Adding Insoles May Not Thwart Back Pain
Whether they cushion existing pain remains unclear

(HealthDay News) -- Back-pain sufferers might be tempted to try padding their shoes with cushioning insoles. At less than $10 a pair, insoles sound like a simple, inexpensive fix for a chronic, nagging problem.

However, in a review of published studies on the issue, Israeli researchers found no evidence that insoles prevent back pain, and there was insufficient evidence to determine whether they are an effective treatment for existing pain.

"Doctors and other health professionals should not recommend insoles for prevention of back pain or even for back pain treatment," lead author Tali Sahar, of the family medicine department at Hebrew University in Jerusalem, said in a prepared statement. "Insoles might be beneficial for prevention or treatment of other disorders, but this was not the topic of our review."

The review findings were published in The Cochrane Library , a collection of databases that provide current scientific evidence on health care topics.

Back pain is a very common problem, affecting eight of 10 people at some point in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. But the causes of back pain vary widely. It can stem from a sprain or fracture; mechanical problems such as disc degeneration; acquired conditions or diseases, including scoliosis or various forms of arthritis; infection; or a tumor.

To ease chronic back pain, people are encouraged to try simple measures first, beginning with hot and cold ice packs, exercise and medications, the institute states. When medicines and other non-surgical treatments fail, doctors sometimes recommend injections for pain relief, and some people pursue alternative therapies, such as acupuncture or massage. Surgery is typically reserved for chronic back-pain sufferers who have exhausted other options.

As for insoles? The Israeli team reviewed three studies involving 2,061 people who compared use of customized and standard insoles to either no treatment or sham inserts for back-pain prevention.

They also looked at three others studies involving 256 people who examined the use of insoles for either prevention or treatment of existing back pain.

Some question remains about the value of insoles for older people because the trials included mostly younger adults. In addition, more data is needed to determine if insoles are useful in treating back pain, the authors reported.

Still, there's "strong evidence" that insoles don't help prevent back pain, Sahar noted.

Not everyone agrees, however. Dr. Scholl's, the maker of a "Back Pain Relief Orthotic," does not claim that its product will prevent back pain, but Jennifer Samolewicz, manager of global communications services for Schering-Plough Corporation, in Kenilworth, N.J., which markets the Dr. Scholl's line, noted that "the insole design was clinically tested in an independent multi-center study and was shown to provide relief from a specific type of lower back pain that is associated with being on your feet all day."

As for the Cochrane review, Samolewicz pointed out that only six of 325 published studies were included. Many of the studies excluded from the review supported the use of insoles or orthotics to reduce back pain, she said.

Dr. Paul Hecht, an orthopedic surgeon at Dartmouth Hitchcock Medical Center in Lebanon , N.H. , said he was not surprised by the results on insoles. "I will use them for certain indications, but not for back pain," he said in a prepared statement.

To keep the back healthy and strong, the National Institute of Neurological Disorders and Stroke recommends that people:

• Exercise. Engaging in regular, low-impact aerobic activities that don't strain or jolt the back can boost back strength and endurance and allow muscles to function better.
• Build muscle strength and flexibility. Core strengthening exercises that condition the abdominal and back muscles can help build support. Hip and upper leg flexibility helps align pelvic bones to improve how the back feels.
• Quit smoking. It saps the oxygen level in spinal tissues, which can impede healing.
• Maintain a healthy weight. Being overweight strains back muscles, whereas trimming down can prevent the pain.

On the Web

To learn more about back pain, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases online.

SOURCES: HealthDay News ; Jennifer Samolewicz, manager of global communications services, Schering-Plough Corporation, Kenilworth, N.J.; Center for the Advancement of Health, news release, Oct. 16, 2007; Oct, 17, 2007, Cochrane Database of Systematic Reviews ; National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Md.; National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov)
Author: Karen Pallarito
Publication Date: Sept. 30, 2008
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