In this article, Drs. Don Aspegren and James Cox discuss some of the recent studies on mechanical and nonmechanical low-back pain that will be of particular interest to field practitioners.
James Cox, DC, DACBR, originated the Cox flexion-distraction technique. He is an internationally recognized author, lecturer, and clinical researcher on chiropractic protocols related to biomechanics, diagnosis, and treatment of spine pain. He practices in Ft. Wayne, Indiana, specializing in treating radiculopathies. He also consults with physicians through the Ft. Wayne Chiropractic Radiological Center.
Don Aspegren, DC, MS, is believed to be the first DC to obtain staff status at a hospital in Colorado. For more than two years, he has performed chiropractic care including manipulation and various types of rehabilitation at Exempla Lutheran Medical Center (ELMC) in Denver. He has been invited to work at the hospital's recently developed spine center. He spent two years as a resident under the direction of Dr. Cox.
A Surprise to the Medical Community
Dr. Cox says the most pain-sensitive tissue in the low back responsible for back pain is the intervertebral disc--which came as a surprise to the medical community. "The medical schools in the 60s taught that the disc had no nerve supply and that it was totally nonpainful. Today, we know that the major generator of low-back pain (LBP) is the disc itself. Second to that are pain-sensitive tissues in the facet joints."
How Do Back Pain and Disc Degeneration Start?
"That's a very wide-open discussion," says Dr. Aspegren. "We see changes and injuries in people who predispose themselves to heightened trauma and pathology. For instance, clinical studies have shown that high-level Olympic athletes at our polyclinic have more degenerative changes in the spine--in their discs--than the age-matched controls. We also treat the classical LBP patients--heavy laborers, farmers, and construction workers. These patients traditionally develop degenerative changes prematurely compared to age-matched controls."
Dr. Aspegren adds that back pain does not necessarily originate with musculoskeletal injury, or even with degenerative changes in the discs. "The literature also supports a discussion of a genetic predisposition that occurs with some of our patients and predisposes them to back problems."
1. Gjerstad J. Genetic susceptibility and development of chronic non-malignant back pain. Rev Neurosci. 2007;18(1):8391.
Chemical Changes that Cause Back and Extremity Pain
"Various substances are exuded out of the intervertebral disc," says Dr. Aspegren. "These become irritating to surrounding structures, whether it's the outer part of the intervertebral disc--the annular fibrosus, which is highly innervated--or when the meninges, the dural lining, becomes irritated. That can cause a chemical radiculitis that accentuates the level and intensity of an extremity-type pain. It's in patients with extremely high amounts of chemical irritation that we see the real sharp pain--10 out of 10."
Chiropractic Contributions to Discs and Tissue
Dr. Aspegren says chiropractic offers far more than the ability to reverse some of the mechanical-type changes and reduce stress on the body, augmenting healing. "After we manipulate patients whose tissue trauma has caused them to develop chemical-type irritation, we...