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Institute for Work & Health's Review of Lack of Benefits in passive treatments for Back & Neck Pain

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Institute for Work & Health’s Review of Lack of Benefits in passive treatments for Back & Neck Pain

Fast but finite: Complementary and alternative therapies

“A review led by a scientist from the Institute for Work & Health investigated the effectiveness of alternative therapies for back & neck pain and found that the benefits may be immediate, but not lasting.”  
OPC Inc’s research arm highlights these findings by IWH as our consultants across Canada fine most employees are seeking massage and chiropractic care for back & neck pain even though the effectiveness is limited at best and not recommended as per the Cochrane International review.
“Conventional medical therapies, such as prescriptions for medication, traction & rest are not always successful for back and neck pain. Therefore, injured workers often turn to acupuncture, spinal manipulation (chiropractic) and massage looking for relief. But which of these complementary and alternative medicine (CAM) therapies, as they are called, actually work? This was the focus of a systematic review led by Institute for Work & Health (IWH) Associate Scientist Dr. Andrea Furlan.”
“The review, released last October, looked at 270 studies. Most were randomized controlled trials. The key findings were:
CAMs were more effective in reducing pain compared to no treatment or standard care in the short term.”
  • Acupuncture for certain types of back pain was better than placebo, but only in the short term. For certain types of neck pain, it was better than no treatment immediately after the treatment.
  • Manipulation by chiropractors was better than placebo or no treatment for back and neck pain in the short term. It was also better than acupuncture.
  • Mobilization was better than no treatment, but no different than placebo, for certain types of back pain. For certain types of neck pain, it was better than placebo.
  • Massage was better than placebo or no treatment for certain types of back pain”

OPC Inc cautions about these conclusions to a certain degree as these studies only looked at the short term benefits of certain therapies for back and neck pain. It is critical for your employees to be properly diagnosed up front by a qualified Physiotherapist which in turn determines the best course of treatment for the employee.

To illustrate; if an employee presents with an acute facet joint injury of the lower to mid back, the Cochrane Network has found that a short course (2-3 visits) for manipulation by a chiropractor is effective (remember to have your employees avoid manipulative therapy to the neck at all costs as the findings show the vertebral arteries at the back of the neck can be sheared which can lead to strokes in the brain stem).

Whereas injury to the discs of the spine in the lower back are better treated with Physiotherapeutic education; posture, ice & waiting for 3 days for the acute phase to be completed. 
The use of massage therapy during the acute episode of back and neck pain has been found to increase the amount of inflammatory product in the injured area and surrounding tissues which can slow the healing process. Massage therapy should therefore NOT be used in the first 3-5 days following injury.

Simply put: injured employees with low back and neck pain should stick to simple & easy to recall rules; ice the area every hour for 20 minutes; take ibuprofin or ASA to limit inflammation; use postures which are most comfortable to assume for the first 3- 5 days following injury. After that time get back onto your active program your Physiotherapist and Kinesiologist gave you and slowly build back up to your pre-injury condition. No fancy pills, no trips to the Emerg, no mis-use of MRI’s and x-rays. Keep it simple and keep active after 3-5 days. 

And if you want to read more about this we recommend the Carswell Publication Understanding, Preventing and Controlling Back and Neck Pain, Jane Sleeth Author Carswell.com

Source: At Work, Issue 67, Winter 2012: Institute for Work & Health, Toronto

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