Dr. Robert Hayden
Chiropractor and Spokesperson, The American Chiropractic Association
Many things can cause chronic neck and back pain, from strained muscles and ligaments, to aging and osteoporosis, but a common cause is repetitive actions or postures associated with work. Dr. Robert Hayden, a chiropractor and spokesperson for the American Chiropractic Association, works with clients who have developed chronic pain over decades.
“I’m seeing a retired dentist,” Hayden said. “He spent his entire career sitting in a chair and leaning to his left. When you look at his X-ray, you see a spine leaning to the left. He assumed that posture so often and for such long hours through the day, that the musculature around his skeleton either contracted or stretched to accommodate that position. Now he’s trying to walk erect and he’s getting pain from it.”
Chronic postural pain is very common for people working at a desk all day, looking at a computer.
“People who sit at a desk a lot, I sometimes ask them to describe or take a picture of their workstation,” Hayden said. “Are their feet on the floor? Is the back supported and straight? Sitting properly is really important.”
Getting to the root
Hayden, who initially practiced as a cardiovascular clinical nurse specialist, became a chiropractor because of its noninvasive approach that addressed the structural causes of physical pain, rather than simply treating pain symptoms.
“We understand that structure determines function,” he said. “If we look at the natural history of a condition, look at how it evolved, intervene at the source, and correct the underlying structure, we’ll get really good results without having to create holes in people or do surgery.”
To evaluate the cause of chronic pain, chiropractors look at the combination of many factors.
“It starts with a very careful history,” Hayden said. “When I take a history on somebody, I’m going to ask a lot of questions that will seem a little odd. I’m going to ask them what they did for a living. Are they interested in sports? What I’m looking for is how they stressed their skeleton in the past.”
Sleeping postures also have a large impact on a patient’s physical history.
“You spend a third of your life in that posture, so I need to know what that is and how well your skeleton is supported during those sleeping hours,” Hayden said.
The best medicine
Prevention of the underlying causes is typically the best treatment.
“To prevent chronic pain, we recommend a lot of low-impact, aerobic exercise,” Hayden said. “I have a lot of people who are runners, and ten or fifteen years down the line, they have a lot of knee problems from the impact. You can get the same cardiovascular workout with a brisk walk.”
There are other surprising causes of chronic pain. A 2016 study has shown that cigarette smoking can have a direct link to back pain.
“The research says there are substances in cigarette smoke that destroy vitamin C,” Hayden said. “Vitamin C is necessary for retaining cartilage. If your cartilage is worn, you’re looking at osteoarthritis.”
While back and neck pain manifest physically, sometimes the cause can be mental.
“In chronic pain, whether it’s back pain, headaches, etc., there are psychological factors,” Hayden said. “Depression and anxiety affect the whole body and will intensify a pain experience.”
Hayden stressed the importance of treating pain holistically.
“If you concentrate only on your physical exam, you may miss the primary diagnosis if you don’t listen to what someone is telling you about their psyche,” he said. “This is something that a lot of patients won’t share, but you’ll find it if you look at how they’re carrying themselves.”