What kind of treatment do I need: Part II

Once we have ruled out the nasty causes of back pain (cancer, infection, etc.) and we know we are dealing with a musculoskeletal condition (disc herniation, arthritis, back sprain, etc. etc.), we can talk about treatment options. There are two main types of treatment for neck and back pain: passive care and active care.

Passive Care

Passive care includes things that are done to you. This includes massage, chiropractic adjustments, ultrasound, microcurrent, traction and more. The general rule on passive care is that it should be a bigger part of your care at the start and a smaller part of your care as you get better.

Passive care can be great. It makes you feel better! However, if you are not getting active care, more than likely you are getting less than the best treatment.

Active Care

Active care is things that you do to and for yourself. Usually active care means some type of exercise. Walking is a form of active care that everyone should do. However, general exercises like walking are not enough by themselves. Most neck and back pain needs some specific exercises to correct your specific problems.

The good news is that you almost never need any fancy or expensive equipment or a lot of time. For most, five minutes per day five days per week is enough – for your specific therapy exercises, not your exercise for general health (darn!).

An example of a specific therapy exercise that is commonly needed is in my earlier column, “The Back Pain Vaccine”.

Shedding light on Scoliosis

For many years it has been known that we can cause scoliosis in chickens if we remove their pineal gland. The pineal gland is almond shape and sits, more or less, above and between your eyes. The pineal gland releases melatonin and is a big player in maintaining our sleep wake cycle.

If this gland is removed in young chickens, 50-80% will develop scoliosis. A study has also shown that exposing young chickens to bright lights 24 hours a day (which decreases their melatonin levels to almost zero) can cause scoliosis in 15% of otherwise normal chickens.

However, when we look at humans with scoliosis, they don’t have changes in melatonin levels. (Reference here.) But, changes are found in the melatonin receptors along the spine from side to side. (Reference here). But, the researchers seem to think this is secondary to some other change.

And a recent study showed a much higher rate of scoliosis in blind women. (Reference here.) Vision, light, melatonin…all seem related, but the relationship is not clear.

Unfortunately, we really have more questions than answers.

Adult Scoliosis: The Real Story

Earlier I wrote a mild rant about doctors scaring adult patients with mild scoliosis (click here to read).

After finding out that some of the common fears are overblown, some of you wanted to know what is a realistic expectation. I am glad you asked. Some Swedish researchers followed a group of patients with adolescent idiopathic scoliosis, who were treated with bracing as adolescents, for more than 20 years.

Over this time, the average increase in the size of the scoliosis curve was 7.9 degrees. One scoliosis patient out of 127 had a large increase of 27 degrees and ended up with surgical treatment. The odds of having a large curve increase were 0.079% in this study. Or looking from the other side, the odds of having mild curve progression were 99.21%.

The scoliosis patients did have more degenerative disc disease and more mild back pain. Of those with scoliosis 75% had back pain compared to 47% of those without scoliosis. Remember, the pain was mild and only 24% had daily pain.

Clearly this is not the horror story that some clinicians are selling to patients with scoliosis. And, if you are one that has a very mild curve, these statistics don’t even apply to you.

If you had scoliosis as a teenager – enough to require bracing – you can expect to have mild back pain and some extra spinal degeneration. Not great, but not too bad either. (click here for the study)

Scoliosis: Be Afraid…Be Very Afraid!

On a regular basis, patients come into my office with big worries about their scoliosis. The thing is, most of these patients DON’T HAVE SCOLIOSIS….never had it, never will. But, someone, either at school or some doctor (often, I am ashamed to say, a chiropractor) has told them falsely that they have a scoliosis.

As a result, they carry these visions of future pain and disability around for years. Sometimes they even avoid activities they love because they think it will be bad for their scoliosis.

Here is an example of a mild case of scoliosis. He has probably had this curve for decades. I would guess that his curve is about 20 degrees. Looking at his back, you can see he has a curve. But if you didn’t know to look for it, would you notice it? Probably not.

Even with this long-standing scoliosis, he does not have much disk disease. Looking on his x-ray (it is a little hard to read on the computer at this size), I don’t see any more degeneration than I would expect in someone who has gray hair.

He is doing well. Most of the patients who come into my office have a curve that is half the size of this curve and usually more like 1/4 or 1/8. They have no more reason to worry about their backs than anybody else – at least not related to the curve.

So, what about people with a real scoliosis – as big as the picture or more?…………I’ll put that in another post.