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Back Surgery, the Movie–Coming Soon to a Surgeon’s Office Near You

Back surgery is usually optional. Most of the time, patients weigh the pros and cons and decide whether it will work for them. Down the road, research shows that a group of people who had back surgery fared no better–and no worse–than people who did not.

Patients need to know this kind of information when they are considering back surgery. If patients were well informed about their options, it might affect whether or not they chose surgery. What are the best ways to teach people about the pros and cons of back surgery?

This study was designed to answer those questions. It involved 100 patients who were candidates for a first back surgery. Most of them had a herniated disc. The next most common problems were spinal stenosis and sciatica. Researchers divided the patients into two groups. The control group only received a booklet with back surgery information. The second group received the same booklet plus they had access to an interactive video. The video included a touch-screen so people could pick topics of interest. It also showed interviews with patients who had undergone back surgery, with both good and bad results.

The patients were tested before and after going through their information. In both groups, patients who scored high on the pretest did equally well after getting more information. However, the patients who scored lowest on the pretest had much better scores after watching the video. The low-scoring group was generally older than the group average and included fewer high school graduates.

Patients reported they liked the video better than the booklet. And overall, the video group did slightly better on the test than the control group. The biggest difference was in patients’ choices. Patients who watched the video were much less likely to choose surgery. Only 23% of those who watched the video chose surgery, compared to 42% of the group who only got a booklet.

The researchers concluded that the video format was the best educational tool. Patients liked it better and got better test scores after watching the video. But the researchers also acknowledged how giving patients a simple booklet was helpful, even though the booklet might be considered “low-tech.”

Affirmative Nod in Favor of Active Treatments for Chronic Neck Pain

Health providers rely on results of carefully designed research studies to know which types of treatments will best help their patients. Researchers pursuing this quest recently compared the benefits of three types of programs for patients with chronic neck pain.

Three groups of patients were randomly assigned to receive different forms of treatment. One group received active treatments twice each week for 12 weeks with direct help from a physical therapist. They also received relaxation training and neck posture and coordination exercises. They were encouraged to work through fears of pain that might otherwise keep them from doing normal activity. A second group was given two separate lectures about neck pain, got a handout of exercises to do at home, and kept an exercise diary of their progress. Participants in the third group attended one lecture about neck problems. They then took home information about neck exercises to do on their own.

Before starting their treatment programs, all the patients completed a survey with basic physical information and information about their pain levels, use of medications, and ability to do daily activities. The patients answered questions about work, including how much and how often they had to lift and whether they got adequate breaks or felt rushed. Patients also reported their feelings and attitudes about their pain, and whether it was keeping them from their normal activities. The researchers then measured how well each person’s neck moved and how much pain patients had when pressure was place on certain neck muscles. The surveys, motion measurements, and pressure scores were rechecked after three months and then again at 12 months.

People seen for active treatments with a physical therapist showed the best results. They had fewer neck symptoms, reported better general health, and even showed better moods and feelings of well-being. They reported doing better at work, a finding the authors feel may “have an affect on absenteeism and costs due to neck pain.” All these benefits were reported at three months and 12 months.

The measurements of neck motion and pressure responses didn’t change much in any of the groups. However, individual reports of benefits were highest in the active group. People in the active group had better results than those in the home-exercise group, who in turn had better results than people who only got a lecture and information about exercise.

More research is needed. But this study indicates the benefits of an active program. It is noteworthy that people who are monitored in their exercise program do better than patients who merely get a recommendation for exercise.

No Magic Formulas for Muscle Strains

Muscle strains are a common type of injury, especially among sports participants. Even in this high-tech era, diagnosing and treating these injuries remains somewhat low-tech. For the most part, health care providers can usually determine if a muscle has been strained, torn, or ruptured simply by getting a history and examining the sore area. In some rare cases, an MRI scan may be needed to precisely locate the area that has been injured. (An MRI uses magnetic waves to show pictures of the soft and hard tissues of the body.) The time it takes the injury to heal depends on how bad the tear is. Minor tears often heal quickly. If more muscle fibers and deeper tissues are torn, the injured muscle may not respond as well to treatment and often takes longer to heal.

Common remedies for most muscle strains are resting the muscle and applying cold treatments. The authors report that cold treatments can be very helpful for easing pain, but they don’t always reduce swelling. If it’s too cold, the treatment can trigger the body to actually pump extra blood to the area, making the swelling worse. Compression and elevation also seem to help and are often recommended for pain and swelling. But the authors point out that there are no studies to prove this.

The authors also reviewed the benefits of using nonsteroidal anti-inflammatory drugs (NSAIDs) for muscle strains. Although NSAIDs may prove helpful for pain and swelling after the injury, the authors caution that long-term use of these medications might actually do more harm than good. According to the article, most experts agree that physical therapy treatments help patients regain flexibility and strength in the injured muscle.

Muscles that are flexible and strong are not as likely to become strained. When they are fatigued or are not properly warmed up, injury is more likely. With this in mind, the authors conclude that people who are recovering from a muscle strain should be sure to regain good strength and flexibility in the muscle before going back to more demanding activities. They should also start by warming up the muscle and then avoid overworking it when doing physically demanding activities.

Jack and Jill Should Build Muscle Strength Now–Before Heading Over the Hill

Building strength during the upward climb of adulthood may yield improved health on the other side of the hill. The results of this research article caution young and middle-aged adults to work on their strength and endurance now–before heading into their golden years. People who do no activities to strengthen their muscles are at risk for more physical limitations later in life. The advice usually given to elderly people to stay active appears to be equally important for young and middle-aged adults.

Researchers measured the physical strength and fitness of 3658 healthy men and women. They were scored in bench and leg press, sit-ups, and treadmill tests. Over about five years, everyone in the study answered questions about their physical abilities. People who were weaker when first tested were found to have more physical limitations at the time of follow-up. New health problems caused some of these limitations. However, poor strength and aerobic fitness scores were also important factors in whether people developed functional limitations.

Adults of all ages are encouraged to keep physically fit. The authors conclude that people should do both aerobic exercise and activities to strengthen muscles to avoid limitations in their later years. So maybe Jack and Jill should fetch a few extra pails of water before they hit the top of the hill, to avoid tumbling down the other side.

Doctors Add Hands-On Treatments for Low Back Patients

What if your family physician were trained to do some of the same basic moves used by chiropractors and physical therapists to help with low back problems? By adding these techniques to regular office visits, would you get better sooner, need less medication, and feel better about the care you received?

This study was designed to address such questions. Thirty-one general physicians trained for a total of 18 hours in how and when to use a set of manual therapy treatments that are more commonly given by physical therapists, osteopathic physicians, and chiropractors. The participants were shown five muscle energy techniques, treatments that rely on the patient’s own muscle power to help stretch joints and soft tissues. They also learned how to use three different adjustment techniques.

A total of 295 patients with back pain were randomly placed into two groups. Half received a medical back care program alone. The other half got the same medical care program plus the hands-on treatments. Patients in both groups were evaluated every two weeks over a period of two months to see which approach worked best. The researchers compared how fast patients got better, how long they were off work, their ability to do their activities, and their level of satisfaction with their care.

The patients’ answers showed that the extra hands-on treatments did help a few patients, at least a little. But differences between both groups were minor. Patients who received hands-on care were prescribed fewer muscle relaxation medications. But the number of visits, special X-ray tests, and the number of referrals to other health providers were about the same for each group. And both groups ended up needing about the same number of prescriptions for painkillers.

The hands-on treatment did have immediate benefits for some patients. Fourteen percent showed complete recovery after only one visit.

As for the doctors, more than half who used the hands-on techniques reported feeling optimistic that they were providing improved care for their patients. Still, the physicians didn’t always follow the directions when doing the hands-on moves. On average, the doctors only used three of the eight treatment choices. Yet when more than four maneuvers were used, patients showed faster improvement by an average of 2.5 days.

The authors emphasize that the results of doctors in this study should not be compared with the results achieved by experts in manual therapy. The mixed results of this study suggest that doctors who get limited training won’t necessarily work miracles for everyone. But there seem to be possible benefits when doctors use some hands-on techniques in the exam room.

Low Back Pain: Is It Picture Perfect?

For many years there has been a controversy about the connection between back pain and what doctors can see on X-rays and other special pictures of the spine. The problem is that about 30% of people without any back pain show abnormal findings on pictures of the spine. Also, some people with severe back pain have entirely normal spine pictures. Is there really a connection between abnormal back pictures and back pain?

A seven-year study showed that there is, in fact, a connection between abnormal spine pictures and low back pain. The study also looked at men who did different types of labor. The results also suggest that the type of work can affect the odds of developing certain types of back pain.

Groups of Finnish machine workers, carpenters, and office workers were examined and questioned about back pain two times, with three years in between examinations. Each man was asked the same set of questions both times and then underwent a magnetic resonance imaging (MRI) study of his lower spine. The men were divided into groups that had no back symptoms, low back pain that stays in the lower back (local back pain), or back pain that moves from the lower spine down into the leg (sciatic pain).

An MRI produces a very clear picture of the bones, discs, and overall structure of the spine. A team of three radiologists (physicians that read imaging tests) checked for signs of abnormal wear and tear (degeneration) or bulging of the discs within the spine. Then the researchers determined whether the men with pain had abnormal MRI pictures. They also looked to see if the type of work made a difference in the men’s risk for getting back pain.

The pictures showed that when signs of wear and tear were present on the MRI, the chances of back pain were significantly higher. There was a strong connection between degeneration or bulging on the MRI and sciatic pain. However, the chances of having local low back pain did not seem to be affected by the number of worn, degenerated discs seen on the MRI pictures.

Machine drivers (including bulldozer operators, longshoremen, and heavy equipment operators) do a lot of sitting on large machines that are constantly vibrating. They do not have a lot of opportunities to get up, move, or change position. Occasionally they have to lift heavy materials. These men had the highest risk of all types of back pain. Over 50% of them suffered from sciatic pains.

Carpenters do a lot of lifting, carrying, and moving around on the job. Their chances of having an accident are high due to climbing, uneven work surfaces, and obstacles at the work site. Their chances of having lower back pain were about as high as the machine operators, but far fewer of the carpenters had sciatic pain. Office workers had the lowest chance of having lower back pain.

So researchers concluded that your type of work does indeed affect your risk of back problems. And if you are having low back pain, chances are that a MRI study will show degeneration or bulging discs.

Super-Glued to Exercise: Super Results

If sticking with exercise were easy, more people with chronic low back pain would probably do it, and most would reap the positive benefits. Participants in a recent study kept doing their exercises long after finishing a four- to eight-week period of intensive physical therapy. They actually did exercises more frequently at three months than they did when first evaluated. And they exercised even more by the twelfth month.

Their efforts paid off. People reported having less pain and being able to do more activities. They also showed more strength and flexibility. Their muscles performed better, and they were able to lift more. These scores improved by the third month, and the results were even better a year later.

Here are some of the reasons why more people kept up with their exercises. First, to be part of the study, participants had to make progress with their exercises during their treatment sessions. Second, by taking on the responsibility of working the settings on the exercise equipment, they became independent in doing the exercises. People are more likely to stick with exercises when they feel self-sufficient and don’t feel passive while doing their program. Third, the doctors and physical therapists instilled confidence by giving lots of positive feedback and showing support, even when people felt some pain during their exercises. Patients were encouraged to do all their exercises and to go about their activities, even when they were having pain. The ones who did reported having less pain overall and were having an easier time doing their activities.

The authors conclude that people who have chronic low back pain can do regular exercises, and those who do can achieve the benefits of sticking with them.

This Just In: Myths about Treating Back Pain Are Out

A fresh approach for helping injured workers get back to work sooner is gaining ground. The newer ideas may eventually replace outmoded ones that are based on back pain myths. One such myth is that back pain happens because of physical loads and forces from activity (like work). Treatment is thus aimed at limiting the patient’s activity. Health providers who cling to this idea often caution their patients about doing too much. These doctors may even order patients to rest in bed.

However, new evidence shows that workers with back pain do better when encouraged to get back to normal activities as soon as possible. Researchers studied how well this new approach helped workers with back pain get back on the job.

The study was done in Norway and included 457 patients, all of whom had been out of work for more than eight weeks. The participants were randomly placed in either a control or treatment group. The control group simply followed the advice of their general practitioner. Patients in the treatment group were given a thorough evaluation by a spine doctor and a physiotherapist. When there were no major medical concerns, the patients were informed about their good prognosis and were shown ways to stretch, train, and walk as part of a home program. They also got advice about how to take care of their back, and they were encouraged to resume normal activity.

The researchers gauged the success of treatment by the number of people who got back to work. People in the treatment group got back to work sooner than those in the control group. And by the end of the study period, a higher percentage of patients completing the treatment program had gotten back to work. These patients, say the authors, “seem to benefit from maintaining activity as normal as possible, as compared with inactivity and bed rest.”

There are several themes in this new model of treatment. Medical professionals examine and inform patients. Health providers offer enthusiasm and instill optimism about the positive benefits and results of treatment. They encourage patients to get back to normal life activities by helping them overcome fears of having pain. In this way patients avoid becoming inactive and show a greater ability to get back to work.

Dispelling old myths takes time. So it shouldn’t be expected that practitioners would readily move toward this new approach to back care. The growing volume of studies with results like the ones in this article may help speed acceptance of the new model.

Putting Low Back Pain in a Box–And Keeping It There

Medical professionals continue to search for ways to put chronic low back pain in a box and nail the lid shut. Expert physical therapists have recently unveiled a new way to classify back pain. Their new system guides clinicians in finding and treating causes of pain. The new system may be just the “box” that medical science wants.

Actually, there are five such boxes, or categories, in the new system. The categories describe spinal movements and positions that people tend to use during routine activities. The system is based on the idea that people with back pain may have developed unhealthy habits in how they move or position their spine. These incorrect positions or movements happen over and over again during daily activities. The authors call these faulty movement patterns lumbar movement dysfunctions. Over time, these dysfunctional movements can cause soreness. They may eventually lead to a full-blown back problem.

The classification system is useful for identifying which lumbar movement dysfunction is to blame. First the problem is classified in one of the five categories. Patients are then shown how to avoid the positions and movements that may be causing the pain, thus keeping their pain “in the box.” Strategies are suggested for positioning the spine safely during exercise and activity. Even routine activities like bending and reaching may need to be modified to help the spine stay balanced.

The authors present a case study of a 55-year-old woman who had been dealing with back pain on and off for 40 years. When she came for help, she had been in pain for 10 weeks and hadn’t gotten any relief with standard treatments. She felt pain whenever she bent back or twisted her trunk to the left. The lumbar movement dysfunction was categorized as “rotation with extension.” Her physical therapist showed her ways to avoid moving or positioning her spine in rotation or extension during exercise and routine activities. After this one treatment, she came back and reported having 75% less pain in her back. Over the next three months and a total of eight physical therapy visits, her functional scores went from “severe disability” to “minimal disability.” And the activities that used to cause her pain no longer gave her problems.

Had she kept on doing the same harmful movements, it is likely she would still be having problems. The authors acknowledge that other factors might have played into the patient’s improvement. They encourage future research to validate this approach for helping people nail the lid on low back pain.

Doctors Offer a Mixed Bag of Recommendations to Patients with Low Back Pain

Opinions. Everyone’s got one, including doctors who make recommendations to their back patients about activity and work levels. A recent mail survey indicates that these recommendations vary widely. The results also show that most doctors tend to restrict the activities of their patients with back pain.

The authors mailed survey packets to 142 doctors. The surveys included questions about their training and their expertise in treating back patients. To see what they would recommend for their back patients, each doctor was given information detailing the condition of three mock patients, each with a different back problem. The physicians were asked to give their impression about how bad each patient’s problem was and to give recommendations about activity and work levels for each patient.

There was general agreement that patients with chronic back pain should limit their activities and work duties. Doctors also tended to restrict activity if the patient’s symptoms were severe. And the responses showed that doctors based their recommendations on their own personal viewpoints and attitudes about pain. These factors had more to do with the doctors’ decisions than current trends and recommendations for people with chronic low back pain. A newer approach shows improved results when patients with back pain swiftly return to normal activity.

Athletic Performance Hinges on Knee Brace Selection

When choosing a protective knee brace, research shows that the make and model may affect the speed and agility of an athlete. Thirty football players dressed in full gear were timed in the 40-yard dash and in a four-cone agility drill. Their scores doing the drills while wearing one of six types of braces were compared to their scores when they didn’t wear a brace. The authors found that certain types of protective knee braces do not necessarily hamper an athlete’s performance, either in speed or agility.

Another consideration is how much the brace slides up or down on the athlete’s leg during the sport activity. Measurements were taken to see which braces seemed to hold the best. By placing a mark on the leg, researchers compared how much each brace moved up or down during each drill. The authors noted that the braces tended to move during activity. The athletes were asked how much they thought the brace moved during the drill. Most of the time, their answers didn’t match up to the actual measurements.

This study specifically did not test how much these braces would protect the knee. But according to the authors, the fact that braces showed some movement during the tests “could affect their protective function and athlete performance.”

Preventing Knee Injuries: It’s a “Gal” Thing

Call it hormones; call it anatomy. Females have nearly six times the risk of having a knee injury when doing jump-and-cut sports compared to males in the same sports. Depending on the sport, women athletes have up to 10 times the risk of serious knee injury than men. “Lowering these high figures by even a small percentage could have a significant effect on the number of knee injuries,” say the authors of this study.

To this end, these researchers put an idea to the test: namely, that female athletes would have fewer knee injuries if they did a program of stretching, jump training, and weight lifting. Participants included sports team members from 12 high schools. Half of the female teams went through this specialized training program. The other half did not. The authors also included a control group of 13 untrained male teams.

The training program lasted six weeks, during which female participants worked out three days per week for up to 90 minutes. The training paid off. They had a lower injury rate and fewer serious injuries than the untrained group. And even though the exercise group had a higher incidence of injury than untrained males, the rate was far lower than among females who didn’t train.

Jump training, also called plyometrics, improves muscle strength and dampens joint impact. The authors believe that female athletes benefit from this type of training by gaining improved hamstring muscle strength. The authors suggest that strengthening this muscle helps keep the knee in better alignment and cushions the knee during high-level sport activities, like landing a jump.

In view of their findings, the authors recommend that “young female athletes in sports that entail jumping, pivoting, and cutting, such as basketball, volleyball, and soccer, be trained before participation with a proven effective jump training program that includes progressive resistance weight training for the lower extremity.” They conclude that “such training, if effectively used on a widespread basis, might help to significantly decrease the number of athletes injured each year.”

Back Pain Wears Me Out–or Does It?

Many clinicians who treat patients with chronic low back pain believe their patients need to do conditioning exercises for the heart and lungs. They believe these patients limit activity because of their pain, which leads to poor overall fitness. So patients with chronic low back pain are generally prescribed exercises to improve their aerobic stamina.

The first part of this study involved forming an equation to predict fitness levels in people with chronic low back pain. The authors then tested the long-held notion that these patients are generally less fit. The new formula showed that people with chronic low back pain had similar scores when compared with subjects who don’t have pain. The authors found that the patient group with chronic low back pain is “moderately fit” and not significantly deconditioned as commonly thought. However, the authors still suggest that people with chronic low back pain should be given aerobic conditioning exercises in order to help improve their overall ability to do their activities.

Bracing the Unbraceable: Boston Brace Shows Positive Results for Large Curves of Scoliosis

The Boston brace has been shown to help people with scoliosis when their spinal curve is less than 30 degrees. But most experts have felt the brace couldn’t keep curves over 35 degrees from getting worse. There is agreement that surgery should be held off until the curve reaches 40 degrees, which poses a dilemma when the curve is between 35 and 40 degrees. These curves are too small for surgery and too big to be helped by a brace.

The authors questioned whether the Boston brace could halt curves that were over 35 degrees. They also questioned if the amount of time the brace was worn each day mattered. The study included 45 girls and 5 boys averaging 13 years old. Each patient was prescribed the Boston brace to treat spine curves of 35 degrees or more. They were told to wear the brace 23 hours each day. They had appointments every four to six months to check their spine curves and to see how many hours they actually were actually wearing their braces. When they reached spinal maturity, they gradually stopped using the brace.

Results were compared an average of two years after skeletal maturity and again about 10 years later. By looking back at the patients’ records, the authors found that the Boston brace was effective in preventing large curves from getting worse. This was especially true when patients actually wore their brace for the recommended amount of time each day.

Those who wore their brace for more than 18 hours each day had the best results. Their curves actually improved by about 12% from the time they started using the brace. Those wearing the brace less than 12 hours per day showed an increase of almost 14% in the size of their curves.

The conclusions are clear. The Boston brace can help keep large curves from getting worse in patients with scoliosis, especially when it is worn 18 or more hours per day.

Minor League Baseball Rookies at Higher Risk of Injury Than Veteran Players

Rookies entering the minor leagues run a greater risk of injury than veteran players, according to this study. The authors say that rookies may not be prepared physically for the new demands of higher levels of play. Playing at such a high level requires the tissues of the body to adapt over a longer period of time. Rookies simply haven’t made these adaptations, which could account for their higher injury rates.

By reviewing the injury reports of six minor league teams from 1985 to 1997, the authors were able to compare how often players of different experience levels were injured. The rate for rookies was calculated at 2.42, a significantly higher rate than the 1.62 figure for veteran players.

The researchers also categorized how bad the injuries were to see who suffered the worst injuries. Even though the differences were slight, veteran players tended to have less severe injuries than rookies.

The authors suggest several reasons why rookies were injured more often. The authors believe longer seasons, insufficient training, and extra effort during high school or collegiate play may put players at risk of overuse. Then when they enter professional careers, their tissues are more likely to get injured. New injuries could also be related to injuries that happened earlier in players’ careers. The lower numbers of injuries in veteran and higher-ranked players could have to do with better training than in amateur levels of play.

To help offset the risks of injury for rookies, the authors suggest that they undergo specially designed strength and conditioning training before moving to a higher level of competition. The authors also recommend that players who move up be tested to see what kind of conditioning program will help the most.

Neck Burners and Stingers: Getting to the Nerve Root of the Problem

Many football players and wrestlers are familiar with the terms burner and stinger. They describe how nerve pain can “zing” down one arm from a hard hit to the head and neck. This intense sensation of burning pain is thought to be from a pinching of the nerve root where it comes out of the spinal column of the neck.

The area between the bones of the spine where the nerve comes out is called the foramen. When the head is bent back and then compressed, as can happen in a football tackle, the foramen becomes narrower, and the nerve can get pinched. The authors wanted to see if athletes who had problems with burners tended to have a smaller foramen, a condition called stenosis. Researchers came up with a formula to quickly and accurately size the foramen by measuring the height of the foramen and the spinal bone below it on an X-ray image.

Researchers looked at neck X-rays of 64 athletes between the ages of 15 and 18 who reported having had a burner. Comparisons were made to another group of athletes in the same age range who reported having a neck injury in the past but no burner.

Two calculations were used. The first measured the spinal canal. The second was the formula designed by the authors for measuring the size of the foramen. They discovered that athletes who had a burner in the past had smaller spinal canals and smaller foramen. It is likely these athletes were at risk for a burner because a hit to the head and neck, especially with the head tilted back, tends to close the foramen down and pinch the nerve root.

Athletes who keep having problems with burners or who show signs of stenosis on X-ray might benefit from safety features to keep their necks from bending into unsafe positions and from being compressed from impact. These measures, according to the authors, could include neck rolls, special collars, and tips on how to tackle without putting the neck at risk.

Making Butts about Smoking Improves the Chance Smokers Will Quit

Stop! That one word is likely the most helpful advice health practitioners can give to their spine patients who smoke. Many times, patients will quit the habit when they are treated by a health professional who takes the time and effort to help. Too often, however, medical professionals don’t bring up the issue with their patients.

Many smokers responded dramatically when their health provider makes the effort to help them quit. Researchers tracked a group of 3041 spine patients who smoked. Patients got either “usual” or “aggressive” assistance for quitting by their practitioner. The first group got a handout, and their provider occasionally mentioned the patients’ habit. Providers for the other group members brought up the subject and recorded smoking status at each visit. They also gave their patients handouts and educated them about the negative impact smoking could have on their spine condition.

Over 35% of the patients getting aggressive help quit smoking, compared to 19.5% in the other group. And more patients at least cut down on their habit when they got aggressive help (67% vs. 38%). Merely asking about a patient’s habit had a drastic impact on cigarette usage.

Perhaps health providers don’t bring up the issue because they fear they’ll lose business. This did not happen in the research study. An equal number of patients from both groups returned for ongoing treatment.

Some patients had an easier time quitting. Quitters typically had smoked fewer packs per day and hadn’t smoked for as many years. Older patients also tended to quit easier than younger smokers. The decision to quit usually happened within the first four months of treatment.

The authors conclude that health providers need to be educated on ways they can help their patients who smoke kick the habit. They believe smokers will be more successful at quitting if at each visit their habit is addressed and their smoking status is tracked. Providers need to be a source of support and encouragement for their patients. Surprisingly, using this approach to help patients quit doesn’t cost a lot of money, yet the results can be dramatic.

“It is clear,” conclude the authors, “that the more the health care practitioner shows an interest, the more likely the patient will stop smoking.”

New Thoughts to Keep Back Problems from Becoming Chronic

When back pain or injury becomes chronic, health-care costs escalate dramatically. By offering effective treatment right away, chronic problems might be avoided and costs reduced. But which treatments work best to keep back problems from becoming chronic?

The way people think about their back problem affects how well they recuperate, which may explain why new types of treatment that help people change their thoughts and behaviors about back pain are showing good results in preventing chronic problems.

One idea is to help back patients learn to overcome their fears about doing activities. Another school of thought is the cognitive-behavior approach, which gives people ways to cope with their situation in order to counteract chronic problems.

Researchers tested how well the cognitive behavior model compared to simply giving patients information about their problem. The patients in this new model took part in six group sessions led by a behavioral therapist. They learned and practiced ways to solve problems that might happen to people with pain. Other patients only received information. Some got a pamphlet about back pain. The rest received a packet each week for six weeks showing how to keep their backs safe and healthy.

Major benchmarks of how well patients did included the amount of time people were out of work and how often they needed to see their doctor or physical therapist. Levels of pain and ability to do activity were also measured. The authors also kept track of whether fear kept people from doing activities and how patients though about their back problem.

The results show that the new model can really help, especially when it is used when people first start having back problems. Patients receiving the behavior treatment were nine times less likely to develop chronic problems. They also had fewer visits to their doctor and physical therapist.

The chance of helping people avoid chronic problems improves when a program like this is started soon after back pain or injury. “These findings,” say the authors, “underscore the significance of early interventions that specifically aim to prevent chronic problems.”

Bending Over Backwards to Affect Disc Pain in the Low Back

A popular form of treatment for people with disc pain in the low back is the lumbar extension exercise. The basic principle is to bend the spine backwards to try and ease low back pain. Some people get nearly immediate relief. However, the treatment is not a magic bullet for people with disc pain. Sometimes, the pain doesn’t go away. The pain may even become worse. This study may shed some light on why some patients get relief and others don’t.

One theory behind this treatment is that bending the spine backwards squeezes the disc material forward, away from pain-sensitive soft tissues like the nerves and ligaments. A second theory has to do with pain from pressure on the back part of the disc. The disc is made up of a central nucleus pulposus, surrounded by rings of ligament-like material known as the annulus. The outer rings of the annulus are richly supplied with pain sensors, so injury or pressure on this part of the disc can hurt. If pain comes from the annulus on the back part of the disc, it makes sense that getting pressure off these sore tissues would feel better.

To measure disc pressure in various positions of the spine, a team of researchers tested the discs of 19 cadaver spines. To make the tests more life-like, the discs were altered to behave as though they were degenerated. Backward bending works differently when the discs are degenerated because the spine tends to pivot on the joints along the back of the spine. This shifts the forces onto the bony ring of the vertebra and can take pressure off the back part of the disc.

A key discovery is that backward bending didn’t always take pressure off annular rings near the back of the disc. In fact, when the spines were bent back two degrees, only seven out of nine spines showed less pressure. Discs that registered lower pressures in a neutral position tended to have less pressure on the annular rings near the back of the disc when the spine was bent backward.

These differences might explain why some people get better with extension exercises and others don’t. “The results,” say the authors, “caution against making predictive rules based on anatomic or pathologic assumptions.” In other words, patients are unique, and their symptoms may react differently to lumbar extension exercises.

Does Exercise Really Help People with Low Back Pain?

Although exercise is routinely prescribed for people with low back pain, its role in treatment is still unclear. A recent study showed what appeared to be significant benefits of exercise in the areas of pain, disability, and physical fitness. But the authors weren’t sure whether the favorable results could be attributed to the exercises alone.

The authors followed two groups of people with low back pain. Both groups were given a fitness test. At first, both groups showed lower scores on the fitness test than others of their same age and sex. Patients with low back pain took part in exercise sessions three times week for six weeks. In each session, they did up to 20 minutes of aerobic exercise, five minutes of stretching, and muscle toning exercises for the upper and lower body.

After the six-week program, the exercisers showed significant improvements in their fitness scores. Their scores afterward were much higher than the other group of patients. Even more surprising, they scored higher than the healthy subjects who took the fitness test. Their reports of pain and disability also showed remarkable improvements after the exercise program ended.

At first glance, the results seem to show that exercise really helped people with low back pain. Because of some of the limitations in the study, however, it is still not clear whether exercise alone should be credited for all the improvements. The authors acknowledge that patients might have achieved better results because some of them received other treatments over the course of the exercise program. This makes it impossible to determine whether one of the other treatments, the exercise, or all the strategies together improved the patients’ conditions.

Even though there is a question of just how effective exercise can be for people with low back pain, the authors believe their study “supports the hypothesis that a course of active treatment, such as exercise or conditioning, in conjunction with other forms of treatment, may be helpful in the management of patients with chronic low back pain.”