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What a pain in the.. BACK! Did you know that spinal pain is more common in persons living with diabetes?

A recent study published in the European Spine Journal suggests that spinal pain impacting both leisure and active movement is more common in persons who live with diabetes.

In a survey of over 3700 patients in Danish medical centers persons with diabetes reported higher levels of cervical lumbar and thoracic pain than patients who did not have diabetes. Lumbar pain was strongly correlated to type 2 diabetes, which may be expected as type 2 diabetes is more directly correlated to a higher waist-to-hip ratio. A larger waistline will pull the spine forward out of alignment, a problem referred to as lordosis. This compresses the lumbar spinal disks, pinching nerves, particularly the sciatic nerve causing a great deal of pain, numbness, and loss of function. This loss of alignment also causes muscles around the lumbar spine and radiating around the torso to tense for stability all of which adds more injury and pain. Rates of lumbar pain in the type 1 population were statistically the same as in the general public.

Cervical and thoracic pain was higher in patients under the age of 60 with rates of cervical pain higher in both patients with type 1 and type 2 diabetes than the general public.

The most common causes of cervical pain are postural issues typically related to sitting at desks, computers, texting, or reading. As these are common activities of one’s employment the age differential may be related to the retirement age of the surveyed population. It was also noted that persons with type 1 diabetes have a higher rate of complaint of shoulder pain than the general public and shoulder pain and injury is often directly related to cervical pain (either the cervical pain causing shoulder limitations which result in pain, or shoulder injury resulting in cervical support muscle tension which results in pain)

What a pain in the…pain in the...BACK!

What is it about diabetes itself that could be leaving us at higher risk for back pain?

First, there are the other diagnoses that may come with diabetes. Rheumatoid arthritis, osteoarthritis, and osteoporosis are all more common in people with type 1 diabetes as well as other autoimmune diseases that can increase the risk for inflammation, connective tissue disorders, and more.

Other studies have also suggested that people with diabetes may be more sensitive to pain and less receptive to analgesic medications and therapies. In other words, we may literally just be feeling more pain, and treatments may be less effective.

We also know that elevated blood glucose levels can cause muscles and connective tissues to lose their elasticity over time. This glycosylation can even cause muscles to atrophy and range of motion can be restricted or lost. Maintaining blood sugars in range will help prevent these losses. Here at IDS, this is obviously one area in which we specialize.

What is the best way to avoid and reduce back pain?

> IDS specializes in helping those who use insulin to optimize weight management. Maintaining a healthy weight reduces excessive pull on the spine that causes misalignment and pain. It also reduces excess joint pressure that can cause compression and degeneration of the cushioning disks between the spinal vertebrae.

> By far the best way to avoid and reduce back pain is movement! As the old saying goes “If you don’t use it, you lose it” and this goes especially for joint function. Since the spine is essentially a highly complex series of joints, keeping it moving and in full range of use is key to maintaining it. This means moving from the top of our heads to the tips of our vestigial tails daily. This can be through organized activities like yoga, Pilates, or dance, or even just having a good stretch in the morning and evening.

> Avoiding postural injury by making sure that workstations are ergonomically set up and that you avoid maintaining any one posture for more than 20 minutes at a time is key in our modern world. Every 20 minutes we should be getting away from our desks, standing, and moving our spines in a full range of motion. If your job is a lot of standing, sitting down relaxing, and stretching hard-worked muscles is key.

> Performing weight-bearing exercises is key to having strong bones and strong supportive spinal muscles to avoid fractures and muscle strain. This does not mean you have to lift weights, one’s own body can be weight enough when done properly. But also using proper form when lifting heavy weight is key, lifting from the knees with one’s hips centered under one’s spinal column and maintaining vertebral alignment is a MUST for avoiding back injury like muscle pulls or herniated disks. Wearing supportive belts or harnesses when lifting, using full body range of movement, and avoiding leaning over and taking one’s spine out of “stacked” alignment avoids injury.

But what if we already suffer from back pain?

Pain limits our range of motion and more than that, it limits our DESIRE to move. Getting moving in any way we can is key. Don’t try to move beyond your capacity. But get moving and watch your capacity broaden. Work with your physician, a physical therapist, and/or a skilled sports medicine/ chiropractic clinician to find safe effective movements for you to strengthen, stretch and support your spine. Over time pain is reduced and old habits that caused the pain are replaced by healthier habits and pain that you thought could only be solved with medication or surgery can be overcome with proper use and stability.

Be sure to work with your medical team to determine whether there could be an underlying medical cause of back pain such as RA, Lupus, microfractures, connective tissue issues etc. A full medical evaluation of any chronic issue is always important. And any acute injury of the spine should always be fully evaluated to ensure that recovery does not cause more harm.

If you have reached the point where corrective action is needed then keeping blood sugars and weight in range becomes more important than ever as the very therapies meant to improve back pain can weaken our spine and muscles and leave us more vulnerable to additional injuries.

SO before, during, and after any spinal medical intervention work with your diabetes team to optimize your overall wellness for the best possible outcomes.

If you are struggling with pain it can be a complex puzzle to negotiate the interaction of blood sugar control, activity level, weight management, and pain management. The nursing team here at IDS has extensive (And even personal) experience working through these kinds of challenges and excels in working as part of a collaborative interdisciplinary team alongside your healthcare team to help you finally break the cycle and make progress toward your goals of not only blood sugar management but living a fully functional enjoyable lifestyle.

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