Low Back Pain
Non-Surgical Solutions for
Chronic Low Back Pain
For patients with chronic low back pain (pain in the lower back lasting longer than 3 months, our multidisciplinary program uses a combined-therapies approach to offer a minimally-invasive treatment option for spinal correction compared with long-term bracing or surgical fusion procedures.
≥3 months
Scoliosis is Diagnosed if the Cobb Angle is ≥10°
Scoliosis is defined as a three-dimensional (3D) structural deformity of the spine and is diagnosed on the basis of a measurement of the major curves comprising the deformity. This measurement is traditionally done using the Cobb method and gives the Cobb angle. Scoliosis is diagnosed if the Cobb angle is ≥10. In addition to spinal curves, scoliosis is frequently associated with asymmetries of the trunk and the extremities.
1-4%
Scoliosis is Found in More Women than in Men
Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in early puberty, affects 1–4% of adolescents and disproportionately affects young women. Idiopathic scoliosis denotes curve of unknown aetiology, in contrast to congenital, neuromuscular and other types of scoliosis that have better understood underlying mechanisms. AIS can be classified according to different criteria, including age of onset and the location of the maximal curve.
60-75%
Scoliosis is Known to Decrease Quality of Life
Quality of life of patients with adolescent idiopathic scoliosis (AIS) is influenced by several consequences of the condition, including reduced pulmonary function, back-related problems such as pain and stiffness (60-75%), degenerative spine disease, decreased physical ability and function, body image concerns, mental well-being, social and psychological consequences, as well as changes in brain connectivity.
What the Research Says
Chronic pain is one of the most costly and prevalent sources of human suffering, especially in, but not limited to, modern industrialized societies. Low back pain is normally considered as pain, muscle tension or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica (pain traveling down the leg from the lower back). Almost everyone has a brief, acute episode of low back pain during their lifetime. Although many people with back pain recover within 1 year, some will develop a chronic condition with fluctuating or persisting pain of low or medium intensity, interrupted by periods of no pain or pain exacerbation. When back pain persists for >3 months, it is (by consensus) no longer considered as a symptom but as a disorder in itself that is maintained by factors that might be different from the initiating causes. Chronic back pain can be associated with functional disability and work incapacity and can affect quality of life. Often, back pain does not occur in isolation, as many individuals with back pain also report pain in other regions of the body. A higher number of painful body regions is associated with higher functional disability, more work absences, more severe feelings of depression and anxiety, and reduced quality of life. The large majority of patients with back pain have nonspecific pain, whereby an underlying pathology or a nociceptive contributor has not been identified.
The societal and economic costs of back pain are high, and indirect costs are usually higher than direct medical costs. In Australia, the total cost for low back pain was estimated at AUD$9 billion in 2001, but only 11% of this amount was accounted for by direct health care costs. Similar proportions have been observed in the Netherlands and the United Kingdom. Although the costs associated with back pain in the Netherlands have reduced from €4.3 billion in 2002 to €3.5 bil lion in 2007, the costs are still substantial and constituted 0.6% of the gross national product in 2007. In all these estimates, the majority of costs were attributed to productivity losses.
Traditionally, back pain was considered as a result of injury (the socalled injury model). This model is overly simplistic; the association is modest between physical loads with structural degenerative changes and pathology of the vertebral column or supporting structures, and pathological findings have been observed in asymptomatic individuals. A biopsychosocial model of back pain has been developed in which biological factors with modest effect sizes interacting with other risk factors are likely to contribute to the development of chronic back pain. The nonbiological risk factors include negative beliefs and expectations about pain, emotional responses, pain behaviors, perceptions about the relationship between pain, health and work, and societal obstacles.
In the International Classification of Diseases 10th revision (ICD10), diagnostic codes for pain conditions, including low back pain, are included but do not account for the heterogeneity of chronic back pain in particular. Thus, a new classification of chronic pain has been developed for ICD11, in which chronic back pain is classified under a new entity, ‘chronic primary pain’. Chronic primary pain is defined as pain in at least one anatomical region that persists or recurs for >3 months and that is associated with substantial emotional distress or functional disability and that cannot be better explained by another chronic pain condition. In patients with chronic back pain as a symptom of another disease — such as endometriosis, pancreatitis, aortic aneurysm, renal colic, inflammatory bowel disease, or rheumatoid arthritis — it is coded under the new classification ‘chronic secondary musculoskeletal pain’. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) included a painspecific mental disorder, but this diagnosis was not retained in DSM5 owing to the uncertain importance of medically unexplained pain and the lack of clarity about what psychological factors are of relevance in explaining the symptoms, among other reasons.
Low Back Pain Program
Our Scoliosis program has been designed to help both local and out of town patients of all ages and abilities. Depending on the severity and needs of the patient, 24-36 sessions over 3-6 months will be prescribed along with weekly home exercise prescription. For patients who have already been prescribed bracing, or who have already undergone fusion surgery, we offer a modified program to optimize movement and minimize post-surgical neuro-musculoskeletal compensations.
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Individualized Care
We combine the latest research-supported evaluations with broad-based diagnostic testing performed in our office. Our comprehensive formative evaluation includes a physical examination, functional movement screen, diagnostic computerized posturography and more, serving to record baseline capabilities and deficits related to motor function. 
Evidence-Based Diagnostics
We provide each patient with an individualized care plan designed to address the specific impairments or goals of the patient. The patient’s care plan includes an intensive regimen of in-office and customized at-home exercises that facilitate accelerated improvement. Treatments are scheduled based on the specific needs of the patient and progress is measured frequently against the formative assessment. Treatment plans are refined as progress improves to achieve the best possible results.
Breakthrough Therapies
Our innovative therapies help restore impaired function by leveraging the body’s inherent ability to repair, compensate, learn and adapt through passive physiotherapy, chiropractic, and active corrective exercises. The combined-therapies approach targets affected areas with specific activities to decrease pain, restore normal movement, neuromuscular functioning and improve performance. Progress testing provides continuous feedback on improvement or success. Follow up and at-home exercise prescription help to optimize improvement times and minimize in-office visits required for full improvement.