Back pain becomes Childs’ play

  • Published
  • By 1st Lt. Mike Chillstrom
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas (AFPN) --  Capt. John Childs, a physical therapist, is literally taking on a pain in the backside. By studying how patients respond to certain treatments, Captain Childs is aiming to reduce lower back pain, a condition that afflicts millions of Americans.

Captain Childs, an Air Force Institute of Technology student at the University of Pittsburgh, has spent the past year at Wilford Hall Medical Center here working on the first of two studies designed to reduce or eliminate lower back pain.

The first study, completed in April, identified patients likely to experience a rapid improvement after spinal manipulation, a treatment in which the physical therapist applies a quick thrust to the patient’s spine to increase mobility of the joints.

“A lot of studies have shown that manipulation is a beneficial treatment,” Captain Childs said. “But then other studies have shown it may not be helpful. This conflicting information suggests that there is probably a subgroup of patients for whom manipulation may be effective.”

Wilford Hall, one of eight centers nationwide where patient data was collected, contributed 32 of 131 patients for the study between February 2002 and April. Seven of the eight centers were military treatment facilities.

Captain Childs said this study aimed to validate a previously developed clinical prediction rule that identifies patients likely to experience a rapid improvement after manipulation.

“Among those people who have a really successful outcome from manipulation, what are the characteristics of those people?” he said.

For example, if a patient has symptoms A, B and C, then perhaps manipulation is the treatment of choice, he said. On the other hand, if the patient has symptoms X, Y and Z, another treatment may be more appropriate.

“Clinicians who use manipulation previously had to rely on the results of a largely inaccurate battery of tests to determine when spinal manipulation was appropriate,” Captain Childs said.

He found that manipulation is best for patients with low back pain when they have a relatively new onset of pain, pain centered in the back and buttocks that does not extend below the knee, stiffness in the lumbar spine, adequate hip rotation range of motion and individuals who are anxious to resume normal physical activity.

Patients who meet four of these five criteria have a 95 percent chance of experiencing a successful outcome from manipulation after only a week or two.

“The results of this study are immediately relevant for clinical practice because healthcare professionals who use manipulation can accurately identify those patients likely to receive a dramatic benefit in only a few days,” he said.

In October, Captain Childs received the 2003 Excellence in Research Award from the American Academy of Orthopaedic Manual Physical Therapists.

“It was a team effort; there were 15 to 20 people involved in managing this project,” Captain Childs said. “Our team was honored to receive this prestigious award.”

His success does not end with the research award. In November, he started a second study to evaluate the effectiveness of backward bending exercises in treating low back pain.

These backward bending exercises, called extension exercises, are traditionally used for patients whose back pain may be coming from a herniated disk. Sometimes a herniated disk can cause pain to extend down the legs. For a variety of reasons that are not well understood, backward bending helps to relieve pressure from the nerve, thus alleviating pain.

“We’re now trying to figure out who will benefit from this specific form of exercise,” Captain Childs said.

The second study will run throughout 2004 and collect data from roughly 120 patients, including some from Wilford Hall and a number of other military treatment facilities. An investigator will travel to each study site to train people and help set up the sites.

“The key is to recognize that not everyone with back pain is the same," said Captain Childs. "I’m excited for this study so we can learn more about low back pain and improve the quality of life for the multitude of individuals who experience back pain."