NSAIDS vs. Exercise

12 July 2018
The Study: Therapeutic efficacy of nonsteroidal anti-inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study.

The Facts

  1. The study included 33 total subjects divided into two groups.
  2. According to the authors, “Therapy for chronic, nonspecific low back pain is mainly conservative: medication and/or exercise.”
  3. They indicate that exercise can improve function but its effect on pain is limited.
  4. They also acknowledge that NSAIDs can reduce inflammation (thus, pain) but can also produce side effects.
  5. The participating institution was the Aizu Medical Center Fukushima Medical University (a decent school not normally associated with conflicts of interest in research results).
  6. They compared the two types of care for treatment of chronic nonspecific low back pain: Exercise vs. NSAIDs.
  7. Patients were divided into an exercise group and a medication group.
  8. The exercise group had 18 subjects and the type of exercise was trunk muscle strengthening and stretching exercises.
  9. The NSAID groups contained 15 subjects.
  10. Both groups reported pain relief at 3 month follow up.
  11. “In patients with strictly defined CNLBP (chronic nonspecific low back pain), as defined using a diagnostic support tool designed for lumbar spinal stenosis, the therapeutic efficacy of NSAID therapy and exercise seemed to be almost equivalent with regard to pain relief. However, the QOL of the patients was statistically improved in the exercise group but not in the NSAID group during the initial 3 months of this study.” (emphasis ours)

 The Take Home Message

For chronic nonspecific low back pain (that constant achy, dull pain) exercise and taking NSAID pain relievers are basically equal.

For Quality of Life issues, the exercise group reported more improvement.  My problem with most (in fact, nearly all) exercise programs are 1) they are kinda boring and 2) the programs are generally mindless (they do not focus on exercises or routines that actually improve correct structural imbalances).  However, boring or not getting patients doing something is better than doing nothing.

In the end, Active always trumps Inactive.

Reference: Takahashi N, Omata JI, Iwabuchi M, Fukuda H, Shirdo O. Therapeutic efficacy of nonsteroidal anti-inflammatory drug therapy versus exercise therapy in patients with chronic nonspecific low back pain: a prospective study. Fukushima J Med Sci. 2017 Apr 28;63(1):8-15. doi: 10.5387/fms.2016-12. Epub 2017 Mar 22.

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28331155

Synopsis of Research Readings:  Dr. Gary Pribble, AdvanTech Chiropractic, 1000 23rd Street Bettendorf, Iowa (563) 355-2378

Leg Length and Pain

A common cause of low back, knee and ankle pain.

Leg length inequalities, when one leg appears to be longer than the other, mostly affect pelvic tilt in the coronal plane. (The coronal plane divides the front part of the body from the rear part.)

PribbleImage1Pelvic tilt increases the Lordotic curvature of the spine, thus   causing low back pain.

PribbleImageClinically, I have also found that the knee on the short leg rotates inward and the inner most arch of the same affected foot drops.

PribbleImage2
This is called eversion.

PribbleImage3The lateral curves of the spine (think scoliosis) tend to not be significantly affected.

Clinical Prognosis:  Typically, Ankle/Knee/Low Back pain diminishes nearly as soon as the length deficiency is addressed.  The challenge is to initiate a long term correction.  I find recovery requires two, sometimes three, office visits about a week apart.  In cases when the symptoms return, they often return in about four to six weeks and another corrective office visit make be required.

Reference: Kwon YJ, Song M, Baek IH, Lee T. The effect of simulating a leg-length discrepancy on pelvic position and spinal posture. J Phys Ther Sci. 2015 Mar;27(3):689-91. doi: 10.1589/jpts.27.689. Epub 2015 Mar 31

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/25931709

Synopsis of Research Readings:  Dr. Gary Pribble, AdvanTech Chiropractic, 1000 23rd Street Bettendorf, Iowa (563) 355-2378

Knee OA and the Motion of the Spine

13 July 2018

The Study: Influence of spinal imbalance on knee osteoarthritis in community-living elderly adults.

Hopefully, most of us recognize that the spine has three main functions:

  • Protect the spinal cord, nerve roots and several of the body’s internal organs.
  • Provide structural support and balance to maintain an upright posture.
  • Enable flexible motion.

Anytime you have limp or unequal leg lengths or injured knee, your gait is imbalanced and, therefore, your spinal will become immobile and stiff.  An immobile or stiff spine is often caused by knee issues.

This is a particularly interesting research paper because it reported on the effects of osteoarthritis (OA) total spinal alignment, spinal range of motion and knee osteoarthritis (OA).

The Facts:

a.  The study looked at 170 subjects with a mean age of 69.4.  (This is a good sized study group.)

b. While they used radiographs to measure knee OA, they also measured both spinal motion and alignment using a surface method.

c. “The spinal inclination angle is the most important factor associated with knee OA, although spinal ROM is also associated with knee OA. Decreased lumbar lordosis and lumbar ROM is related to increased spinal inclination angle.”

Take Home Message:

I was not surprised to see an association of spinal alignment and spinal motion to knee OA. I would expect to see mechanical stresses produced by spinal malalignment have an effect on the supporting structures below it. Just as any tilting of a skyscraper would have an effect on its foundation.

It should be understood that foot/ankle/knee/hip misalignment can have just as much influence on back pain as an injury or trauma from improper lifting.

Keep this study in mind when you have pain after wearing those one dollar sponge flip-flops that break down the arches of the foot (forcing the foot into inversion or eversion), don’t support the talus or ankles, and cause the knee to internally rotate.

Reference: Tauchi R, Imagama S, Muramoto A, Tsuboi M, Ishiguro N, Hasegawa Y. Influence of spinal imbalance on knee osteoarthritis in community-living elderly adults. Nagoya J Med Sci. 2015 Aug;77(3):329-37

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26412878

Synopsis of Research Readings:  Dr. Gary Pribble, AdvanTech Chiropractic, 1000 23rd Street Bettendorf, Iowa (563) 355-2378

Multi-Tasking

Multi-tasking.

What makes you more stupid: smoking marijuana, emailing while talking on the phone or losing a night’s sleep?

Researchers at the Institute of Psychiatry at the University of London studied 1,100 workers at a British company and found that multitasking with electronic media caused a greater decrease in IQ than smoking pot or losing a nights sleep.

A similar study was reported in 2005 at King’s College in London tested the IQ of three groups:

The first group did nothing but perform the IQ test

The second group was distracted by e-mail and a ringing phone

The third group was stoned on marijuana

The results:  The first group performed best – by an average of 10 IQ points.

The stoners outperformed the e-mailers by 6 IQ points.

Dr. Glenn Wilson of the University of Nevada calls it “informania”, a condition created by using multiple electronic devices and employer’s growing demands to tackle more than one task at a time.

Professor David Meyer, director of the University of Michigan’s Brain Cognition and Action Laboratory, concluded that even brief mental blocks created by shifting between tasks cost as much as 40% of someone’s productive time.

There are studies that show it can take up to 15 minutes to get yourself back into the same degree of immersion after an interruption.

How about women being better multi-taskers than men?  Dr. Julia Irwin, senior lecturer in psychology at Macquarie University, Sydney Australia reports, “When I looked in the literature, there is not a single study in psychology that showed that women are better at multitasking.  But what I did find in the sociological literature is that they [women] multiple task more often.”

“This has led to the belief that women are better at multitasking, but the more studies are done, the fewer differences they find between female and male brains.

What to do?  Well, at the risk of oversimplifying, here is what you need to do:

Do one think at a time—-

Do it right ——

Finish it—————–