Shoe Orthotics for Treatment of Chronic Low Back Pain

This week from Dr. Cerami and Utah Sports and Wellness

From: Archives of Physical Medicine and Rehabilitation, April 2017 (https://www.archives-pmr.org/article/S0003-9993(17)30262-9/pdf)

Quick Summary:

The objective of this study was to investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain as compared to no treatment. It is a Randomized Controlled Trial (three groups) that involved 225 adults with symptomatic low back pain of 3 months or longer. Within-group disability scores were significantly improved in the Orthotics and Plus Groups after six weeks of care, with an average of 2.3 and 4.3 point improvements in the Orthotics and Plus Groups respectively. The addition of chiropractic care to the orthotic treatment demonstrated better outcomes than orthotic care alone. The best results were in the Orthotics Plus group in which 70% had a decrease in pain and 56% a decrease in disability of 30% or more compared to baseline; followed by 58% and 38% respectively in the Orthotics group, and only 22% and 20% in the Wait-List Control group. This is the first large-scale clinical trial assessing orthotics for treatment of LBP. As hypothesized, LBP and dysfunction were significantly improved with custom-made shoe orthotics compared to a wait-list control group, and disability was more significantly improved with the addition of chiropractic care.

Abstract:

To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain compared with no treatment. Randomized controlled trial. Integrative medicine teaching clinic at a university. Adult subjects (NZ225) with symptomatic low back pain of !3 months were recruited from a volunteer sample. Subjects were randomized into 1 of 3 treatment groups (shoe orthotic, plus, and waitlist groups). The shoe orthotic group received custom-made shoe orthotics. The plus group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The waitlist group received no care. The primary outcome measures were change in perceived back pain (numerical pain rating scale) and functional health status (Oswestry Disability Index) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months. After 6 weeks, all 3 groups demonstrated significant within-group improvement in average back pain, but only the shoe orthotic and plus groups had significant within-group improvement in function. When compared with the waitlist group, the shoe orthotic group demonstrated significantly greater improvements in pain (P<.0001) and function (PZ.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (PZ.0278) when compared with orthotics alone, but no significant difference in pain (PZ.3431). Group differences at 12 weeks and later were not significant. Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared with no treatment. The addition of chiropractic care led to higher improvements in function.

These authors also note:

• “Low back pain (LBP) is a steadily increasing global epidemic.”
• Approximately 25% of the US adult population experiences LBP during a 3- month time period, and nearly half experience back pain over the course of a year.
• Podiatrists have connected the use of foot orthotics with the relief of low back pain because back pain may be related to a disruption in the kinetic chain.
• A number of studies have linked foot hyperpronation to abnormal pelvic alignment and low back pain.
• “Foot dysfunction should not be overlooked as a potential contributing factor in treating individuals with LBP and dysfunction.”
• “72.1% of chiropractors combine spinal manipulation with custom-made shoe orthotics for the treatment of pain.”
• “When compared to the Wait-list Group, the Orthotics Group demonstrated significantly greater improvements in pain and function.”
• “Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared to no treatment. The addition of chiropractic care led to higher improvements in function.”