A recent Newsweek article on low back pain discussed the latest update from Harvard Medical School.1
The article focused on alternative therapies and chiropractic was obviously a part of that discussion. The article began with the admission that low back pain often mystifies not only the patient, but the doctor as well, as a specific diagnosis is rarely determined.
Due to the difficulty in determining a specific diagnosis, treatment can only attempt to reduce symptoms, and in that context, chiropractic becomes one of the multiple alternative therapies used for the relief of pain. Chiropractic has debatable benefits; some say short term treatment offers some relief while others say it provides minimal benefits. This, however, is only considering chiropractic as an alternative when measuring symptomatic relief, which has unfortunately become the objective of care in the back pain industry.
Low back pain causes
According to another article on The Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging, published in the October, 2002 Annals of Internal Medicine, 97 percent of all low back pains are due to mechanical causes, while less than 3 percent are due to pathological causes.2
The article also states…a definitive diagnosis cannot be made in as many as 85 percent of patients because symptoms and pathologic changes are not closely associated. Many cases of uncomplicated low back pain are assumed to result from muscle sprains and strains, ligamentous injuries, and spinal degenerative changes.
The admission by this publication that 97 percent of all low back pains are a direct result of mechanical causes and that an accurate diagnosis is difficult because symptoms and pathologic changes are not closely associated with the condition begs the question, why do chiropractors see only 10-14 percent of the population. Why is it that our pathology-based specialists, the medical doctors and osteopaths, see the majority of patients who suffer with mechanical injuries?
Why aren’t mechanical diagnostic tests and treatments the standard in today’s industry? And what other health care provider is in a better position to be the specialist in mechanically based injuries than the chiropractor?
Chiropractic in many cases has fallen victim of the managed care industry guidelines where the objective of the provider is to reduce symptoms only. Chiropractors should be the structural experts, using structurally-based testing and treatment to determine an accurate status of the patient and then to provide structural corrective care, not just symptomatic relief.
And when our profession can achieve these standards, we will no longer be known as an “alternative”, we will then be “the only” profession even grasping the concept that mechanical causes require mechanical diagnosis and correction.
The structural management program
This program was designed to begin to address the needs of the mechanically injured. There are three aspects of the program;
- The Structural Fingerprint Exam
- The quantifying of structural imbalances, weaknesses and distortion patterns in a patient.
- The Advanced Conditioning Program
- A 6 month corrective program designed to restore mobility back to the joints of the spine while also rehabilitating and re-educating the muscles and joints of the spine.
- The Maggs Muscle Management Program
- A program designed to remove harmful toxins from repetitively used muscles, thus increasing flexibility, performance, and recoverability of a muscle.
When applied to each and every patient, this program offers many possibilities. First of all, it can be incorporated prior to injury, such as in pre-season, prior to hiring an employee or for the pro-active patient who wants to dramatically improve their conditioning while reducing the likelihood of injury.
Secondly, when working with injured patients, this program looks at the patient as an architectural structure, determining where the imbalances and stress-points are. This allows the doctor to establish a corrective conditioning program using objective structural corrections as the goal rather than just the elimination of symptoms.
Finally, those looking to dramatically improve conditioning can learn the uniqueness of their structure, so that corrective treatment and conditioning exercises can be set up. This should apply to all youths in sports today. No one performs structural evaluations on the pediatric market, especially the pediatric sports market. This market blindly and aggressively trains and competes without any clinical knowledge of the status of a child’s structure. Many distortion patterns and imbalances can be determined with The Structural Fingerprint Exam.
A case study
Kaitlin Howard rows for her school crew team. She paddles only on the left side of the shell. Kaitlin came into my office with a history of low back pain for many years. She also suffered with pains in her left neck radiating into her left trapezius. These symptoms were worsening with increased rowing.
The structural fingerprint exam
Every person alive has many contributing factors that make up their structural strengths and weaknesses. Heredity, prior injuries, habits, diet, height, weight, sport and position, attitude, shoes, mattress, etc. are but a few of the contributing factors that will decide the fate of someone’s structural wellness. Therefore, a detailed structural exam is imperative in determining the status of one’s structure.
Upon Kaitlin’s examination, the medial arches of her feet were equal and normal. There was no toe flare. There was an increase Q angle of the right knee. Low back range of motion was full and without pain, as was the cervical range of motion. Toe/heel walk was negative. Cervical compression and distraction were negative. Lasegue’s, bilateral leg lowering, and Patrick-Fabere were negative. Gaenslen’s was positive bilaterally.
Trigger points were noted in the left trapezius, the left rotator cuff, the left quadratus lumborum, bilateral gluteus medius and bilateral piriformis muscles.
A structural X-ray series was taken; an A-P open mouth, a lateral Cervical, an A-P L-S and a lateral L-S, all in the standing position. As noted on the A-P open mouth, there is a rotation of the spinous process of the axis, and there is an imbalance in alignment with the odontoid process, as compared to the normal A-P open mouth . On the lateral Cervical, there is a reversal of the normal lordotic curve with the gravity line falling anterior to the spine, as compared to the normal lateral Cervical (Fig. 4). Keeping in mind the head is approximately 10% of the body weight, an abnormal weight distribution will lead to premature injury, difficult recovery and accelerated degeneration.
On the A-P L-S there is a significant elevation of the left crest over the right crest, as compared to the normal A-P L-S. The lateral L-S showed a posterior gravity line with a 33° sacral base angle (normal SBA is 36°-42°), as compared to the normal lateral L-S.
There were several objectives in this case; to improve the structural positioning seen on the x-rays, to improve the status of the non-compliant, over-used muscles harboring trigger points in Kaitlin’s structure and to get her managing her structure on a daily basis.
Improvement of structural positioning began with the recommendations of custom orthotics. The elevation of one crest, as seen on the x-ray, in the absence of an anatomical short leg (both legs measured 29 ½”), combined with an increased Q angle on the right, was enough reason to recommend custom orthotics.
The advanced conditioning program
This six month program is designed to restore mobility and structural integrity while also re-educating muscles and joints to begin to resume normal function. The program is a combination of chiropractic adjustments, 40 over a six month time frame (3x’s/wk.-6 wks., 2x’s/wk.-6 wks., 1x/wk.-6 wks., 1x/2wks.-8 wks.) to restore mobility back to all joints of the spine. And a specific exercise program designed and taught by a personal trainer who works in the office to re-educate the involved muscles and joints and a re-education of habit patterns that may have affected the patient adversely. There are two re-exams performed on the patient during this six month period, and re-X-rays are performed at the completion of the program.
The Maggs muscle management program
This program was designed with multiple benefits in mind; first, to address the accumulation of harmful toxins in repetitively used muscles, by increasing blood flow (oxygen and nutrition) and eliminating harmful toxins. This process accelerates recovery and relaxation of injured, taut muscles. The second benefit is the ability to efficiently warm a muscle prior to using it and thirdly to accelerate the recovery of fatigued and tightened muscle after activity. This program is fully designed to support and enhance normal muscle activity while drastically reducing the potential for injury and accelerating the recovery of injured muscle.
The Intracell Stick is the desired tool of choice, and each muscle must be in a relaxed state and rolled 20-30 times. The muscle is then stretched for 5-7 seconds. There is a technique for every major muscle group in the body.
Kaitlin is just entering her 2nd month of care under this program. The fact that her treatment will result in lifetime benefits, not just short-term symptomatic relief, will dramatically help her life while saving hundreds and thousands of dollars along the way.
Every patient deserves this type of an approach for their present and future well being. When chiropractic can bind together and become the structural management specialists out there, we can then hope for a significant portion of the 97 percent of mechanical injuries that exist in our country today, as well as many uninjured athletes and employees looking to prevent injuries.
Tim Maggs, DC, has been in practice nearly 40 years, and is the developer of the Concerned parents of Young Athletes (CPOYA) network, with the goal of offering every middle and high school athlete a biomechanical exam prior to each sports season. The network, in partnership with Foot levelers, provides training, resources, networking opportunities, and more for DCs interested in working with youth athletes. Maggs can be contacted at firstname.lastname@example.org or through CPOYA.com.
- Cherkin, Dan, Ph.D., Sherman, Karen, Ph.D., Eisenberg, David, M.D., Beyond the Backache. Newsweek December 2, 2002: p. 56.
- Jarvik, Jeffrey G., M.D., MPH, Deyo, Richard A., M.D., MPH. Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging. Annals of Internal Medicine. October 1, 2002. pp. 586-597.