Low Back Pain

More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

By Frank M. Painter|October 4, 2012|Iatrogenic Injury, Low Back Pain, Steroids|

More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

SOURCE: Associated Press ~ Oct 4, 2012

By MIKE STOBBE

Medication Linked to Meningitis Deaths May Have Reached 23 States

The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

UPDATE: October 09, 2012: The number of identified cases has reached 119, with 11 deaths in 10 different states.

UPDATE: October 11, 2012: The number of identified cases has reached 170, with 14 deaths in 11 different states.

UPDATE: October 12, 2012: from MedScape The number of people exposed to potentially contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC) in Framingham, Massachusetts, is closer to 14,000 — not 13,000 — as originally reported on October 8, federal health officials said today.

“These 14,000 patients received the medication as a steroid injection either into the spinal area or into a joint space such as a knee, shoulder or ankle,” said J. Todd Weber, MD, incident manager of the multistate meningitis outbreak at the Centers for Disease Control and Prevention (CDC). More than 12,000 of these people have been contacted to date, he said.

As of today, the CDC said a total of 170 cases (including the 14 deaths) have been reported across 11 states: Florida (7 cases, 2 deaths), Idaho (1 case), Indiana (21 cases, 1 death), Maryland (13 cases, 1 death), Michigan (39 cases, 3 deaths), Minnesota (3 cases), New Jersey (2 cases), North Carolina (2 cases), Ohio (3 cases), Tennessee (49 cases, 6 deaths), and Virginia (30 cases, 1 death).

UPDATE: October 25, 2012: from MedScape There are currently 328 reported cases of fungal infection, with 24 deaths now reported in 18 states. This includes 5 peripheral joint infections.

UPDATE: November 27, 2012: from Fox News There are currently 510 reported cases of fungal infection, with 36 deaths now reported in 19 states, and another 14 cases of peripheral joint infection reported.

NEW YORK (AP) — The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

Clinics and medical centers rushed to contact patients who may have received the apparently fungus-contaminated shots. And the Food and Drug Administration urged doctors not to use any products at all from the Massachusetts pharmacy that supplied the suspect steroid solution.

It is not clear how many patients received tainted injections, or even whether everyone who got one will get sick.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died, according to the Centers for Disease Control and Prevention. All had received steroid shots for back pain, a highly common treatment.

This is especially disturbing, because

Steroid Injections Offer Minimal Relief for Lower Back Pain

(more…)

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Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

By Frank M. Painter|September 13, 2012|Chiropractic Care, Low Back Pain, Piriformis Syndrome|

Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2012 (Mar); 11 (1): 24-9

Cynthia Chapman, and Barclay W. Bakkum

Chiropractor, Private Practice,
Occoquan Family Chiropractic, PLLC,
Occoquan, VA 22125

OBJECTIVE: The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care.

CASE REPORT: A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome.

INTERVENTION AND OUTCOME: Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation.

CONCLUSION: A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.

You may also want to review

Post-isometric Relaxation (PIR) of the Psoas

The Full-Text Article:

Introduction

Piriformis syndrome is an uncommon cause of low back pain and sciatica that results from entrapment and/or irritation of the sciatic nerve in the region of the greater sciatic foramen. [1-4] Although no definitive causative factors are known for this syndrome, the usual source is thought to be an abnormal condition of the piriformis muscle. A common basis of the problem appears to be trauma to the piriformis muscle that results in spasm, edema, and contracture of the muscle, which can cause subsequent compression and entrapment of the sciatic nerve. [2] Other possible etiologies include reflex spasm of the piriformis muscle and an abnormal course of the sciatic nerve through the piriformis muscle. Altered biomechanics of the lower limb, low back, and pelvic regions can lead to stretching and shortening of the piriformis muscle, which can also lead to piriformis syndrome. Although, in 1928, Yeoman [5] first described the clinical picture of what would later be called piriformis syndrome, this diagnosis still remains somewhat controversial. This controversy stems from several factors that include variable and sometimes unclear cause, similarity to other more easily recognizable causes of sciatica, lack of consistent objective diagnostic findings, and relative rarity. Piriformis syndrome had been thought to be a purely clinical diagnosis; but more recently, magnetic resonance imaging (MRI) has begun to be used to help with the diagnosis of this problem. [6] (more…)

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Neck and Back Pain in Children: Prevalence and Progression Over Time

By Frank M. Painter|June 19, 2012|Low Back Pain, Neck Pain, Pediatrics|

Neck and Back Pain in Children:
Prevalence and Progression Over Time

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2011 (May 16); 12: 98 ~ FULL TEXT

Per Kjaer, Niels Wedderkopp, Lars Korsholm, and
Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark.

The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood.

Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.

Table 2: Prevalence rates of different types of back pain in a cohort of Danish children/ adolescents surveyed at three time points

Age Group	Age 9	Age 13	Age 15
Neck Pain
All children Boys Girls	10%9%11%	7%5%9%	15%13%18%
Mid Back Pain
All children Boys Girls	20%22%19%	13%13%13%	28%22%32%
Low Back Pain
All children Boys Girls	33%32%34%	28%26%30%	48%39%54%

The Abstract and Full Text Article: (more…)

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Low-Back Pain, Leg Pain, and Chronic Idiopathic Testicular Pain Treated with Chiropractic Care

By Frank M. Painter|June 2, 2012|Chiropractic Care, Low Back Pain|

Low-Back Pain, Leg Pain, and Chronic Idiopathic Testicular Pain Treated with Chiropractic Care

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2012 (Apr); 18 (4): 420-422

Robert M. Rowell, DC, MS, and Steven J. Rylander, DC, MS

Diagnosis and Radiology Department,
Palmer College of Chiropractic,
Davenport, IA 52803, USA.

OBJECTIVES: The purpose of this article is to report the case of a patient who had low-back pain, leg pain, and idiopathic chronic testicular pain and who sought chiropractic care for his low-back and leg pain and received pain relief including his testicular pain.

SUBJECT: A 36-year-old male patient had low-back pain, right leg pain, and testicular pain that was worsening. All had been present for 5 years. He had been seen by several medical physicians and had lumbar magnetic resonance imaging and x-rays performed. All were read as normal. Examination revealed tenderness of the testicles bilaterally with no masses or other abnormality of the testicles or scrotum. Orthopedic and neurological testing was unremarkable. Tenderness rated 8 out of 10 was noted at the L4 spinous process.

INTERVENTION: The patient was treated with Cox Technic (flexion-distraction) of the lumbar spine, receiving a total of 19 treatments over an 8-week time period. (more…)

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Lower Back Trauma (Lumbar Spine and Pelvis)

By Frank M. Painter|May 20, 2012|Chiropractic Care, Chronic Pain, Evidence-based Medicine, Low Back Pain, Orthopedic Tests, Rehabilitation, Spinal Manipulation|

Lower Back Trauma (Lumbar Spine and Pelvis)

The Chiro.Org Blog

Clinical Monograph 24

By R. C. Schafer, DC, PhD, FICC

Although it may be easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the other parts. We should also keep in mind that an axial kinematic chain of weight-supporting segments extends from the occipital base to the soles of the feet.

Because the number of professional papers concerning the cause and diagnosis of low-back pain is voluminous, emphasis herein is placed on points that the author believes are important but not often emphasized in popular literature.

BACKGROUND

A wide assortment of muscle, tendon, ligament, bone, nerve, and vascular injuries in this area is witnessed during posttrauma care. As with other areas of the body, the first step in the posttrauma examination process is knowing the mechanism of injury if possible. Evaluation can be rapid and accurate with this knowledge.

Low-back disability rapidly demotivates productivity and athletic participation. The mechanism of injury is usually intrinsic rather than extrinsic. The cause can often be through overbending, a heavy steady lift, or a sudden release –all which primarily involve the muscles. IVD disorders are more often, but not exclusively, attributed to extrinsic blows and intrinsic wrenches. An accurate and complete history is invariably necessary to offer the best management and counsel.

Initial Assessment

A player injured on the field or a worker injured in the shop should never be moved until emergency assessment is completed. Once severe injury has been eliminated, transfer to a backboard can be made and further evaluation conducted at an aid station.

Neurologic Levels

Neurologic assessment should be made as soon as logical. Muscle tonus (flaccidity, rigidity, spasticity) by passive movements is determined. Voluntary power of each suspected group of muscles against resistance is tested, and the force is compared bilaterally. Check pupil size, ability to follow finger motion, and reaction to light. Cremasteric (L1–L2), patellar (L2–L4), gluteal (L4–S1), suprapatellar, Achilles (L5–S2), plantar (S1–S2), and anal (S5–Cx1) reflexes are evaluated. Patellar and ankle clonuses are noted. Coordination and sensation by gait, heel-to-knee and foot-to-buttock tests, and Romberg’s station test are checked. These are typical minimal evaluations.

Initial Assessment

Tenderness. Tenderness is frequently found at the apices of spinal curves and not infrequently where one curve merges with another. Tenderness about spinous or transverse processes is usually of low intensity and suggests articular stress. Tenderness noted at the points of nerve exit from the spine and continuing in the pathway of the peripheral division of the nerves is a valuable aid in spinal analysis pointing to a foraminal lesion. However, the lack of tenderness is not a clear indication of lack of spinal dysfunction. Tenderness is a subjective symptom influenced by many individual structural, functional, and psychologic factors that can make it an unreliable sign. An area for clues sometimes overlooked is the presence and symmetry of lower-extremity pulses.

Keep in mind that lumbopelvic tenderness as well as pain can be referred from pelvic and lower abdominal viscera.

LUMBAR SUBLUXATION SYNDROMES

Functional revolts associated with subluxation syndromes can manifest as abnormalities in sensory interpretations and/or motor activities. These disturbances may be through one of two primary mechanisms: direct nerve disorders or be of a reflex nature.

Nerve Root Insults

Read the rest of this Full Text article now!

Enjoy the rest of Dr. Schafer’s Monographs at:

Rehabilitation Monograph Page

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The First Domino: Chiropractic Before Spinal Surgery for Chronic Low Back Pain

By Frank M. Painter|May 17, 2012|Chiropractic Care, Evidence-based Medicine, Guidelines, Health Care Reform, Low Back Pain, Rehabilitation|

The First Domino:
Chiropractic Before Spinal Surgery for Chronic Low Back Pain

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Peter W. Crownfield

University of Pittsburgh Medical Center Health Plan mandates conservative care before even considering surgery for chronic Low Back Pain cases.

The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain.

As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”

Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members “understand the pros and cons of surgery and high-tech radiology.” It is the first reported implementation of such a policy by a health care plan.

Putting a Clamp on the Soaring Rates of Spine Surgery

According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, “We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process.”

The update also noted, “Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.” (more…)

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