...Chiropractic care for low back pain included taking the patient from acute to transitional state, to rehabilitation, to resume normal activities and work. In other words, are you doing the complete job or just hitting the high spots.
In the last few years, research has made it obvious that physical activity is mandatory to all patients with back pain and back dysfunction. The stage of transition (the beginning stage of active exercise) not only starts the restoration of function, but is also associated with a reduction in pain. The rehabilitation stage furthers this process and would include active exercises with and without weight resistance. As a general rule, people who are physically fit recover faster from any musculoskeletal ailment.
There is no doubt in anyone's mind that prolonged bed rest and inactivity will lead to muscle atrophy, shifts in the IAM, resultant multiple site subluxations, and significant deleterious changes in the patient's entire musculoskeletal system, and if left in this state, somatovisceral manifestations are likely to occur. Taking this further, there would be the following:
1. A steady decline of overall body fitness levels.
2. A reduction or loss of muscular and ligamentous flexibility.
3. A reduction of joint ROM and loss of segmental joint play.
4. A change in the Q and Q of weight bearing bone.
5. All components of the subluxation complex will be involved in some form and all will be to the patient's disadvantage.
All components of the musculoskeletal system need constant use from birth to death in order to maintain their strength, flexibility, and efficiency. The osseous spine in general is largely dependent upon the movement of other structures. The IVD and articular cartilage are dependent upon the motions of the extremities and spinal column for the maintenance of fluid transfer and nutrition. A steady decrease in a person's activity levels is inevitably associated with a reduction in a person's ability to react appropriately to changes in the environment. A return to physical work, following a period of rest for low back pain, exposes the patient to further back injury since the level of physical and spinal fitness is much poorer than when the back pain initially caused the person to stop work in the first place. Therefore, it should be of no surprise to the treating doctor when the patient suffers early recurrence of back pain upon returning to work. Literature is overloaded with data to show that work absence due to back pain relates to the level of physical changes brought about from bed rest, inactivity, and a lack of rehabilitation after spinal function has been restored.
Doctors and students, there is no evidence that prolonged rest, ultraconservative care, or the avoidance of exercise/activity brings about a reduction in back pain; indeed, the evidence supports the view that, except for a short period (24 hours is considered maximum) after injury, rest has no effect on the natural history of back pain. A number of major studies suggest that prolonged inactivity accentuates the problem and may, in fact, increase the severity of the pain. The treatment time will almost always be a function of the time spent resting; the more rest and lack of activity, the longer it takes to return to normal spinal health.
In spite of all of this evidence, bed rest, modalities, creams, corsets, power belts, heating pads, orthopedics, and avoidance of physical activity are still the most commonly prescribed remedies given by chiropractic doctors. What happened to the spinal adjustment for the spinal subluxation?
What happened to make new chiropractors fear the power of the adjustment? I strongly urge new grads and students to look at the adjustment and the subluxation complex for your treatment protocol, and leave the other non-productive stuff to the uneducated and unsure.
Keith Innes, D.C.
Scarborough, Ontario
Canada
Editor's Note:
Dr. Innes will be conducting his next Cervicals and Thoracics seminar on September 26-27, 1992, in Denver, Colorado. You may register by dialing 1-800-359-2289.
