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Spinal Decay
Soon after the discovery of the X-ray, chiropractors began using this tool in the examination and care of the spine.
Besides revealing the presence or absence of proper spinal curves, side views of the spine can more easily show the long-term effects of neglected spinal trauma. We call the body’s adaptation process spinal decay.
What Causes Spinal Decay?
This process in the spine has similarities to tooth decay in that it shows up usually because of neglect. Also, just like tooth decay, it can happen to anyone, regardless of age.
Because it is often seen in older people, many believe it’s merely the normal aging process. It is not. This progressively worsening, degenerative condition is the result of uncorrected spinal misalignment. Spinal decay is how your body deals with the stress of gravity.
It just so happens that most people have spinal problems that they’ve ignored for years.
Three Phase Process
Spinal decay is a process. Whether you take three snapshots of the process or twenty-three snapshots, it’s a process. We use the three-phase model based on the book Managing Low Back Pain, by W. H. Kirkaldly-Willis and Thomas Bernard, Jr. We find that it makes the differences between each phase great enough so our practice members can appreciate what they’re seeing.
This would be considered a textbook “normal” side view of the neck.Text Book Normal
This would be considered a textbook “normal” side view of the neck.Text Book Normal
Normal
While this process can occur anywhere in the spine, it’s easiest to see in the cervical (neck) spine. This is what the side view of the neck should look like. From the side, the neck should have a graceful forward curve. The edges of each bone are well defined. There should be equal disc spacing between each bone and the openings for nerve roots should be clear and unobstructed.
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The first thing you notice is a loss of the normal cervical curve.
Phase One
In Phase One there is a loss of curve and a reduced ability to turn and bend. In some cases, the disc space between adjacent vertebrae may be reduced. Or, discs can become wedge-shaped, risking more serious soft tissue damage. Depending upon your body’s adaptive capacity, pain or other obvious symptoms may not be present. Even the resulting reduced range of motion may be too subtle for some to notice.
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Adjacent joint surfaces become rough and uneven.
Phase Two
If neglected, in Phase Two, joint surfaces lose their clearly defined edges as the early signs of bone spurs become visible on X-ray views. Some believe that the body senses the accompanying inflammation as the sign of a broken bone. It begins the process of depositing calcium salts. Without being in a cast to prevent movement, the fusion doesn’t occur. Yet.
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The affected bones have lost their individuality and ability to move.
Phase Three
If still left uncorrected, the problem worsens in Phase Three. Amazingly, pain or other obvious symptoms may not yet show up. But finally, the body successfully “mends the broken bone.” This process can take years. Its presence calls into question the claim that many practice members make that they were “…fine until last week when I bent over to tie my shoes.” That’s not what the X-rays tell us!
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The Prognosis
Some practice members who begin chiropractic care in Phase One discover a restoration of their spinal curves and improved range of motion. Success with Phase Two practice members is less predictable and depends on many factors. While we can do little after decades of neglect with Phase Three cases, we instead turn our attention to those areas of the spine that have not yet been lost to the process.
It’s impossible to predict what effect, if any, chiropractic care will have on slowing, stopping or reversing this process. Nor can a particular phase be used to predict how much care will be needed.
Why Choose Chiropractic Care?
Chiropractic care is safe, affordable, effective, and based on sound scientific principles.
Doctors of Chiropractic are primary health care providers.
According to the Center for Studies in Health Policy, “The DC can provide all three levels of primary care interventions and therefore is a primary care provider, as are MDs and DOs. The doctor of chiropractic is a gatekeeper to the health care system and an independent practitioner who provides primary care services. The DC’s office is a direct access portal of entry to the full scope of service.”
Doctors of chiropractic provide effective, low-cost health care for a wide range of conditions.
Studies conducted according to the highest scientific standards and published by organizations not affiliated in any way with chiropractic institutions or associations continue to show the clinical appropriateness and effectiveness of chiropractic care. One of the most recent, funded by the Ontario Ministry of Health, stated emphatically that:”On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain…There would be highly significant cost savings if more management of low back pain was transferred from physician to chiropractors.”
Doctors of Chiropractic receive extensive, demanding professional education on par with medical doctors (MDs) and osteopaths (DOs).
To receive the doctor of chiropractic degree, candidates must complete extensive undergraduate prerequisites and four years of graduate-level instruction and internship at an accredited chiropractic institution. Comprehensive knowledge of all systems of the body and diagnostic procedures enable the DC to thoroughly evaluate a patient, address disorders relating to the spine and determine the need for referral to another health care provider.
Chiropractic is the fastest-growing and second-largest primary health care profession.
There are approximately 60,000 doctors of 
chiropractic (DCs) in active practice in the United States spread from rural areas to inner cities. More than 10,000 students are currently enrolled in chiropractic educational programs accredited by a federally-recognized body (CCE).
Chiropractic services are in high demand.
Tens of millions of Americans routinely opt for chiropractic services and this number is rapidly growing. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program.
Doctors of Chiropractic are licensed in all 50 states.
DCs have been licensed and recognized for many decades in all states, the District of Columbia and Puerto Rico.
Chiropractic is recognized by governmental health care programs.
Chiropractic is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers’ Compensation and all state workers’ compensation programs. Chiropractic students are qualified to receive federal student loan assistance and DCs are authorized to be commissioned as health care officers in the U.S. Armed Forces.
The practice of chiropractic is based on sound scientific principles.
The existence of the nervous system as the primary control mechanism of the body is an undisputed scientific fact. Its relationship with the spine is the focus of the practice of chiropractic. The spine develops in utero to provide two primary functions: (1) allow for freedom of movement and (2) house and protect the spinal cord. When the vertebrae of the spine become misaligned through trauma or repetitive injury, two major consequences will result: (1) the range of motion becomes limited and (2) spinal nerves emerging from the spinal cord are compromised. DCs use the term “subluxation” to describe such disruptions. Interruption of nerve flow can eventually lead to pain, disability, and an overall decrease in the quality of life. Conversely, the removal of that interference has been shown to have significant, lasting health benefits. Through the adjustment of the subluxation, the doctor of chiropractic endeavors to restore normal nerve expression. The body is then able to respond appropriately to any imbalance in the system, thus relieving symptoms and restoring health.
The doctor of chiropractic is an effective source of preventative and wellness care.
The anatomical focus of the DC on the human spine has created the perception of the DC as just a “back doctor.” Although this perception is not entirely incorrect, it is very much incomplete. Doctors of chiropractic are a highly appropriate resource in matters of work-place safety, stress management, injury prevention, postural correction and nutritional counseling.”
The process of chiropractic adjusment is a safe, efficient procedure which is performed nearly one million times every working day in the United States.
There is a singular lack of actuarial data that would justify concluding that chiropractic care is in any way harmful or dangerous. Chiropractic care is non-invasive, therefore, the body’s response to chiropractic care is far more predictable than its reactions to drug treatments or surgical procedures. Of the nearly one million adjustments given every day in this country, complications are exceedingly rare. Perhaps the best summary statement on the subject of safety was published in 1979 by the Government of New Zealand which established a special commission to study chiropractic. They found:
“The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record.”
Lower Back Pain During Pregnancy
Victoria C. Arcadi, DC
One of the most common complaints during pregnancy is lower back pain. In my experience, lower back pain can be the first sign that a woman may be pregnant, especially when there has not been a trauma or any other reason for back pain to appear. My patients always give me a surprised sort of smile when I ask them if they might be pregnant. A large percentage of them are pregnant. Whether newly pregnant or very pregnant, lower back pain in pregnancy can be very uncomfortable and frustrating, especially when their medical doctor tells them that it is “normal.” Actually, studies have reported lower back pain in half of all pregnant women.1 These suffering women are told by their doctors that they need to wait until they have the baby to get relief. Meanwhile, there is no known medical treatment. I have been specializing in treating pregnant women for over nine years, and from clinical experience I am here to tell you that there is much that can be done for these women who suffer from sometimes debilitating lower back pain. Chiropractic adjustments have been shown clinically to be successful in relieving this discomfort in a large majority of cases, and usually with only one adjustment. In a recent paper published in Obstetrics and Gynecology, January 1988, “Low back pain during pregnancy,”2 862 pregnant women participated in a study in the community of Linkoping, Sweden answered detailed questionnaires in the 20th, 30th, and 35th week of pregnancy. All women had symptoms of low back pain. Seventy-nine had such severe pain that they were unable to continue work, and were referred to an orthopedic surgeon for orthoneurologic examination. These 79 were followed from six to 12 months after delivery. The results of this study are important to chiropractors. Low back pain was caused in 78 percent of the women by sacroiliac dysfunction, resulting from the sacroiliac fixation test also know as Piedallu’s sign. The patient is examined and one posterior superior spine is lower than the other. On forward flexion, the position is reversed. The test used was our motion palpation test for a fixation of the SI joints, where the examiner puts one thumb over the PSIS, and the other over the ipsilateral second sacral tubercle. With the patient standing, the examiner asks the patient to flex the knee and hip, bringing the thigh up toward the abdomen. In a moving joint the PSIS of course will move inferiorly with respect to the sacral tubercle. A fixation or reduction of mobility of the joint is indicated if the PSIS fails to move. This would indicate some sort of blockage of the joint.3
Other tests used to diagnose sacroiliac dysfunction were Patrick’s test, placing the heel on the opposite knee, supine and rotating the leg outward to elicit pain in either the hip or the SI joint; and Derbolowski’s test, in which a change was noted in the medial malleoli in relation to each other, when the patient is either lying down or sitting. Shortening of one leg would indicate rotation backward on the ipsilateral half of the pelvis.4
I thought these tests to be the type of testing that chiropractors use every day to diagnose a sacroiliac dysfunction. But what was really interesting was the treatment and results of the study. Of the 79 women treated for severe back pain, 52 were diagnosed with sacroiliac dysfunction. Of 54 patients given a trochanteric belt to restrict the movement of the sacroiliac joints during the pregnancy, 39 experienced relief. Ten women were treated with mobilization of the joints, which was administered by two orthopedic surgeons. They used a technique described by Maitland and Corrigan.5 But whichever techniques used, whether Maitland and Corrigan, diversified, etc., seven of these women were totally relieved, and three had only temporarily relief for one to two days: still a good result.
The outcomes from this study support chiropractic adjustments during pregnancy. Complete relief was only found when treatment included adjustments or manipulation as stated in the study. From these results, we can conclude that chiropractic adjustments beneficial and also alleviate back pain in at least 70 percent of all patients from this study, with adjustments to the SI joints.
In my experience adjusting and evaluating pregnant women, I have found that the sacrum seems to be subluxated most commonly when there is severe lower back pain. Later in the pregnancy, especially in the last trimester, the SI joint as well as the buttock muscles seem to be strained and must be treated. Occasionally, a trochanteric belt is necessary to totally relieve the pain and stabilize the joint to reduce edemic infusion into the joint. But as I stated above, chiropractic care has been shown clinically to be extremely beneficial in alleviating lower back pain in pregnancy.
Pregnant women comprise a significant group who can utilize our approach in relieving their discomforts. I would like to see every chiropractor become knowledgeable and confident and excited about treating and helping pregnant women because, after all, we are not only benefitting one life, but two. Think about it.
References
1. Mantle MJ, Greenwood RM, Currey HLF: Backache in pregnancy. Rheumatol Rehabil 16: 95, 1977.
2. Berg et al: Low back pain in pregnancy. Obstetrics and Gynecology 71: 1, 1988.
3. Maigne R: Sacroiliac joints, the problem of their blockings and strains. Douleurs d’Origine Vertebrale et Traitements par Manipulations, 2nd ed. Paris, Expansion Scientifique, 1972, p.294.
4. Grieve GP: Common Vertebral Joint Problems. New York: Churchill Livingstone, 1981.
5. Maitland GC, Corrigan B: Practical Orthopaedic Medicine. London: Butterworths & Co. Ltd., 1983, pp.330-331.
Victoria C. Arcadi, DC
Sherman Oaks, California
Back Pain in School Children
According to the recently released U.S. guidelines (AHCPR) for patients with recent onset low back pain, chiropractic treatment is most effective. The guidelines however, specifically did not apply to back pain in childhood, principally because of the lack of published studies in this area. Back pain in children has been the topic of several epidemiological studies during the past decade and the results of those studies are reviewed and discussed in this column. The most apparent fact from these studies of the pediatric population is that many children experience back pain. A 1994 Scandinavian study, by Trousler, identified the prevalence of back pain in a group of 1,174 school children at 51 percent. This study also found significance in the following risk factors:
Age
A significant increase in back pain incidence occurred at the age of 12 years and over. In all age groups above 11 years, more than 50 percent of the subjects had experienced back pain at some time in their life.
Gender
Females were more likely to experience back pain than males. A significant increase in back pain incidence in females was noted at 58.1 percent, compared with 43.2 percent for males.
TV
Children who watched television for extended periods were more likely to have back pain. Of those children who watched TV between 1-2 hours each day, 59.3 percent had experienced back pain. When the viewing time was increased to more than two hours each day, the incidence of back pain increased to 68.8 percent.
Sports
The prevalence of back pain associated with sports was calculated and found to exceed 60 percent for participants of the following sports: volleyball (78.2 percent); climbing (68.7 percent); golf (64.8 percent); basketball (62.6 percent); and handball (61.7 percent).
Previous Back Injury
For children who had previously experienced back pain, there was a significant risk identified for future occurrence. Trousler’s study also identified that 41.6 percent of the participants experienced back pain while sitting in class; 30 percent within one hour, and 70 percent after sitting for longer than one hour. On the issue of satchel carrying position, 68.6 percent of children had back pain when they carried their satchels by hand, compared with 53.7 percent who carried their satchels on the shoulder, and 45 percent when carried on their back. The specific incidence of location of back pain was identified as being lumbar 41 percent, thoracic 34 percent and cervical 26.5 percent.
Other studies have examined body size and flexibility as possible precursors to back pain in children.
Nissinen studied anthropometric measurements and the incidence of low back pain in a group of 1,060 children, and concluded that sitting height and trunk asymmetry appeared to contribute to low back pain.
Ebrall, in a study of adolescent males, concluded that upper body size significantly influenced the prevalence of back pain, as did pelvic height.
In a controlled study of 1,503 children, all 15 years of age, Salminen concluded that:
- males who had recurrent or continual low back pain were over 4 cm taller than controls, – in both sexes of those who had back pain, lumbar extension and straight leg raising was decreased, while lumbar flexion was increased, and – endurance strength in abdominal and back muscles, in those who experienced back pain, was decreased relative to the control group.
Kujala studied 100 athletes and 38 non-athletes and concluded that prevalence of low back pain in the athletes could be correlated only with tightness of the hip flexor muscles. The study suggested that high training duration predisposes young athletes to low back pain. Olsen, studying the epidemiology of low back pain in an adolescent population of 1,242 subjects identified that one third of the subjects had restricted activities due to low back pain and that 7.3 percent required medical attention.
Salminen, in a study of 1,503 school children, aged 14 years, found that low back pain was the third most common form of pain interfering with school work and leisure activities. Of the children who experienced back pain, 65 percent recovered within one month and 35 percent reported disabling low back pain and were aware of recurrent or continual pain.
Miereau and Cassidy studied 402 subjects 6-18 years old and identified a significant direct relationship between history of low back pain and decreased straight leg raising in adolescent males.
In studying female gymnasts, Olsen identified that subjects with low back pain had significantly larger lumbar lordosis (41 degrees) than in those with no history of low back pain (35 degrees).
Balague, studying 1,715 school children of both sexes, identified significant positive correlation between low back pain and age, female sex, time spent watching TV, smoking and competitive sports.
Back pain is a major problem which afflicts about 80 percent of the population. Prevalence studies in children have reported incidence rates varying between 7 and 51 percent. Although the methodology, age range and criteria for back pain has varied widely in these studies, there appears one strong theme: that back pain in children is a major public health issue. Further studies must be conducted to evaluate not only epidemiology, but also to evaluate treatment protocols and preventive measures for children with back pain.
References
Balague F et al. Cross-sectional study of isokinetic muscle trunk strength among school children, Spine, July 1993, Vol 18(9), 1199-1205.
Balague F et al. Low-back pain in school children: An epidemiological study. Scandinavian Journal of Rehabilitative Medicine, 1988, Vol 20, 175-179.
Ebrall P. Some anthropometric dimensions of male adolescents with idiopathic low-back pain. Journal of Manipulative and Physiological Therapeutics, June 1994, Vol 17(5), 296-301.
Kujala U et al. Subject characteristics and low-back pain in young athletes and non-athletes. Medicine and Science in Sports and Exercise, June 1992, Vol 24(6), 627-632.
Miereau D et al. Low-back pain and straight leg raising in children and adolescents, Spine 1989, Vol 14(5), 526-528.
Nissinen M et al. Anthropometric measurements and the incidence of low back pain in a cohort of pubertal children, Spine, June 1994, Vol 19 (12), 1367-70.
Olsen T et al. The epidemiology of low-back pain in an adolescent population. American Journal of Emergency Medicine, May 1994, Vol 12(3), 334-336.
Olsen G et al. Spinal sagittal configuration and mobility related to low back-pain in the female gymnast. Spine, 1989, Vol 14, 847-850.
Salminen J et al. Spinal mobility and trunk muscle strength in 15 year-old school children with and without low-back pain. Spine, April 1992, Vol 17(4), 405-411.
Salminen J et al. Low-back pain and disability in 14-year-old school children. Acta Paediatrica Scandinavica, Dec 1992, Vol 81(12), 1035-9.
Troussler B et al. Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitative Medicine, 1994, Vol 26, 143-146.
Peter Fysh, DC
San Jose, California