. 24 lessons of Alexander technique

Questionnaires were completed at 3 and 12 months. Overall, there was little improvement in the control group, while at 3 months significant improvements were found in the other 3 intervention groups. The massage benefits did not last through 12 months, while both the  Alexander technique lesson groups maintained their benefits. In fact, the group which received 24 lessons acutally showed a better result at 12 months than at 3 months. When exercise was added to the interventions, it significantly improved the outcome of the 6 lesson group, but not the 24 lesson group.

This is a very large and well-structured study showing the potential benefits of the Alexander Technique in improving pain and disability levels for chronic back pain patients. Obviously this is just one study, but the fact that this study involved many clinics and many different practitioners gives it more validity. Below you will find a video produced by the BMJ demonstrating the Alexander Technique and describing their research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

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Chronic Foot Pain – Its Plantar Fasciitis!

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The Plantar Fascia
The Plantar Fascia

The plantar fascia of the foot is a thick band of connective tissue that supports the arch of the foot. It runs from the heel up towards the toes on the bottom of the foot. Excessive wear and tear on this structure can lead to inflammation and results in pain on the bottom of the foot or heel, which is often worse first thing in the morning or with too much walking. In certain cases, it can lead to the formation of a heel spur on the heel bone.

In my experience, this condition usually builds up slowly over long periods of time. Excess stress on the plantar fascia due to fallen arches (flat feet), improper footwear or excess time spent on the feet can lead to the development of plantar fasciitis. Treatment is aimed at reducing the inflammation and supporting the arch of the foot if it needs it.

In my office, anyone presenting with plantar fasciitis receives a low back, hip, knee, ankle and foot examination including gait (walking). Depending on the state of the arch, over the counter or custom made orthotics may be prescribed. Apart from restoring proper motion of the back, hip, knee and ankle, I tend to pay special attention to the movement of the foot bones that make up the arch (navicular and cuboid). I use active release therapy and/or muscle stripping with biofreeze to reduce the inflammation in the plantar fascia itself. Finally, I always end a session with application of Kinesiotape which often works wonders.

A thorough home stretch plan is very important in this case, as you are on your feet all day. I usually suggest stretching the plantar fascia (pull back on your toes), calf muscles and shins. I recommend icing at the end of the day, which is best done by freezing water in a 500 ml plastic water bottle and proceeding to roll your foot forward and backwards on it. Further self-massage can be done with some moisturizer and your thumbs. For severe or stubborn cases, I will recommend that my patient wear a good supportive pair of running shoes at all times when in the house. Finally, low intensity laser therapy is a great option to boost healing of the plantar fascia especially when recovery is slow.

I think that one thing all health professionals will agree upon is that you don’t want to let plantar fasciitis go. As with most problems, it is much easier to treat in the early stages. Listen to your body before it forces you to pay attention!

Dr Debbie Wright is a practicing Comox Valley Chiropractor.

Management of Chronic Low Back Pain

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Chronic low back pain has been the subject of much research and funding, with very little relevant information coming from the effort. It is a very difficult condition to manage, and its effect on society can be valued into the billions of dollars. However, it is also a condition that is seen with much frequency at the office of this Comox Valley Chiropractor.

A recent study in the prestigious journal Spine set out to analyze the evidence-based management of chronic low back pain with electrical stimulation, interferential current, ultrasound and hot/cold packs. These modalities are used often in the offices of manual medicine practitioners, usually with the goal of relieving pain and inflammation.

What was surprising about this study was the blatant lack of evidence to support the use of these modalities, especially given that they are so prevalent.  No eligible studies of good quality were even found for interferential current, ultrasound and hot/cold pack therapy, leading to the suggestion that these modalities should be avoided. Of the 6 studies that were found for electrical stimulation, 4 were of very poor quality and the remaining 2 found benefit only in the short term. These results suggest that electrical stimulation should be used as only one component of a short term treatment plan (and not on its own).

This article was part of a special edition of Spine in which many different treatments were analyzed for their effectiveness. The general consensus is that not enough research exists to choose one specific treatment over another, however “when viewed optimistically, the articles in this special focus issue do suggest that a reasonable approach to CLBP (chronic low back pain) would include education strategies, exercise, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization, or massage, and possibly acupuncture.”  Haldeman S, Dagenais S. What have we learned about the evidence-informed management of chronic low back pain? Spine J. 2008 Jan-Feb;8(1):266-77.

If you have any questions about chronic low back pain, feel free to contact your Comox Valley Chiropractor.