Low back pain

Cost of sickness

Low back pain costs society vast amounts of money; how is it made up?

Lumbar spine conditions, it is freely admitted, is imposing a real, rapidly increasing and substantial economic burden on society, despite the technological advances in recent years; and perhaps because of that so called progress.

A general pessimism prevails, owing to the disabling nature of chronic lumbar disorders, the economic cost to society, and the great expense to the patient, the insurer, and the loss of productivity in the place of work.

Last night I attended a lecture by an esteemed neurosurgeon. I came away with only one impression; chronic low back pain is just as challenging to the man with the knife as it is to the chiropractor.

Only in the presence of cauda equina signs, the inability to urinate, did he feel that there was urgency for a referral. Foot drops do not always recover after the procedure, and the humble man admitted that surgery can cause a paresis in the leg. Technically the operation is difficult, and just one slip can and does injure the nerve root.

Low Back Pain

Smoking is the cause of 50 percent of fusion failures, he said. That rings a bell with chiropractic too. The smoker with low back pain is far more difficult to manage. The tissues just don't get enough oxygen to heal properly.

So, we would both acknowledge that the treatment of back pain is clinically challenging, even to the most experienced doctor; whilst under care a bout of coughing, a prolonged sit, an awkward turn, the unexpected can radically change the course the condition is taking. Yesterday in my practice it was a patient just over a severe episode of low back pain who lifted and moved a bed "because it was too hard". Now he's back at square one. Worse in fact. Sometimes massaging bed rest is the only way.

The economic burden of a sickness

It's defined as the total of all expenses associated with a condition which would not otherwise be billed if that condition in fact did not exist. And that amounts to far more than just the chiropractor or surgeon's fees.


Economic costs related to low back pain are extremely difficult to measure. For example, the so called OPPORTUNITY cost is that value which corresponds best to another and perhaps better use of that money;

Would for example the economic saving by avoiding expensive surgery, scans and hospitalisation and using more conservative means actually provide in the long term a lower sum of the total expenses?

Would the savings associated with sending a patient with low back pain back to the work place too soon, with the attendant risk of a relapse, be greater or less than the acknowledged increasing risk of allowing the patient to remain too long away from work?

Is your work hard and physical? Then obviously return to the work place must be done with care and guidance.

On the other hand, sitting is often reckoned to be the greatest enemy of the low back.


What then is this total cost of lower lumbar back pain — the economic burden? Economists point to three components:


Lower lumbar back pain direct costs would include the services of medical doctors and complementary practitioners such as chiropractors, medication, hospitals, scans etc. These are relatively easy to estimate, but it would also include the cost of travel to the doctor and even renovations to the patient's home to make it more accessible to a person disabled by chronic LBP.

Economic surveys of ten countries found that 65% of direct costs went to medical care, excluding imaging, whereas only 5% was allocated to Chiropractic Help care in the treatment of LBP.


Lower lumbar back pain causes loss of productivity due to sick leave, ‘absenteeism’ and the decreased 'presence' of the patient; the so called ‘presenteeism’ is staggeringly large; the patient is in fact present at work but ineffectual. These indirect costs may be even greater than the direct costs.

This is where chiropractic really comes into its own; numerous Workman’s Compensation studies conclude that chiropractors get their patients back on the job sooner.

  • Lost earnings,
  • early retirement and the
  • inability of an employers to replace an essential worker – the so called friction cost - are included in the indirect costs.
  • Help hired in the home to do vacuuming, say, and to do routine maintenance tasks such as cleaning gutters and mowing the lawn, which could not done due to low back pain.

Lost productivity costs due to low back pain was estimated at seventeen billion dollars in a 2006 US economics study. (Spine 31)


The economic costs should also include the value of decreased fulfilment from life because of illness. However, these intangible costs are rarely included when estimating the economic burden of an illness; how does one place a monetary value on the enjoyment of life? Regularly at Chiropractic Help I get letters from people whose lives have been completely dominated and ruined by low back pain. But how do you estimate this "intangible cost?"

Personal medical insurance

To be insured, or not to be insured, that is the question. Personal medical insurance is, obviously, a very personal decision. For your peace of mind, do you NEED full insurance? Just a hospital plan?

Do you have the discipline to deposit your premium on a debit order into your own "medical" account, instead of into that "insurance company account?"

Are you comfortable having "NO INSURANCE"? If you can get through the first three years without a disaster, and have the discipline not to plunder than "medical account" then, provided you follow the basic laws of good health, you're into a big win to nothing.

Smoker? Obese? Couch potato? Dislike apples and fruit? Won't eat your mandantory five colours a day? You need full insurance. Don't even start to think about a personal medical insurance.



Every chiropractor knows it, and it's the most important factor in failed back surgery, that the patient who smokes and/or has seriously raised serum cholesterol is much more difficult to manage.

Why is that? Chiropractic Help will help you grasp it: Smokers have far more back pain too ...


Numerous studies related to LBP suggest that the greatest economic cost savings from society's perspective may be obtained by early return to work and minimizing lost productivity.

Further studies point that overall this is also to the patient’s benefit, and not only the employer and the health insurer.

Furthermore, exercise, rehabilitation and fear avoidance training are all considered vital in achieving a good end result in the care of the patient suffering from lower lumbar back pain.

Alternative care for low back pain saves insurance companies huge amounts.

A 2005 study reported in the journal Spine of 190,000 patients suffering from lower lumbar back pain clearly showed that inclusion of Chiropractic Help resulted in significant economic savings for two insurance companies;

  • $342 per patient for those consulting mainly chiropractors –vs-
  • $506 for those consulting mainly medical doctors, and this excluded lumbar spinal surgery and hospital costs.

* Spine is one of the most respected medical journals.


Done faithfully every morning before getting out of bed, less than one minute, these basic lower back exercises will make a profound difference to the health of your lumbar spine and sacroiliac joints. LOWER BACK EXERCISES ...watch a short YouTube video.

Chiropractic Help

On a personal note...

I have over the years, like most people, had recurrent episodes of low back pain. It's the result in part of a short leg and the sort of injuries that every one has. A ladder sliding to the side, lifting a heavy roll of wire for launching my glider, thirty years of playing squash at a fairly high level, and lifting beehives have all taken their toll.

What's interesting is that five months ago I went into semi retirement. At 62 definitely over the hill; and started spending a large amount of time doing heavy gardening. Within weeks I had an acute episode of low back pain that my daughter, Dr Jane Ackerman DC, had to sort out; very competently, if I say it myself. But since then my whole back has got stronger and stronger. Not a twinge in the last months except when sitting at this damn computer.

The enemy of the back is the chair. The friend? Physical activity. For me that's meant making my own compost heap and growing green beans, and cooking them too, and the like. That's meant stalking my garden, paintball gun in hand, watching for Stealth, the monkey who has a liking for my sweetcorn and butternut squash. To date it's Stealth 10 to Bernard Preston 0; he just cleaned us out but just you wait, Stealth, just you wait. I'm ready for you, and just as determined and patient as you are to raid and decimate our garden.

My point? The back thrives on exercise. The deckchair and car seat is its downfall. Couch potato? You'll pay for it in more ways than one. Low back pain is a costly affair. Especially when the leg pain starts...

Leg length inequality

A short leg - how short is short remains controversial - contributes greatly to the direct costs of health care. It increases back pain and neck pain, is one of the significant causes of Maignes syndrome (upper lumbar pain radiating to the buttock and groin), but also to hip arthritis and knee arthritis symptoms ...

A simple shoe insert, inexpensive, can make an enormous difference, but deciding whether it should go in the shoe, just under the heel, the whole inner, how thick, under the shoe, whether pronation should be corrected, is problematic. Leg length inequality ...

Note the very unlevel pelvis. A short leg can be hereditary, but also caused by trauma to the leg, or even a flat foot.

Useful Links to prevent Lumbar Surgery

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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