Back pain

How does back pain relate to cardiovascular disease and diabetes? What role does physical activity play? We spoke with Dr. Jeffrey Hebert about his research with back pain and other musculoskeletal disorders, which he hopes will have an impact on clinical practice in the future.

Q: Tell me about the research you’re doing right now.  

A: We’re researching how musculoskeletal disorders like back pain relate to other diseases like cardiovascular disease and diabetes. We’re asking ourselves if back pain can increase someone’s risk of developing other diseases as well as the role of physical activity in these relationships.

In order to develop these conclusions, we’re studying two population groups: children/adolescents and adults aged 65+. Much of this work is being done in collaboration with our Danish colleagues in the Childhood Health, Activity, Motor Performance Study (CHAMPS) and the European Youth Heart Study. I’m extremely fortunate to work with a number of talented researchers with backgrounds in chiropractic, medicine, and epidemiology.

Q: Why those two specific population groups?

A: Each group offers different types of information. For example, adults aged 65+ have often already developed cardiovascular disease whereas children and adolescents can present with different risk factors for disease in the future.

We recently completed a study of ~1000 children and discovered that girls with back pain have elevated cardiovascular disease risk factors such as insulin resistance compared to girls without back pain. Contrary to our hypotheses, physical inactivity does not totally explain the association between back pain and cardiovascular disease risk, and this relationship was not present in boys. As is often the case in research, we’ve ended up with more questions than answers.

We will soon be starting a project to evaluate changes in cardiovascular disease risk in older patients who undergo surgical treatment for degenerative spinal stenosis.

Q: Why are you looking at cardiovascular disease, in particular?

A: As health researchers, we try and undertake research with the largest potential benefit to society. Cardiovascular disease is the largest cause of mortality worldwide, while back pain is the largest cause of disability. It is important to understand how these diseases relate to one another and attempt to identify what could be responsible for these links.

We already know that a lack of physical activity is linked to cardiovascular disease and diabetes. We also know that many musculoskeletal diseases like spinal stenosis impact people’s ability to be physically active. I’m interested in whether musculoskeletal disorders are the gateway to developing more serious diseases.

Q: How will your research make a difference for chiropractors?

A: If we understand the link between musculoskeletal conditions and other serious health challenges, we’ll be in a better position to impact people’s lives. For example, a patient living with knee osteoarthritis may find it more difficult to be physically active. And effectively treating someone’s pain will not necessarily change their physical activity levels. In fact, health habits often remain unchanged despite improvements in pain and capacity.

As chiropractors, if we solely focus on pain and disability, I think we’re missing opportunities to improve people’s lives long-term. Systematically inquiring about each patient’s physical activity and providing appropriate advice should become the standard of care for patients with musculoskeletal disorders. “Exercise is medicine” represents an important opportunity for chiropractors.

I’m really excited about answering these research questions in a way that can inform clinical practice in the future.

Dr. Jeffrey Hebert is the Research Chair in Musculoskeletal Health at the University of New Brunswick for the Canadian Chiropractic Research Foundation. He is also a full, tenured professor in the Faculty of Kinesiology at UNB.


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Royal York Chiropractic and Massage Therapy (416) 233-5413
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  • I started going to Dr. Marco back in January 2020 when I was suffering a lower back injury. After seeing the reviews on google, I decided to give him a chance and I haven't looked back. Dr. Marco has helped me in my recovery and brought me back to feeling healthier than ever. He is extremely knowledgeable, kind and easy to talk too. Not to mention, the prices are very reasonable and not overpriced. I highly recommend him to anyone looking for a chiropractor in Etobicoke.
  • Royal York Chiropractic was recommended to me by multiple people, so I decided to give it a go for my back and shoulder problems. My first experience with Dr. Marco was extremely positive. He is very knowledgeable and easy to talk to. His honesty and commitment to improving my pain is what kept me coming back. Very positive experience!
  • I have been seeing Dr. Marco for many years now and he helps me each time I see him. He’s friendly, knowledgeable and has a level of clinical awareness that comes from years of experience which helps to create an overall positive interaction. Making appointments is never an issue and the clinic environment is welcoming and relaxing. Highly recommend him!
  • I have had very positive experiences with Royal York Chiropractic. While Dr. Peter has predominantly been overseeing my care, I have had adjustments with Dr. Marco as well. Both are competent, caring, friendly and willing to answer questions. Anna keeps the office well-organized and the few times I've had to wait, it has never been for long.
  • I have been seeing Dr. Marco for a few years now and he helps me every time. His adjustments are precise and effective, he knows what he is doing. He can be aggressive or as gentle as you need. Appointments have never been an issue, he always works around my schedule. I would highly recommend him!