Running head: Lumbar Sprain

Lumbar Sprain; The Plague of the Working Individual
Michelle Johnson
Everglades University Alternative Medicine

Abstract
A simple lumbar sprain for some is just a little pain. For others it is a devastating issue. Treatments can range from prescriptions and ice to chiropractors and acupuncturists. Many treat this problem differently or not at all. For any working individual, it can be an end to the job or it can be a new beginning in what kind of care is available.

Lumbar Sprain; The Plague of the Working Individual
In today’s society, even the simplest of pain brings a working person down. A lumbar sprain, or as many know it, low back pain, can be crippling. It can happen quickly and without warning. Many seek out the help of traditional doctor, thinking that a muscle relaxer or a pain pill will make it all better. Most don’t realize that the cost of something alternative may be close to the same amount as a traditional doctor. After you factor in the expense of the co-pay, the meds, the possible diagnostic testing, and the other specialists that you might have to see, costs can add up quickly. Finding something different may work more in your favor than you think.

Traditional Medicine
Of the US population, 85% will experience an episode of mechanical LBP at some point during their lifetime (Hill, 2015). For traditional medicine, the patient would go to their family physician with the complaint. The doctor would begin by evaluating their symptoms. The symptoms would be low back pain, stiffness, inability to sit or stand for extended periods of time, pain running down the leg(s), extreme soreness while twisting or turning of the trunk, stabbing pains, or a dull ache. After the patient describes the pain, the physician will ask about history. Possible causes of LBP might be car accident, work accident, bad sleeping position, or picking up something that was awkward or cumbersome. If the patient is female, other factors may be added. Pregnancies, kidney stone, and small children at home that are picked up are all factors the doctor must decipher when evaluating a patient. The doctor will also consider activity level or if the patient is obese.
After the initial history, the doctor will move on to the physical exam. The doctor will look for scoliosis or any other abnormalities or skin irritations, i.e. bruising, scrapes, or cuts that could indicate injury. Palpation or percussion of the area may be done, looking for vertebral sensitivity or soft tissue tenderness. After the physical exam, the doctor will then prescribe meds. Usually, the cocktail is a muscle relaxer, pain pill, anti-inflammatory, and a steroid shot or pill. Imaging and other diagnostic testing are not needed in patients with less than four weeks of pain. The doctor may recommend physical therapy to help strengthen the core muscles of the back and the stomach. The physician will then have the patient come back for a follow-up in about 2-4 weeks, depending on pain level.
During the recovery time, if the patient does what they are told, the problem will usually resolve itself in about 4-6 weeks. If the patient takes it easy and eases back into their usual routine, the problem may never recur.
The cost associated with traditional treatment ranges based on the patient's insurance coverage. Usually, you have the copay that averages $25 for each time you go to the doctor. Then you have the prescription cost, depending on what meds were given; roughly about $30-$50. So, the bill is up to about $75 on the high end. But, let’s include physical therapy. That is a big one. If the doctor has prescribed it for three times a week for four weeks, and your insurance considers it a specialist, that makes the copay about $50 each visit! That is a whopping $600! Also figure in the time off of work needed to heal, go to appointments, and go back to the doctor for a follow-up! All of this cost, just for some low back pain.
Alternative Medicine
Now we will look at the alternative ways low back pain can be handled. The first choice for most is chiropractic care. Unfortunately, chiropractic care has gotten a bad rap for a long time. “In 1948, the president of the AMA announced they would totally destroy chiropractic by any means.” (Fueling, 1999, page 16) The care comes down to cost for some, but for others, it comes down to what works.
Let's suppose you have decided to see a chiropractor after waking up in terrible pain. Your low back is on fire, and it feels like you have slept on a rock all night. So this is your first visit with the chiropractor, and the first thing that is done is a history. The doctor will go over everything from what you do for a living, what extra activities you do, to how much you weigh, and what other avenues you have tried to relieve the pain. X-rays will be taken next. The chiropractor will be looking at the spacing of your discs, the curve in your neck, seeing if there is a curve in your spine, whether your hips are even. After the evaluation of your films, he will adjust you. The technique used by the chiropractor will depend on the amount of pain you are in, and how tight or inflamed the muscles surrounding the area. He will most likely begin with you lying on your stomach. You will feel him push down on your spine, usually starting out from about mid to low back and going up. After that, he will have you lie on one side and raise your knee up parallel with your other leg. He will use a twisting motion to adjust your hips and low back. You will roll over to the other side and will do the same to the other side. Then he will adjust your neck. When the adjustment is complete, he will probably do some therapy, usually a tens unit and ice for about twenty minutes. After you have completed therapy, the chiropractor will recommend what to do at home. Usually, you will ice for about twenty minutes about every two hours. Then he will set up at least two more visits for that week. Now, of course, some are saying, “Wait, the cost of that is going to be just as much as the traditional treatment!” The cost of chiropractic care is less than that of traditional care. Your copay will be the same with the chiropractor as with the traditional doctor. So let’s say $25. But you don’t have to buy any meds, and you may be lucky enough only to have to spend about $150-$200 on your copays with the chiropractor. “There is little evidence to guide the duration of therapy. Most clinical trials evaluated courses of twice weekly manipulation for two to three weeks, and none lasted more than nine weeks. Older American guidelines suggest that treatment last no longer than one month if patients are not improving; more recent European guidelines suggest "short" courses of therapy.”(Bigos,Braem,1994) The cost of seeing the chiropractor is so much lower also because the therapy is involved with the treatments.
Acupuncture
Let's take a look at another alternative treatment: acupuncture. You're getting ready for bed and you know that you are probably going to hurt in the morning. Your low back is already a little twingy, and you are hoping that with just a good night’s sleep, you will be ready in the morning. Morning comes, you roll over and prepare to stand up, and down you go. You can’t walk to the end of the bed. You realize that you have hurt your back. So, now what? The last time this happened, your best friend recommended you see her acupuncturist, and you scoffed at her. But, it is different this time. You had been to the doctor a few weeks ago for a simple cough and were put on a med that caused your blood pressure to rise, and you ended up missing a day of work because you had a headache so bad you couldn’t function. You call your friend and ask for the number. You call and make an appointment with the acupuncturist and almost start to second guess yourself because there is no way they can help with the amount of pain you are experiencing.
You hesitantly walk in and begin the new patient paperwork. After that is filled out, you find out that it is covered under your insurance. Score 1 for the friend on that one! The acupuncturist calls you back, and you try to sit down and realize that it hurts to sit down. You go over your history, what hurts, where, and how you might have sustained the injury. The typical acupuncture treatment begins with the identification of the patient's constitutional pattern. To accomplish this, acupuncturists use the "Four Pillars of Evaluation": inspection, auscultation, inquiring, and palpation.”(Birch,Felt,1999) Now it is needle time! Oh boy! So, you try to relax, and the acupuncturist says they are almost done. You ask if he's even started! He's already put about 15 needles in you, and you didn’t even know! It is time to relax. “In order to stimulate qi, the needles are twirled once when placed in the skin and then left in for at least 20-40 minutes.”(Synovitz, Larson, 2013, pg 105.) As you continue to relax, the pain seems to drift away. The needles are removed, and you are counseled on what is next. Maybe by changing some simple things in your life, you can help alleviate the pain. Examples of simples changes might be exercise, mattress, body weight, even your shoes. Leaving the office, you pay your copay of $25 and schedule to return twice more that week. Your total cost is $75. One day of lost wages. No medicine to take.
Massage Therapy
Yesterday, after going non-stop with shopping, working, raking leaves, carrying the baby, bending during bath time, washing dishes, and bringing that last load of laundry up from the basement, there is that all-too-familiar pain in your low back. You lie down and do a little stretching like you do in yoga, to try and calm the muscle down. This isn’t the first time this has started this way, but since you have been seeing a chiropractor frequently, you know what to do. The next morning you wake up and it isn’t any better but you don’t have time to stop and do anything. Off to work you go, realizing that the pain is not easing up at all. But the bills won’t pay themselves. At work, your boss asks you to move some boxes from the store room and you know you shouldn’t, but again, it’s back to that whole paying the bills part of life. After two boxes moved, out goes the back, and down you go. Your boss sends you to the chiropractor and you are able to see the massage therapist. She evaluates your pain level and what hurts and where. With some light movements, it is determined where the inflammation is, and she starts working on it. With light pressure and slow strokes you have to remind yourself to take deep breaths. She is always asking if the pressure is ok and can she go just a little deeper. She finds the major part of the pain in your low back near your SI joint and your QL muscle on the left side. Yep, time to stop carrying that small human being that has legs for a reason. The massage therapist tells you that she is going to use some ice and rub it on your skin around the area that is in the worst discomfort. She explains that the ice goes deeper into the tissue if she manually rubs it in. It is cold at first, but as the area numbs the pain disappears. Afterwards you get dressed with a lot less pain and the massage therapist explains that ice needs to be applied a few times a day for the next few days. She suggests you come back at least one more time towards the end of the week to see her and the chiropractor again. You are still stiff and sore as the week goes on. With the next treatment, she is able to go a little deeper and you don’t come up off the table! Finally feeling better, you are able to move and sleep so much better. “Research on patients with chronic lumbosacral pain suggested that massage was effective in reducing the intensity of pain and in improving patient’s functionality.”(Majchrzycki,Kocur,Kotwicki, 2014) So, looking back at my choice for coming to the chiropractor and the massage therapist, you are so much happier! And the cost was so much cheaper than you thought because the care was covered under insurance with only a $25 copay! You might have missed a half day of work, but that is still better than how much you could have missed if you had gone to a regular doctor and taken the prescriptions. Massage therapy clearly saved your back and your sanity.

Conclusion
Traditional medicine does have its place in today’s society. It does help with many things. It is vital for things like vaccines, wound care, breaks, and even reattachment surgery. The biggest issue with traditional medicine is how it is overused and abused. Between the pain meds and the side effects caused by those meds, our society is becoming addicted to chemically infused medicines and practices that are slowly killing everyone. A simple headache or back pain turns into an addiction. People lose their jobs, homes, and even families over what traditional medicine offers. Alternative medicines offer so much for everyone, from babies to senior citizens. The cost is usually cheaper and covered by insurance just as much as the traditional methods. It offers safe, time proven methods that do not harm the body, but use what the body has in itself to heal. The cost with alternative medicine can be as simple as some ginger root from the produce department to some peppermint tea. Doing some simple stretches can help with so many ailments. Low back pain is a plague across many countries. The US is not the only place that has working individuals that hurt themselves. By following some simple steps you can stop low back pain and the need for traditional medicine to step in.

Work Cited
1. A. D. Furlan, L. Brosseau, M. Imamura, and E. Irvin, “Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group,” Spine, vol. 27, no. 17, pp. 1896–1910, 2002.
2. Bigos S, Bowyer O, Braen G, et al. Acute low back pain in adults. Clinic Practice Guideline No. 14. Agency for Health Care Policy and Research; US Department of Health and Human Services, Rockville, MD 1994.
3. Birch, S, Felt, R. Understanding Acupuncture. Churchill Livingstone, London 1999
4. Fueling, Timothy J., Chiropractic Works! 1999
5. Institute for Clinical Systems Improvement. Adult low back pain. Bloomington, Minn: Institute for Clinical Systems Improvement;. Sept 2005.
6. Synovitz Linda Bailey, Larson Karl L., Complementary and Alternative Medicine for Health Professionals.