Are you at Risk for Spine Pain?By: Dr. Connie D’Astolfo, DC, PhD (c)

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Spine pain is an extremely common prob-lem, affecting more than 65% of adults and 85% of seniors in Ontario. In fact four out of five adults will experience spine or back pain sometime during their lifetime and the prevalence of back pain increases as you age. As clinical director of a busy rehabilitation clinic, treating hundreds of patients with multiple chronic conditions, we see neck and back pain as one of the most popular complaints in our adult and senior population.In fact, studies have demonstrated that back pain is often a co-morbidity associ-ated with another illness most commonly depression, anxiety, diabetes, heart disease and obesity. It is evident from the serious-ness of this condition that effective man-agement is required to reduce its impact.What causes spine pain?As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae. Pain can occur when, for example, someone lifts or pulls/pushes something too heavy, causing a sprain, strain in the muscles or ligaments in the back. If the spinal seg-ments becomes overly strained or stressed, a disc may rupture or bulge outward. This rupture may put pressure on nerves rooted to the spinal cord that control body move-ments and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results. Spine pain may reflect nerve or muscle irritation or bone lesions. Most back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury. Occasionally, spine pain may indicate a more serious problem. Pain accompanied by fever or loss of bowel or bladder con-trol, pain when coughing and progressive weakness in the legs may indicate central canal stenosis. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should seek attention immediately to help prevent permanent damage. Who is most likely to develop low back pain?Nearly everyone has low back pain some-time. Men and women are equally affect-ed. It occurs in part to the aging process but most often as a result of sedentary life styles with too little exercise. The risk of experiencing low back pain from disc dis-

ease or spinal degeneration increases with age. Low back pain unrelated to injury or other known cause is unusual in pre-teen chil-dren. However, a backpack overloaded with schoolbooks and supplies can quickly strain the back and cause muscle fatigue. The U.S. Consumer Product Safety Com-mission estimates that more than 13,260 injuries related to backpacks were treated at doctors’ offices, clinics, and emergency rooms in the year 2000.

SPINEgroup’s clinical process for the management of spine pain disorders

parallels none in Ontario

SPINEgroup®: The Centre of Excel-lence for Spine CareAt SPINEgroup, we strive for the highest possible standards in spine care. We are a unique clinic in Ontario that brings to-gether a team of clinical experts trained in spine and spine related conditions targeted at diagnosing and managing chronic and complex spine pain disorders through co-ordinated programs of care. This means the treatment is aimed at getting you better, faster and at the lowest cost. The program of care is delivered by our clinical team of experts including our chiropractor, physio-therapist, massage therapist, psychologist and case managed by our registered nurse in conjunction with your family doctor and/or specialist.

“We are highly recommended and re-ferred by medical physicians across the

greater Toronto area”

I will give you a real case example of one of our past patients, who for confidentially reasons, we will refer to as “Mr. Brown”. Mr. Brown, a 55 year old man, presented to our clinic four months ago with severe bilateral leg pain, weakness, instability and numbness/tingling. The patient was un-able to work due to the pain and had been off work for over 2 months. He had at-tempted weeks of regular chiropractic and physiotherapy treatments with no success. After a thorough history, orthopedic evalu-ation and review of his x-rays and MRI, we diagnosed the patient with central canal spinal stenosis (a degenerative condition where spinal arthritic changes narrow the spinal canal causing pain and neurological changes. The arthritic damage had been irritating his nerve roots and compressing the spinal cord causing weakness and se-vere, sharp pain down his legs. As a con-sequence of his pain and disability, the patient had also become depressed. His history and exam also revealed high blood pressure, elevated glucose levels (diabetic) and significant weight gain since the onset of his disability. Along with his pain con-dition, diabetes and depression, the patient was at high risk for heart disease or stroke.Mr. Brown was triaged to the Spine Care Program and after his 8 week treatment; Mr. Brown’s pain was reduced from 9/10 to a rate of 3/10 and has regained a great deal of strength and balance in his legs. He lost

10 pounds, his blood pressure had normal-ized and his glucose levels were reduced. With the help of the psychological counsel-ing, the patient demonstrated a reduction in his depressive symptoms. Mr. Brown was

finally gaining more control of his life and able to resume his normal daily activities. For an additional 3 weeks, we were able to assist Mr. Brown with a return to work plan and at the 11 week mark he was discharged with a home exercise plan and successfully returned to full work duties. The full cost of his treatment was less than half the cost of typical rehab care with positive results.Our Unique Treatment ApproachThe Spine Care program has a high suc-cess rate for complex spinal injuries and conditions including Idiopathic scoliosis,

herniated and bulging discs, moderate to severe disc degeneration, spinal stenosis, with on our evidence based, team modelled and self-management approach. Treatment management typically includes spinal manipulation, spinal rehabilitation, laser therapy, spinal decompression, massage therapy and psychotherapy. In most cases patients are able to receive reimbursement for the program cost through their extend-ed benefit insurance plans.Currently our success rate for the program is an average of 85-100% for pain reduc-tion and functional improvement and we have scored high for continued improve-ment post discharge.The program length is 16 sessions over 8 weeks, followed by a consult at one month and at three months post discharge. Pa-tients thereafter will receive complimen-tary assessments (in person or through teleconference) every year to ensure con-tinued compliance, motivation and clinical outcomes. Your medical physician will re-ceive reports on your progress.Dr. Connie D’Astolfo, DC, PhD (c) is a chiropractor and the director of SPINE-group® an integrated medical rehab clinic located in Vaughan. Dr. D’Astolfo is cur-rently pursuing a PhD at York University.

She has several published peer reviewed articles and is a chapter author for several medical texts. Her interests include chron-ic disease prevention and management, spinal disorders and rehabilitation. You can visit our website at www.spinegroup.ca or contact our client care representative at 905-850-7746 for more information on our clinical programs including our popu-lar Spine Care Program.