Nevertheless, six months ago the presidents of the colleges and universities in the Washington, D.C. region charged our organization, the Consortium of Universities of the Washington Metropolitan Area, with bringing together the best and brightest researchers across our institutions.  We came together for months of meetings and workings groups seeking to identify the potential solutions to reducing gun violence that showed the most promise.  To my surprise, we were able to find a great deal of common ground – although not without continuing areas of reasonable debate.

Gun violence itself is often misunderstood as focusing on mass shooting events, which themselves can be defined in different ways.  While those events are terrifying and receive tremendous coverage, far more people in our country die from suicide or homicide by gun than in mass shootings. 

Solutions have to start with understanding the causes of that violence, and we know that far more research is needed.  It seems evident to suggest that less ready access to guns would reduce suicide by gun, and likely homicides as well – yet according to our experts, gun buyback programs, which are often very comforting to a community, have had little impact on gun violence.

Community intervention programs were the single solution that found the most common ground in our discussions.  These programs engage local communities, sometimes through community-based organizations, schools, places of worship, or hospitals, in interrupting patterns of violence. 

They are very promising – and best of all, compared to most solutions, they are very inexpensive.  It is an area where far more investments should be made both in expanding and piloting programs, and in long term research in their outcomes.

Our experts also had many ideas for communication and education campaigns.  Of course, past public health campaigns have mixed results.  From encouraging use of seat belts to discouraging illegal drug abuse to COVID vaccinations, we can all readily remember campaigns that seem to have worked, and just as many that did not. 

Nevertheless, our experts highlighted a number of very targeted campaigns that were likely to generate success, including anti violence campaigns and conflict resolution training in schools, but only if they can be done without vilifying gun ownership.  Additionally, there was admiration for the very promising field of pushing back against online efforts by extremist groups to incite violence.

There seemed to be little or no downside to ideas surrounding increased safety and training.  Many of our most ardent gun rights supporters felt most passionately that providing easier access to safer gun storage and better training would make everyone safer. 

I was fortunate to be in the room for discussions with so many amazing experts giving their time and talent to respond to this crisis.  From them, I learned that all of these proposals will work best if aligned with wise legislation and policy, and that it is likely the best ways to reduce overall violence is to address root causes of economic equity and marginalization. 

It was shocking to me that the primary cause of death in children in our country has relatively little funding for research.  Most of all, it was hopeful to find that by collaborating across diverse thinkers from many disciplines, we were able to find that elusive common ground.  It made me believe, more than ever, that even on subjects where we have such deep divides, we can come together to find ways to make our children safer.

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The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

1. Nonpharmacologic treatments
2. Superficial heat
3. Massage
4. Spinal manipulation
5. Exercise
6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

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