Chiropractic care is a well-known alternative treatment option commonly used for a variety of injuries and/or conditions, including low back pain and sciatica. Of course, not all pain is physical nor does it always have a physical cause. Stress, anxiety and depression affects millions of people each year. While many patients require prescription drug therapy to treat their mental health issues, others may be able to control and treat they symptoms with a holistic approach. Chiropractic care is an effective stress management treatment which can help reduce symptoms associated with stress, such as low back pain and sciatica.
How Does Stress Affect the Body?
There are 3 major categories of stress: bodily, environmental and emotional.
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- Bodily stress: Caused by lack of sleep, disease, trauma or injury, and an improper nutrition.
- Environmental stress: Caused by loud noises (sudden or sustained), pollution and world events, such as war and politics.
- Emotional stress: Caused by a variety of life events, such as moving homes, starting a new job and regular personal interactions. In contrast to the other two categories of stress, however, people can have some control over their emotional stress. Such can depend on the individual’s own attitude.
Stress can affect the human body in a variety of ways, both positively and negatively, physically and emotionally. Although short-term stress can be helpful, long-term stress can cause many cumulative health issues on both the mind and body. Stress activates the “fight or flight” response, a defense mechanism triggered by the sympathetic nervous system to prepare the body for perceived danger by increasing heart rate and breathing as well as the senses, by way of instance, eyesight can become more acute. Once the stressor goes away, the central nervous system relays the message to the body and the vitals return to normal.
In several instances, the central nervous system can fail to relay the signal to the body when it is time to return to its relaxed state. Many people also experience persistent, recurrent stress, referred to as chronic stress. Either occurrence takes a toll on the human body. This type of stress can often lead to pain, anxiety, irritability and depression.
Managing Your Stress
Chronic stress can cause painful symptoms, such as low back pain and sciatica, which can then cause more stress. Pain generally contributes to mood issues, such as anxiety and depression, clouded thought processes, and an inability to concentrate. Individuals with chronic stress who experience painful symptoms may feel unable to perform and engage in regular activities.
Stress management treatment can help people improve as well as manage their chronic stress and its associated symptoms. Chiropractic care can help reduce pain and muscle tension, further decreasing stress. The central nervous system can also benefit from the effects of chiropractic treatment. The central nervous system, or CNS, helps regulate mood, as well as full-body health and wellness, meaning that a balanced central nervous system can help enhance overall well-being.
Benefits of Chiropractic Care
Chiropractic care is a holistic treatment approach, designed to return the body to the original state it needs to maintain the muscles and joints functioning properly. Chronic stress can cause muscle tension along the back, which can eventually lead to spinal misalignments. A misalignment of the spine, or a subluxation, can contribute to a variety of symptoms, including nausea and vomiting, headaches and migraines, stress and digestive issues. A chiropractor utilized spinal adjustments and manual manipulations to release pressure and decrease the inflammation around the spine to improve nerve function and allow the body to heal itself naturally. Alleviating pain can ultimately help decrease stress and enhance overall health and wellness. Chiropractic care can also include massage as well as counseling to help control stress, anxiety and depression.
A Holistic Care Approach
Most chiropractors will utilize other treatment methods and techniques, such as physical therapy, exercise, and nutrition advice, to further increase the stress management effects of chiropractic care. These lifestyle changes affect every area of your well-being. Furthermore, the purpose of the article below is to demonstrate the effects of mindfulness-based stress reduction compared to cognitive-behavioral therapy and usual care on stress with associated symptoms of chronic low back pain and sciatica.
Effects of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy and Usual Care on Back Pain and Functional Limitations among Adults with Chronic Low Back Pain: A Randomized Clinical Trial
Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.
To evaluate the effectiveness for chronic low back pain of MBSR versus usual care (UC) and cognitive-behavioral therapy (CBT).
Design, Setting, and Participants
Randomized, interviewer-blind, controlled trial in integrated healthcare system in Washington State of 342 adults aged 20–70 years with CLBP enrolled between September 2012 and April 2014 and randomly assigned to MBSR (n = 116), CBT (n = 113), or UC (n = 113).
CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. UC included whatever care participants received.
Main Outcomes and Measures
Co-primary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range 0 to 23) and in self-reported back pain bothersomeness (0 to 10 scale) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.
Among 342 randomized participants (mean age, 49 (range, 20–70); 225 (66%) women; mean duration of back pain, 7.3 years (range 3 months to 50 years), <60% attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks and 290 (84.8%) completed the study 52weeks. In intent-to-treat analyses, at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for MBSR (61%) and CBT (58%) than for UC (44%) (overall P = 0.04; MBSR versus UC: RR [95% CI] = 1.37 [1.06 to 1.77]; MBSR versus CBT: 0.95 [0.77 to 1.18]; CBT versus UC: 1.31 [1.01 to 1.69]. The percentage of participants with clinically meaningful improvement in pain bothersomeness was 44% in MBSR and 45% in CBT, versus 27% in UC (overall P = 0.01; MBSR versus UC: 1.64 [1.15 to 2.34]; MBSR versus CBT: 1.03 [0.78 to 1.36]; CBT versus UC: 1.69 [1.18 to 2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.
Conclusions and Relevance
Among adults with chronic low back pain, treatment with MBSR and CBT, compared with UC, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.
Low back pain is a leading cause of disability in the U.S. . Despite numerous treatment options and greatly increased medical care resources devoted to this problem, the functional status of persons with back pain in the U.S. has deteriorated [2, 3]. There is need for treatments with demonstrated effectiveness that are low-risk and have potential for widespread availability.
Psychosocial factors play important roles in pain and associated physical and psychosocial disability . In fact, 4 of the 8 non-pharmacologic treatments recommended for persistent back pain include “mind-body” components . One of these, cognitive-behavioral therapy (CBT), has demonstrated effectiveness for various chronic pain conditions [5–8] and is widely recommended for patients with chronic low back pain (CLBP). However, patient access to CBT is limited. Mindfulness-Based Stress Reduction (MBSR) , another “mind-body” approach, focuses on increasing awareness and acceptance of moment-to-moment experiences, including physical discomfort and difficult emotions. MBSR is becoming increasingly popular and available in the U.S. Thus, if demonstrated beneficial for CLBP, MBSR could offer another psychosocial treatment option for the large number of Americans with this condition. MBSR and other mindfulness-based interventions have been found helpful for a range of conditions, including chronic pain [10–12]. However, only one large randomized clinical trial (RCT) has evaluated MBSR for CLBP , and that trial was limited to older adults.
This RCT compared MBSR with CBT and usual care (UC). We hypothesized that adults with CLBP randomized to MBSR would show greater short- and long-term improvement in back pain-related functional limitations, back pain bothersomeness, and other outcomes, as compared with those randomized to UC. We also hypothesized that MBSR would be superior to CBT because it includes yoga, which has been found effective for CLBP .
Study Design, Setting, and Participants
We previously published the Mind-Body Approaches to Pain (MAP) trial protocol . The primary source of participants was Group Health (GH), a large integrated healthcare system in Washington State. Letters describing the trial and inviting participation were mailed to GH members who met the electronic medical record (EMR) inclusion/exclusion criteria, and to random samples of residents in communities served by GH. Individuals who responded to the invitations were screened and enrolled by telephone (Figure 1). Potential participants were told that they would be randomized to one of “two different widely-used pain self-management programs that have been found helpful for reducing pain and making it easier to carry out daily activities” or to continued usual care plus $50. Those assigned to MBSR or CBT were not informed of their treatment allocation until they attended the first session. We recruited participants from 6 cities in 10 separate waves.
We recruited individuals 20 to 70 years of age with non-specific low back pain persisting at least 3 months. Persons with back pain associated with a specific diagnosis (e.g., spinal stenosis), with compensation or litigation issues, who would have difficulty participating (e.g., unable to speak English, unable to attend classes at the scheduled time and location), or who rated pain bothersomeness <4 and/or pain interference with activities <3 on 0–10 scales were excluded. Inclusion and exclusion criteria were assessed using EMR data for the previous year (for GH enrollees) and screening interviews. Participants were enrolled between September 2012 and April 2014. Due to slow enrollment, after 99 participants were enrolled, we stopped excluding persons 64–70 years old, GH members without recent visits for back pain, and patients with sciatica. The trial protocol was approved by the GH Human Subjects Review Committee. All participants gave informed consent.
Immediately after providing consent and completing the baseline assessment, participants were randomized in equal proportions to MBSR, CBT, or UC. Randomization was stratified by the baseline score (≤12 versus ≥13, 0–23 scale) of one of the primary outcome measures, the modified Roland Disability Questionnaire (RDQ) . Participants were randomized within these strata in blocks of 3, 6, or 9. The stratified randomization sequence was generated by the study biostatistician using R statistical software , and the sequence was stored in the study recruitment database and concealed from study staff until randomization.
All participants received any medical care they would normally receive. Those randomized to UC received $50 but no MBSR training or CBT as part of the study and were free to seek whatever treatment, if any, they desired.
The interventions were comparable in format (group), duration (2 hours/week for 8 weeks, although the MBSR program also included an optional 6-hour retreat), frequency (weekly), and number of participants per group [See reference 15 for intervention details]. Each intervention was delivered according to a manualized protocol in which all instructors were trained. Participants in both interventions were given workbooks, audio CDs, and instructions for home practice (e.g., meditation, body scan, and yoga in MBSR; relaxation and imagery in CBT). MBSR was delivered by 8 instructors with 5 to 29 years of MBSR experience. Six of the instructors had received training from the Center for Mindfulness at the University of Massachusetts Medical School. CBT was delivered by 4 licensed Ph.D.-level psychologists experienced in group and individual CBT for chronic pain. Checklists of treatment protocol components were completed by a research assistant at each session and reviewed weekly by a study investigator to ensure all treatment components were delivered. In addition, sessions were audio-recorded and a study investigator monitored instructors’ adherence to the protocol in person or via audio-recording for at least one session per group.
MBSR was modelled closely after the original MBSR program , with adaptation of the 2009 MBSR instructor’s manual  by a senior MBSR instructor. The MBSR program does not focus specifically on a particular condition such as pain. All classes included didactic content and mindfulness practice (body scan, yoga, meditation [attention to thoughts, emotions, and sensations in the present moment without trying to change them, sitting meditation with awareness of breathing, walking meditation]). The CBT protocol included CBT techniques most commonly applied and studied for CLBP [8, 19–22]. The intervention included (1) education about chronic pain, relationships between thoughts and emotional and physical reactions, sleep hygiene, relapse prevention, and maintenance of gains; and (2) instruction and practice in changing dysfunctional thoughts, setting and working towards behavioral goals, relaxation skills (abdominal breathing, progressive muscle relaxation, guided imagery), activity pacing, and pain coping strategies. Between-session activities included reading chapters of The Pain Survival Guide . Mindfulness, meditation, and yoga techniques were proscribed in CBT; methods to challenge dysfunctional thoughts were proscribed in MBSR.
Trained interviewers masked to treatment group collected data by telephone at baseline (before randomization) and 4 (mid-treatment), 8 (post-treatment), 26 (primary endpoint), and 52 weeks post-randomization. Participants were compensated $20 for each interview.
Sociodemographic and back pain information was obtained at baseline (Table 1). All primary outcome measures were administered at each time-point; secondary outcomes were assessed at all time-points except 4 weeks.
Back pain-related functional limitation was assessed by the RDQ , modified to 23 (versus the original 24) items and to ask about the past week rather than today only. Higher scores (range 0–23) indicate greater functional limitation. The original RDQ has demonstrated reliability, validity, and sensitivity to clinical change . Back pain bothersomeness in the past week was measured by a 0–10 scale (0 = “not at all bothersome,” 10 = “extremely bothersome”). Our primary analyses examined the percentages of participants with clinically meaningful improvement (≥30% improvement from baseline)  on each measure. Secondary analyses compared the adjusted mean change from baseline between groups.
Depressive symptoms were assessed by the Patient Health Questionnaire-8 (PHQ-8; range, 0–24; higher scores indicate greater severity) . Anxiety was measured using the 2-item Generalized Anxiety Disorder scale (GAD-2; range, 0–6; higher scores indicate greater severity) . Characteristic pain intensity was assessed as the mean of three 0–10 ratings (current back pain and worst and average back pain in the previous month; range, 0–10; higher scores indicate greater intensity) from the Graded Chronic Pain Scale . The Patient Global Impression of Change scale  asked participants to rate their improvement in pain on a 7-point scale (“completely gone, much better, somewhat better, a little better, about the same, a little worse, and much worse”). Physical and mental general health status were assessed with the 12-item Short-Form Health Survey (SF-12) (0–100 scale; lower scores indicate poorer health status) . Participants were also asked about their use of medications and exercise for back pain during the previous week.
Adverse experiences were identified during intervention sessions and by follow-up interview questions about significant discomfort, pain, or harm caused by the intervention.
A sample size of 264 participants (88 in each group) was chosen to provide adequate power to detect meaningful differences between MBSR and CBT and UC at 26 weeks. Sample size calculations were based on the outcome of clinically meaningful improvement (≥30% from baseline) on the RDQ . Estimates of clinically meaningful improvement in the intervention and UC groups were based on unpublished analyses of data from our previous trial of massage for CLBP in a similar population . This sample size provided adequate power for both co-primary outcomes. The planned sample size provided 90% power to detect a 25% difference between MBSR and UC in the proportion with meaningful improvement on the RDQ, and ≥80% power to detect a 20% difference between MBSR and CBT, assuming 30% of UC participants and 55% of CBT participants showed meaningful improvement. For meaningful improvement in pain bothersomeness, the planned sample size provided ≥80% power to detect a 21.8% difference between MBSR and UC, and a 16.7% difference between MBSR and CBT, assuming 47.5% in UC and 69.3% in CBT showed meaningful improvement.
Allowing for an 11% loss to follow-up, we planned to recruit 297 participants (99 per group). Because observed follow-up rates were lower than expected, an additional wave was recruited. A total of 342 participants were randomized to achieve a target sample size of 264 with complete outcome data at 26 weeks.
Following the pre-specified analysis plan , differences among the three groups on each primary outcome were assessed by fitting a regression model that included outcome measures from all four time-points after baseline (4, 8, 26, and 52 weeks). A separate model was fit for each co-primary outcome (RDQ and bothersomeness). Indicators for time-point, randomization group, and the interactions between these variables were included in each model to estimate intervention effects at each time-point. Models were fit using generalized estimating equations (GEE) , which accounted for possible correlation within individuals. For binary primary outcomes, we used a modified Poisson regression model with a log link and robust sandwich variance estimator  to estimate relative risks. For continuous measures, we used linear regression models to estimate mean change from baseline. Models adjusted for age, sex, education, pain duration (<1 year versus ≥1 year since experiencing a week without back pain), and the baseline score on the outcome measure. Evaluation of secondary outcomes followed a similar analytic approach, although models did not include 4-week scores because secondary outcomes were not assessed at 4 weeks.
We evaluated the statistical significance of intervention effects at each time-point separately. We decided a priori to consider MBSR successful only if group differences were significant at the 26-week primary endpoint. To protect against multiple comparisons, we used the Fisher protected least-significant difference approach , which requires that pairwise treatment comparisons are made only if the overall omnibus test is statistically significant.
Because our observed follow-up rates differed across intervention groups and were lower than anticipated (Figure 1), we used an imputation method for non-ignorable nonresponse as our primary analysis to account for possible non-response bias. The imputation method used a pattern mixture model framework using a 2-step GEE approach . The first step estimated the GEE model previously outlined with observed outcome data adjusting for covariates, but further adjusting for patterns of non-response. We included the following missing pattern indicator variables: missing one outcome, missing one outcome and assigned CBT, missing one outcome and assigned MBSR, and missing ≥2 outcomes (no further interaction with group was included because very few UC participants missed ≥2 follow-up time-points). The second step estimated the GEE model previously outlined, but included imputed outcomes from step 1 for those with missing follow-up times. We adjusted the variance estimates to account for using imputed outcome measures for unobserved outcomes.
All analyses followed an intention-to-treat approach. Participants were included in the analysis by randomization assignment, regardless of level of intervention participation. All tests and confidence intervals were 2-sided and statistical significance was defined as a P-value ≤ 0.05. All analyses were performed using the statistical package R version 3.0.2 .
Figure 1 depicts participant flow through the study. Among 1,767 individuals expressing interest in study participation and screened for eligibility, 342 were enrolled and randomized. The main reasons for exclusion were inability to attend treatment sessions, pain lasting <3 months, and minimal pain bothersomeness or interference with activities. All but 7 participants were recruited from GH. Almost 90% of participants randomized to MBSR and CBT attended at least 1 session, but only 51% in MBSR and 57% in CBT attended at least 6 sessions. Only 26% of those randomized to MBSR attended the 6-hour retreat. Overall follow-up response rates ranged from 89.2% at 4 weeks to 84.8% at 52 weeks, and were higher in the UC group.
At baseline, treatment groups were similar in sociodemographic and pain characteristics except for more women in UC and fewer college graduates in MBSR (Table 1). Over 75% reported at least one year since a week without back pain and most reported pain on at least 160 of the previous 180 days. The mean RDQ score (11.4) and pain bothersomeness rating (6.0) indicated moderate levels of severity. Eleven percent reported using opioids for their pain in the past week. Seventeen percent had at least moderate levels of depression (PHQ-8 scores ≥10) and 18% had at least moderate levels of anxiety (GAD-2 scores ≥3).
At the 26-week primary endpoint, the groups differed significantly (P = 0.04) in percent with clinically meaningful improvement on the RDQ (MBSR 61%, UC 44%, CBT 58%; Table 2a). Participants randomized to MBSR were more likely than those randomized to UC to show meaningful improvement on the RDQ (RR = 1.37; 95% CI, 1.06–1.77), but did not differ significantly from those randomized to CBT. The overall difference among groups in clinically meaningful improvement in pain bothersomeness at 26 weeks was also statistically significant (MBSR 44%, UC 27%, CBT 45%; P = 0.01). Participants randomized to MBSR were more likely to show meaningful improvement when compared with UC (RR = 1.64; 95% CI, 1.15–2.34), but not when compared with CBT (RR = 1.03; 95% CI, 0.78–1.36). The significant differences between MBSR and UC, and non-significant differences between MBSR and CBT, in percent with meaningful function and pain improvement persisted at 52 weeks, with relative risks similar to those at 26 weeks (Table 2a). CBT was superior to UC for both primary outcomes at 26, but not 52, weeks. Treatment effects were not apparent before end of treatment (8 weeks). Generally similar results were found when the primary outcomes were analyzed as continuous variables, although more differences were statistically significant at 8 weeks and the CBT group improved more than the UC group at 52 weeks (Table 2b).
Mental health outcomes (depression, anxiety, SF-12 Mental Component) differed significantly across groups at 8 and 26, but not 52, weeks (Table 3). Among these measures and time-points, participants randomized to MBSR improved more than those randomized to UC only on the depression and SF-12 Mental Component measures at 8 weeks. Participants randomized to CBT improved more than those randomized to MBSR on depression at 8 weeks and anxiety at 26 weeks, and more than the UC group at 8 and 26 weeks on all three measures.
The groups differed significantly in improvement in characteristic pain intensity at all three time-points, with greater improvement in MBSR and CBT than in UC and no significant difference between MBSR and CBT. No overall differences in treatment effects were observed for the SF-12 Physical Component score or self-reported use of medications for back pain. Groups differed at 26 and 52 weeks in self-reported global improvement, with both the MBSR and CBT groups reporting greater improvement than the UC group, but not differing significantly from each other.
Thirty of the 103 (29%) participants attending at least 1 MBSR session reported an adverse experience (mostly temporarily increased pain with yoga). Ten of the 100 (10%) participants who attended at least one CBT session reported an adverse experience (mostly temporarily increased pain with progressive muscle relaxation). No serious adverse events were reported.
Dr. Alex Jimenez’s Insight
Stress management treatment includes a combination of stress management methods and techniques as well as lifestyle changes to help improve and manage stress and its associated symptoms. Because every person responds to stress in a wide variety of ways, treatment for stress will often vary greatly depending on the specific symptoms the individual is experiencing and according to their grade of severity. Chiropractic care is an effective stress management treatment which helps reduce chronic stress and its associated symptoms by reducing pain and muscle tension on the structures surrounding the spine. A spinal misalignment, or subluxation, can create stress and other symptoms, such as low back pain and sciatica. Furthermore, the results of the article above demonstrated that mindfulness-based stress reduction, or MBSR, is an effective stress management treatment for adults with chronic low back pain.
Among adults with CLBP, both MBSR and CBT resulted in greater improvement in back pain and functional limitations at 26 and 52 weeks, as compared with UC. There were no meaningful differences in outcomes between MBSR and CBT. The effects were moderate in size, which has been typical of evidence-based treatments recommended for CLBP . These benefits are remarkable given that only 51% of those randomized to MBSR and 57% of those randomized to CBT attended ≥6 of the 8 sessions.
Our findings are consistent with the conclusions of a 2011 systematic review  that “acceptance-based” interventions such as MBSR have beneficial effects on the physical and mental health of patients with chronic pain, comparable to those of CBT. They are only partially consistent with the only other large RCT of MBSR for CLBP , which found that MBSR, as compared with a time- and attention-matched health education control group, provided benefits for function at post-treatment (but not at 6-month follow-up) and for average pain at 6-month follow-up (but not post-treatment). Several differences between our trial and theirs (which was limited to adults ≥65 years and had a different comparison condition) could be responsible for differences in findings.
Although our trial lacked a condition controlling for nonspecific effects of instructor attention and group participation, CBT and MBSR have been shown to be more effective than control and active interventions for pain conditions. In addition to the trial of older adults with CLBP  that found MBSR to be more effective than a health education control condition, a recent systematic review of CBT for nonspecific low back pain found CBT to be more effective than guideline-based active treatments in improving pain and disability at short- and long-term follow-ups . Further research is needed to identify moderators and mediators of the effects of MBSR on function and pain, evaluate benefits of MBSR beyond one year, and determine its cost-effectiveness. Research is also needed to identify reasons for session non-attendance and ways to increase attendance, and to determine the minimum number of sessions required.
Our finding of increased effectiveness of MBSR at 26–52 weeks relative to post-treatment for both primary outcomes contrasts with findings of our previous studies of acupuncture, massage, and yoga conducted in the same population as the current trial [30, 36, 37]. In those studies, treatment effects decreased between the end of treatment (8 to 12 weeks) and long-term follow-up (26 to 52 weeks). Long-lasting effects of CBT for CLBP have been reported [7, 38, 39]. This suggests that mind-body treatments such as MBSR and CBT may provide patients with long-lasting skills effective for managing pain.
There were more differences between CBT and UC than between MBSR and UC on measures of psychological distress. CBT was superior to MBSR on the depression measure at 8 weeks, but the mean difference between groups was small. Because our sample was not very distressed at baseline, further research is needed to compare MBSR to CBT in a more distressed patient population.
Limitations of this study must be acknowledged. Study participants were enrolled in a single healthcare system and generally highly educated. The generalizability of findings to other settings and populations is unknown. About 20% of participants randomized to MBSR and CBT were lost to follow-up. We attempted to correct for bias from missing data in our analyses by using imputation methods. Finally, the generalizability of our findings to CBT delivered in an individual rather than group format is unknown; CBT may be more effective when delivered individually . Study strengths include a large sample with adequate statistical power to detect clinically meaningful effects, close matching of the MBSR and CBT interventions in format, and long-term follow-up.
Among adults with chronic low back pain, treatment with MBSR and CBT, compared with UC, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.
Funding/Support: Research reported in this publication was supported by the National Center for Complementary & Integrative Health of the National Institutes of Health under Award Number R01AT006226. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Role of sponsor: The study funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
- Daniel C. Cherkin, Group Health Research Institute; Departments of Health Services and Family Medicine, University of Washington.
- Karen J. Sherman, Group Health Research Institute; Department of Epidemiology, University of Washington.
- Benjamin H. Balderson, Group Health Research Institute, University of Washington.
- Andrea J. Cook, Group Health Research Institute; Department of Biostatistics, University of Washington.
- Melissa L. Anderson, Group Health Research Institute, University of Washington.
- Rene J. Hawkes, Group Health Research Institute, University of Washington.
- Kelly E. Hansen, Group Health Research Institute, University of Washington.
- Judith A. Turner, Departments of Psychiatry and Behavioral Sciences and Rehabilitation Medicine, University of Washington.
In conclusion, chiropractic care is recognized as an effective stress management treatment for low back pain and sciatica. Because chronic stress can cause a variety of health issues over time, improving as well as managing stress accordingly is essential towards achieving overall health and wellness. Additionally, as demonstrated in the article above comparing the effects of mindfulness-based stress reduction with cognitive-behavioral therapy and usual care for stress with associated chronic low back pain, mindfulness-based stress reduction, or MBSR, is effective as a stress management treatment. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.
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These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
- Dr. Alexander D. Jimenez D.C., C.C.S.TChief Clinical DirectorPhone: 9155408444Email: email@example.com
Specializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.
Message from: Dr. Alex Jimenez D.C., C.C.S.T
( Biography and my promise to you )
My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...
My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.
The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.
Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.
As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.
My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.
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Truide has been working for the past 20 years in claims resolutions. She works hand in hand with patients and is availible to resolve dispute resolutions.
Truide Torres (Bio)
Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.
Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.
As a wife and mother of 2 children, 3 dogs and 2 Cats. My passion is for God, Family and the mission of serving my fellow man.
Let it be clearly stated... I am here to help. My phone 915-850-0900Read moreRead less
- Daniel AlvaradoExercise PhysiologistPhone: 9152038122Email: email@example.com
Daniel Alvarado is the owner and the top trainer at PUSHasRx® CrossFit Fitness Facility. Since becoming a Trainer Daniel has kept up to date on many continuing educational classes, ensuring that his clients receive the most comprehensive and advanced training. Working directly with the Doctors, he develops and collaborates on care plans that are patient specific. No patient ever gets the same clinical protocol. His expert clinical kinesiology experience spans over 2 decades. He has trained injured patients and NCAA National Champion Athletes. His technical ability to create programs that are clinically sound and second to none. He too has used his physical therapy and recovery experience to take broken top tier athletes into strict recovery protocols assisting them to achieve highly competitive national championships. He certainly will not admit it but, he is a top national champion trainer. Daniel, also develops youth programs that are sport specific to aid young athletes achieve great success. His mastery of clinical recovery is applied applied to all patients and top tier athletes alike. All patient programs are specifically designed with patient focused recovery priorities. He is happily married to beautiful Victoria Alvarado has one child. He enjoys strength training, movies, singing, conducting, writing poetry and being a CrossFit champion. Just a way cool dude. We think you will agree.Read moreRead less
- Dennise AcostaHead Office ManagerPhone: 915-850-0900Email: firstname.lastname@example.org
Dennise has been at Injury Medical & Chiropractic Clinic for four years. Known as the master multi-tasker. Dennise, handles patient care from the moment you walk in the door. She is akin to the air traffic controller. She will assist you in matter requiring clinical preparation and effective inter-office communication. She unifies all department and clinical providers making sure all important information reaches all clinicians in a timely manner. She also loves to work out, stay in shape, watch movies and help people.Read moreRead less
- Sandra MartinezHead Clinical TherapistPhone: 915-850-0900Email: email@example.com
Sandra has been working at Injury Medical & Chiropractic Clinic for over 5 years. As the head Licensed Massage Therapist, she manages and directs critical aspect of clinical care. The patients love her ability to make you laugh while removing those pesky trigger points causing pain. She is able to relax and bring comfort to all she touches. There just simply is no patient that escapes her talented touch. Trained in advance myofascial techniques, she is an integral part of patient recovery. You will never see anything but a kind smile and resolute persona ready to correct your condition and aid in your recovery. She definitely enjoys helping people, has 1 dog and loves movies. She loves flowers too.Read moreRead less
- AlejandraBilling AgentPhone: 915-850-0900Email: firstname.lastname@example.org
Alejandra works in accounts & billing. She is the radar of the bunch. Nothing appears to escape her mind. Highly intelligent and appears not to need a computer for recall of facts. She provides information retrieval for patients and clinical staff. She has been at Injury Medical & Chiropractic Clinic for three years and ready for any task at hand. She performs interoffice communications with attorneys and medical director of ancillary offices. She loves her family and places know how to prioritize well.Read moreRead less
- Mike ContrerasPersonal TrainerPhone: 915-203-8122
Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.Read moreRead less
- Alexander Isaiah JimenezCollegiate Athletic Consultant & NCAA Wrestling ChampionPhone: 915-820-9443Email: email@example.com
Alexander Isaiah Jimenez leads the power and agility education programs for the high school athletes. While still studying for his medical degree he provides physical performance testing in order to collaborate with clinicians. He is gifted in creating physical performance programs no matter what the clinical presentation is. As national fitness champion and collegiate wrestler, he too understands what performing at high levels entails. He too has had to recover from debilitating injuries only to return better then before an win national titles. He understand how the recovery process is different for clients, patients and extreme athletes. We are blessed to have his counsel.Read moreRead less
- Ethan PadillaPersonal Trainer & Strength CoachPhone: 915-203-8122
Ethan was born and raised in El Paso and is one of our most outgoing and friendly coaches. Ethan earned his nickname “rampage Ethan” from his years at El Dorado High School, where he played inside linebacker. He has placed twice in the Strongman Competition and also recently competed in the Desert Games with his fellow PUSH Athletes as a team and placed 4th overall! Ethan is currently pursuing his Bachelor’s Degree in Kinesiology at UTEP. His focus on clients is obvious to all. Ethan is able to manage very large groups of individuals like no other. His awareness of the dangers while exercising is his greatest concern. When he’s not coaching or studying for class, he likes to spend time with his family (who are here in El Paso) or with his weimaraner puppy. Fun fact: Ethan loves any food with sprinkles (especially donuts with sprinkles) and is a diehard Seattle Seahawks fan.Read moreRead less
- AndresRecovery & Nutrition
Andres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.Read moreRead less
- Iylene AvalosPUSHasRx TrainerPhone: 915-203-8122
ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.Read moreRead less
- Rick CanoPersonal Trainier Level VPhone: 915-203-8122
Most early-rising PUSHasRx members know Rick well as a fantastic coach who focuses strongly on form and will always make you laugh. He was born and raised in El Paso and loves to train his athletes and coach CrossFit. Rick is a very diligent, kind and considerate trainer. He is always mindful of client techniques and aware of client goals. When he’s not coaching, Rick loves to work on cars, especially his ’69 Chevelle (his next car will hopefully be a ’69 Charger). He not only became a certified Automotive Mechanic at 17, but while working on his certification at EPCC, he won 1st place in a bench competition when he was 16 (approx. 56 reps at 155#). His favorite movements are clean & jerks and snatches. He loves oreos (eats them every night), loves watching the CrossFit games, and loves his three bulldogs. He spent one year full-time personal training before he started coaching CrossFit two years ago. He is CrossFit Level 1 Certified and hopes to get his Level 2 Certification soon. Rick has competed in several competitions, including WOD for Toys in 2014, where his team placed 1st.Read moreRead less
- Astrid OrnelasBlogger/Research/CuratorPhone: 915-850-0900
Astrid has been at Injury Medical & Chiropractic Clinic for about three years. Astrid has taken her love for writing to an new level. She is a gifted and talented copywriter able to create amazing storylines. She creates content for patient consumption. She is able to bring words to life in a way that perplexes even the elite authors of the day. She loves nutrition and the healing power of clean eating. A naturalist at heart you will never see her eating processed foods that would be contra to clean living. She enjoys movies and creating storylines for Anime.Read moreRead less
- AdamVideographer & Graphics SpecialistPhone: 915-850-0900
Adam has been at Injury Medical & Chiropractic Clinic for about a year. He enjoys designing and various forms of art. A story teller by trade he can see things people don’t see until his masterpieces are revealed. Adam is a director of many medias using the top graphics, audio and video medias to tell the story of our patient. Modest to the core, you would never know what he is about to create. We are blessed to have his talents telling the world about Chiropractic using any and all medias available.Read moreRead less
- Our PassionsEmail: firstname.lastname@example.org
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.
We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.
We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.
As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.
Come learn how to improve your health for yourself and your loved ones.
With a bit of work, we can achieve optimal health together, no matter the age or disability.
Its all about: LIVING, LOVING & MATTERING! 🍎
2 CONVENIENT LOCATIONS:
(LOCATION#1) CENTRAL ELPASO:
6440 Gateway East, Suite B
(LOCATION#2) EAST SIDE ELPASO:
11860 Vista Del Sol, Suite 128
PHONE: 915-850-0900 ✔️Read moreRead less