Failure of the current spinal care model
“It is time to tackle an economic burden”, writes Lesley Russell
“Lower back pain in Australian adults is a massive health problem that sends more people to the doctor than any condition other than the common cold and generates a substantial economic burden. At any one time, 26 per cent of Australians have lower back pain and 79 per cent of the population will experience it at some time in their lives. The direct cost of care amount to about $1 Billion annually with most of this spent on treatment. However, the direct costs are minor compared with the indirect costs of $8 Billion that arise as a consequence of lost productivity and disability.”
“Moreover, of the patients who seek care from their General Practitioners, 94 per cent are classed as having “non-specific low-back pain”, meaning that the source of their pain has not been found. Persistent non-specific lower back pain is poorly understood by the general community, researchers, and health care professionals, making effective care problematic. Causes of chronic lower-back pain are rarely found using conventional investigations such as radiography and MRI, with fewer than 10 per cent of cases diagnosed by these means. Many experts say spine imaging is overused in patients without “red-flag” symptoms and does not alter treatment or improve clinical outcomes.”
“We need to think differently about prevention. As the main causes of lower back pain remain largely unknown, reducing the risk factors and primary prevention will prove difficult tasks… Because it is such a large and costly issue for society and individuals, we need a cultural shift in the way back pain is viewed, as a national health problem, and in relationship to activity and the work environment.”
Dr Lesley Russell is a senior research fellow at the Australian Primary Health Care Research Institute at the Australian National University
The excerpts are from an article in the Sydney Morning Herald, April 11th 2013
The high percentage of occurrence and the incredible costs of lower back pain are in no way an Australian problem, with most studies worldwide showing similar figures. In 2004 the total cost of back pain in America was estimated to be more than $100 billion per year including medical bills, disability and lost productivity at work.
Worth noting are the facts that:
- Degenerative changes in the lower back are present in 10% of the population at age 20, 50% at age 40 and 90% at age 60. The majority of people who possesses these changes do not have symptoms.
- In autopsy studies, 100% of the population over age 50 has detectable disc and joint pathology.
- Some degree of disc herniation/protrusion can be found in 50% of the population who have never experienced back pain.
Why is the current spinal care model not working?
I think the AAOS – (American Association of Orthopaedic Surgeons) raised an interesting question in an article of their journal in January 2009;
“Greater understanding of the causes of back pain and its resultant disability is needed to halt the rising trend. Understanding why disk degeneration causes pain in some while not in others is needed to address both the burden of pain and the disability it causes.”
The reason that the current spinal care model is not working lies in the simple fact that:
There is no current spinal care model!
When we compare “Spinal Care” with Dental Care” the problem becomes very obvious.
In Dental Care we have been instructed to brush our teeth at least twice a day, we floss, and we rinse. We have also been trained from an early age to go and see a dentist every 6 months for a check-up, and on top of that many individuals also use the services of dental hygienists.
In Spinal Care most people completely ignore their back until it hurts, then seek help (a quick fix), and as soon as the pain subsides they return to ignoring it until the next pain episode emerges.
Most parents would insist that their children’s teeth get thoroughly brushed after eating sweets, but would not think twice about the child’s spine when sitting hunch over a computer game for hours on end.
The ironic fact in this comparison is that there are procedures to replace the deteriorated old teeth with new shiny ones, and they work well and look good. With the spine there is a different story, with no back replacements available. In those instances when spinal surgery has to be done it will never leave the spine with a better performance capacity than the original spine.
What is the solution?
Looking back at the AAOS question of why some people with spinal degeneration experience pain and while others don’t even though performing the same activities, it would be reasonable to assume that some people have better movement patterns than others. An individual’s ability to stabilize the spine during activity to minimize the loading is crucial in avoiding pain syndromes.
Instead of only focusing on altering work situations to lessen the loading of the spine it is equally important to prepare the individual for the task. Avoiding the loading of the Musculo-Skeletal system leads to de-conditioning and the less individuals do, the less they will be capable of doing in the future.
The solution is not as simple as strengthening the individual’s muscles. The key word is MOVEMENT, which can be summarised as the combination of mobility and stability.
We have to teach people to move better.
Most healthy babies develop perfect movement patterns naturally, and if we could maintain these healthy baby patterns into adulthood the back-pain situation would be very different. Well, why can’t we?
Spinal care should be aimed at developing and maintaining ideal movement patterns and could consist of:
- Ensuring that babies develop good quality of the essential stabilization patterns, by keeping an eye on the most crucial mile-stones in their development.
- Developing a form of “Postural Tai-Chi” that children perform daily from a very young age to maintain the ideal patterns developed as a baby.
- Emphasising the importance of maintaining these ideal movement patterns in adulthood.
- Ensuring the daily “Postural Tai-Chi” becomes a natural part of our lives from childhood to old age. Most stiffness in old age is not from the ageing process, but from lack of movement.
An effective spinal care model must be focused on educating individuals about the importance of good movement patterns, and motivate them to do the “Postural Tai-Chi” exercises every day.
People would be much better off doing their movement exercises rather than brushing their teeth given the scenario that both cannot be fitted into their busy lives.
Spinal care doesn’t just offer a solution for sore backs. By learning better movement patterns the knees, hips, ankles, feet, shoulders, elbows and wrists would not deteriorate at the same rate as they do now for many individuals participating in the “No spinal care model”, and that would really save some serious money and suffering.