{"id":3397,"date":"1991-04-12T21:09:18","date_gmt":"1991-04-13T04:09:18","guid":{"rendered":"https:\/\/www.activator.com\/?p=3397"},"modified":"2023-06-07T08:34:44","modified_gmt":"2023-06-07T15:34:44","slug":"chiropractic-treatment-of-chronic-mechanical-low-back-pain-in-a-geriatric-population-a-practitioner-scientist-protocol","status":"publish","type":"post","link":"https:\/\/activator.com\/chiropractic-treatment-of-chronic-mechanical-low-back-pain-in-a-geriatric-population-a-practitioner-scientist-protocol\/","title":{"rendered":"Chiropractic Treatment Of Chronic Mechanical Low Back Pain In A Geriatric Population: A Practitioner-Scientist Protocol"},"content":{"rendered":"

Introduction:<\/h4>\n

Low back pain (LBP) is a common health\u00a0 problem among the elderly, affecting up to 90% of the over 65\u00a0 population, and accounting for nearly $1 billion per year in Medicare\u00a0 payments alone. By far the greatest single cause of low back pain in the\u00a0 elderly is mechanical derangements occurring within the confines of the\u00a0 lumbar spine as a consequence of chronic degenerative joint disease\u00a0 which, in itself, is often painless and of little or no clinical\u00a0 significance. Most of these cases (many of whom are presently being\u00a0 unsuccessfully treated in medical clinics and\/or hospitals) would quite\u00a0 likely respond very well to routine office-based conservative\u00a0 chiropractic care. However, insofar as there is no conclusive data to\u00a0 support any particular method of chiropractic treatment for these cases,\u00a0 nor has there been any standardized procedures established by which\u00a0 such data might be collected for analysis, the issue is problematic\u00a0 inasmuch as most chiropractic physicians have had little training in\u00a0 clinical research methodology. Therefore, a \u201cpractitioner scientist\u201d\u00a0 protocol was developed whereby selected office-based chiropractic\u00a0 physicians would collect the necessary data and provide treatment\u00a0 according to specified procedures under the direction of an experienced\u00a0 clinical researcher. Basic inclusion\/exclusion criteria were chosen for a\u00a0 standardized approach to the diagnosis of mechanical low back pain in\u00a0 the elderly and its treatment by conservative chiropractic technics.<\/p>\n

Inclusion criteria are as follows:<\/p>\n

    \n
  1. Age: 65 and over<\/li>\n
  2. Present episode of LBP greater than three months duration<\/li>\n
  3. Greater than 20 percent Modified Oswestry disability score (MODS)<\/li>\n
  4. Primary pain localized to the lumbar spine (L1-S1)<\/li>\n
  5. No prior chiropractic or medical treatment for present episode of LBP<\/li>\n
  6. No radicular or neurological symptoms<\/li>\n
  7. Any three of the following positive orthopedic tests:\n
      \n
    1. Kemp\u2019s test (include only if it increased lumbar pain)<\/li>\n
    2. Adam\u2019s and supported Adam\u2019s test (both equally cause pain in the lumbar spine)<\/li>\n
    3. Goldthwait\u2019s test (evokes lumbar pain or makes it worse, does not increase radiation of pain into the leg)<\/li>\n
    4. Hyperextension test<\/li>\n
    5. Pain evoked on spinous process percussion which seated patient\u2019s lumbar spine is flexed<\/li>\n<\/ol>\n

       <\/p>\n

      Exclusion criteria are as follows:<\/p>\n

        \n
      1. History of serious medical illness<\/li>\n
      2. Psychological disturbances<\/li>\n
      3. Recent trauma (major bruises; fractures; auto accidents; etc.)<\/li>\n
      4. Leg or buttock pain of suspected neurological involvement<\/li>\n
      5. Obesity<\/li>\n
      6. Anomalies such as spondylolisthesis<\/li>\n
      7. Uncertain diagnosis<\/li>\n
      8. referred pain of viscero-somatic origin<\/li>\n
      9. Change in diagnosis; new symptoms; deteriorating health while study is underway<\/li>\n
      10. More than two weeks of missed appointments<\/li>\n<\/ol>\n
        \n

        Reference:<\/strong> Paul J. Osterbauer, DC, Tom DeVita, DC,\u00a0 Arlan W. Fuhr, DC.\u00a0Proceedings of the FCER\u2019s Third Annual International Conference on\u00a0 Spinal Manipulation. Washington. D.C., April 12-13. 1991. pp. 230-1.<\/li>\n<\/ol>\n