Introduction and Background
Low back pain has a high prevalence across the globe. According to Weigel et al., majority of people with low back pain experience recurrent episodes of pain (577). Due to the high prevalence rates of back pain, there have been increased interventions that target to treat lower back pain. Some of the conventional interventions entail the use pharmacological, surgery, and orthopedic exercises. Despite the adoption of the conventional intervention procedures, the prevalence of the symptoms related to low back ache has been on the rise. The low back pain conditions if not managed and treated can proceed beyond the normal pain to complex chronic conditions (Dunn, Baylis and Ryan 125). The chronic conditions can cause changes in the central nervous system and also lead to structural changes in the back. Hence, untreated low back pain is associated with degenerative changes in the spinal region and dislocation of para-spinal muscles. These changes reduce the quality of life for the patients.
The low back pain affects different categories of people. The literature on the people suffering from lumbago is scarce. This is especially in relation to activities carried out by housewives and their impact on exposing the housewives to the low back pain. According to Dunn, Baylis and Ryan, some patients who report low back pain have clear histories of their daily activities that may have exposed them to the condition (128). In most cases, the activities strain the lower region of the back. Parachute military personnel and athletes involved in strenuous exercises are likely to suffer from low back pain. The problem has also been reported among postpartum women. However, for some people there is no clear cause of what could have led to the pain or its association to the low back pain.
Many conventional approaches are used for the intervention of low back pains. As noted by Escoffon and Wallace, the common methods include medications, injections, and nutritional supplements, changes in lifestyle, physical exercise and surgeries (68). Studies on the effectiveness of the approaches have documented different benefits and levels of effectiveness. In addition to the conventional management of low back pain, there are conservative management methods of back pain. This includes the use of the chiropractic care. The chiropractic care is a drug-free approach that focuses on musculoskeletal and nervous systems. It is usually applied in the treatment of back pain, joint aches, headaches and neck pains. Studies have shown that the purpose of the chiropractic care is to restore joint mobility. This is achieved by manipulating a force that is controlled in order to restore the mobility of the targeted muscles and joints (Weigel et al. 579)
Therefore, the main purpose of this report is to present a case example of the application of chiropractic process to manage back pain. The case provides an evidence based evidence of the effectiveness of the conservative management of low back pain using the chiropractic care. The case is intended to supplement the existing knowledge and provide the basis for further studies.
Case Report: Methods
The patient being managed was a 46-year-old housewife. In the chiropractic care unit, the patient complained of low back pain. The pain started in the low back region and traveled to the cervical. The patient described the pain as dull, sharp and aching. The intensity of the symptoms was rated 5/10. The frequency of occurrence ranged from 51% to 75% of the day. The patient noted that the pain and the accompanying symptoms such as a headache were worse at the end of the day. A further probe of the patient established that the relieving mechanism for the pain was stretching and exercises. The factors that aggravated the pain included sitting and sleeping. The medical history of the patient established that she was previously diagnosed and treated of cervicalgia.
In relation to daily activity, the lady reported a history of repetitive motion such as low back flexion and extension that she undergoes while carrying out her housewife duties. The family history indicated that her mother and father were hypertensive.
Physical examination of the patient was also carried out. The vitals as recorded were blood pressure of 122/82, the temperature was 98.3F, respiration was 12 per minute, and the pulse rate was 70bpm. The physical observation established that the gait was normal. The check of the Posture established anterior head carriage and head rotation in which the patient was comfortable. The other examination included palpation. The results showed tenderness at the right SI joint. There was also taut and tender joint fixation on the left side of L4. The findings of the palpation pointed to decreased ROM of right SI joint.
Orthopedic and neurological tests were also conducted and their clinical findings established. The tests on supported Adam’s position were positive. The implication of the findings was existence of SI joint problem. The Yeoman’s test was positive while the Kemp test was also positive with pain at waist. Other tests that were conducted included SLR/Seated, SLR/Braggard, CSLR/Fjerztajn’s, Linder/Milgram and Sicard tests which were all were negative. The sensory, motor and reflex tests on the lower extremities were negative. The radiographs pointed to early degenerative disc disease at L1-3 with adjacent plate osteophytosis and early degenerative joint disease in the SI joints.
The management of the low back pain in the chiropractic care was an eight-week plan in which different frequencies of chiropractic techniques were used. There were no modifications prescribed to the patient. However, the patient was advised to carry out stretching exercise. Each stretch session was to last five minutes. This was supposed to be repeated for two to three times a day. The management also included a nutritional intervention in which the patient was advised on the intake of proteins. The patient was to ensure that 40% of her diet was protein. The patient was also instructed to drink about 80 oz of water each day. The actual management entailed chiropractic techniques. Gonstead Diversified and Thompson techniques were used. In the first four weeks of the management, the frequency of exposure to the techniques was twice a week. After the first four weeks, the frequency was reduced to once a week and continued for the remaining four weeks. These processes were combined with rehabilitative procedures in which soft tissue was applied to stretch muscles. There were no supportive procedures for the patient.
The focus of the management was to restore the lumbar ROM and reduce the intensive back pain. During the care process, the patient was monitored closely. The patient was also supposed to give a report on her progress in relation to the decrease or increase in the lower back pain.
Results
The course of the care continued for eight weeks as had been planned. At the end of the course, the pain intensity had significantly reduced. The analysis showed that the pain had decreased from 8/10 to 5/10. In addition, the patient reported that there was a substantial reduction in the percentage of pain experienced during the day. For instance, the pain reduced from 75% to 25%. The patient also reported that the accompanying headache and severity of the pain at the end of the day had substantially decreased. The lumbar ROM had been fully restored. Due to the recorded improvements, the patient attested that she could sleep with minimal pain. Management and follow-up plan was designed for the patient. This was necessary in order to ensure that the patient could recover fully from the low back pain.
Discussion
The differential diagnosis for the patient was lumbago, unspecified myalgia and myositis, strain of the lumbar, segmental dysfunction of the lumbosacral region and segment dysfunction of the cervicalthoracic region. The radiographs established early degenerative disc disease at L1-3 with adjacent plate osteophytosis. There were also decreased ROM of the right SI joint. The findings can be attributed to the repetitive posture the woman assumed during her household activities. The pain experienced by the housewife while sitting or sleeping was due to the decreased ROM of the right SI joint. The outcome assessment tool used for the case was Back Bourne-mouth questionnaire. The outcome measure was 43/70.The pain reduced drastically after the application of chiropractic care course. The chiropractic process manipulated the joints and hence restored the lumbar ROM. The effectiveness points to chiropractic care as an alternative approach to the pharmacological and surgical interventions for lower back pain.
The management of patients suffering from back conditions includes different approaches. The approach involves the use of pharmacologic, surgery or non-pharmacologic interventions. The non-pharmacologic intervention entails dynamic exercise programs that are used to improve the strength of the muscles and joints. The physical therapies have been reported to modulate pain. Chiropractic is beneficial to the patients with back conditions. The main focus of the chiropractic is to ensure that the patient attains the capacity to carry out the daily activities comfortably (Whedon 1771).
Some studies have been carried in relation to the management of the low back pain. According to Excoffon and Wallace, the condition is prevalent in different age groups and occupational divides (69). For instance, there are many reports among the military personnel who are diagnosed with lumbago spondylosis. According to Dunn, Baylis and Ryan the commonly suspected etiology of lumbago spondylosis among the military men is fatigue caused by heavy axial compression and twisting during physical exercises (127). This is common among parachutists. Low back pain is also common among pregnant women and people who engage in strenuous activities that affect their backs. The chiropractic process relates to other conservative management measures that entail the restriction or modification of exercise in order to achieve stabilization in the targeted musculoskeletal. Evidence-based studies have shown that many patients respond to the technique positively. For instance, the study carried out by Dunn, Baylis and Ryan to investigate the effects of conservative management of low back pain in a case involving a veteran U.S Marine Corp pointed to a 25% reduction in the low back pain severity (125-130).
Another study was carried out to investigate the benefits of chiropractic on people that report increased difficulties while undertaking their daily activities that involve the movement of lower back joints. The study was a controlled study in which comparisons were made between the people who used the chiropractic and those who did not. The results indicated that the chiropractic beneficiaries who initially complained of back conditions reported significant improvements (Weigel et al. 579-580).
These findings for past studies are supported by the literature that indicates that conservative management has a high degree of effectiveness. However, Dunn, Baylis and Ryan noted that surgical management should be prioritized in the cases of patients that report persistent low back pain or neurologic symptoms after undergoing non-operative treatments (128). For instance, five cases of persistent low back pain and had failed conservative management were successfully corrected using surgical processes such as wire fixation and bone grafting. Despite the effectiveness associated with the chiropractic care; there are limited studies on the application and limitation of the approaches. In addition, most of the studies have not analyzed the safety of the conservative approaches.
The main goal for the case was to reduce the low back pain by the use of the chiropractic care. In relation to the case, positive results were obtained that support the effectiveness of chiropractic procedures in the management of lumbago and the restoration of the lumbar ROM. However, there is the need for further investigation into the application of the chiropractic care in management back pain for patients who have different presentations.
Limitations
The findings of the case report are specific to the housewife who had experienced the pain for only three months. Therefore, generalizations cannot be made for other people who may have suffered from a similar condition for a long time. Furthermore, there are different causes of the back pain. The severity may differ depending on the personal occupation. There was no control case; thus, the effectiveness of the therapy can be biased. This is because there were no pharmacological or surgery interventions to compare the outcome. The report did not provide baseline figures for what could be termed as clinically meaningful. The sample size that formed the basis of the study was only one person. Such a small sample size cannot be used for generalization due to individual bias. Therefore, there is the need for further investigations that include more and diverse populations of patients.
Conclusion
Back pain is a problem that affects many people. The literature review showed that persons involved in strenuous physical exercises such as military personnel and athletes are prone to low back pains. Among the women population, low back pain is a common postpartum condition especially for the mothers who experience back pain during pregnancy. The management of pain using conservative methods such as the chiropractic points to a great extent of effectiveness. The application of conservative management for a military man with lumbar spondylolysis and spondylolisthesis was effective. Similarly, in the current case report presented, the intensity of the pain was significantly reduced. However, it worth noting that the case presented in the report was unique because it involved a housewife who did not participate in strenuous exercises.
The case report has added to the existing knowledge and evidence-based studies that point to the importance of conservative management of back pains. Chiropractic management presents a general standard care that should be explored in treatment with lumbago and related complication. However, it should not be relied on as a management alternative for in cases of patients with neurologic complications. The findings of the report point to the effectiveness of the chiropractic care. Thus, it is anticipated that chiropractic care will become a core alternative in the management of pains that affect joints and musculoskeletal complications.
References
Dunn, Andrew S., Shayne Baylis and Danielle Ryan. “Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report.” Journal of Chiropractic Medicine 8.3 (2009): 125-130. Print.
Excoffon, Simon and Harry Wallace. “Chiropractic and rehabilitative management of a patient with progressive lumbar disk injury, spondylolisthesis, and spondyloptosis.” Journal of Manipulative and Physiological Therapeutics 29.1 (2006): 66-71. Print.
Weigel, Paula , Jason Hockenberry, Suzanne Bentler and Fredric Wolinsky. “Chiropractic use and changes in health among older medicare beneficiaries: comparative effectiveness observational study.” Journal of Manipulative and Physiological Therapeutics 36.9 (2013): 572-584. Print.
Whedon, James. “Use of chiropractic spinal manipulation in older adults is strongly correlated with supply.” Spine 37.20 (2012): 1771. Print.