Low Back Pain, Reduced Disability and Chiropractic:
A Study in Proper Diagnosis
Courtesy of Dr. Frank Gomez
www.sayvillechiropractor.com
When you are experiencing pain in the lower back, it can often be intense and cause for worry. You wonder how something can hurt so badly and are looking for anything to reduce the discomfort. Many times these types of pain cause an admission the emergency room. In a recent study by Orlin and Didriksen (2007), the authors stated, “The objectives of this study were to report on and evaluate the results of chiropractic care for patients with low back pain in an orthopedic department” (p. 135). This is an important study since it shows the results of direct cooperative care amongst chiropractors and orthopedic surgeons in a hospital setting.1 With pain in any body area, proper diagnosis is a key component of care and directly effects treatment methods and expected response time (prognosis). The primary goal is to reduce pain and return you to your normal personal and working activities. The longer an accurate diagnosis and treatment plan is delayed, the longer disability continues.
Many studies have shown that collaboration among clinicians is in the best interest of the patient and results in better care. When you are diagnosed with low back pain, the assessment of the mechanics of the bones and muscles is an important component of your examination. This is completed in conjunction with neurologic and orthopedic examination procedures completed by the chiropractor and ensures that the cause of your pain is identified. In some cases such as trauma, advanced imaging such as MRI may be ordered prior to treatment. A proper diagnosis MUST precede treatment. Otherwise, the doctor does not know what he/she is treating!
In this study, the authors stated, “Examination by the doctor of chiropractic indicated that the patients had lumbopelvic fixation” (Orlin & Didreksen, 2007, p. 135). What this means is there was a biomechanical problem in the bones of the spine and pelvic area, also known as a subluxation. This is a functional problem that doctors of chiropractic are specifically trained to identify and treat. When these types of conditions are identified early on in care, the response to treatment is impressive. The authors stated, “According to pre-established inclusion and exclusion criteria, 33 patients were treated in the chiropractor’s clinic, whereas 11 who could not be transported were initially treated by the chiropractor in the hospital.”(Orlin & Didreksen, 2007, p. 135). In this study, only two patients could not return to work.
"The period of sick leave among the patients was reduced by two thirds as compared with that associated with conventional medical treatment.” (Orlin & Didreksen, 2007, p. 135). This is important because it showcases integrative care utilizing doctors of chiropractic, but also demonstrates how achieving a diagnosis quickly truly influences care. In fact, this approach is so effective that the Federal Government is utilizing doctors of chiropractic as part of the comprehensive approach to caring for our soldiers. H.R. 1017 requires the VA to have doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and for all major VA medical centers to have a doctor of chiropractic on staff before the end of 2013. There are nearly 160 VA treatment facilities nationwide. Currently, the VA provides chiropractic care at 32 treatment facilities across the country.2
All in all, cooperation is truly the “best medicine” for spine care. If you have spinal pain, seeking the attention of a doctor of chiropractic is a good decision. Communicating with your medical provider that you have sought out chiropractic care allows for better management of your pain and will ultimately help others as well. The final word from the authors was that, “This study shows that a chiropractor may play an important role in an orthopedic department by reducing pain and shortening the duration of sick leave among patients" (Orlin & Didreksen, 2007, p. 138).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. Thank you for reading my article. More on back pain can be found on my website http://www.sayvillechiropractor.com/.
Any questions please contact us.631 991-3492
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References
1. Orlin, J. R. & Didriksen, A. (2007). Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiologic Therapeutics, 30(2),135-139.
2. Lukcas, C. & Lee, M. (2010). House passes bill to expand chiropractic care to all major VA medical hospitals. ACA Today. Retrieved from http://www.acatoday.org/press_css.cfm?CID=3943
Headaches and Posture
Have you ever glanced at your reflection in a storefront window or mirror as you walked by and noticed your posture? Scary, isn’t it? We all know that we should stand up straight but we soon forget when we get busy and stop thinking about it.
Poor posture is often due to years of standing slouched and this bad “habit” usually starts at a young age. Just look around when you’re in an airport or shopping mall and notice the many people have poor posture. In fact, people’s posture may reflect their attitude – if they’re happy, sad or depressed. Poor posture may be related to self-consciousness, especially during adolescence. It is also genetic as we frequently see a “trait” throughout family members with similar postural tendencies.
The most common postural fault associated with headaches is the forward based head and shoulders. From the side, it appears that the head is significantly forward relative to the shoulders, the upper back is rounded forward and the shoulders are rolled forwards and rotated inward. One exercise that helps reduce this postural bad habit is tucking in the chin and pretending a book is balancing on top of the head. The objective is to not allow the book to slide forward off your head and land on your toes!
It takes approximately 3 months of CONSTANT self-reminding before the new “good habit” posture becomes automatic, so be patient. Soon you’ll “catch yourself doing it right” without thinking about it.
Frequently, posture is faulty lower down the “kinetic chain.” The first link of the chain is the feet and the last link is the head. Since we stand on two feet, any change in that first link or the feet, can alter the rest of the chain, especially areas furthest away – the head, resulting in headaches. For example, if one leg is short, the pelvis drops, the spine shifts (scoliosis), the shoulder drops and the head shifts trying to keep the eyes level. A short leg usually needs to be managed with a heel lift, an arch support or combination of both to properly treat the headache patient.
Most health care providers EXCEPT Chiropractic Physicians typically ignore these issues. Chiropractic Doctors are specifically trained to analyze posture and correct it. You can depend on our clinic for up-to-date treatment approaches such as these.
Since neck pain and headaches are one of the most common complaints presenting to the chiropractic physician, please ask for more information about this if you or a loved one is suffering. It’s one of most significant acts of kindness you can give to those you care about.
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The Neck and Headache Connection
Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:
Since neck pain and headaches are one of the most common complaints presenting to the chiropractic physician, please ask for more information about this if you or a loved one is suffering. It’s one of most significant acts of kindness you can give to those you care about.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR HEADACHE PAIN!
FOR A FREE NO-OBLIGATION CONSULTATION CALL DR. FRANK GOMEZ @ (631) 991-3492
Does The Use Of A Low Back Support Or Brace Really Make A Difference?
“Do you think a back brace will help my condition?” This is a question that is frequently asked of many health care providers who treat low back pain. The answers typically vary, as there is support for and against the use of a brace when low back pain is present. In a Feb. 2009 study, the use of an elastic lumbar belt was studied in a group of subacute low back pain patients for its effect on functional capacity (lift and carry types of activities), pain intensity, and the effects on health care service costs. This study was unique in that it was carried out in several different locations and, the patients were randomized and received either a lumbar belt or nothing (“control group”). 197 patients were included in the study, which is a good sample size for research purposes. The results of the study, at the end of 90 days, revealed a higher score for the back brace treated group than the non-braced control group. The pain scale improved greater in the brace treated group as an improvement of 42 points vs. 32 points was reported. Similarly, 61% in the brace treated group used no medication compared to 40% in the non-braced group. It was concluded that patients with subacute low back pain improved significantly in functional status, pain reduction and medication utilization.
The use of back braces has been considered a “standard” in the treatment of patients with LBP for many years. One argument against using back braces centers around becoming “dependant” either physically or mentally on its use and this has long been a concern amongst health care providers. For most patients, this is not a concern as most do not “enjoy” the use of a brace and they look forward to discontinuing their use of it. Braces are particularly helpful when the patient cannot stop performing needed activities, such as work. This is especially true for farmers who have to tend to the animals and crops during planting, cultivating and harvest times of the year. In addition, single moms or dads who have to go to work in order to provide for their children are driven to stay on the job. In these cases, the use of a back brace can be of utmost importance.
There are many types of back braces. Some are narrow and are particularly favored when frequent bending and/or twisting movements are required by a job, sport, or other daily activity. Other braces are taller in the back and taper in the front, which give better support but still allow some bending / twisting movements. Some braces are more rigid and can actually stop movement in certain directions. These types include a hard, rigid surface that is placed in the area of the back where movement is not desired. These are used at times when there are fractures of the spine, after spinal surgery and in scoliosis bracing. Some braces are to be worn low on the pelvis to support that area, while most are placed in the center of the low back region. There are also rib belts sometimes used when ribs fracture, soft and rigid neck braces sometimes used after car accidents, and braces for the arms or legs. The decision to use a brace rests on the degree of injury and the patient’s ability to avoid certain activities or positions. When the injury is significant and/or the patient cannot control his/her activities (such as work), then the use of a brace may be one of the most important treatment approaches for that patient. It’s similar to having stitches when a deep or wide cut occurs. Ask us about the use of supports, braces, or belts if you or your family or friends are suffering with low back pain.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN!
FOR A FREE NO-OBLIGATION CONSULTATION CALL DR. FRANK GOMEZ @ (631) 991-3492
Migraine Headaches and Chiropractic
Thousands of people in the United States suffer with headaches and many do not realize there are different types of headaches that are a reaction to a variety of causes. One of the major tenants of Chiropractic is to find the cause of the problem instead of chasing symptoms. Although Migraine headaches are truly caused by changes in the flow of blood in the brain, many people refer to any headache that is severe enough to negatively affect their day a “migraine”. Many of these cases are people who have headaches on a regular basis, and for whatever reason, they slowly get worse over time. This usually results in increases in medication dosage, prescription of more dangerous drugs with more side-effects and decreases in quality of life. The research paper being reviewed stated “The estimated costs of migraines in the United States is over $17 billion per annum [year]”.1 (p 91)
This research study that was published in 2000 was titled “A randomize controlled trial of chiropractic spinal manipulative therapy for migraine”. This was designed “To assess the efficacy of chiropractic spinal manipulative therapy [Chiropractic Adjustment} in the treatment of migraine”.1 (p 91). This study followed others that had delivered similar results.
The authors state “However, the level of evidence is steadily increasing to the point where there is now seen to be a moderate level of efficacy for Chiropractic SMT [Spinal Manipulative Therapy/ AKA Chiropractic Adjustment] in the treatment of headaches or migraines”1(p95). The paper also reported “The mean number of migraines per month was reduced from 7.6 to 4.1 episodes. The greatest area of improvement was medication use, for which participants were asked to note the use of medication for each episode. A significant number of participants recorded that their medication use had reduced to zero by the end of the 6-month trial”.1(p95) Expressed in other terms, 72% of participants reported significant improvement!
When administered by trained Doctor of Chiropractic, adjustments to the neck are safe and effective. This study has also show that Chiropractic care results in the reduction of medication utilization, some of which have significant long term side-effects having a profound effect on your long term health. Chiropractic chooses to use a safe and scientifically effective approach to the management of migraine headaches and if you are suffering, Chiropractic care is just what the doctor ordered!
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Tuchin PJ; Pollar H; Bonello R. A randomize controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 23(2): 91-5, 2000.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
Low Back Pain, Arthritis and Chiropractic, A Clinical Correlation
The American Chiropractic Association (2010) reported that 31 million Americans experience low back pain. This is an epidemic at a staggering rate because what most of the public and doctors alike do not understand is what that sets the patient up for later in life that can be prevented. Stupar, Pierre, French and Hawker (2010) found that 49% of the general population reported a 6 month prevalence of low back pain, with11% reporting the back pain to be so significant that it seriously limited their activities.
Low back pain and arthritis have now been linked. According to Dawson and Shaffrey (2009), the most common form of arthritis is called osteoarthritis. It is also known as degenerative joint disease. It affects more than 20 million American adults. The cause of osteoarthritis is a breakdown of cartilage, the connective tissue that provides a cushion between the bones of the joints. Healthy cartilage is what permits bones to move over one another and acts as a shock absorber during physical activity. Those afflicted with this disease experience a breakdown of cartilage in which the cartilage wears away. As a result, the bones under the cartilage rub together, resulting in pain, swelling, and a loss of motion in the joints.
Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint. Other symptoms may include:
1. Swelling or sensitivity in one or more joints, especially when related to a change in the weather
2. Loss of joint flexibility
3. Stiffness in the joint(s) after getting out of bed
4. Either a crunching feeling or a sound that results from bone rubbing on bone
5. Bony lumps on the finger joints or at the base of the thumb
6. Intermittent or regular pain in a joint
As Stupar et al. (2010) reported, osteoarthritis or OA has long been associated with back pain and reported comorbidity (they exist together). 40% of hip or knee osteoarthritis patients have had low back pain. That is a significant number and associated with hip arthritis. The 2010 study concluded having hip osteoarthritis and low back pain is a conclusive predictor for future leg pain and disability and suggested that alleviating low back pain may impact future hip pain and function.
Clinically, the authors have seen in patients with low back instabilities and persistent pain the degeneration of the spine and hips over a lifetime. This has been termed "subluxation degeneration." The Association of Chiropractic Colleges has defined subluxation as "...a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health" (The Association of Chiropractic Colleges, 2010,http://www.chirocolleges.org/paradigm_scope_practice.html). Simply put, subluxation is a diagnostic entity that denotes the vertebrate is out of position, is fixed or stuck in the wrong position to some degree and has a negative neurological effect. Once the vertebrate is out of position, the body automatically tries to stabilize the spine and mobilizes calcium to use as cement or glue to prevent further malpositions. This is one of the causes of the degeneration or osteoarthritis as a sequella to malpositions of the vertebrate.
A 2009 study by Aspegren, Enebo, Miller, White, Akuthota, Hyde, & Cox concluded that 81.5% of workers with an acute injury causing low back or neck pain reported immediate post-treatment relief. That doesn’t take into account those patients who got better over time.
In 2009, Painter reported that Consumer Reports conducted an independent survey of 14,000 subscribers who rated hands-on therapy as the #1 treatment of choice for low back pain. The report went on to say that 88% of those who tried a chiropractic adjustment reported positive outcomes and 59% were "completely" or "very" satisfied. The complete results are:
Professional Highly satisfied
Chiropractor 59%
Physical therapist 55%
Acupuncturist 53%
Physician, specialist 44%
Physician, primary-care doctor 34%
We at Sayville Immediate Chiropractic Care have concluded that there is a definitive clinical correlation between low back pain and osteoarthritis as a prognostic indicator of significant future problems if the low back pain is not resolved. We have also concluded that chiropractic care is a safe, highly effective treatment choice for low back pain patients and as a result, low back pain cannot be ignored. These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
References:
1. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Stupar, M., Pierre, C., French, M. R., Hawker, G. A., (2010). The association between low back pain and osteoarthritis of the hip and knee: A population-based cohort study. Journal of Manipulative and Physiological Therapeutics, 33(5), 349-354.
3. Dawson, E. G., & Shaffrey, C. I. (2009, December). Osteoarthritis: Degenerative spinal joint disease.Spineuniverse. Retrieved from http://www.spineuniverse.com/conditions/spondylosis/osteoarthritis-degenerative-spinal-joint-disease
4. The Association of Chiropractic Colleges. (2010). Bylaws. Retrieved fromhttp://www.chirocolleges.org/paradigm_scope_practice.html
5. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics, 32(9), 765-771.
6. Painter, F. M. (2009). Consumer reports survey shows hands-on therapies were the top-rated treatments. The Chiropractic Rescue Organization. Retrieved from http://www.chiro.org/LINKS/ABSTRACTS/Hands_on_Therapies.shtml
Herniated Discs, Radiating Pain and Chiropractic
80% of chiropractic patients reported excellent
or good result in a 2 year study
Courtesy of : Dr. Frank Gomez, DACBSP
www.sayvillechiropractor.com
Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a “slipped disc” because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with fewer traumas due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients.1
Although many of these are surgical cases, it has been estimated that only 2-4% have actual surgical indications. Therefore, most patients need to be treated non-surgically and until recently, there have been few metrics affording guidance to the healthcare profession and public alike directing them to the right care. In a 2009 research report, culminating a 2 year study, a clear direction is now available for patients that suffer with radiating pain from herniated discs.1 The results of the study show that as a result of chiropractic care, “clinically meaningful improvement in pain intensity was seen in 73.9% of patients(Murphy, Hurwitz, & McGovern, 2009, p. 728). "'Good' or 'excellent' improvement was reported by 80% of patients" (Murphy, Hurwitz, & McGovern, 2009, p. 723).
Chiropractic treatment protocols utilized were 2-3 times per week tapering down to 2 times per week and less until the patients were released from care. The reports go on to state that there were no major complications with any patient. The results of the study also suggest that patients with cervical radiculopathy (neck pain radiating in to the arms), lumbar spinal stenosis, pregnancy related lumbo-pelvic pain and chronic work related neck-arm pain may also benefit from non-surgical treatment such as chiropractic care.1
This study clearly shows that chiropractic is not only an alternative for disc related radiating pain, but would be the most logical place to begin care, as 80% of the patients studied got well and without being exposed to drugs, their side effects or the added burden to the healthcare system with more costly treatments. In practice, the balance of the patients who need necessary drugs or more complicated intervention would be referred to the appropriate specialist as is the standard of care within chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for disc and radiating pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.
Decreased Muscle Spasms and Chiropractic Care
Courtesy of: Dr. Frank Gomez
www.sayvillechiropractor.com
There have been many discussions regarding the effects of the short and long term benefits of a chiropractic adjustment. The ultimate focus is a change in the biomechanics and therefore, the physiology surrounding the affected area of the spine. Although there is a significant amount of evidence showing the effects of spinal adjusting on the central nervous system, this study concentrated on the effects on the peripheral nervous system (outside of the brain and spinal cord) and paraspinal musculature, specifically of the effects of spinal adjusting on the paraspinal musculature in the mid-lower back (thoracic and lumbar spines).
The authors stated, "Many chiropractors palpate for tight muscle bundles in the paraspinal musculature as one indication of where to adjust. It seems reasonable to expect resting muscle activity, which can be monitored by an electromyogram (nerve test to determine muscle firing, and resultant spasm) to be abnormally high in the region of a tight muscle bundle" (DeVocht, Pickar, & Wilder, 2005, pp. 465-466). They went on to state, "In this descriptive study, we have further explored the phenomenon of reduced electromyogram (muscle firing and resultant spasms) activity after [spinal adjusting] to better understand the immediate effects of [spinal adjusting]" (DeVocht et al., 2005, p. 466).
The results of the study showed, "With electromyogram recordings obtained from 2 paraspinal muscle sites on each participant (except for one), 27 of the 31 pre-treatment resting electromyogram levels decreased after treatment. During the 5 to 10 minutes of the treatment protocol, distinct changes (both increases and decreases) in the level of muscle activity were often observed" (DeVocht et al., 2005, p. 470). Ultimately the study revealed, "… the reduction of resting electromyogram activity after [spinal adjusting that we observed in the greater majority of cases is consistent with and supportive of the commonly held perception that tight muscle bundles are associated with low back pain and that they can be alleviated by [a chiropractic spinal adjustment]" (DeVocht et al., 2005, p. 470).
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Reference:
1. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
Comparing the Satisfaction of Low Back Pain Patients Receiving Medical vs. Chiropractic Care: Results from the UCLA Back Pain Study
Courtesy of Dr. Frank Gomez
www.Sayvillechiropractor.com
The relationship between a patient and a doctor is a very important aspect of healthcare. Many patients call this “bedside manner." Researchers call it “patient satisfaction.” In a recent study published in the peer reviewed journal, American Journal of Public Health, and produced by the UCLA School of Public Health, the authors reported on the results of a comparison of patient satisfaction between patients that received chiropractic care and those that received medical care for lower back pain. The authors stated, “Results from observational studies suggest that back pain patients are more satisfied with chiropractic care than with medical care” (Hertzman-Miller et al., 2002, p. 1628).
“Our study was conducted in a large managed care organization in Southern California...for approximately 100000 members” Hertzman-Miller et al., 2002, p. 1628). They go on to report, “Of the 681 randomized, 340 were assigned to the 2 medical groups and 341 were assigned to the 2 chiropractic groups”(Hertzman-Miller et al., 2002, p. 1630). Interestingly, the paper goes on to show “Chiropractic patients reported receiving more self-care advice than did medical patients, were more likely to report an explanation of their treatment, and visited their primary providers [their assigned chiropractor in this study] more often" (Hertzman-Miller et al., 2002, p. 1630). The results showed, “In this randomized trial, chiropractic patients were more satisfied with their back care providers after 4 weeks of treatment than were medical patients” (Hertzman-Miller et al., 2002, p. 1631). It should also be noted, “No deaths or serious adverse events occurred during the 4-week period” (Hertzman-Miller et al., 2002, p. 1630).
This paper in no way minimizes the importance of the medical physician as part of the team necessary to care for patients, understanding that there are diagnoses that mandate the services exclusively of the MD and other circumstances where concurrent care is required. However, when there is a choice based on overlapping care, common sense dictates a drugless treatment first, treatment involving drugs second and surgery last. Those patients, according to this study, who have chosen the chiropractic, drugless approach first, have reported a very high level of satisfaction with chiropractic care with no adverse events.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Hertzman-Miller, R. P., Morgenstern, H., Hurwitz, E. L., Yu, F., Adams, A. H., Harber, P., & Kominski, G. F. (2002). Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: Results from the UCLA low-back pain study. American Journal of Public Health, 92(10),1628-1633.
Chronic Low Back Pain:Chiropractic vs. Medicine
Research Results: Chiropractic is 457% more effective
As reported in 2003 by the National Institute of Neurological Disorders and Stroke, "If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common" (http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm)
They went on to report many of the causes of low back pain. " As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae" (National Institute of Neurological Disorders and Stroke, 2003,http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results" (National Institute of Neurological Disorders and Stroke, 2003,http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury" (National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
Chronic low back pain is where the symptoms have persisted for longer than 3 months, as reported by Bogduk in 2004, although recent studies have classified chronic low back pain as pain persisting for only 4 weeks. The duration is important from a diagnosis and prognosis perspective, where it is critical for the doctor to develop an accurate plan of care. The most important component is not the label, but a complete history being performed, including examination and subsequent testing, when indicated, to develop the right treatment plan.
Wilkey, Gregory, Byfield, & McCarthy reported in 2008 that the proportion of the population that suffers from persistent or chronic low back pain is between 8% and 33%. 13% accounts for those whose pain never goes away and the remainder fluctuate in and out of pain. They also reported that the low back pain was generally recurring, indicating that doing nothing is a poor choice.
While there are a limitless number of treatments, the National Institute of Health in the United States and the National Health Service in the United Kingdom have listed accepted treatment modalities for this very prevalent condition. While there are choices for the public, the question is what is the best treatment choice for each individual back pain sufferer? The answer has to be based on real evidence and outcome based studies offer the answer.
As mentioned ealier, Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain. To say that the medical approach doesn't have a place in healthcare would be inaccurate and irresponsible, but based upon evidenced based outcome studies, research concludes that for chronic low back pain, the path is chiropractic first and drugs 457% second. Chiropractic doctors are trained to determine the cause of the injury and are expert at formulating an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment.
These studies along with many others conclude that a drug-free approach of chiropractic care is the best solutions for patients with chronic low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References
1. National Institute of Neurological Disorders and Stroke. (2003, July). Low Back Pain Fact Sheet.Retrieved from http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. Bogduk, N. (2004). Management of chronic low back pain. The Medical Journal of Australia, 180(2), 79-83. Retrieved from http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html
3. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.
Whiplash and Work Disability
Whiplash results from a sudden trauma, usually involving an accident, where the injured person’s car was struck from behind, from the front, or from one of the sides. The injury is caused from the head quickly accelerating, like a “crack the whip” action, which often results in headache, neck pain and sometimes loss of memory or the ability to concentrate. There are many reports about whiplash and factors about the collision that may predict who will become disabled from such an injury. Previous reports have suggested that female gender (due to a slender neck), older age (due to less flexible joints), marital status (due to stress if divorced or single), heavy manual labor, self-employment, previous psychological problems, the inability to concentrate, catastrophizing about pain, and fear of relapse by doing regular activity have all been common issues discussed in research articles. In order to sort through these possible risk factors of a prolonged recovery and disability, a recent February 2009 study looked at this question and reviewed 879 claims. Those involved in the car accidents were sent questionnaires that requested information about the accident, the injuries that had occurred, their current complaints, and questions regarding work and disability. These questions were rechecked at 6 and 12 months after the accident date. Of the 879 claims, 59% were found to be work disabled. The most important factors were age and concentration complaints identified at the 1-month were most predictive of those that would still be disabled at 1 year. What was interesting was that most of the previously accepted risk factors of long-term disability such as the intensity of manual labor, educational level, and the like, were not found to be helpful in predicting long-term disability prior to the 1 year point with only age and concentration impairment being identified. The authors suggested that we should focus treatment on the complaints involving concentration – that is, brain related functions, rather than managing solely the physical complaints.
A condition called mild traumatic brain injury or, post-concussive syndrome, can apply to people injured in car accidents who have lost some of the higher cortical or brain related functions. Though the majority of patients will usually recover from this, a minority will not. It is therefore, important for patients and healthcare providers to become keenly aware of symptoms like memory loss (primarily short-term), loss of your train of thought (forgetting what you were about to say), or having difficulty formulating what you want to say (getting the right words out). Many patients are reluctant to say anything to their health care provider as they are often embarrassed and don’t feel comfortable talking about it. They often think they are “…just going through a stage,” and that they may “sound strange” if they discuss these symptoms and therefore avoid even bringing it up during the history. In the end, most patients are relieved after they find out that it’s “not all in their head,” and are more comfortable discussing it when they know their health care provider is aware of their cognitive dysfunction and that it’s a real problem. As one patient put it, “…I thought I was going crazy,” when in fact these, sometimes quite subtle, symptoms are very important clues in identifying this condition so that prompt attention can be directed at these problems. We are keenly aware of this information and are happy to share it with you so that you can feel more comfortable discussing it with us as well as any other symptoms that exists because of a whiplash injury.
If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
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Dr. Frank Gomez at 631 991-3492
Whiplash "Anatomy"
To better understand Whiplash, let’s take a look at the anatomy and what is actually injured in a whiplash injury. Our spine is basically a long chain made up of blocks that are larger at the bottom and smaller at the top. This means the low back vertebra are huge compared to the neck vertebrae. The vertebrae fit together in a way that “locks” them together by the small joints in the back called “facets” and in the front by the disks. These joints function as shock absorbers between the blocks or “vertebral bodies.” Also in the front, there is a tough piece of tissue called the “anterior longitudinal ligament” that provides a barrier so that when the neck is bent backwards (into “extension”), it becomes tight and stops that movement so it doesn’t over-extend, which could fracture the small facet joints in the back.
There are ligaments, or tissues that hold bone to bone, in the back of the spine that connect between the “spinous processes,” or bony “bumps” in the middle of the back. These ligaments check or stop excessive forward motion of the neck during whiplash. Joint capsules surround joints, which we all have seen when we separate a chicken leg from the thigh. Remember how smooth and shiny the end of the chicken leg is? That smooth surface at the end of long bones is call “hyaline cartilage”, and it allows for slippery gliding between the ends of our bones when we move any joint, including our fingers, wrists, shoulders, hip as well as the facet joints of the spine. Joint movement is facilitated by the presence of an oily substance called “synovial fluid” which acts like a lubricant for the joint allowing for pain-free movement.
A “sprain” occurs when we damage a joint capsule or a ligament, or when the muscle or its attachment (tendon) is injured. These are graded as mild, moderate or severe, or grades 1, 2,or 3, with grade 3 being the worst at 75% or greater tearing, and healing takes progressively longer with each grade.
During a whiplash injury, the classic rear-end collision results in over stretching of the ligaments in the neck, and tearing can occur (sprain, grades 1, 2 or 3). If one of the nerves gets pinched, then numbness, pain, and/or weakness can occur, radiating down the arm to a specific location. When this occurs, the long-term prognosis is worse. Concussion can also occur if the brain is slammed against the inside of the skull. Chiropractic adjustments, when administered early, yield the best results for treating whiplash, according to many studies.
We at Sayville Immediate Chiropractic Care realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Children and Chiropractic Care:
Birth to 18 Years
Conditions cared for and side effects
2012 Report
Courtesy of: Dr. Frank Gomez
www.sayvillechiropractor.com
Chiropractic has been successfully caring for children for various conditions for over a century. The main issues are what conditions are cared for by chiropractors, what is the reported success rate and what is the incidence of side effects. Over time, research has started to catch up on what individual chiropractors have been realizing in their private practices and this article will outline the current state of the literature.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The pediatric related conditions that were reported to be cared for by chiropractors were the following:
1. Musculoskeletal
1. Joint pain
2. Walking/crawling
3. Neck pain
4. Mid back pain
5. Low back pain
2. Neurological
1. Headaches
2. Autism
3. Balance
4. Cerebral Palsy
5. Movement Disorders
6. ADD/ADHD
7. Behavioral
8. Crying/Irritability/Sleep
9. Developmental
10. Growing
11. Cognitive
3. Gastrointestinal
1. Colic
2. Constipation
3. Digestive
4. Eating
5. Drinking
6. Reflux
7. Hiatus hernia
8. Bowel problems
4. Genitourinary
1. Menstrual cramps
2. Bed wetting
5. Immune
1. Allergies
2. Asthma
3. Food intolerance
4. Respiratory
5. Eczema
6. Skin rashes
6. Infections
1. Ear infections
2. Ear-nose-throat problems
3. Common cold
4. Flu
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Marchand (2012) also reported the negative side effects of chiropractic care in children to be less then 1% (0.23%,) which is consistent with what Miller and Benfield reported 4 years prior in an independent study. However, Marchand went further to categorize the negative side effects into mild, moderate and severe. In a 1 year study of 237,857 pediatric patients, there was a reported 534 mild side effects (0.2%) and 23 (0.009%) had moderate side effects with 0 (zero) reporting any severe side effects.
To render perspective on the safety of chiropractic care and children Le, Nguyen, Law and Hodding (2006) reported "The incidence of adverse drug reactions among hospitalized children in the United States has not been well studied. Because clinical trials involving neonates, infants, children, and adolescents are limited, the safety and tolerability of many pharmacologic agents are not well established. Often the pharmacologic actions of drugs in neonates, infants, and children are not similar to those identified for adults; therefore, information obtained from research with adults cannot be applied directly. On the basis of a meta-analysis of 17 prospective
studies
conducted in the United States and Europe, the incidence of adverse drug reactions among hospitalized children was 9.5%, with severe reactions accounting for 12% of the total (pg. 557.)
The above study indicates that side effects need more researched in many sects of health care, but comparatively speaking, chiropractic is a much safer choice than most alternative options.
Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in the pediatric population with minimal to no side effects.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380
2. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
3. Studin M. (2010, September). Chiropractic and Children; A Study in Adverse Effects, US Chiropractic Directory. Retrieved from http://uschirodirectory.com/index.php?option=com_flexicontent&view=items&id=261
4. Le, J., Nguyen, T., Law, A., Hodding, J. (2006) Adverse Drug reactions Among Children Over a 10-Year Period, Pediatrics, 118 (2) 555-562
Chest Pain, Mid-Back Pain and Chiropractic
Courtesy of Dr. Frank Gomez
www.sayvillechiropractor.com
Chiropractic care is targeted to reducing the Vertebral Subluxation Complex and associated neuro-muscular conditions after more serious medical conditions have been ruled out with chest pain. Vertebral Subluxation Complex is the most common reason for pain in the middle back and chest that is not the result of a heart problem or acid reflux. In cases of non-cardiac (not involving the heart) middle back and chest pain, Chiropractic has been shown to have significant results in reducing or eliminating pain and discomfort. Many people experience pain between the shoulder blades, over the breast bone or the collar bones. In today’s society of increasing demands in the office setting, endless hours in front of a computer or all day commutes in our vehicles the stress on the thoracic spine (middle back)and chest continues to increase. Unfortunately when we sit and slouch forward, the brunt of the forces are condensed to the area just below our shoulder blades and our breast bone. We have all been cautioned to “have good posture”, but anyone that has worked a full day knows, once you are tired there is really not much you can do about your posture.
A recent study stated that “Traditionally, patients with chest discomfort are admitted to a cardiology ward because the heart is under suspicion as the pain source; however, the etiology of pain may be non-cardiac in up to 50% of cases”1 (p654). The authors continue on to say “Although patients with non-cardiac chest pain have an excellent prognosis for survival and a future risk of cardiac morbidity [complications] similar to that of the general population, approximately 3 quarters of these patients continue to suffer from residual chest pain, one half remain or become unemployed, and one half report being significantly disabled”1 (p 654)
The most important aspect of this study states “There is a broad agreement among clinicians that the musculoskeletal system is a potential source of pain in non-cardiac chest discomfort, but very few studies have addressed this issue systematically despite the compelling issues discussed above.”1 (p 654) This study found that there was a significant reduction in the anxiety associated with the patient’s chest pain, the patients had a better understanding that the musculoskeletal system was the source of their discomfort and 96% of patients believed that chiropractic treatment had helped.1
In a case study published in 2003, the authors discovered that after the possibility of cardiac involvement was considered, Vertebral Subluxation Complex located at the junction of the breast bones and ribs in the front of the chest was the cause. Reducing the Vertebral Subluxation Complex with Chiropractic techniques had resolved this patients symptoms. 2
Chiropractic interventions into managing and/or eliminating chest and middle back pain have been shown to be safe once cardiac causes have been ruled out. Doctors of Chiropractic are trained to not only evaluate for non-musculoskeletal conditions, but to work as part of your healthcare team. 3
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Henrik W. Christensen, DC, MD, PhD, Werner Vach, PhD, Anthony Cichangi, Claus Manniche, MD, DMSc, Torben Haghfelt, MD, DMSc, and Poul F. Hilund-CaHsen, MD, DMSc. Manual Therapy for Patients with Stable Angina Pectoris: A Nonrandomized open prospective trial. J Manipulative Physiol Ther 2005;28:654-661
2. Bradley S. Polkinghorn, DC, Christopher J. Colloca, DC. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. J Manipulative Physiol Ther 2003;26:108-15.
3. Kaufman, RL, Manipulative reduction and management of anterior sternoclavicular joint dislocation. J Manipulative Physiol Ther, 1997 Jun; 20(5): 338-42
Lower Back Injuries and Chiropractic
One of the most common areas of the body to be hurt while working is the lower back. The injuries can be as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with a lower back injury while working or know someone that did. Finding a doctor that can determine what exactly is wrong and prescribing the right treatment is the most important aspect of healing. Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective treatment plan. The cornerstone of that plan is the Chiropractic Adjustment.
A recent research article published in 2009 revealed the results of 100 injured workers with back or neck pain that were treated with Chiropractic care. This study was in partnership with the University of Colorado School of Medicine and Lakewood Spine and Sports Center in Lakewood Colorado. The authors state in the research paper “Over the last 15 years, the percentage of pre-retirement disabled US workers has increased from 5% to 9% such that more people receive disability income that are unemployed”1. (This of course was published prior to the most recent economic downturn). They go on to note, “Consequently, finding treatment methods that encourage a safe and rapid return of the injured worker to the workforce is an important issue for all clinicians addressing occupational neck and low back pain.”1 (765)
Chiropractic care was shown in this review of 100 injured workers, 81.5% of patients with acute pain reported post treatment improvement! That is a very significant number. Chiropractic, especially when part of a larger integrated model is extremely safe and effective.
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD, Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAIN TREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES. J Manipulative Physiol Ther 2009;32:765-771
Do Chiropractors Help Patients With Headaches?
This seems like an easy question to answer, doesn’t it? The answer of course being, YES!!! However, there are many people who suffer with headaches who have never been to a chiropractor or have not even ever considered it as a “good option.”
So, rather than having me “reassure you” that chiropractic works GREAT for headache management, let’s look at the scientific literature to see if “they” (the scientific community) agree or not.
In a 2011 meta-analysis, researchers reviewed journals published through 2009 and found 21 articles that met their inclusion criteria and used the results to develop treatment recommendations. Researchers discovered there is literature support utilizing Chiropractic care for the treatment of migraine headaches of either episodic or chronic migraine. Similarly, support for the Chiropractic treatment of cervicogenic headaches, or headaches arising from the neck region (see last month’s Health Update), was reported. In addition, joint mobilization (the “non-cracking” type of neck treatment such as figure 8 stretching and manual traction) or strengthening of the deep neck flexor muscles may improve symptoms in those suffering from cervicogenic headaches as well. The literature review also found low load craniocervical mobilization may be helpful for longer term management of patients with episodic or chronic tension-type headaches where manipulation was found to be less effective.
Okay, we at Sayville Immediate Chiropractic Care realize this is all fairly technical, so sorry about that. But, it is important to “hear” this so when people ask you why are going to a chiropractor for your headaches, you can say that not only that it helps a lot, but there are a lot of scientific studies that support it too!
Bottom line is that it DOES REALLY HELP and maybe, most importantly, it helps WITHOUT drugs and their related side effects. Just ask someone who has taken some of the headache medications what their side-effects were and you’ll soon realize a non-drug approach should at least be tried first since it carries few to no side effects.
We at Sayville Immediate Chiropractic Care realize that you have a choice in where you choose your healthcare services.
If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Carpal Tunnel Syndrome and Chiropractic
When people experience pain in the wrist, the common assumption is that it is carpal tunnel syndrome. The wrists are made of 2 rows of 4 bones called the carpal bones. When you flip your hand over with the palm facing the sky, there is a covering over those bones at the wrist. To the side of this covering is where you can take your pulse. One of two major nerves that go to the hand travel between this covering and the carpal bones. The nerve travels with the tendons, which connect muscle to bone, of nine muscles that flex the wrist or bring your fingers toward you. The nerve is named the median nerve, so carpal tunnel syndrome is the compression of the median nerve between the carpal bones and the covering of the tunnel at the wrist. This causes numbness and tingling in the thumb, index finger and ½ of the middle finger because that is where the median nerve goes. Numbness or tingling in any other finger or the palm is not due to carpal tunnel and may be coming from the elbow, shoulder or neck.
There are a few common reasons for carpal tunnel syndrome, the primary one being inflammation or swelling in the tunnel. This can be due to direct trauma like a wrist injury or a result of a car accident involving your hands twisting on the steering wheel. Other causes can be overuse, like typing too much on a keyboard, fine movements at work or weakness and overuse of the forearm muscles. The mild and moderate symptoms can generally be controlled and treated with conservative therapy. More severe cases often require surgery and can only be quantified with a neurological test. Surgery, although necessary in some cases, is a last resort since scar tissue can result from the surgical incision and over time can result in the return of compression of the median nerve in the carpal tunnel. In the cases of the mild or moderate symptoms, they may be due to improper mechanics of the 8 bones of the wrist. In these cases, chiropractic management, using the chiropractic adjustment administered to this area, has been shown to be effective in a recent study.
In this study the authors stated, “From a mechanistic viewpoint, manual therapy techniques designed to release tissue adhesions and increase the range of motion (ROM) of the wrist may alleviate the mechanical compression of the median nerve without the need for surgical interventions" (Burke et al., 2007, p. 51). They also state, "Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks" (Burke et al., 2007, p. 50). "The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions” (Burke et al., 2007, p. 50).
The authors related the following statistic, “The American Academy of Neurology and 40% of neurologists in the Netherlands recommend conservative management of CTS before surgical intervention" (Burke et al., 2007, pp. 50-51). An important perspective to have on surgical intervention was also included and the authors stated, “In addition, of patients with failed primary surgical interventions, up to 12% may require a secondary surgical procedure. Persistent symptoms after a secondary surgical procedure ranged from 25% to 95%" (Burke et al., 2007, p. 51). Therefore, we see that the American Academy of Neurology recommends holding off on surgery until other options are explored.
In conclusion, the paper reports, “Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS" (Burke et al., 2007, p. 59). In the end, it was the management of carpal tunnel syndrome by a doctor of chiropractic that was the most important factor; the individual techniques did not matter.
If you are experiencing numbness and tingling into hands or fingers, please discuss this with a doctor of chiropractic. Conservative care is recommended by the American Academy of Neurology.
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61.
Arthritis and Low Back Pain:
Chiropractic Care vs. Heat Treatment
Chiropractic care rendered significantly greater relief of pain
and significantly more mobility
"31 million Americans experience low-back pain at any given time" (The American Chiropractic Association, 2010, https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68)
Interesting facts about back pain:1
What Causes Back Pain?
The back is made up of bones, joints, ligaments and muscles. Ligaments can be sprained, muscles can be strained, disks can rupture, and joints can be irritated. All of these can result in back pain. It doesn't always take a major event like a sports inury or an accident to cause back pain. Even the simplest of movements, like picking a small object up from the floor, can have painful results. There are also numerous conditions that can cause or complicate back pain, such as arthritis, poor posture, obesity, and psychological stress. Disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss, can also result in back pain.1
The most common form of arthritis is called osteoarthritis. It is also known as degenerative joint disease and is a disease of the joints. It affects more than 20 million American adults. The cause of osteoarthritis is a breakdown of cartilage, the connective tissue that provides a cushion between the bones of the joints. Healthy cartilage is what permits bones to move over one another and acts as a shock absorber during physical movement. Those afflicted with this disease experience a breakdown of cartilage that wears away. As a result, the bones under the cartilage rub together, resulting in pain, swelling, and loss of joint motion.2
What Causes Osteoarthritis?2
There is often no known cause of osteoarthritis. Risk factors include:
Signs and Symptoms of Osteoarthritis2
Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint . Other symptoms may include:
In 2006, "...an experimental design was used to compare the effects of chiropractic care (and moist heat) to the effects of moist heat alone for treating lower back pain that is secondary to [arthritis] of the lumbar spine" (Beyerman, Palmerino, Zohn, Kane, & Foster, 2006, p. 107). This was the first study of its kind. There were 3 parameters measured, pain, mobility and activities of daily living. The results conclusively revealed in every metric analyzed that chiropractic care rendered significantly better results, rendering greater relief of pain and significantly more mobility had been restored.
Low back pain and osteoarthritis is a very common condition treated daily in chiropractor’s offices nationwide. This study confirms scientifically the clinical results treating chiropractors have been experiencing for over 100 years. The degree to which pain interferes with aspects of daily living was statistically measured, specifically with walking, sitting and social life and those test subjects under chiropractic care had superior results that simply utilized moist heat.3
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain and arthritis. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
References:
1. The American Chriopractic Association. (2010). Back pain facts and & statistics. Retrieved fromhttps://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Dawson, E. G., & Shaffrey, C. I. (2009, December). Osteoarthritis: Degenerative spinal joint disease.Spineuniverse. Retrieved from http://www.spineuniverse.com/conditions/spondylosis/osteoarthritis-degenerative-spinal-joint-disease
3. Beyerman, K. L., Palmerino, M. B., Zohn, L. E., Kane, G. M., & Foster, K. A. (2006). Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: Chiropractic care compared with moist heat alone. Journal of Manipulative and Physiological Therapeutics, 29(2), 107-114.
Herniated Discs, Radiating Pain and Chiropractic
80% of chiropractic patients reported excellent or good result in a 2 year study
Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a “slipped disc” because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients.1
Although many of these are surgical cases, it has been estimated that only 2-4% have actual surgical indications. Therefore, most patients need to be treated non-surgically and until recently, there have been few metrics affording guidance to the healthcare profession and public alike directing them to the right care. In a 2009 research report, culminating a 2 year study, a clear direction is now available for patients that suffer with radiating pain from herniated discs.1 The results of the study show that as a result of chiropractic care, “clinically meaningful improvement in pain intensity was seen in 73.9% of patients(Murphy, Hurwitz, & McGovern, 2009, p. 728). "'Good' or 'excellent' improvement was reported by 80% of patients" (Murphy, Hurwitz, & McGovern, 2009, p. 723).
Chiropractic treatment protocols utilized were 2-3 times per week tapering down to 2 times per week and less until the patients were released from care. The reports go on to state that there were no major complications with any patient. The results of the study also suggest that patients with cervical radiculopathy (neck pain radiating in to the arms), lumbar spinal stenosis, pregnancy related lumbo-pelvic pain and chronic work related neck-arm pain may also benefit from non-surgical treatment such as chiropractic care.1
This study clearly shows that chiropractic is not only an alternative for disc related radiating pain, but would be the most logical place to begin care, as 80% of the patients studied got well and without being exposed to drugs, their side effects or the added burden to the healthcare system with more costly treatments. In practice, the balance of the patients who need necessary drugs or more complicated intervention would be referred to the appropriate specialist as is the standard of care within chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for disc and radiating pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
References:
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.
Acute Neck Pain (Torticollis)
Disability and Chiropractic:
Patient Satisfaction Results
The overall patient satisfaction rate was 94%
"Acute neck pain means immediate neck pain. Neck pain that just started. This type of pain comes on suddenly and affects the ability to properly move your head in its proper range of motion. One serious type of acute neck pain is whiplash - the sudden jarring motion of your head going backwards and forward. This often occurs with a rear end collision. Acute neck pain can also be the result of a fall, sleeping awkwardly, a trauma or even a fall.. Often times when someone has just strained or irritated their neck in some way the pain is most severe. There is usually inflammation, immobility, and muscle tenderness. Often with acute neck pain, the muscles or ligaments are involved" (The Neck Pain Relief Shop, n.d.,http://www.neckpainreliefkit.com/acuteneckpain).
The “real life” issue for the patient who either wakes up with this debilitating pain or is in an accident that causes it, is that taking drugs without narcotics is insufficient for relieving the pain. With the narcotics, one can be severely hampered and may not be able to go about his/her life. It is often a double-edged sword; take strong drugs and compromise your life or don't take drugs, receive no chiropractic care and suffer.
A 2006 study examined "...the extent to which a group of patients with acute neck pain managed with chiropractic [adjustments]...and the degree to which they were subsequently satisfied...A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years...The mean number of visits was 24.5...Pain levels improved significantly from a mean of 7.6...before treatment to 1.9...after treatment...The overall patient satisfaction rate was 94%" (Haneline, 2006, p. 288).
"There were reductions in disability recorded during the study that were statistically significant. Approximately 84% of the patients related that their activities were restricted before chiropractic treatment because of their neck pain, whereas only 25% still had activity restrictions at the time of the interview. Furthermore, 57% of those with physical restrictions described their disabilities as moderately severe or greater before treatment, whereas at the time of the interview, just 12% did (Haneline, 2006, p. 294).
"When comparing trauma with no-trauma cases, Trauma cases received more than 3 times as many visits. This difference may be related to tissue damage that often accompanies trauma, which, many times, heals imperfectly. In addition, patients with this type of problem may have ensuing long-term pain and physical impairment, which further shows that trauma complicates the recovery of acute neck pain (Haneline, 2006, p. 294).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. The Neck Pain Relief Shop. (n.d.). Acute neck pain. Retrieved from http://www.neckpainreliefkit.com/acuteneckpain
2. Haneline, M. T. (2006). Symptomatic outcomes and perceived satisfaction levels of chiropractic patients with a primary diagnosis involving acute neck pain. Journal of Manipulative and Physiological Therapeutics, 29(4), 288-296.
Balance and Movement and The Effect of Chiropractic Care
Utilization with the Elderly, Cerebral Palsy, the Athlete
and the General Population
Courtesy of: Dr. Frank M Gomez
www.sayvillechiropractor.com
Chiropractic care improves motor control
Sensorimotor is defined as our ability to feel and move. With infants, Piaget, the renowned researcher, categorized the first 2 years of an infant’s life as the sensorimotor stage. "During this period, infants are busy discovering relationships between their bodies and the environment. Researchers have discovered that infants have relatively well developed sensory abilities. The child relies on seeing, touching, sucking, feeling, and using their senses to learn things about themselves and the environment. Piaget calls this the sensorimotor stage because the early manifestations of intelligence appear from sensory perceptions and motor activities" (Anderson, n.d., http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html).
As we develop and our nervous systems have acquainted us to our surroundings, we need the neurological "hookups" to remain intact to function optimally and pain free. In addition, our sensory and motor systems need to work in tandem in order for us to function normally.
To further break it down, our sensory system is part of the nervous system that consists of receptors that receive stimuli from both our internal and external environments. These receptors, such as the ones located in our fingertips, sense external stimuli, such as hot or cold, or what we feel. An internal receptor may be found in the tendons (connect your muscles to your bones) and lets you know what your joints are doing, such as are my fingers sensing if they are relaxed or in a fist. The sensory system is also controlled by the brain that processes what we feel.
Pain is part of the sensory nervous system and to the surprise of many, pain is an important component to protecting yourself. Without pain, you could get seriously hurt, such as by keeping your finger on a hot stove too long or touching a sharp object too heavily and cutting your hand. Internally, pain is a warning sign that an organ or system is "sick" and alerts you to seek medical care.
All pain receptors are free nerve endings, meaning they only bring information to your brain and function as the "pain receptors." There are three types of pain receptors; mechanical, thermal and chemical. They are found in skin and on internal surfaces such as the coverings of the bone and joint surfaces. "Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas is experienced. Pain receptors do not adapt to stimulus. In some conditions, excitation of pain fibres becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia [commonly known as, "WOW, that hurts a lot!"]" (Global Oneness, n.d.,http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137).
Your motor system is what allows you to move, maintain your posture and control your muscles. The motor system is controlled through nerves similar to the sensory system and like the sensory system, has a controlling element in the brain.
Functional tasks are defined as those things we do in our lives. Answering a telephone, putting a key in a door lock or picking up a fork to eat are all examples of functions. These functions, just like Piaget described in infants, are how we have a relationship with our body and the environment and require an integrated motor and sensory nervous system. Every functional task that we do involves both the motor and sensory components of our nervous system and while performing these tasks, we are protected by our ability to perceive pain.
Due to the development and integrategration of the world around us necessary to complete every task in our lives, as we get older, postural disturbances can arise and negatively affect how we integrate the sensorimotor information we are receiving both internally and externally and lead to significant balance disorders. Lord and Ward (1994) reported that, "All of the sensory, motor and balance system measures showed significant age-associated differences"(http://ageing.oxfordjournals.org/cgi/content/abstract/23/6/452). This means that as one gets older, his/her sensorimotor system often fails to integrate the internal and external environment as it once could.
A research study by Taylor and Murphy (2008) concluded that chiropractic care reverses maladaptations in sensorimotor integration and improving motor control. The study suggests that spinal dysfunction may lead to muscle specific alterations of the brain’s ability to process motor control. The "real-life" implications of this finding affect every facet of our lives and every person. Whether it be an older person who is starting to exhibit balance disorders, or a cerebral palsy victim who struggles on a daily basis with the simple tasks of life or a world class athlete looking to increase his/her fine motor skills just 1/10 of 1%, the results of chiropractic care can be dramatic.
From the clinical observation of Dr. Mark Studin, a co-author of this article and a practicing chiropractor for 30 years, "This now gives scientific evidence and validation to what patients have been sharing after receiving chiropractic care. The most common comment from patients post care is, 'I perceive my surroundings more acutely and feel straighter.'" Dr. Studin continues, "Although I have heard this from every age group, my first patient was a cerebral palsy patient who stated that without getting adjusted he could barely function. With care, he walked to and from the office, a distance of 3 miles."
These studies, along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions to increase integration between the motor and sensory systems of your body. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory atwww.USChiroDirectory.com and search your state.
References:
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. Anderson, M. (n.d.). Sensorimotor stage. Jean Piaget's Theory of Development. Retrieved from http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html
2. Global Oneness. (n.d.). Pain - Physiology. Retrieved from http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137
3. Lord, S. R. & Ward, J. A. (1994). Age-associated differences in sensori-motor function and balance in community dwelling women. Age and Ageing. Retrieved from http://ageing.oxfordjournals.org/cgi/content/ abstract/23/6/452
4. Taylor, H. H. & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation.Journal of Manipulative and Physiological Therapeutics, 31(2), 115-126.
Acute (Severe) Low Back Pain, Early Intervention and Chiropractic
87% of Chiropractic Patients Showed Improvement!
Courtesy of: Dr.Frank Gomez
www.sayvillechiropractor.com
One of the most common areas of the body to be hurt while working, playing sports, cleaning out the garage or any other household or life chore is the lower back. The American Chiropractic Association has reported that 31 million Americans experience low back pain at any given time. This represents a significant health concern, especially if many of the conditions contributing to low back pain go untreated.
The cause of the pain can be injuries as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with lower back pain, either from an injury while working or simply waking up with it. Finding a doctor that can determine what exactly is wrong (creating an accurate diagnosis) and prescribing the right treatment is the most important aspect of getting well. In fact, one of the most dangerous phrases one can utter is, "Maybe the pain will go away," and is often adopted by too many sufferers.
According to a 2008 study by Globe, Morris, Whalen, Farabaugh, and Hawk on low back pain disorders reported, "Most acute pain, typically the result of injury (micro- or macrotrauma), responds to a short course of conservative treatment [chiropractic care]. If effectively treated at this stage, patients often recover with full resolution of pain...Delayed or inadequate early clinical management may result in increased risk of chronicity and disability" (p. 654).
A 2005 study by DeVocht, Pickar, & Wilder concluded through objective electrodiagnostic studies (neurological testing) that 87% of chiropractic patients exhibited decreased muscle spasms. This study validates the reasoning behind the later study that people with severe muscle spasms in the low back respond well to chiropractic care and prevents future problems and disabilities. It also dictates that care should not be delayed or ignored due to risk of complications.
Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment. Chiropractic and lower back pain has been one of the most commonly researched topics to date. There is a large volume of research showing that the chiropractic adjustment is effective for treating lower back pain.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
Thank you for your time in reading my article. Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
4844 Sunrise Highway
Sayville, NY 11782
(631) 991-3492
Chiropractic Treatment for: Neck Pain, Back Pain, Headaches and Shoulder Pain
No Appointment Necessary, Walk-in Chiropractic Care:
New patients welcome. No Long Term Care Plans
The Chiropractic office that makes it convenient for you to get the care you want in today's busy society! Our practice has a strong working relationship with many local allied health care professionals and primary care MD's.
References
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Globe, G. A., Morris, C. E., Whalen W. M., Farabaugh, R. J., & Hawk C. (2008). Chiropractic management of low back disorders: Report from a consensus process. Journal of Manipulative and Physiologic Therapeutics, 31(9), 651-658.
3. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
Headaches and Migraines:
Chiropractic Saves Federal and Private Insurers $13,680,000,000
and Resolves Many Issues Facing Emergency Rooms Today
Courtesy of: Dr. Frank Gomez
Published in Dynamic Chiropractic, Volume 29, Issue 22
It was reported by Doheny in 2006 that migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism. Doheny goes on to report that according to Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, "The programs are so few and far between because many companies ‘don't perceive it as a priority’" (p. 10).
Much of the public perceive headaches and migraines as normal occurrences. For example, a patient will enter a doctor's office and report they get normal headaches, not realizing that pain is never a normal occurrence. Symons, Shinde and Gilles (2008) highlighted a statement from http://www.iasp-pain.org saying that pain is "'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'" (p. 277). As a result of the public not taking many types of headaches as potential serious problems, they let the condition linger and that can lead to negative sequella.
According to Munakata, Hazard, Serrano, Klingman, Rupnow, Tierce, Reed and Lipton (2009) "...neuroimaging studies have provided compelling evidence that suggests progressive brain changes in persons with migraines...migraine frequency is associated with posterior circulation infarcts and diffuse white-matter lesions...Welch et al. showed that impairments in iron homeostasis in periaqueductal grey areas that were associated with migraine duration and chronic daily headache" (Munakata et al., 2009, p. 499).
Munakata et al. also reported that the economic impact of migraines in both directhealthcare costs and indirect costs of absenteeism is a huge economic burden. The direct cost of migraines ranges from $127 to $7,089 per and the indirect cost due to absenteeism ranges from $709 to $4,453 per victim, making migraines an economic burden to the individual, the insurer, the employer with absenteeism and increased benefits paid and local, state and federal entities who will experience a lowered tax base from lost wages. It was also reported that between 2005 and 2006 there were 1,729,555 physician office visits, 186,603 advanced imaging procedures, 59,589 other diagnostic procedures, and 22,168 hospital days with a primary diagnosis of migraine or headache; all of which are paid by private or public insurers or out of the pockets of individuals. In short, the costs are staggering and a burden to the economy.
Friedman, Feldon, Holloway and Fisher (2009) reported that acute headaches account for 5% of emergency department (ED) visits in hospitals. In addition, they also reported that "…the ED environment that may also contribute to unsatisfactory treatmentresponse include limited physician contact time that may preclude a detailed history, overuse of ED by patients with substance abuse problems, the need for rapid triage, the competing distraction of patients with life-threatening conditions, and directives (or lack thereof) for care dictated by the referring physician…Thus, the treatment of migraine patients in the ED appears to be suboptimal and the high rate of recurrent headache may be attributed to underutilization of relatively ‘migraine specific’ treatment" (Friedman et al., 2009, p. 1164).
Nelson, Suter, Casha, du Plessis and Hurlbert (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care and for amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy. In addition, it was reported that, with the drug group, "...58% experienced medication side effects important enough to report them. In the amatriptyline group, 10% of the subjects had to withdraw from the study because of intolerable side effects. Side effects in the SMT (Spinal Manipulative Therapy) group were much more benign, infrequent, mild and transitory. None required withdrawal from the study (Nelson et al., 1998, p. 511). Although this study was conducted 13 years ago, a more current study by Chaibi, Tuchin and Russell (2011) reported that that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine, supporting the previous findings. Although more research is desperately needed, the above conclusions give the public clear directions with migraines and headaches.
Using the 57% increased effectiveness that chiropractic has over drug therapy (leaving out the overlap that chiropractic could help without drugs) and the $24,000,000,000 ($24 billion) Americans pay for headaches and migraines, the savings would result in $13,680,000,000. back in the insurers, the public's and the government's pockets. In addition, if chiropractic reduced the necessity for emergency room visits by 57%, then the ED doctors could focus on what their primary purpose is, to save lives in urgent scenarios.
Chiropractic offers solutions to the federal government, local government, public and private insurance companies, eases the burden on emergency rooms and prevents unnecessary side effects of drugs that are not clinically indicated, with a more viable and proven drugless solution. Although much more research is desperately needed to explore the benefits of chiropractic with migraines and headaches, the research that is available clearly reports that chiropractic offers immediate solutions. These solutions will add to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year and productivity avoiding absenteeism. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
References:
1. Doheny, K. (2006). Recognizing the financial pain of migraines. Workforce Management, 85(16), 10-12.
2. Symons, F. J., Shinde, S. K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(Pt 4), 275-286.
3. Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F. T., Tierce, J., Reed, M., & Lipton, R. (2009). Economic burden of transformed migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 49(4), 498-508.
4. Friedman, D., Feldon, S., Holloway, R., & Fisher, S. (2009). Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department. Headache,49(8),1163-1173.
5. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
6. Chaibi, A., Tuchin, P. J., & Russell, M.B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain, 12(2), 127-133.
Headaches & Migraine: Chiropractic vs. Medication
Effectiveness & Safety
In randomized clinical trials, chiropractic was 57% more effective in the reduction of headaches and migraines than drug therapy
It was reported in October of 2010 by Wrong Diagnosis that approximately 1 in 6,16.54% or 45 million Americans get headaches yearly, with many people suffering daily. While the statistical numbers vary based upon your source of information, it can be agreed upon that headaches are very common and shared among Americans at an epidemic rate. Taking into account that a single pill for many Americans to treat a headache can cost as much as $43, according to Consumer Reports Health Best Buy Drugs, the overall cost to our economy totals billions of dollars and we need to focus not on the treatment of the effects, but the root of the cause.
When you suffer from headaches, it affects every facet of your life and you search for immediate answers. Most often it is a medication, either over-the-counter or prescription as evidenced by the amount of money spent as previously reported. One of the first medications recognized for the potential treatment of headaches is amatriptyline, commonly known by brand names such as Elavil, Endep or Amitrol as reported by Robert on About.com in 2006. It is also used as an antidepressant. This medication has made up a large part of the billion dollar industry along with over-the counter-medications. Although in many instances, this drug is indicated, the question that arises is what are the risks of taking this widely used medication?
The potential side effects of this medication targeted for headache sufferers, according to drugs.com (n.d.), are: blurred vision, change in sexual desire or ability, constipation, diarrhea, dizziness, drowsiness; dry mouth, headache, loss of appetite, nausea, tiredness, trouble sleeping, and weakness. Severe allergic reactions can be: rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue, chest pain, confusion, dark urine, delusions, difficulty speaking or swallowing, fainting, fast or irregular heartbeat, fever, chills, or sore throat; hallucinations, new or worsening agitation, anxiety, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still, numbness or tingling in an arm or leg, one-sided weakness, seizures, severe or persistent dizziness or headache, severe or persistent trouble sleeping, slurred speech, suicidal thoughts or actions, tremor, trouble urinating, uncontrolled muscle movements (such as in the face, tongue, arms or legs), unusual bleeding or bruising, unusual or severe mental or mood changes, vision problems, and yellowing of the skin or eyes. Over the counter remedies of NSAID's or aspirin have a long list of their own of side effects.
The safety of chiropractic, in spite of rhetoric from naysayers, has been documented in clinical trials by Miller and Benfield (2008), who reported on children younger under 3 years old, "the youngest and most vulnerable population..." (p. 420). There was one reaction reports for every 749 adjustments which was typically crying. None were reported to have any serious side effects.
In adults, clinically, the majority of any side effects are soreness that is transient. This is based upon this author's 30 years of clinical experience and teaching doctors of chiropractic who are trained in creating an accurate diagnosis, prognosis and treatment plan. To say that more serious side effects cannot happen is irresponsible. However, they are rare, non-life threatening and usually transient in nature, no different than infants. To ensure the best outcomes, like with any professional, you have to verify the doctor's credentials and experience, which is best accomplished by securing a copy of the doctor's curriculum vitae (his/her academic and professional credentials).
Nelson et. al. (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care, amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy.
Bryans, et. al. (2011) confirmed Nelson's findings and reported that spinal manipulation (adjusting) is recommended for patients with episodic or chronic migraines with or without aura and patients withcervicogenic headaches. This follow-up study is not a comparison or comment on the use of drugs. It simply demonstrates that chiropractic is a viable solution for many and can save the government and private industry billions in expenditures both in health care coverage, loss of productivity and avoidance of absenteeism in industry creating a new level of cost as sequella to headaches.
Medications and other forms of invasive care are often necessary and it is critical for a trained doctor to perform an accurate history and physical and when indicated, advanced diagnostic testing (CAT scans, MRI's, etc.) to ensure there aren't more serious underlying complications. However, based upon the results of the research provided by Nelson et al. (1998) and Bryans et. al. (2011), it should be chiropractic first, drugs second and surgery last to render better outcomes with less potential side effects and a quicker return to productivity.
By Mark Studin DC, FASBE(C), DAPM, DAAMLP
References:
1. Wrong Diagnosis. (2010, October 6). Prevalence statistics for types of headaches and migraine conditions. Health Grades Inc. Retrieved fromhttp://www.wrongdiagnosis.com/h/headache_and_migraine_conditions/prevalence-types.htm
2. Consumer Reports Health Best Buy Drugs. (n.d.). Treating migraine headaches: The triptans, Comparing effectiveness, safety, and price. Health.org. Retrieved fromhttp://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf
3. Robert, T. (2006, May 26). Amitriptyline: Headache and migraine drug profiles. About.com. Retrieved from http://headaches.about.com/od/medicationprofiles/a/amitriptyline.htm
4. Drugs.com. (n.d.). Amitriptyline side effects. Retrieved from http://www.drugs.com/sfx/amitriptyline-side-effects.html
5. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
6. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
7. Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R.,... White, E. (2011). Evidenced-based guidelines for the treatment of adults with headache. Journal of Manipulative & Physiological Therapeutics, 34(5), 274-289.
Brain Function (Sensorimotor Cortex)
Increases with Chiropractic Care
Courtesy of: Dr. Frank Gomez, DACBSP
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://spdfoundation.net/about-sensory-processing-disorder.html).
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. this alters the way the central nervous system responds to motor training
2. a chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. this explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. this explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. muscular dystrophy
2. Duchenne muscular dystrophy
3. myasthenia gravis
4. Parkinson's disease
5. fibromyalgia
6. multiple sclerosis
7. Huntington's disease
8. stroke victims
9. all other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
by
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved fromhttp://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics, 33(4), 261-272.
Back and Leg Pain (Lumbar Radiculopathy) as a Result of Disc Herniation and the Long Term Effect of Chiropractic Care
90% of all low back-lumbar disc herniation patients got better with chiropractic care
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
The term "herniated disc" has been called many things from a slipped disc to a bulging disc. For a doctor who specializes in disc problems, the term is critical because it tells him/her how to create a prognosis and subsequent treatment plan for a patient. To clarify the disc issue, a herniated disc is where a disc tears and the internal material of the disc, called the nucleus pulposis, extends through that tear. It is always results from trauma or an accident. A bulging disc is a degenerative "wear and tear" phenomenon where the internal material or nucleus pulposis does not extend through the disc because there has been no tear, but the walls of the disc have been thinned from degeneration and the internal disc material creates pressure with thinned external walls. The disc itself "spreads out" or bulges.
There are various forms and degrees of disc issues, but the biggest concern of the specialist is whether nerves are being affected that can cause significant pain or other problems. The problem exists when the disc, as a result of a herniation or bulge, is touching or compressing those neurological elements, which is comprised of either the spinal cord, the nerve root (a nerve the extends from the spinal cord) or the covering of the nerves, called the thecal sac.
With regard to the structure that we have just discussed, the doctor must wonder what the herniation of the neurological element has caused. In this scenario, there are 2 possible problems, the spinal cord and nerve root. If the disc has compromised the spinal cord, it is called a myelopathy (my-e-lo-pathy). You have a compression of the spinal cord and problems with your arms or legs. An immediate visit to the neurosurgeon is warranted for a surgical consultation. The second problem is when the disc is effecting the spinal nerve root, called a radiculopathy. It is a very common problem. A doctor of chiropractic experienced in treating radiculopathy has to determine if there is enough room between the disc and the nerve in order to determine if a surgical consultation is warranted or if he/she can safely treat you. This is done by a thorough clinical examination and in many cases, an MRI is required to make a final diagnosis. Most patients do not need a surgical consultation and can be safely treated by an experienced chiropractor.
While herniations can occur anywhere, it was reported by Jordan, Konstanttinou, & O'Dowd (2009) that 95% occur in the lower back. "The highest prevalence is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years" (http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence).
It was reported by Aspegren et al. (2009) that 80% of the chiropractic patients studied with both neck and low back (cervical and lumbar) disc herniations had a good clinical outcome with post-care visual analog scores under 2 [0 to 10 with 0 being no pain and 10 being the worst pain imaginable] and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. A study by Murphy, Hurwitz, and McGovern (2009) focused only on low back (lumbar) disc herniations and concluded that, "Nearly 90% of patients reported their outcome to be either 'excellent' or 'good'...clinically meaningful improvement in pain intensity was seen in 74% of patients (p. 729)." The researchers also concluded that the improvements from chiropractic care was maintained for 14 1/2 months, the length of the study, indicating this isn't a temporary, but a long-term solution. It was reported by BenEliyahu (1996) that 78% percent of the low back-lumbar disc herniation patients were able to return to work in their pre-disability occupations, which is the result of the 90% of all low back-lumbar disc herniation patients getting better with chiropractic care as discussed above.
These are the reasons that chiropractic has been, and needs to be, considered for the primary care for low back-lumbar disc herniations with resultant pain in the back or legs. This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for herniated discs and low back or leg pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Jordan, J., Konstanttinou, K., & O'Dowd, J. (2009, March 26). Herniated lumbar disc. Clinical Evidence. Retrieved from http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence
2. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal Manipulative Physiological Therapy 32(9), 765-771.
3. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal Manipulative Physiological Therapy, (32)9, 723-733.
4. BenEliyahu, D. J. (1996). Magnetic resonance imaging and clinical follow-up: Study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal Manipulative Physiological Therapy, 19(9), 597-606.
Subluxation vs. Disc Herniation
Old Paradigms & New Technology; The pathway for Chiropractic as "Spinal Primary Care Providers"
by Mark Studin DC, FASBE(C),DAAPM, DAAMLP
Studin, M (2012) Subluxation vs. Disc Herniation Old Paradigms & New Technology; The pathway for Chiropractic as "Spinal Primary Care Providers," The American Chiropractor, 38, 40-42
Chiropractic utilization in the United States remained static at 12.1 million from 2003 until 2006 as reported by Davis, Brenda and Williams in 2010. This represents 4.12% of the population considering the 2003 population reported by the Encyclopedia of the Nations. Davis et. al. also reported that in the early 1990's chiropractic utilization was 7.7% of the United States adults realizing a net loss of utilization of 3.58% in just a decade. The reasons are many and in spite of the growing interest in the utilization of complementary and alternative medicine (CAM) nationwide with chiropractic the largest CAM provider, the numbers are still dwindling. The chiropractic profession must take an honest look at the numbers and realize that it can no longer be "business as usual" or risk the utilization to continue dwindling until we no longer make the positive impact on society that we currently do.
Fiore in 2012 reported that accurate diagnosing was critical to the success of the chiropractic profession in order to be credible in the healthcare community. He also reported that many chiropractors hide behind the definition of chiropractic "...art, science and philosophy of locating and correcting nerve interference..." and continued on to say "This allows the chiropractic profession to have great latitude...but does not excuse us from making an incorrect diagnosis." In order for us to understand the spinal related problem or any pain, we must not create a correct hypothesis, we must conclude an accurate diagnosis before we construct a prognosis and treatment plan. According to Frank Zolli DC, the Dean of the University of Bridgeport College of Chiropractic for over 20 years "every chiropractic student during their doctoral training learns at the most basic level of training that you must have an accurate diagnosis and then create a prognosis before you treat your patient." Dr. Zolli continued by saying that this is taught in every CCE accredited chiropractic college.
With the advent of new and not so new technology, we no longer have to hypothesize or theorize. It's called the MRI and every licensed doctor of chiropractic in the United States has within their scope, the ability to refer a patient for an MRI (with the exception of Medicare as the Federal Government through their actions and regulations have much less regard for the well-being of our seniors.) Chiropractors have to realize that technology takes away much of the hypothesizing and allows us to conclude with a great degree of certainty an accurate diagnosis; the foundation of the treatment plan.
When we look at disc issues, this gives the chiropractic profession a universal platform to becoming and being considered by medicine the "Spinal Primary Care Providers." Back pain, inclusive of disc pathology is a thorn in the sides of most primary care providers (PCP's) and a diagnosis they universally refer to orthopedic surgeons for lack of a better alternative. The orthopedic surgeon is centered on surgery with their $225,000+ malpractice costs and summarily dismiss most non-surgical cases to physical therapists, who in turn render much poorer outcomes according to Cifuentes et. al in 2011 for back related issues compared to chiropractic care.
Cifuentes concluded that chiropractic care during the disability episode resulted in:
24% Decrease in disability duration of first episode compared to physical therapy
250% Decrease in disability duration of first episode compared to medical physician's care
5.9% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care
30.3% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care
19% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care
43% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care
According to the U.S. Department of Health and Human Services in 2008 there were 490.41 million visits to primary care medical doctors (PCP's) in the United States, where almost every United States citizen has visited a primary care doctor across multiple healthcare platforms. The penetration of PCP's nationally is somewhere between 95-100% of the population where chiropractic is 4.12% of the population. Understanding the penetration and influence PCP's have over the population and the positive "evidenced based chiropractic results" that medicine has long asked for, the chiropractic profession is now poised to become the "Spinal Primary Care Providers" with one proviso.
We need to take our place as spine specialists and not just subluxation specialists to conclude accurate diagnosis and converse in a language that is universal and inclusive to both chiropractic and medicine. In order to do that, we need to learn disc and spinal pathology as a beginning.
When utilizing MRI, there has to be a criteria or protocol for ordering a scan and then an understanding of the findings. This author has long held that in the presence of a significant radiculopathic or any myelopathic finding an immediate MRI is warranted BEFORE you create a prognosis and treatment plan. In short; don't touch the patient until you know what the diagnosis is. This protocol has been well documented in the literature as evidenced by the Fish, Koboyashi, Chang and Pham who also concluded that symptomatic radiculopathic findings or central canal stenosis (as found in myelopathies) require MRI for conclusive diagnosis prior to treatment.
When interpreting MRI's it is imperative that each doctor be proficient in interpreting their own film. Lurie et. al reported in 2009“…the specific morphology of the herniation was not reported by the radiologist in 42.2% of cases” meaning that general radiologists inaccurately report what is wrong with your patient almost half the time and you are often delivering a "high velocity thrust" known as an adjustment/manipulation with wrong information. It is here that you start to become the spine specialist and can guide the PCP in their referral pattern based upon your clinical excellence. The best of the best read their own MRI images, no different than the spine surgeons who will not operate unless they have firsthand knowledge that they know is accurate. We are no different.
When interpreting MRI images it is important to understand accurate nomenclature. This following was reported by Bailey in 2005:
Disc Bulge: Synonymous to disc degeneration.
Author's note: a circumferential degeneration over time evidenced by a thinning of the disc with the nucleus pulposis still within the confines of the annulus. The disc bulge or expansion must cover greater than 50% of the disc circumference and is usually close to 100% of the circumference.
Annular Tear: Tear or fissure in the annular fibers, either radially or concentrically
Author's note: The outer 1/3 of the annular fibers are innervated by the A, B and C fibers commonly known as the recurrent meningeal nerve and as reported by Lee et. al. can cause pain in either annular tears or irritated degenerative discs
Herniation: Displacement of the disc beyond the limits of the disc space
Author's note: Tear in the annulus where the nucleus pulposis material goes outside the confines of the nucleus
Focal Herniation: Less than 25% of the disc circumference
Author's note: Where the herniation covers 25-50% of the disc circumference
Broad Based Herniation: Between 25-50% of the circumference of the disc circumference
Author's note: Where the herniation covers 0-25% of the disc circumference
Protrusion Type Herniation: Author's note: Where the base is greater than the apex in any plane
Extrusion Type Herniation: Author's note: Where the apex is greater than the base in any plane
According to Robert Peyster MD, DABR-NR Neuroradiologist, Chief of Neuroradiology, State University of New York at Stony Brook; herniations are traumatically induced.
McMorland et al.'s (2010) found that 60% of surgical candidates had successful outcomes with chiropractic as an alternative to surgery. The evidence shows chiropractic highly effective to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. What about the other 40%?
Over the last 23 years, Magdy Shady MD, Neurosurgeon, Neuro Trauma Fellow has worked with this author to develop a clinical protocol to determine when chiropractic was indicated in a disc herniation patient. If there is room anywhere around the cord or root, then adjusting/manipulation is a clinically indicated first line treatment. In the absence of any room around the cord or disc, then chiropractic, based upon the increase in intrathecal pressure created in the adjustment/manipulation puts active chiropractic care in the second position after the disc has been reduced leaving room.
Over the decades, that protocol has been followed strictly to the benefit of 1000's of patients, where surgery was needed only in a small population of those patients and the first line treatment was either bed rest, cryotherapy or anti-inflammatory medication managed by the neurosurgeon until chiropractic was indicated via a combination of a follow up clinical evaluation and MRI.
Knowing the difference between aggressive chiropractic treatment or waiting a few days or weeks until the swelling has reduced is a result of making an accurate diagnosis, prognosis and treatment plan. That is also the foundation for relationships with PCP's and being part of a healthcare team involving multiple disciplines where the chiropractor is the "Spinal Primary Care Provider" and coordinator of healthcare.
The PCP's appreciate the relationship because it relieves them of the spinal related patients constantly ending up in their offices like a "revolving door" because orthopedics and physical therapy is not the solution and often only serves to delays the exacerbations that end up in the PCP's office over and over.
Becoming expert in disc pathology and reading MRI's is the first step towards becoming a spine specialist and tapping into the 95-!00% of the population cared for by PCP's. Having control over an accurate diagnosis and orchestrating the triaging of the patient puts chiropractic in the epicenter of spinal related care and relives the PCP's of what consider a "burden to their practice.".
It can no longer be business as usual and by becoming proficient in disc, MRI and spine does not change how you care for your patient, nor the philosophy in which you practice. There is room in the both the subluxation and structural models of practice. This level of clinical excellence simply makes you a better doctor and opens doors to allow you to become part of the healthcare team in your community and will ultimately increase awareness and utilization of cost-effective chiropractic management of non-surgical spinal conditions.
References:
1. Davis, M., Sirovich, B., Weeks, W., (2010)Utilization and Expenditures on Chiropractic Care in the United States from 1997 to 2006, Health Research and Education Trust, 45(3) , 748-761
2. United States Population (2012), Encyclopedia of the Nations, Retrieved from: http://www.nationsencyclopedia.com/Americas/United-States-POPULATION.html
3. Fiore, J., (2012) Subluxation vs. Herniation: A New Paradigm for Chiropractic, The American Chiropractor 34(8), 14-18
4. Primary Care Workforce Facts and Stats No. 1, The Number of Practicing Primary Care Physicians in the United States, (2008) U.S. Department of Health and Human Services, Retrieved From: http://www.ahrq.gov/research/pcwork1.htm
5. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.
6. Fish, D., Kobayashi, H., & Pham, Q. (2009). MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. American Journal of Physical Medicine & Rehabilitation 88(3), 239-246
7. Lurie, J. D., Doman, D. M., Spratt, K. F., Tosteson, A. N. A., & Weinstein, J. N. (2009). Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Spine, 34(7), 701-705.
8. Lee, J. M., Song, J. Y., Baek, M., Jung, H. Y., Kang, H., Han, I. B., Kwon, Y. D., & Shin, D. E. (2011). Interleukin-1β induces angiogenesis and innervation in human intervertebral disc degeneration. Journal of Orthopedic Research, 29(2), 265-269
9. Bailey, W., (2005) A practical guide to the application of AJNR guidelines for nomenclature and classification of lumbar disc pathology in Magnetic Resonance Imaging (MRI), Radiology, 12(2) 175-182
10. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.
Urinary Incontinence May Improve With Chiropractic Care
A 6 year "Case Report" study of 21 Cases
81% of chiropractic case showed improvement
Urinary incontinence (UI), according to Cuthbert and Rosner (2012) "occurs when there is leakage of urine that is involuntarily, most commonly in older patients. Incontinence affects 4 of 10 women and 1 of 10 men during their lifetime, and about 17% of children younger than 15 years. A large postpartum study of the prevalence of UI found that 45% of women experienced UI at 7 years postpartum. Thirty-one percent who were initially continent in the postpartum period became incontinent in the future" (pg 50.)
According to Holroyd-Leduc et. al (2010) "Urinary incontinence (involuntary leakage of urine) is of high priority to older women. In a survey of 2,500 women aged 55–95, 64% reported that urinary incontinence was of great concern to them but only 25% perceived that it was being adequately addressed by their healthcare providers. The prevalence rate of urinary incontinence is up to 55% among older women.. Urinary incontinence is associated with poor quality of life, poor self-rated health, social isolation, depressive symptoms, decline in instrumental activities of daily living and out-of-pocket expenses. The majority of older women with urinary incontinence remain under-treated" (pg 228.)
Cuthbert and Rosner addresses co-morbidities (other problems) of pelvic pain and imbalances and Holroyd-Leduc et. al cites sensory involvement in addition; both conditions that have historically responded well under chiropractic care.
Cuthbert and Rosner reported in a study of 21 patients, that were followed for 6 years that in 48% of the case, the UI symptoms resolved totally, another 33% considerably improved and a further 19% slightly improved. That equates to 81% of the case studies showing improvement with urinary incontinence. Comparatively, Holroyd-Leduc et. al reported that 50% improved with pharmacological trials.
Based upon the prevalence of urinary incontinence in our population and the conclusion that the vast majority of the population is being undertreated, the public must take an honest look at treatment choices.
Chiropractic, based upon the results shouldn't be considered an alternative choice, but the first line of care with no side effects to consider from medications.
References:
Scott, C., Rosner A., (2012) Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report, Journal of Chiropractic Medicine, 11 (1) pp 49-57
Holyrod-Leduc J., Straus. S, Thorpe K., Davis D., Schmaltz H., Tannenbaum C, (2010) Translation of evidence into a self-management tool for use by women with urinary incontinence, Oxford Journals, 40 (2) pp 227-233
Low Back Pain:
Chiropractic outperforms muscle relaxants by 24%
Chiropractic Adjustments vs. Muscle Relaxants
Courtesy of: Sayville Immediate Chiropractic Care,
Dr. Frank Gomez, Chiropractic Physician
www.sayvillechiropractor.com
No Appointment Necessary - (631) 991-3492
by Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, "Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, "What works? What's proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible."
Muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain. According to Chou (2010), " The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension headache or back pain." They are drugs that has been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, "Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution"(p. 1978).
Chou (2010) also stated that, "Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects" (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:
More common
Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness
Less common
Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression; shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes
Less common or rare
Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation; diarrhea; excitement, nervousness, restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)
Rare
Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin (http://www.drugs.com/cons/skeletal-muscle-relaxants.html).
When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to a chiropractic spinal adjustment.
Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.
Within that group of 457% falls patients cared for by muscle relaxants.
Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores" (p. 396). This was done in "blinded, randomized clinical trials [which] are considered the gold standard of experimental design" (Hoiriis et al., 2004, p. 396).
We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
REFERENCES
1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E.(2006).Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.
2. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.
3. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4) 387-402.
4. van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine, 28(17), 1978-1992.
5. Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html
6. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.
Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584
Chiropractic Works!!!
1. 87% of low back pain patients improved under chiropractic care
2. 94% of acute neck pain (Torticollis) patients got better under chiropractic care
3. Chiropractic prevents arthritis
4. 90% of lumbar disc patients got better with chiropractic care
5. Chiropractic reverses aberrant sensory issues and improves motor control
6. Chiropractic increases balance and prevent falls
7. Chiropractic has been deemed safe for children
8. Chiropractic is 457% more effective than Medicine for chronic low back pain
9. 83% of dizziness sufferers improved under chiropractic care
10. Chiropractic certified 75% more effective than drug therapy for headaches and migraines
11. 85% to 100% of headache sufferers got better with chiropractic care
Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584
Brain Function (Sensorimotor Cortex) Increases with Chiropractic Care
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
Based upon 2010 research, chiropractic care is critical in the rehabilitation of muscular dystrophy, Duchenne muscular dystrophy, myasthenia gravis, Parkinson's disease, fibromyalgia, multiple sclerosis, Huntington's disease, stroke victims and all other neuro-muscular diseases.
This "groundbreaking" research is imperative for every patient, rehabilitation facility and hospital to understand and integrate chiropractic into the care regimen and to be done concurrently with the rehabilitation treatment of these patients. Patients suffering with these disorders now have a better chance of regaining their lives.
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://www.learningrx.com/sensory-motor-integration-faq.htm)
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/ sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. This alters the way the central nervous system responds to motor training
2. A chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. This explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. This explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. Muscular dystrophy
2. Duchenne muscular dystrophy
3. Myasthenia gravis
4. Parkinson's disease
5. Fibromyalgia
6. Multiple sclerosis
7. Huntington's disease
8. Stroke victims
9. All other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics,33(4), 261-272.
Chiropractic Saves Federal and Private Insurers
$15,897,840,000 and Adds $692,160,000 in Wages to Americans
It was reported by Zigler in 2011 that 200,000 spinal fusion surgeries are performed each year, just in the United States alone. An equal number of microdiscectomies are performed as reported by Mayer (2006), which is considered by many to be a conservative number. Let's consider the chiropractic impact of exposing the public to treatment that could avoid needless surgeries, using the 400,000 disc surgeries as a conservative number, not to mention how this could change the unnecessary cost to government and private insurers and lost revenue to both governmental agencies and workers from absenteeism. Allen and Garfin (2010) reported that spine-related health care expenditures totalled over $97.5 billion (2011 inflation adjusted), a 65% increase from 1997. With an aging population, this trend, based on the biomechanics of the aged, will continue.
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
The study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates. Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.
Let's do the math. If we take the 400,000 disc surgeries (adding cervical surgeries to the equation) done each year as discussed in the opening paragraph and apply McMorland et al.'s (2010) findings that 60% of surgical candidates had successful outcomes with chiropractic as an alternative to surgery, 240,000 patients yearly could avoid needless surgery if they sought chiropractic care.
According to Sherman, Cauthen, Schoenberg, Burns, Reaven and Griffith in 2010, the 2010 inflation adjusted amount per case in Medicare dollars is $13,243.82 per patient once you take into consideration the complications, but exclude many other variables such as repeated MRI's, myelograms, and many hospital charges. Allen and Garfin (2010), taking into account total charges, including mean hospital charges for a single level, uncomplicated, minimally invasive surgery, reported the cost to be $70,159 for all payors. They also went on to report that for 2-level disc surgeries the complication rate increased by 25% with significantly more costs.
If you consider 240,000 preventable surgeries at $70,159 per patient, that equates to $16,838,160,000 healthcare dollars that did not have to be spent. MEDSTAT, as reported by Chiropractic Lifecare of America (2009), estimated that the average cost of chiropractic care per patient per case is $3,918 (2011 inflation adjusted dollars.) If you take this amount and apply it to the 240,000 unnecessary surgeries, you have a net savings of $66,241 per patient. The net savings to the Medicare system and private insurers is $15,897,840,000.
According to Fayssoux, Goldfarb, Vaccaro, James (2010) who studied the indirect costs associated with surgery for low back pain, the average lost productivity related to absenteeism resulted in lost wages of $2,884 per patient for the first postoperative year. "The findings demonstrate the significant, though not surprising, impact of spinal disability on productivity, and the importance of including measurement of lost productivity and return to work..." (Fayssoux et al., 2010, p. 9). This equals an additional $692,160,000 in wages to Americans per year by taking the necessity of absenteeism out of the equation with no surgeries to recover from.
Chiropractic offers solutions to the federal government, local government, and public and private insurance companies by avoiding unnecessary surgeries. Chiropractic offers solutions to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
References:
1. Zigler, J. (2002). Lumbar artificial disc surgery for chronic back pain. spine-health. Retrieved fromhttp://www.spine-health.com/treatment/artificial-disc-replacement/lumbar-artificial-disc-surgery-chronic-back-pain
2. Allen, R. T., & Garfin, S. R. (2010). The economics of minimally invasive spine surgery: The value perspective. Spine, 35(Suppl. 26), 375-382.
3. Mayer, H. M. (Ed.). (2006). Minimally invasive spine surgery: A surgical manual. Germany: Springer.
3. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.
4. Sherman, J., Cauthen, J., Schoenberg, D., Burns, M., Reaven, N. L., & Griffith, S. L. (2010). Economic impact of improving outcomes of lumbar discectomy. The Spine Journal, 10(2), 108–116.
5. Chiropractic Lifecare of America. (2009). The MESTAT Project. Learning. Retrieved from http://www.clahealthcare.com/learning/index.html
6. Fayssoux, R., Goldfarb, N. I., Vaccaro, A. R., & Harrop, J. (2010). Indirect costs associated with surgery for low back pain—A secondary analysis of clinical trial data. Population Health Management, 13(1), 9-13.
Arthritis Prevention and Chiropractic
Chiropractic prevents arthritis in accident victims, the elderly and the sedentary
According to the Arthritis Foundation (2007), "Forty-six million [46,000,000] Americans are currently living with arthritis, the nation's leading cause of disability, and we are all paying a high price for it. The Centers for Disease Control and Prevention (CDC) announced that the annual cost of arthritis to the United States economy was $128 billion in 2003 and increased by $20 billion between 1997 and 2003.
CDC attributes the dramatic increase to the aging of the population, predominantly baby boomers, and increased prevalence of arthritis. CDC also estimates an additional 8 million new cases of arthritis will be diagnosed in the next decade" (http://www.arthritis.org/cost-arthritis.php).
Arthritis, A.D.A.M., Inc. (2010, February 5), "...is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis...
Causes, incidence, and risk factors
Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.
You may have joint inflammation for a variety of reasons, including:
- An autoimmune disease (the body attacks itself because the body immune system believes a body part is foreign)
- Broken bone
- General wear and tear
- Infection (usually cause by bacteria or viruses)...
With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:
- Being overweight
- Previously injuring the affected joint
- Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers and construction workers are all at risk)
Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223). With hypomobility (less mobility or movement), adhesions occur in a joint (the region where 2 bones connect).
According to A.D.A.M., Inc. (2010, March 30), "Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together. As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces.
Causes, incidence, and risk factors
Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body...Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.
Adhesions may form around joints such as the shoulder...or ankles, or in ligaments and tendons. This problem may happen:
- After surgery or trauma
- With certain types of arthritis
- With overuse of a joint or tendon
Symptoms
Adhesions in joints, tendons, or ligaments make it harder to move the joint and may cause pain...Adhesions in the pelvis may cause chronic or long-term pelvic pain.
Signs and tests
Most of the time, the adhesions cannot be seen using x-rays or imaging tests" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462).
Over time, with a sedentary lifestyle as seen in many portions of the population and increasingly with the elderly, joints become hypomobile. Hypomobility is also seen in trauma-related cases and repetitive use injuries, such as reading while looking down for extended periods, carrying heavy items, holding the phone between one's shoulder and ear, prolonged use of hands, wrists, back and neck, excessive use of computers, etc. As time progresses, internal scar tissue or adhesions continue to develop and further increases the loss of mobility.
According to Cramer, Henderson, Little, Daley and Grieve in 2010, previous studies have shown that this hypomobility causes degeneration of the joints that connect the bones, which results in arthritis. As time goes on, both the adhesions (internal scar tissue) and arthritis increase. Therefore, with the persistent sedentary lifestyle and no chiropractic care for the hypomobility, the arthritis will get worse over time.
Cramer et al. (2010) also reported that according to their laboratory studies, chiropractic adjustments increase the "Z gap" or spacing between the joints/bones and increase mobility of the joints. As a result, the adjustments prevent further development of adhesions, degeneration and osteophytes, which is the arthritic process. In short, chiropractic adjustments prevent arthritis.
Regardless of the timing of the beginning of chiropractic care, it conclusively increases mobility and prevents loss of mobility, preventing the development of internal scar tissue (adhesions) and, therefore, arthritis.
This breakthrough research that affects approximately 1 in 7 Americans is also draining our economy with its $128 billion price tag. While not all arthritis is a result of hypomobility, much of it is. If every person was under chiropractic care, we could not only positively affect the lives of every American, we could potentially rescue the economy of the United States and every other country and insurer in the world that assumes risk for an aging and hypomobile society.
References:
1. Arthritis Foundation. (2007, January 17). Cost of arthritis increases to $128 billion annually. Retrieved from http://www.arthritis.org/cost-arthritis.php
2. A.D.A.M., Inc. (2010, February 5). Arthritis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223
3. A.D.A.M., Inc. (2010, March 30). Adhesion. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462
4. Cramer, G. D., Henderson, C. N. R., Little, J. W., Daley, C., & Grieve, T. J. (2010). Zygapophyseal joint adhesions after induced hypomobility. Journal of Manipulative and Physiological Therapeutics, 33(7), 508-518.
Brain Function (Sensorimotor Cortex) Increases with Chiropractic Care
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
Based upon 2010 research, chiropractic care is critical in the rehabilitation of muscular dystrophy, Duchenne muscular dystrophy, myasthenia gravis, Parkinson's disease, fibromyalgia, multiple sclerosis, Huntington's disease, stroke victims and all other neuro-muscular diseases.
This "groundbreaking" research is imperative for every patient, rehabilitation facility and hospital to understand and integrate chiropractic into the care regimen and to be done concurrently with the rehabilitation treatment of these patients. Patients suffering with these disorders now have a better chance of regaining their lives.
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://www.learningrx.com/sensory-motor-integration-faq.htm)
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/ sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. This alters the way the central nervous system responds to motor training
2. A chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. This explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. This explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. Muscular dystrophy
2. Duchenne muscular dystrophy
3. Myasthenia gravis
4. Parkinson's disease
5. Fibromyalgia
6. Multiple sclerosis
7. Huntington's disease
8. Stroke victims
9. All other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics,33(4), 261-272.
Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
By Mark Studin DC, FASBE(C), DAPM, DAAMLP
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584
Lower Back Pain
Courtesy of: Sayville Immediate Chiropractic Care,
Dr. Frank Gomez, Chiropractic Physician
www.sayvillechiropractor.com
No Appointment Necessary - (631) 991-3492
1. 87% of low back pain patients improved under chiropractic care
2. 94% of acute neck pain (Torticollis) patients got better under chiropractic care
3. Chiropractic prevents arthritis
4. 90% of lumbar disc patients got better with chiropractic care
5. Chiropractic reverses aberrant sensory issues and improves motor control
6. Chiropractic increases balance and prevent falls
7. Chiropractic has been deemed safe for children
8. Chiropractic is 457% more effective than Medicine for chronic low back pain
9. 83% of dizziness sufferers improved under chiropractic care
10. Chiropractic certified 75% more effective than drug therapy for headaches and migraines
11. 85% to 100% of headache sufferers got better with chiropractic care
A Study in Proper Diagnosis
Courtesy of Dr. Frank Gomez
www.sayvillechiropractor.com
When you are experiencing pain in the lower back, it can often be intense and cause for worry. You wonder how something can hurt so badly and are looking for anything to reduce the discomfort. Many times these types of pain cause an admission the emergency room. In a recent study by Orlin and Didriksen (2007), the authors stated, “The objectives of this study were to report on and evaluate the results of chiropractic care for patients with low back pain in an orthopedic department” (p. 135). This is an important study since it shows the results of direct cooperative care amongst chiropractors and orthopedic surgeons in a hospital setting.1 With pain in any body area, proper diagnosis is a key component of care and directly effects treatment methods and expected response time (prognosis). The primary goal is to reduce pain and return you to your normal personal and working activities. The longer an accurate diagnosis and treatment plan is delayed, the longer disability continues.
Many studies have shown that collaboration among clinicians is in the best interest of the patient and results in better care. When you are diagnosed with low back pain, the assessment of the mechanics of the bones and muscles is an important component of your examination. This is completed in conjunction with neurologic and orthopedic examination procedures completed by the chiropractor and ensures that the cause of your pain is identified. In some cases such as trauma, advanced imaging such as MRI may be ordered prior to treatment. A proper diagnosis MUST precede treatment. Otherwise, the doctor does not know what he/she is treating!
In this study, the authors stated, “Examination by the doctor of chiropractic indicated that the patients had lumbopelvic fixation” (Orlin & Didreksen, 2007, p. 135). What this means is there was a biomechanical problem in the bones of the spine and pelvic area, also known as a subluxation. This is a functional problem that doctors of chiropractic are specifically trained to identify and treat. When these types of conditions are identified early on in care, the response to treatment is impressive. The authors stated, “According to pre-established inclusion and exclusion criteria, 33 patients were treated in the chiropractor’s clinic, whereas 11 who could not be transported were initially treated by the chiropractor in the hospital.”(Orlin & Didreksen, 2007, p. 135). In this study, only two patients could not return to work.
"The period of sick leave among the patients was reduced by two thirds as compared with that associated with conventional medical treatment.” (Orlin & Didreksen, 2007, p. 135). This is important because it showcases integrative care utilizing doctors of chiropractic, but also demonstrates how achieving a diagnosis quickly truly influences care. In fact, this approach is so effective that the Federal Government is utilizing doctors of chiropractic as part of the comprehensive approach to caring for our soldiers. H.R. 1017 requires the VA to have doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and for all major VA medical centers to have a doctor of chiropractic on staff before the end of 2013. There are nearly 160 VA treatment facilities nationwide. Currently, the VA provides chiropractic care at 32 treatment facilities across the country.2
All in all, cooperation is truly the “best medicine” for spine care. If you have spinal pain, seeking the attention of a doctor of chiropractic is a good decision. Communicating with your medical provider that you have sought out chiropractic care allows for better management of your pain and will ultimately help others as well. The final word from the authors was that, “This study shows that a chiropractor may play an important role in an orthopedic department by reducing pain and shortening the duration of sick leave among patients" (Orlin & Didreksen, 2007, p. 138).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. Thank you for reading my article. More on back pain can be found on my website http://www.sayvillechiropractor.com/.
Any questions please contact us.631 991-3492
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References
1. Orlin, J. R. & Didriksen, A. (2007). Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiologic Therapeutics, 30(2),135-139.
2. Lukcas, C. & Lee, M. (2010). House passes bill to expand chiropractic care to all major VA medical hospitals. ACA Today. Retrieved from http://www.acatoday.org/press_css.cfm?CID=3943
Headaches and Posture
Have you ever glanced at your reflection in a storefront window or mirror as you walked by and noticed your posture? Scary, isn’t it? We all know that we should stand up straight but we soon forget when we get busy and stop thinking about it.
Poor posture is often due to years of standing slouched and this bad “habit” usually starts at a young age. Just look around when you’re in an airport or shopping mall and notice the many people have poor posture. In fact, people’s posture may reflect their attitude – if they’re happy, sad or depressed. Poor posture may be related to self-consciousness, especially during adolescence. It is also genetic as we frequently see a “trait” throughout family members with similar postural tendencies.
The most common postural fault associated with headaches is the forward based head and shoulders. From the side, it appears that the head is significantly forward relative to the shoulders, the upper back is rounded forward and the shoulders are rolled forwards and rotated inward. One exercise that helps reduce this postural bad habit is tucking in the chin and pretending a book is balancing on top of the head. The objective is to not allow the book to slide forward off your head and land on your toes!
It takes approximately 3 months of CONSTANT self-reminding before the new “good habit” posture becomes automatic, so be patient. Soon you’ll “catch yourself doing it right” without thinking about it.
Frequently, posture is faulty lower down the “kinetic chain.” The first link of the chain is the feet and the last link is the head. Since we stand on two feet, any change in that first link or the feet, can alter the rest of the chain, especially areas furthest away – the head, resulting in headaches. For example, if one leg is short, the pelvis drops, the spine shifts (scoliosis), the shoulder drops and the head shifts trying to keep the eyes level. A short leg usually needs to be managed with a heel lift, an arch support or combination of both to properly treat the headache patient.
Most health care providers EXCEPT Chiropractic Physicians typically ignore these issues. Chiropractic Doctors are specifically trained to analyze posture and correct it. You can depend on our clinic for up-to-date treatment approaches such as these.
Since neck pain and headaches are one of the most common complaints presenting to the chiropractic physician, please ask for more information about this if you or a loved one is suffering. It’s one of most significant acts of kindness you can give to those you care about.
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The Neck and Headache Connection
Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:
- The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
- The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
- The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
- Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.
Since neck pain and headaches are one of the most common complaints presenting to the chiropractic physician, please ask for more information about this if you or a loved one is suffering. It’s one of most significant acts of kindness you can give to those you care about.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR HEADACHE PAIN!
FOR A FREE NO-OBLIGATION CONSULTATION CALL DR. FRANK GOMEZ @ (631) 991-3492
Does The Use Of A Low Back Support Or Brace Really Make A Difference?
“Do you think a back brace will help my condition?” This is a question that is frequently asked of many health care providers who treat low back pain. The answers typically vary, as there is support for and against the use of a brace when low back pain is present. In a Feb. 2009 study, the use of an elastic lumbar belt was studied in a group of subacute low back pain patients for its effect on functional capacity (lift and carry types of activities), pain intensity, and the effects on health care service costs. This study was unique in that it was carried out in several different locations and, the patients were randomized and received either a lumbar belt or nothing (“control group”). 197 patients were included in the study, which is a good sample size for research purposes. The results of the study, at the end of 90 days, revealed a higher score for the back brace treated group than the non-braced control group. The pain scale improved greater in the brace treated group as an improvement of 42 points vs. 32 points was reported. Similarly, 61% in the brace treated group used no medication compared to 40% in the non-braced group. It was concluded that patients with subacute low back pain improved significantly in functional status, pain reduction and medication utilization.
The use of back braces has been considered a “standard” in the treatment of patients with LBP for many years. One argument against using back braces centers around becoming “dependant” either physically or mentally on its use and this has long been a concern amongst health care providers. For most patients, this is not a concern as most do not “enjoy” the use of a brace and they look forward to discontinuing their use of it. Braces are particularly helpful when the patient cannot stop performing needed activities, such as work. This is especially true for farmers who have to tend to the animals and crops during planting, cultivating and harvest times of the year. In addition, single moms or dads who have to go to work in order to provide for their children are driven to stay on the job. In these cases, the use of a back brace can be of utmost importance.
There are many types of back braces. Some are narrow and are particularly favored when frequent bending and/or twisting movements are required by a job, sport, or other daily activity. Other braces are taller in the back and taper in the front, which give better support but still allow some bending / twisting movements. Some braces are more rigid and can actually stop movement in certain directions. These types include a hard, rigid surface that is placed in the area of the back where movement is not desired. These are used at times when there are fractures of the spine, after spinal surgery and in scoliosis bracing. Some braces are to be worn low on the pelvis to support that area, while most are placed in the center of the low back region. There are also rib belts sometimes used when ribs fracture, soft and rigid neck braces sometimes used after car accidents, and braces for the arms or legs. The decision to use a brace rests on the degree of injury and the patient’s ability to avoid certain activities or positions. When the injury is significant and/or the patient cannot control his/her activities (such as work), then the use of a brace may be one of the most important treatment approaches for that patient. It’s similar to having stitches when a deep or wide cut occurs. Ask us about the use of supports, braces, or belts if you or your family or friends are suffering with low back pain.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN!
FOR A FREE NO-OBLIGATION CONSULTATION CALL DR. FRANK GOMEZ @ (631) 991-3492
Migraine Headaches and Chiropractic
Thousands of people in the United States suffer with headaches and many do not realize there are different types of headaches that are a reaction to a variety of causes. One of the major tenants of Chiropractic is to find the cause of the problem instead of chasing symptoms. Although Migraine headaches are truly caused by changes in the flow of blood in the brain, many people refer to any headache that is severe enough to negatively affect their day a “migraine”. Many of these cases are people who have headaches on a regular basis, and for whatever reason, they slowly get worse over time. This usually results in increases in medication dosage, prescription of more dangerous drugs with more side-effects and decreases in quality of life. The research paper being reviewed stated “The estimated costs of migraines in the United States is over $17 billion per annum [year]”.1 (p 91)
This research study that was published in 2000 was titled “A randomize controlled trial of chiropractic spinal manipulative therapy for migraine”. This was designed “To assess the efficacy of chiropractic spinal manipulative therapy [Chiropractic Adjustment} in the treatment of migraine”.1 (p 91). This study followed others that had delivered similar results.
The authors state “However, the level of evidence is steadily increasing to the point where there is now seen to be a moderate level of efficacy for Chiropractic SMT [Spinal Manipulative Therapy/ AKA Chiropractic Adjustment] in the treatment of headaches or migraines”1(p95). The paper also reported “The mean number of migraines per month was reduced from 7.6 to 4.1 episodes. The greatest area of improvement was medication use, for which participants were asked to note the use of medication for each episode. A significant number of participants recorded that their medication use had reduced to zero by the end of the 6-month trial”.1(p95) Expressed in other terms, 72% of participants reported significant improvement!
When administered by trained Doctor of Chiropractic, adjustments to the neck are safe and effective. This study has also show that Chiropractic care results in the reduction of medication utilization, some of which have significant long term side-effects having a profound effect on your long term health. Chiropractic chooses to use a safe and scientifically effective approach to the management of migraine headaches and if you are suffering, Chiropractic care is just what the doctor ordered!
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Tuchin PJ; Pollar H; Bonello R. A randomize controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 23(2): 91-5, 2000.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
Low Back Pain, Arthritis and Chiropractic, A Clinical Correlation
The American Chiropractic Association (2010) reported that 31 million Americans experience low back pain. This is an epidemic at a staggering rate because what most of the public and doctors alike do not understand is what that sets the patient up for later in life that can be prevented. Stupar, Pierre, French and Hawker (2010) found that 49% of the general population reported a 6 month prevalence of low back pain, with11% reporting the back pain to be so significant that it seriously limited their activities.
Low back pain and arthritis have now been linked. According to Dawson and Shaffrey (2009), the most common form of arthritis is called osteoarthritis. It is also known as degenerative joint disease. It affects more than 20 million American adults. The cause of osteoarthritis is a breakdown of cartilage, the connective tissue that provides a cushion between the bones of the joints. Healthy cartilage is what permits bones to move over one another and acts as a shock absorber during physical activity. Those afflicted with this disease experience a breakdown of cartilage in which the cartilage wears away. As a result, the bones under the cartilage rub together, resulting in pain, swelling, and a loss of motion in the joints.
Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint. Other symptoms may include:
1. Swelling or sensitivity in one or more joints, especially when related to a change in the weather
2. Loss of joint flexibility
3. Stiffness in the joint(s) after getting out of bed
4. Either a crunching feeling or a sound that results from bone rubbing on bone
5. Bony lumps on the finger joints or at the base of the thumb
6. Intermittent or regular pain in a joint
As Stupar et al. (2010) reported, osteoarthritis or OA has long been associated with back pain and reported comorbidity (they exist together). 40% of hip or knee osteoarthritis patients have had low back pain. That is a significant number and associated with hip arthritis. The 2010 study concluded having hip osteoarthritis and low back pain is a conclusive predictor for future leg pain and disability and suggested that alleviating low back pain may impact future hip pain and function.
Clinically, the authors have seen in patients with low back instabilities and persistent pain the degeneration of the spine and hips over a lifetime. This has been termed "subluxation degeneration." The Association of Chiropractic Colleges has defined subluxation as "...a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health" (The Association of Chiropractic Colleges, 2010,http://www.chirocolleges.org/paradigm_scope_practice.html). Simply put, subluxation is a diagnostic entity that denotes the vertebrate is out of position, is fixed or stuck in the wrong position to some degree and has a negative neurological effect. Once the vertebrate is out of position, the body automatically tries to stabilize the spine and mobilizes calcium to use as cement or glue to prevent further malpositions. This is one of the causes of the degeneration or osteoarthritis as a sequella to malpositions of the vertebrate.
A 2009 study by Aspegren, Enebo, Miller, White, Akuthota, Hyde, & Cox concluded that 81.5% of workers with an acute injury causing low back or neck pain reported immediate post-treatment relief. That doesn’t take into account those patients who got better over time.
In 2009, Painter reported that Consumer Reports conducted an independent survey of 14,000 subscribers who rated hands-on therapy as the #1 treatment of choice for low back pain. The report went on to say that 88% of those who tried a chiropractic adjustment reported positive outcomes and 59% were "completely" or "very" satisfied. The complete results are:
Professional Highly satisfied
Chiropractor 59%
Physical therapist 55%
Acupuncturist 53%
Physician, specialist 44%
Physician, primary-care doctor 34%
We at Sayville Immediate Chiropractic Care have concluded that there is a definitive clinical correlation between low back pain and osteoarthritis as a prognostic indicator of significant future problems if the low back pain is not resolved. We have also concluded that chiropractic care is a safe, highly effective treatment choice for low back pain patients and as a result, low back pain cannot be ignored. These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
References:
1. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Stupar, M., Pierre, C., French, M. R., Hawker, G. A., (2010). The association between low back pain and osteoarthritis of the hip and knee: A population-based cohort study. Journal of Manipulative and Physiological Therapeutics, 33(5), 349-354.
3. Dawson, E. G., & Shaffrey, C. I. (2009, December). Osteoarthritis: Degenerative spinal joint disease.Spineuniverse. Retrieved from http://www.spineuniverse.com/conditions/spondylosis/osteoarthritis-degenerative-spinal-joint-disease
4. The Association of Chiropractic Colleges. (2010). Bylaws. Retrieved fromhttp://www.chirocolleges.org/paradigm_scope_practice.html
5. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics, 32(9), 765-771.
6. Painter, F. M. (2009). Consumer reports survey shows hands-on therapies were the top-rated treatments. The Chiropractic Rescue Organization. Retrieved from http://www.chiro.org/LINKS/ABSTRACTS/Hands_on_Therapies.shtml
Herniated Discs, Radiating Pain and Chiropractic
80% of chiropractic patients reported excellent
or good result in a 2 year study
Courtesy of : Dr. Frank Gomez, DACBSP
www.sayvillechiropractor.com
Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a “slipped disc” because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with fewer traumas due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients.1
Although many of these are surgical cases, it has been estimated that only 2-4% have actual surgical indications. Therefore, most patients need to be treated non-surgically and until recently, there have been few metrics affording guidance to the healthcare profession and public alike directing them to the right care. In a 2009 research report, culminating a 2 year study, a clear direction is now available for patients that suffer with radiating pain from herniated discs.1 The results of the study show that as a result of chiropractic care, “clinically meaningful improvement in pain intensity was seen in 73.9% of patients(Murphy, Hurwitz, & McGovern, 2009, p. 728). "'Good' or 'excellent' improvement was reported by 80% of patients" (Murphy, Hurwitz, & McGovern, 2009, p. 723).
Chiropractic treatment protocols utilized were 2-3 times per week tapering down to 2 times per week and less until the patients were released from care. The reports go on to state that there were no major complications with any patient. The results of the study also suggest that patients with cervical radiculopathy (neck pain radiating in to the arms), lumbar spinal stenosis, pregnancy related lumbo-pelvic pain and chronic work related neck-arm pain may also benefit from non-surgical treatment such as chiropractic care.1
This study clearly shows that chiropractic is not only an alternative for disc related radiating pain, but would be the most logical place to begin care, as 80% of the patients studied got well and without being exposed to drugs, their side effects or the added burden to the healthcare system with more costly treatments. In practice, the balance of the patients who need necessary drugs or more complicated intervention would be referred to the appropriate specialist as is the standard of care within chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for disc and radiating pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.
Decreased Muscle Spasms and Chiropractic Care
Courtesy of: Dr. Frank Gomez
www.sayvillechiropractor.com
There have been many discussions regarding the effects of the short and long term benefits of a chiropractic adjustment. The ultimate focus is a change in the biomechanics and therefore, the physiology surrounding the affected area of the spine. Although there is a significant amount of evidence showing the effects of spinal adjusting on the central nervous system, this study concentrated on the effects on the peripheral nervous system (outside of the brain and spinal cord) and paraspinal musculature, specifically of the effects of spinal adjusting on the paraspinal musculature in the mid-lower back (thoracic and lumbar spines).
The authors stated, "Many chiropractors palpate for tight muscle bundles in the paraspinal musculature as one indication of where to adjust. It seems reasonable to expect resting muscle activity, which can be monitored by an electromyogram (nerve test to determine muscle firing, and resultant spasm) to be abnormally high in the region of a tight muscle bundle" (DeVocht, Pickar, & Wilder, 2005, pp. 465-466). They went on to state, "In this descriptive study, we have further explored the phenomenon of reduced electromyogram (muscle firing and resultant spasms) activity after [spinal adjusting] to better understand the immediate effects of [spinal adjusting]" (DeVocht et al., 2005, p. 466).
The results of the study showed, "With electromyogram recordings obtained from 2 paraspinal muscle sites on each participant (except for one), 27 of the 31 pre-treatment resting electromyogram levels decreased after treatment. During the 5 to 10 minutes of the treatment protocol, distinct changes (both increases and decreases) in the level of muscle activity were often observed" (DeVocht et al., 2005, p. 470). Ultimately the study revealed, "… the reduction of resting electromyogram activity after [spinal adjusting that we observed in the greater majority of cases is consistent with and supportive of the commonly held perception that tight muscle bundles are associated with low back pain and that they can be alleviated by [a chiropractic spinal adjustment]" (DeVocht et al., 2005, p. 470).
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Reference:
1. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
Comparing the Satisfaction of Low Back Pain Patients Receiving Medical vs. Chiropractic Care: Results from the UCLA Back Pain Study
Courtesy of Dr. Frank Gomez
www.Sayvillechiropractor.com
The relationship between a patient and a doctor is a very important aspect of healthcare. Many patients call this “bedside manner." Researchers call it “patient satisfaction.” In a recent study published in the peer reviewed journal, American Journal of Public Health, and produced by the UCLA School of Public Health, the authors reported on the results of a comparison of patient satisfaction between patients that received chiropractic care and those that received medical care for lower back pain. The authors stated, “Results from observational studies suggest that back pain patients are more satisfied with chiropractic care than with medical care” (Hertzman-Miller et al., 2002, p. 1628).
“Our study was conducted in a large managed care organization in Southern California...for approximately 100000 members” Hertzman-Miller et al., 2002, p. 1628). They go on to report, “Of the 681 randomized, 340 were assigned to the 2 medical groups and 341 were assigned to the 2 chiropractic groups”(Hertzman-Miller et al., 2002, p. 1630). Interestingly, the paper goes on to show “Chiropractic patients reported receiving more self-care advice than did medical patients, were more likely to report an explanation of their treatment, and visited their primary providers [their assigned chiropractor in this study] more often" (Hertzman-Miller et al., 2002, p. 1630). The results showed, “In this randomized trial, chiropractic patients were more satisfied with their back care providers after 4 weeks of treatment than were medical patients” (Hertzman-Miller et al., 2002, p. 1631). It should also be noted, “No deaths or serious adverse events occurred during the 4-week period” (Hertzman-Miller et al., 2002, p. 1630).
This paper in no way minimizes the importance of the medical physician as part of the team necessary to care for patients, understanding that there are diagnoses that mandate the services exclusively of the MD and other circumstances where concurrent care is required. However, when there is a choice based on overlapping care, common sense dictates a drugless treatment first, treatment involving drugs second and surgery last. Those patients, according to this study, who have chosen the chiropractic, drugless approach first, have reported a very high level of satisfaction with chiropractic care with no adverse events.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Hertzman-Miller, R. P., Morgenstern, H., Hurwitz, E. L., Yu, F., Adams, A. H., Harber, P., & Kominski, G. F. (2002). Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: Results from the UCLA low-back pain study. American Journal of Public Health, 92(10),1628-1633.
Chronic Low Back Pain:Chiropractic vs. Medicine
Research Results: Chiropractic is 457% more effective
As reported in 2003 by the National Institute of Neurological Disorders and Stroke, "If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common" (http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm)
They went on to report many of the causes of low back pain. " As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae" (National Institute of Neurological Disorders and Stroke, 2003,http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results" (National Institute of Neurological Disorders and Stroke, 2003,http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury" (National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
Chronic low back pain is where the symptoms have persisted for longer than 3 months, as reported by Bogduk in 2004, although recent studies have classified chronic low back pain as pain persisting for only 4 weeks. The duration is important from a diagnosis and prognosis perspective, where it is critical for the doctor to develop an accurate plan of care. The most important component is not the label, but a complete history being performed, including examination and subsequent testing, when indicated, to develop the right treatment plan.
Wilkey, Gregory, Byfield, & McCarthy reported in 2008 that the proportion of the population that suffers from persistent or chronic low back pain is between 8% and 33%. 13% accounts for those whose pain never goes away and the remainder fluctuate in and out of pain. They also reported that the low back pain was generally recurring, indicating that doing nothing is a poor choice.
While there are a limitless number of treatments, the National Institute of Health in the United States and the National Health Service in the United Kingdom have listed accepted treatment modalities for this very prevalent condition. While there are choices for the public, the question is what is the best treatment choice for each individual back pain sufferer? The answer has to be based on real evidence and outcome based studies offer the answer.
As mentioned ealier, Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain. To say that the medical approach doesn't have a place in healthcare would be inaccurate and irresponsible, but based upon evidenced based outcome studies, research concludes that for chronic low back pain, the path is chiropractic first and drugs 457% second. Chiropractic doctors are trained to determine the cause of the injury and are expert at formulating an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment.
These studies along with many others conclude that a drug-free approach of chiropractic care is the best solutions for patients with chronic low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References
1. National Institute of Neurological Disorders and Stroke. (2003, July). Low Back Pain Fact Sheet.Retrieved from http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. Bogduk, N. (2004). Management of chronic low back pain. The Medical Journal of Australia, 180(2), 79-83. Retrieved from http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html
3. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.
Whiplash and Work Disability
Whiplash results from a sudden trauma, usually involving an accident, where the injured person’s car was struck from behind, from the front, or from one of the sides. The injury is caused from the head quickly accelerating, like a “crack the whip” action, which often results in headache, neck pain and sometimes loss of memory or the ability to concentrate. There are many reports about whiplash and factors about the collision that may predict who will become disabled from such an injury. Previous reports have suggested that female gender (due to a slender neck), older age (due to less flexible joints), marital status (due to stress if divorced or single), heavy manual labor, self-employment, previous psychological problems, the inability to concentrate, catastrophizing about pain, and fear of relapse by doing regular activity have all been common issues discussed in research articles. In order to sort through these possible risk factors of a prolonged recovery and disability, a recent February 2009 study looked at this question and reviewed 879 claims. Those involved in the car accidents were sent questionnaires that requested information about the accident, the injuries that had occurred, their current complaints, and questions regarding work and disability. These questions were rechecked at 6 and 12 months after the accident date. Of the 879 claims, 59% were found to be work disabled. The most important factors were age and concentration complaints identified at the 1-month were most predictive of those that would still be disabled at 1 year. What was interesting was that most of the previously accepted risk factors of long-term disability such as the intensity of manual labor, educational level, and the like, were not found to be helpful in predicting long-term disability prior to the 1 year point with only age and concentration impairment being identified. The authors suggested that we should focus treatment on the complaints involving concentration – that is, brain related functions, rather than managing solely the physical complaints.
A condition called mild traumatic brain injury or, post-concussive syndrome, can apply to people injured in car accidents who have lost some of the higher cortical or brain related functions. Though the majority of patients will usually recover from this, a minority will not. It is therefore, important for patients and healthcare providers to become keenly aware of symptoms like memory loss (primarily short-term), loss of your train of thought (forgetting what you were about to say), or having difficulty formulating what you want to say (getting the right words out). Many patients are reluctant to say anything to their health care provider as they are often embarrassed and don’t feel comfortable talking about it. They often think they are “…just going through a stage,” and that they may “sound strange” if they discuss these symptoms and therefore avoid even bringing it up during the history. In the end, most patients are relieved after they find out that it’s “not all in their head,” and are more comfortable discussing it when they know their health care provider is aware of their cognitive dysfunction and that it’s a real problem. As one patient put it, “…I thought I was going crazy,” when in fact these, sometimes quite subtle, symptoms are very important clues in identifying this condition so that prompt attention can be directed at these problems. We are keenly aware of this information and are happy to share it with you so that you can feel more comfortable discussing it with us as well as any other symptoms that exists because of a whiplash injury.
If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
YOU MAYBE A CANDIDATE FOR DRUG FREE RELIEF!
FOR A FREE NO-OBLIGATION CONSULTATION CALL
Dr. Frank Gomez at 631 991-3492
Whiplash "Anatomy"
To better understand Whiplash, let’s take a look at the anatomy and what is actually injured in a whiplash injury. Our spine is basically a long chain made up of blocks that are larger at the bottom and smaller at the top. This means the low back vertebra are huge compared to the neck vertebrae. The vertebrae fit together in a way that “locks” them together by the small joints in the back called “facets” and in the front by the disks. These joints function as shock absorbers between the blocks or “vertebral bodies.” Also in the front, there is a tough piece of tissue called the “anterior longitudinal ligament” that provides a barrier so that when the neck is bent backwards (into “extension”), it becomes tight and stops that movement so it doesn’t over-extend, which could fracture the small facet joints in the back.
There are ligaments, or tissues that hold bone to bone, in the back of the spine that connect between the “spinous processes,” or bony “bumps” in the middle of the back. These ligaments check or stop excessive forward motion of the neck during whiplash. Joint capsules surround joints, which we all have seen when we separate a chicken leg from the thigh. Remember how smooth and shiny the end of the chicken leg is? That smooth surface at the end of long bones is call “hyaline cartilage”, and it allows for slippery gliding between the ends of our bones when we move any joint, including our fingers, wrists, shoulders, hip as well as the facet joints of the spine. Joint movement is facilitated by the presence of an oily substance called “synovial fluid” which acts like a lubricant for the joint allowing for pain-free movement.
A “sprain” occurs when we damage a joint capsule or a ligament, or when the muscle or its attachment (tendon) is injured. These are graded as mild, moderate or severe, or grades 1, 2,or 3, with grade 3 being the worst at 75% or greater tearing, and healing takes progressively longer with each grade.
During a whiplash injury, the classic rear-end collision results in over stretching of the ligaments in the neck, and tearing can occur (sprain, grades 1, 2 or 3). If one of the nerves gets pinched, then numbness, pain, and/or weakness can occur, radiating down the arm to a specific location. When this occurs, the long-term prognosis is worse. Concussion can also occur if the brain is slammed against the inside of the skull. Chiropractic adjustments, when administered early, yield the best results for treating whiplash, according to many studies.
We at Sayville Immediate Chiropractic Care realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Children and Chiropractic Care:
Birth to 18 Years
Conditions cared for and side effects
2012 Report
Courtesy of: Dr. Frank Gomez
www.sayvillechiropractor.com
Chiropractic has been successfully caring for children for various conditions for over a century. The main issues are what conditions are cared for by chiropractors, what is the reported success rate and what is the incidence of side effects. Over time, research has started to catch up on what individual chiropractors have been realizing in their private practices and this article will outline the current state of the literature.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The pediatric related conditions that were reported to be cared for by chiropractors were the following:
1. Musculoskeletal
1. Joint pain
2. Walking/crawling
3. Neck pain
4. Mid back pain
5. Low back pain
2. Neurological
1. Headaches
2. Autism
3. Balance
4. Cerebral Palsy
5. Movement Disorders
6. ADD/ADHD
7. Behavioral
8. Crying/Irritability/Sleep
9. Developmental
10. Growing
11. Cognitive
3. Gastrointestinal
1. Colic
2. Constipation
3. Digestive
4. Eating
5. Drinking
6. Reflux
7. Hiatus hernia
8. Bowel problems
4. Genitourinary
1. Menstrual cramps
2. Bed wetting
5. Immune
1. Allergies
2. Asthma
3. Food intolerance
4. Respiratory
5. Eczema
6. Skin rashes
6. Infections
1. Ear infections
2. Ear-nose-throat problems
3. Common cold
4. Flu
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Marchand (2012) also reported the negative side effects of chiropractic care in children to be less then 1% (0.23%,) which is consistent with what Miller and Benfield reported 4 years prior in an independent study. However, Marchand went further to categorize the negative side effects into mild, moderate and severe. In a 1 year study of 237,857 pediatric patients, there was a reported 534 mild side effects (0.2%) and 23 (0.009%) had moderate side effects with 0 (zero) reporting any severe side effects.
To render perspective on the safety of chiropractic care and children Le, Nguyen, Law and Hodding (2006) reported "The incidence of adverse drug reactions among hospitalized children in the United States has not been well studied. Because clinical trials involving neonates, infants, children, and adolescents are limited, the safety and tolerability of many pharmacologic agents are not well established. Often the pharmacologic actions of drugs in neonates, infants, and children are not similar to those identified for adults; therefore, information obtained from research with adults cannot be applied directly. On the basis of a meta-analysis of 17 prospective
studies
conducted in the United States and Europe, the incidence of adverse drug reactions among hospitalized children was 9.5%, with severe reactions accounting for 12% of the total (pg. 557.)
The above study indicates that side effects need more researched in many sects of health care, but comparatively speaking, chiropractic is a much safer choice than most alternative options.
Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in the pediatric population with minimal to no side effects.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380
2. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
3. Studin M. (2010, September). Chiropractic and Children; A Study in Adverse Effects, US Chiropractic Directory. Retrieved from http://uschirodirectory.com/index.php?option=com_flexicontent&view=items&id=261
4. Le, J., Nguyen, T., Law, A., Hodding, J. (2006) Adverse Drug reactions Among Children Over a 10-Year Period, Pediatrics, 118 (2) 555-562
Chest Pain, Mid-Back Pain and Chiropractic
Courtesy of Dr. Frank Gomez
www.sayvillechiropractor.com
Chiropractic care is targeted to reducing the Vertebral Subluxation Complex and associated neuro-muscular conditions after more serious medical conditions have been ruled out with chest pain. Vertebral Subluxation Complex is the most common reason for pain in the middle back and chest that is not the result of a heart problem or acid reflux. In cases of non-cardiac (not involving the heart) middle back and chest pain, Chiropractic has been shown to have significant results in reducing or eliminating pain and discomfort. Many people experience pain between the shoulder blades, over the breast bone or the collar bones. In today’s society of increasing demands in the office setting, endless hours in front of a computer or all day commutes in our vehicles the stress on the thoracic spine (middle back)and chest continues to increase. Unfortunately when we sit and slouch forward, the brunt of the forces are condensed to the area just below our shoulder blades and our breast bone. We have all been cautioned to “have good posture”, but anyone that has worked a full day knows, once you are tired there is really not much you can do about your posture.
A recent study stated that “Traditionally, patients with chest discomfort are admitted to a cardiology ward because the heart is under suspicion as the pain source; however, the etiology of pain may be non-cardiac in up to 50% of cases”1 (p654). The authors continue on to say “Although patients with non-cardiac chest pain have an excellent prognosis for survival and a future risk of cardiac morbidity [complications] similar to that of the general population, approximately 3 quarters of these patients continue to suffer from residual chest pain, one half remain or become unemployed, and one half report being significantly disabled”1 (p 654)
The most important aspect of this study states “There is a broad agreement among clinicians that the musculoskeletal system is a potential source of pain in non-cardiac chest discomfort, but very few studies have addressed this issue systematically despite the compelling issues discussed above.”1 (p 654) This study found that there was a significant reduction in the anxiety associated with the patient’s chest pain, the patients had a better understanding that the musculoskeletal system was the source of their discomfort and 96% of patients believed that chiropractic treatment had helped.1
In a case study published in 2003, the authors discovered that after the possibility of cardiac involvement was considered, Vertebral Subluxation Complex located at the junction of the breast bones and ribs in the front of the chest was the cause. Reducing the Vertebral Subluxation Complex with Chiropractic techniques had resolved this patients symptoms. 2
Chiropractic interventions into managing and/or eliminating chest and middle back pain have been shown to be safe once cardiac causes have been ruled out. Doctors of Chiropractic are trained to not only evaluate for non-musculoskeletal conditions, but to work as part of your healthcare team. 3
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Henrik W. Christensen, DC, MD, PhD, Werner Vach, PhD, Anthony Cichangi, Claus Manniche, MD, DMSc, Torben Haghfelt, MD, DMSc, and Poul F. Hilund-CaHsen, MD, DMSc. Manual Therapy for Patients with Stable Angina Pectoris: A Nonrandomized open prospective trial. J Manipulative Physiol Ther 2005;28:654-661
2. Bradley S. Polkinghorn, DC, Christopher J. Colloca, DC. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. J Manipulative Physiol Ther 2003;26:108-15.
3. Kaufman, RL, Manipulative reduction and management of anterior sternoclavicular joint dislocation. J Manipulative Physiol Ther, 1997 Jun; 20(5): 338-42
Lower Back Injuries and Chiropractic
One of the most common areas of the body to be hurt while working is the lower back. The injuries can be as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with a lower back injury while working or know someone that did. Finding a doctor that can determine what exactly is wrong and prescribing the right treatment is the most important aspect of healing. Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective treatment plan. The cornerstone of that plan is the Chiropractic Adjustment.
A recent research article published in 2009 revealed the results of 100 injured workers with back or neck pain that were treated with Chiropractic care. This study was in partnership with the University of Colorado School of Medicine and Lakewood Spine and Sports Center in Lakewood Colorado. The authors state in the research paper “Over the last 15 years, the percentage of pre-retirement disabled US workers has increased from 5% to 9% such that more people receive disability income that are unemployed”1. (This of course was published prior to the most recent economic downturn). They go on to note, “Consequently, finding treatment methods that encourage a safe and rapid return of the injured worker to the workforce is an important issue for all clinicians addressing occupational neck and low back pain.”1 (765)
Chiropractic care was shown in this review of 100 injured workers, 81.5% of patients with acute pain reported post treatment improvement! That is a very significant number. Chiropractic, especially when part of a larger integrated model is extremely safe and effective.
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD, Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAIN TREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES. J Manipulative Physiol Ther 2009;32:765-771
Do Chiropractors Help Patients With Headaches?
This seems like an easy question to answer, doesn’t it? The answer of course being, YES!!! However, there are many people who suffer with headaches who have never been to a chiropractor or have not even ever considered it as a “good option.”
So, rather than having me “reassure you” that chiropractic works GREAT for headache management, let’s look at the scientific literature to see if “they” (the scientific community) agree or not.
In a 2011 meta-analysis, researchers reviewed journals published through 2009 and found 21 articles that met their inclusion criteria and used the results to develop treatment recommendations. Researchers discovered there is literature support utilizing Chiropractic care for the treatment of migraine headaches of either episodic or chronic migraine. Similarly, support for the Chiropractic treatment of cervicogenic headaches, or headaches arising from the neck region (see last month’s Health Update), was reported. In addition, joint mobilization (the “non-cracking” type of neck treatment such as figure 8 stretching and manual traction) or strengthening of the deep neck flexor muscles may improve symptoms in those suffering from cervicogenic headaches as well. The literature review also found low load craniocervical mobilization may be helpful for longer term management of patients with episodic or chronic tension-type headaches where manipulation was found to be less effective.
Okay, we at Sayville Immediate Chiropractic Care realize this is all fairly technical, so sorry about that. But, it is important to “hear” this so when people ask you why are going to a chiropractor for your headaches, you can say that not only that it helps a lot, but there are a lot of scientific studies that support it too!
Bottom line is that it DOES REALLY HELP and maybe, most importantly, it helps WITHOUT drugs and their related side effects. Just ask someone who has taken some of the headache medications what their side-effects were and you’ll soon realize a non-drug approach should at least be tried first since it carries few to no side effects.
We at Sayville Immediate Chiropractic Care realize that you have a choice in where you choose your healthcare services.
If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Carpal Tunnel Syndrome and Chiropractic
When people experience pain in the wrist, the common assumption is that it is carpal tunnel syndrome. The wrists are made of 2 rows of 4 bones called the carpal bones. When you flip your hand over with the palm facing the sky, there is a covering over those bones at the wrist. To the side of this covering is where you can take your pulse. One of two major nerves that go to the hand travel between this covering and the carpal bones. The nerve travels with the tendons, which connect muscle to bone, of nine muscles that flex the wrist or bring your fingers toward you. The nerve is named the median nerve, so carpal tunnel syndrome is the compression of the median nerve between the carpal bones and the covering of the tunnel at the wrist. This causes numbness and tingling in the thumb, index finger and ½ of the middle finger because that is where the median nerve goes. Numbness or tingling in any other finger or the palm is not due to carpal tunnel and may be coming from the elbow, shoulder or neck.
There are a few common reasons for carpal tunnel syndrome, the primary one being inflammation or swelling in the tunnel. This can be due to direct trauma like a wrist injury or a result of a car accident involving your hands twisting on the steering wheel. Other causes can be overuse, like typing too much on a keyboard, fine movements at work or weakness and overuse of the forearm muscles. The mild and moderate symptoms can generally be controlled and treated with conservative therapy. More severe cases often require surgery and can only be quantified with a neurological test. Surgery, although necessary in some cases, is a last resort since scar tissue can result from the surgical incision and over time can result in the return of compression of the median nerve in the carpal tunnel. In the cases of the mild or moderate symptoms, they may be due to improper mechanics of the 8 bones of the wrist. In these cases, chiropractic management, using the chiropractic adjustment administered to this area, has been shown to be effective in a recent study.
In this study the authors stated, “From a mechanistic viewpoint, manual therapy techniques designed to release tissue adhesions and increase the range of motion (ROM) of the wrist may alleviate the mechanical compression of the median nerve without the need for surgical interventions" (Burke et al., 2007, p. 51). They also state, "Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks" (Burke et al., 2007, p. 50). "The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions” (Burke et al., 2007, p. 50).
The authors related the following statistic, “The American Academy of Neurology and 40% of neurologists in the Netherlands recommend conservative management of CTS before surgical intervention" (Burke et al., 2007, pp. 50-51). An important perspective to have on surgical intervention was also included and the authors stated, “In addition, of patients with failed primary surgical interventions, up to 12% may require a secondary surgical procedure. Persistent symptoms after a secondary surgical procedure ranged from 25% to 95%" (Burke et al., 2007, p. 51). Therefore, we see that the American Academy of Neurology recommends holding off on surgery until other options are explored.
In conclusion, the paper reports, “Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS" (Burke et al., 2007, p. 59). In the end, it was the management of carpal tunnel syndrome by a doctor of chiropractic that was the most important factor; the individual techniques did not matter.
If you are experiencing numbness and tingling into hands or fingers, please discuss this with a doctor of chiropractic. Conservative care is recommended by the American Academy of Neurology.
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
References:
1. Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61.
Arthritis and Low Back Pain:
Chiropractic Care vs. Heat Treatment
Chiropractic care rendered significantly greater relief of pain
and significantly more mobility
"31 million Americans experience low-back pain at any given time" (The American Chiropractic Association, 2010, https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68)
Interesting facts about back pain:1
- One-half of all working Americans state that they experience back pain each year.
- One of the most common reasons people call out of work is back pain. It is also the second most common reason for a visit to the doctor's office.
- Back pain is often mechanical or non-organic, meaning it is not caused by a serious condition, such as inflammatory arthritis, infection, fracture or cancer.
- At least $50 billion per year is spent by Americans on back pain.
- Experts estimate as much as 80% of the population will experience a back problem at some time in their lives.
What Causes Back Pain?
The back is made up of bones, joints, ligaments and muscles. Ligaments can be sprained, muscles can be strained, disks can rupture, and joints can be irritated. All of these can result in back pain. It doesn't always take a major event like a sports inury or an accident to cause back pain. Even the simplest of movements, like picking a small object up from the floor, can have painful results. There are also numerous conditions that can cause or complicate back pain, such as arthritis, poor posture, obesity, and psychological stress. Disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss, can also result in back pain.1
The most common form of arthritis is called osteoarthritis. It is also known as degenerative joint disease and is a disease of the joints. It affects more than 20 million American adults. The cause of osteoarthritis is a breakdown of cartilage, the connective tissue that provides a cushion between the bones of the joints. Healthy cartilage is what permits bones to move over one another and acts as a shock absorber during physical movement. Those afflicted with this disease experience a breakdown of cartilage that wears away. As a result, the bones under the cartilage rub together, resulting in pain, swelling, and loss of joint motion.2
What Causes Osteoarthritis?2
There is often no known cause of osteoarthritis. Risk factors include:
- Age – More people over the age of 45 are affected by osteoarthritis
- Female – Osteoarthritis more often affects women than in men
- Particular hereditary conditions like defective cartilage and joint deformity
- Joint injuries that result from sports, work-related activity or accidents
- Obesity
Signs and Symptoms of Osteoarthritis2
Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint . Other symptoms may include:
- Swelling or sensitivity in one or more joints, especially when related to a change in the weather
- Loss of joint flexibility
- Stiffness in the joint(s) after getting out of bed
- Either a crunching feeling or sound resulting from bone rubbing on bone
- Bony lumps on the finger joints or at the base of the thumb
- Intermittent or regular pain in a joint
In 2006, "...an experimental design was used to compare the effects of chiropractic care (and moist heat) to the effects of moist heat alone for treating lower back pain that is secondary to [arthritis] of the lumbar spine" (Beyerman, Palmerino, Zohn, Kane, & Foster, 2006, p. 107). This was the first study of its kind. There were 3 parameters measured, pain, mobility and activities of daily living. The results conclusively revealed in every metric analyzed that chiropractic care rendered significantly better results, rendering greater relief of pain and significantly more mobility had been restored.
Low back pain and osteoarthritis is a very common condition treated daily in chiropractor’s offices nationwide. This study confirms scientifically the clinical results treating chiropractors have been experiencing for over 100 years. The degree to which pain interferes with aspects of daily living was statistically measured, specifically with walking, sitting and social life and those test subjects under chiropractic care had superior results that simply utilized moist heat.3
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain and arthritis. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
References:
1. The American Chriopractic Association. (2010). Back pain facts and & statistics. Retrieved fromhttps://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Dawson, E. G., & Shaffrey, C. I. (2009, December). Osteoarthritis: Degenerative spinal joint disease.Spineuniverse. Retrieved from http://www.spineuniverse.com/conditions/spondylosis/osteoarthritis-degenerative-spinal-joint-disease
3. Beyerman, K. L., Palmerino, M. B., Zohn, L. E., Kane, G. M., & Foster, K. A. (2006). Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: Chiropractic care compared with moist heat alone. Journal of Manipulative and Physiological Therapeutics, 29(2), 107-114.
Herniated Discs, Radiating Pain and Chiropractic
80% of chiropractic patients reported excellent or good result in a 2 year study
Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a “slipped disc” because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients.1
Although many of these are surgical cases, it has been estimated that only 2-4% have actual surgical indications. Therefore, most patients need to be treated non-surgically and until recently, there have been few metrics affording guidance to the healthcare profession and public alike directing them to the right care. In a 2009 research report, culminating a 2 year study, a clear direction is now available for patients that suffer with radiating pain from herniated discs.1 The results of the study show that as a result of chiropractic care, “clinically meaningful improvement in pain intensity was seen in 73.9% of patients(Murphy, Hurwitz, & McGovern, 2009, p. 728). "'Good' or 'excellent' improvement was reported by 80% of patients" (Murphy, Hurwitz, & McGovern, 2009, p. 723).
Chiropractic treatment protocols utilized were 2-3 times per week tapering down to 2 times per week and less until the patients were released from care. The reports go on to state that there were no major complications with any patient. The results of the study also suggest that patients with cervical radiculopathy (neck pain radiating in to the arms), lumbar spinal stenosis, pregnancy related lumbo-pelvic pain and chronic work related neck-arm pain may also benefit from non-surgical treatment such as chiropractic care.1
This study clearly shows that chiropractic is not only an alternative for disc related radiating pain, but would be the most logical place to begin care, as 80% of the patients studied got well and without being exposed to drugs, their side effects or the added burden to the healthcare system with more costly treatments. In practice, the balance of the patients who need necessary drugs or more complicated intervention would be referred to the appropriate specialist as is the standard of care within chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for disc and radiating pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.
References:
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
1. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.
Acute Neck Pain (Torticollis)
Disability and Chiropractic:
Patient Satisfaction Results
The overall patient satisfaction rate was 94%
"Acute neck pain means immediate neck pain. Neck pain that just started. This type of pain comes on suddenly and affects the ability to properly move your head in its proper range of motion. One serious type of acute neck pain is whiplash - the sudden jarring motion of your head going backwards and forward. This often occurs with a rear end collision. Acute neck pain can also be the result of a fall, sleeping awkwardly, a trauma or even a fall.. Often times when someone has just strained or irritated their neck in some way the pain is most severe. There is usually inflammation, immobility, and muscle tenderness. Often with acute neck pain, the muscles or ligaments are involved" (The Neck Pain Relief Shop, n.d.,http://www.neckpainreliefkit.com/acuteneckpain).
The “real life” issue for the patient who either wakes up with this debilitating pain or is in an accident that causes it, is that taking drugs without narcotics is insufficient for relieving the pain. With the narcotics, one can be severely hampered and may not be able to go about his/her life. It is often a double-edged sword; take strong drugs and compromise your life or don't take drugs, receive no chiropractic care and suffer.
A 2006 study examined "...the extent to which a group of patients with acute neck pain managed with chiropractic [adjustments]...and the degree to which they were subsequently satisfied...A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years...The mean number of visits was 24.5...Pain levels improved significantly from a mean of 7.6...before treatment to 1.9...after treatment...The overall patient satisfaction rate was 94%" (Haneline, 2006, p. 288).
"There were reductions in disability recorded during the study that were statistically significant. Approximately 84% of the patients related that their activities were restricted before chiropractic treatment because of their neck pain, whereas only 25% still had activity restrictions at the time of the interview. Furthermore, 57% of those with physical restrictions described their disabilities as moderately severe or greater before treatment, whereas at the time of the interview, just 12% did (Haneline, 2006, p. 294).
"When comparing trauma with no-trauma cases, Trauma cases received more than 3 times as many visits. This difference may be related to tissue damage that often accompanies trauma, which, many times, heals imperfectly. In addition, patients with this type of problem may have ensuing long-term pain and physical impairment, which further shows that trauma complicates the recovery of acute neck pain (Haneline, 2006, p. 294).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. The Neck Pain Relief Shop. (n.d.). Acute neck pain. Retrieved from http://www.neckpainreliefkit.com/acuteneckpain
2. Haneline, M. T. (2006). Symptomatic outcomes and perceived satisfaction levels of chiropractic patients with a primary diagnosis involving acute neck pain. Journal of Manipulative and Physiological Therapeutics, 29(4), 288-296.
Balance and Movement and The Effect of Chiropractic Care
Utilization with the Elderly, Cerebral Palsy, the Athlete
and the General Population
Courtesy of: Dr. Frank M Gomez
www.sayvillechiropractor.com
Chiropractic care improves motor control
Sensorimotor is defined as our ability to feel and move. With infants, Piaget, the renowned researcher, categorized the first 2 years of an infant’s life as the sensorimotor stage. "During this period, infants are busy discovering relationships between their bodies and the environment. Researchers have discovered that infants have relatively well developed sensory abilities. The child relies on seeing, touching, sucking, feeling, and using their senses to learn things about themselves and the environment. Piaget calls this the sensorimotor stage because the early manifestations of intelligence appear from sensory perceptions and motor activities" (Anderson, n.d., http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html).
As we develop and our nervous systems have acquainted us to our surroundings, we need the neurological "hookups" to remain intact to function optimally and pain free. In addition, our sensory and motor systems need to work in tandem in order for us to function normally.
To further break it down, our sensory system is part of the nervous system that consists of receptors that receive stimuli from both our internal and external environments. These receptors, such as the ones located in our fingertips, sense external stimuli, such as hot or cold, or what we feel. An internal receptor may be found in the tendons (connect your muscles to your bones) and lets you know what your joints are doing, such as are my fingers sensing if they are relaxed or in a fist. The sensory system is also controlled by the brain that processes what we feel.
Pain is part of the sensory nervous system and to the surprise of many, pain is an important component to protecting yourself. Without pain, you could get seriously hurt, such as by keeping your finger on a hot stove too long or touching a sharp object too heavily and cutting your hand. Internally, pain is a warning sign that an organ or system is "sick" and alerts you to seek medical care.
All pain receptors are free nerve endings, meaning they only bring information to your brain and function as the "pain receptors." There are three types of pain receptors; mechanical, thermal and chemical. They are found in skin and on internal surfaces such as the coverings of the bone and joint surfaces. "Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas is experienced. Pain receptors do not adapt to stimulus. In some conditions, excitation of pain fibres becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia [commonly known as, "WOW, that hurts a lot!"]" (Global Oneness, n.d.,http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137).
Your motor system is what allows you to move, maintain your posture and control your muscles. The motor system is controlled through nerves similar to the sensory system and like the sensory system, has a controlling element in the brain.
Functional tasks are defined as those things we do in our lives. Answering a telephone, putting a key in a door lock or picking up a fork to eat are all examples of functions. These functions, just like Piaget described in infants, are how we have a relationship with our body and the environment and require an integrated motor and sensory nervous system. Every functional task that we do involves both the motor and sensory components of our nervous system and while performing these tasks, we are protected by our ability to perceive pain.
Due to the development and integrategration of the world around us necessary to complete every task in our lives, as we get older, postural disturbances can arise and negatively affect how we integrate the sensorimotor information we are receiving both internally and externally and lead to significant balance disorders. Lord and Ward (1994) reported that, "All of the sensory, motor and balance system measures showed significant age-associated differences"(http://ageing.oxfordjournals.org/cgi/content/abstract/23/6/452). This means that as one gets older, his/her sensorimotor system often fails to integrate the internal and external environment as it once could.
A research study by Taylor and Murphy (2008) concluded that chiropractic care reverses maladaptations in sensorimotor integration and improving motor control. The study suggests that spinal dysfunction may lead to muscle specific alterations of the brain’s ability to process motor control. The "real-life" implications of this finding affect every facet of our lives and every person. Whether it be an older person who is starting to exhibit balance disorders, or a cerebral palsy victim who struggles on a daily basis with the simple tasks of life or a world class athlete looking to increase his/her fine motor skills just 1/10 of 1%, the results of chiropractic care can be dramatic.
From the clinical observation of Dr. Mark Studin, a co-author of this article and a practicing chiropractor for 30 years, "This now gives scientific evidence and validation to what patients have been sharing after receiving chiropractic care. The most common comment from patients post care is, 'I perceive my surroundings more acutely and feel straighter.'" Dr. Studin continues, "Although I have heard this from every age group, my first patient was a cerebral palsy patient who stated that without getting adjusted he could barely function. With care, he walked to and from the office, a distance of 3 miles."
These studies, along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions to increase integration between the motor and sensory systems of your body. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory atwww.USChiroDirectory.com and search your state.
References:
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. Anderson, M. (n.d.). Sensorimotor stage. Jean Piaget's Theory of Development. Retrieved from http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html
2. Global Oneness. (n.d.). Pain - Physiology. Retrieved from http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137
3. Lord, S. R. & Ward, J. A. (1994). Age-associated differences in sensori-motor function and balance in community dwelling women. Age and Ageing. Retrieved from http://ageing.oxfordjournals.org/cgi/content/ abstract/23/6/452
4. Taylor, H. H. & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation.Journal of Manipulative and Physiological Therapeutics, 31(2), 115-126.
Acute (Severe) Low Back Pain, Early Intervention and Chiropractic
87% of Chiropractic Patients Showed Improvement!
Courtesy of: Dr.Frank Gomez
www.sayvillechiropractor.com
One of the most common areas of the body to be hurt while working, playing sports, cleaning out the garage or any other household or life chore is the lower back. The American Chiropractic Association has reported that 31 million Americans experience low back pain at any given time. This represents a significant health concern, especially if many of the conditions contributing to low back pain go untreated.
The cause of the pain can be injuries as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with lower back pain, either from an injury while working or simply waking up with it. Finding a doctor that can determine what exactly is wrong (creating an accurate diagnosis) and prescribing the right treatment is the most important aspect of getting well. In fact, one of the most dangerous phrases one can utter is, "Maybe the pain will go away," and is often adopted by too many sufferers.
According to a 2008 study by Globe, Morris, Whalen, Farabaugh, and Hawk on low back pain disorders reported, "Most acute pain, typically the result of injury (micro- or macrotrauma), responds to a short course of conservative treatment [chiropractic care]. If effectively treated at this stage, patients often recover with full resolution of pain...Delayed or inadequate early clinical management may result in increased risk of chronicity and disability" (p. 654).
A 2005 study by DeVocht, Pickar, & Wilder concluded through objective electrodiagnostic studies (neurological testing) that 87% of chiropractic patients exhibited decreased muscle spasms. This study validates the reasoning behind the later study that people with severe muscle spasms in the low back respond well to chiropractic care and prevents future problems and disabilities. It also dictates that care should not be delayed or ignored due to risk of complications.
Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment. Chiropractic and lower back pain has been one of the most commonly researched topics to date. There is a large volume of research showing that the chiropractic adjustment is effective for treating lower back pain.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
Thank you for your time in reading my article. Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
4844 Sunrise Highway
Sayville, NY 11782
(631) 991-3492
Chiropractic Treatment for: Neck Pain, Back Pain, Headaches and Shoulder Pain
No Appointment Necessary, Walk-in Chiropractic Care:
New patients welcome. No Long Term Care Plans
The Chiropractic office that makes it convenient for you to get the care you want in today's busy society! Our practice has a strong working relationship with many local allied health care professionals and primary care MD's.
References
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
1. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Globe, G. A., Morris, C. E., Whalen W. M., Farabaugh, R. J., & Hawk C. (2008). Chiropractic management of low back disorders: Report from a consensus process. Journal of Manipulative and Physiologic Therapeutics, 31(9), 651-658.
3. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
Headaches and Migraines:
Chiropractic Saves Federal and Private Insurers $13,680,000,000
and Resolves Many Issues Facing Emergency Rooms Today
Courtesy of: Dr. Frank Gomez
Published in Dynamic Chiropractic, Volume 29, Issue 22
It was reported by Doheny in 2006 that migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism. Doheny goes on to report that according to Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, "The programs are so few and far between because many companies ‘don't perceive it as a priority’" (p. 10).
Much of the public perceive headaches and migraines as normal occurrences. For example, a patient will enter a doctor's office and report they get normal headaches, not realizing that pain is never a normal occurrence. Symons, Shinde and Gilles (2008) highlighted a statement from http://www.iasp-pain.org saying that pain is "'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'" (p. 277). As a result of the public not taking many types of headaches as potential serious problems, they let the condition linger and that can lead to negative sequella.
According to Munakata, Hazard, Serrano, Klingman, Rupnow, Tierce, Reed and Lipton (2009) "...neuroimaging studies have provided compelling evidence that suggests progressive brain changes in persons with migraines...migraine frequency is associated with posterior circulation infarcts and diffuse white-matter lesions...Welch et al. showed that impairments in iron homeostasis in periaqueductal grey areas that were associated with migraine duration and chronic daily headache" (Munakata et al., 2009, p. 499).
Munakata et al. also reported that the economic impact of migraines in both directhealthcare costs and indirect costs of absenteeism is a huge economic burden. The direct cost of migraines ranges from $127 to $7,089 per and the indirect cost due to absenteeism ranges from $709 to $4,453 per victim, making migraines an economic burden to the individual, the insurer, the employer with absenteeism and increased benefits paid and local, state and federal entities who will experience a lowered tax base from lost wages. It was also reported that between 2005 and 2006 there were 1,729,555 physician office visits, 186,603 advanced imaging procedures, 59,589 other diagnostic procedures, and 22,168 hospital days with a primary diagnosis of migraine or headache; all of which are paid by private or public insurers or out of the pockets of individuals. In short, the costs are staggering and a burden to the economy.
Friedman, Feldon, Holloway and Fisher (2009) reported that acute headaches account for 5% of emergency department (ED) visits in hospitals. In addition, they also reported that "…the ED environment that may also contribute to unsatisfactory treatmentresponse include limited physician contact time that may preclude a detailed history, overuse of ED by patients with substance abuse problems, the need for rapid triage, the competing distraction of patients with life-threatening conditions, and directives (or lack thereof) for care dictated by the referring physician…Thus, the treatment of migraine patients in the ED appears to be suboptimal and the high rate of recurrent headache may be attributed to underutilization of relatively ‘migraine specific’ treatment" (Friedman et al., 2009, p. 1164).
Nelson, Suter, Casha, du Plessis and Hurlbert (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care and for amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy. In addition, it was reported that, with the drug group, "...58% experienced medication side effects important enough to report them. In the amatriptyline group, 10% of the subjects had to withdraw from the study because of intolerable side effects. Side effects in the SMT (Spinal Manipulative Therapy) group were much more benign, infrequent, mild and transitory. None required withdrawal from the study (Nelson et al., 1998, p. 511). Although this study was conducted 13 years ago, a more current study by Chaibi, Tuchin and Russell (2011) reported that that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine, supporting the previous findings. Although more research is desperately needed, the above conclusions give the public clear directions with migraines and headaches.
Using the 57% increased effectiveness that chiropractic has over drug therapy (leaving out the overlap that chiropractic could help without drugs) and the $24,000,000,000 ($24 billion) Americans pay for headaches and migraines, the savings would result in $13,680,000,000. back in the insurers, the public's and the government's pockets. In addition, if chiropractic reduced the necessity for emergency room visits by 57%, then the ED doctors could focus on what their primary purpose is, to save lives in urgent scenarios.
Chiropractic offers solutions to the federal government, local government, public and private insurance companies, eases the burden on emergency rooms and prevents unnecessary side effects of drugs that are not clinically indicated, with a more viable and proven drugless solution. Although much more research is desperately needed to explore the benefits of chiropractic with migraines and headaches, the research that is available clearly reports that chiropractic offers immediate solutions. These solutions will add to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year and productivity avoiding absenteeism. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
References:
1. Doheny, K. (2006). Recognizing the financial pain of migraines. Workforce Management, 85(16), 10-12.
2. Symons, F. J., Shinde, S. K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(Pt 4), 275-286.
3. Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F. T., Tierce, J., Reed, M., & Lipton, R. (2009). Economic burden of transformed migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 49(4), 498-508.
4. Friedman, D., Feldon, S., Holloway, R., & Fisher, S. (2009). Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department. Headache,49(8),1163-1173.
5. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
6. Chaibi, A., Tuchin, P. J., & Russell, M.B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain, 12(2), 127-133.
Headaches & Migraine: Chiropractic vs. Medication
Effectiveness & Safety
In randomized clinical trials, chiropractic was 57% more effective in the reduction of headaches and migraines than drug therapy
It was reported in October of 2010 by Wrong Diagnosis that approximately 1 in 6,16.54% or 45 million Americans get headaches yearly, with many people suffering daily. While the statistical numbers vary based upon your source of information, it can be agreed upon that headaches are very common and shared among Americans at an epidemic rate. Taking into account that a single pill for many Americans to treat a headache can cost as much as $43, according to Consumer Reports Health Best Buy Drugs, the overall cost to our economy totals billions of dollars and we need to focus not on the treatment of the effects, but the root of the cause.
When you suffer from headaches, it affects every facet of your life and you search for immediate answers. Most often it is a medication, either over-the-counter or prescription as evidenced by the amount of money spent as previously reported. One of the first medications recognized for the potential treatment of headaches is amatriptyline, commonly known by brand names such as Elavil, Endep or Amitrol as reported by Robert on About.com in 2006. It is also used as an antidepressant. This medication has made up a large part of the billion dollar industry along with over-the counter-medications. Although in many instances, this drug is indicated, the question that arises is what are the risks of taking this widely used medication?
The potential side effects of this medication targeted for headache sufferers, according to drugs.com (n.d.), are: blurred vision, change in sexual desire or ability, constipation, diarrhea, dizziness, drowsiness; dry mouth, headache, loss of appetite, nausea, tiredness, trouble sleeping, and weakness. Severe allergic reactions can be: rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue, chest pain, confusion, dark urine, delusions, difficulty speaking or swallowing, fainting, fast or irregular heartbeat, fever, chills, or sore throat; hallucinations, new or worsening agitation, anxiety, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still, numbness or tingling in an arm or leg, one-sided weakness, seizures, severe or persistent dizziness or headache, severe or persistent trouble sleeping, slurred speech, suicidal thoughts or actions, tremor, trouble urinating, uncontrolled muscle movements (such as in the face, tongue, arms or legs), unusual bleeding or bruising, unusual or severe mental or mood changes, vision problems, and yellowing of the skin or eyes. Over the counter remedies of NSAID's or aspirin have a long list of their own of side effects.
The safety of chiropractic, in spite of rhetoric from naysayers, has been documented in clinical trials by Miller and Benfield (2008), who reported on children younger under 3 years old, "the youngest and most vulnerable population..." (p. 420). There was one reaction reports for every 749 adjustments which was typically crying. None were reported to have any serious side effects.
In adults, clinically, the majority of any side effects are soreness that is transient. This is based upon this author's 30 years of clinical experience and teaching doctors of chiropractic who are trained in creating an accurate diagnosis, prognosis and treatment plan. To say that more serious side effects cannot happen is irresponsible. However, they are rare, non-life threatening and usually transient in nature, no different than infants. To ensure the best outcomes, like with any professional, you have to verify the doctor's credentials and experience, which is best accomplished by securing a copy of the doctor's curriculum vitae (his/her academic and professional credentials).
Nelson et. al. (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care, amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy.
Bryans, et. al. (2011) confirmed Nelson's findings and reported that spinal manipulation (adjusting) is recommended for patients with episodic or chronic migraines with or without aura and patients withcervicogenic headaches. This follow-up study is not a comparison or comment on the use of drugs. It simply demonstrates that chiropractic is a viable solution for many and can save the government and private industry billions in expenditures both in health care coverage, loss of productivity and avoidance of absenteeism in industry creating a new level of cost as sequella to headaches.
Medications and other forms of invasive care are often necessary and it is critical for a trained doctor to perform an accurate history and physical and when indicated, advanced diagnostic testing (CAT scans, MRI's, etc.) to ensure there aren't more serious underlying complications. However, based upon the results of the research provided by Nelson et al. (1998) and Bryans et. al. (2011), it should be chiropractic first, drugs second and surgery last to render better outcomes with less potential side effects and a quicker return to productivity.
By Mark Studin DC, FASBE(C), DAPM, DAAMLP
References:
1. Wrong Diagnosis. (2010, October 6). Prevalence statistics for types of headaches and migraine conditions. Health Grades Inc. Retrieved fromhttp://www.wrongdiagnosis.com/h/headache_and_migraine_conditions/prevalence-types.htm
2. Consumer Reports Health Best Buy Drugs. (n.d.). Treating migraine headaches: The triptans, Comparing effectiveness, safety, and price. Health.org. Retrieved fromhttp://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf
3. Robert, T. (2006, May 26). Amitriptyline: Headache and migraine drug profiles. About.com. Retrieved from http://headaches.about.com/od/medicationprofiles/a/amitriptyline.htm
4. Drugs.com. (n.d.). Amitriptyline side effects. Retrieved from http://www.drugs.com/sfx/amitriptyline-side-effects.html
5. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
6. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
7. Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R.,... White, E. (2011). Evidenced-based guidelines for the treatment of adults with headache. Journal of Manipulative & Physiological Therapeutics, 34(5), 274-289.
Brain Function (Sensorimotor Cortex)
Increases with Chiropractic Care
Courtesy of: Dr. Frank Gomez, DACBSP
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://spdfoundation.net/about-sensory-processing-disorder.html).
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. this alters the way the central nervous system responds to motor training
2. a chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. this explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. this explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. muscular dystrophy
2. Duchenne muscular dystrophy
3. myasthenia gravis
4. Parkinson's disease
5. fibromyalgia
6. multiple sclerosis
7. Huntington's disease
8. stroke victims
9. all other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
by
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved fromhttp://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics, 33(4), 261-272.
Back and Leg Pain (Lumbar Radiculopathy) as a Result of Disc Herniation and the Long Term Effect of Chiropractic Care
90% of all low back-lumbar disc herniation patients got better with chiropractic care
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
The term "herniated disc" has been called many things from a slipped disc to a bulging disc. For a doctor who specializes in disc problems, the term is critical because it tells him/her how to create a prognosis and subsequent treatment plan for a patient. To clarify the disc issue, a herniated disc is where a disc tears and the internal material of the disc, called the nucleus pulposis, extends through that tear. It is always results from trauma or an accident. A bulging disc is a degenerative "wear and tear" phenomenon where the internal material or nucleus pulposis does not extend through the disc because there has been no tear, but the walls of the disc have been thinned from degeneration and the internal disc material creates pressure with thinned external walls. The disc itself "spreads out" or bulges.
There are various forms and degrees of disc issues, but the biggest concern of the specialist is whether nerves are being affected that can cause significant pain or other problems. The problem exists when the disc, as a result of a herniation or bulge, is touching or compressing those neurological elements, which is comprised of either the spinal cord, the nerve root (a nerve the extends from the spinal cord) or the covering of the nerves, called the thecal sac.
With regard to the structure that we have just discussed, the doctor must wonder what the herniation of the neurological element has caused. In this scenario, there are 2 possible problems, the spinal cord and nerve root. If the disc has compromised the spinal cord, it is called a myelopathy (my-e-lo-pathy). You have a compression of the spinal cord and problems with your arms or legs. An immediate visit to the neurosurgeon is warranted for a surgical consultation. The second problem is when the disc is effecting the spinal nerve root, called a radiculopathy. It is a very common problem. A doctor of chiropractic experienced in treating radiculopathy has to determine if there is enough room between the disc and the nerve in order to determine if a surgical consultation is warranted or if he/she can safely treat you. This is done by a thorough clinical examination and in many cases, an MRI is required to make a final diagnosis. Most patients do not need a surgical consultation and can be safely treated by an experienced chiropractor.
While herniations can occur anywhere, it was reported by Jordan, Konstanttinou, & O'Dowd (2009) that 95% occur in the lower back. "The highest prevalence is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years" (http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence).
It was reported by Aspegren et al. (2009) that 80% of the chiropractic patients studied with both neck and low back (cervical and lumbar) disc herniations had a good clinical outcome with post-care visual analog scores under 2 [0 to 10 with 0 being no pain and 10 being the worst pain imaginable] and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. A study by Murphy, Hurwitz, and McGovern (2009) focused only on low back (lumbar) disc herniations and concluded that, "Nearly 90% of patients reported their outcome to be either 'excellent' or 'good'...clinically meaningful improvement in pain intensity was seen in 74% of patients (p. 729)." The researchers also concluded that the improvements from chiropractic care was maintained for 14 1/2 months, the length of the study, indicating this isn't a temporary, but a long-term solution. It was reported by BenEliyahu (1996) that 78% percent of the low back-lumbar disc herniation patients were able to return to work in their pre-disability occupations, which is the result of the 90% of all low back-lumbar disc herniation patients getting better with chiropractic care as discussed above.
These are the reasons that chiropractic has been, and needs to be, considered for the primary care for low back-lumbar disc herniations with resultant pain in the back or legs. This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for herniated discs and low back or leg pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Jordan, J., Konstanttinou, K., & O'Dowd, J. (2009, March 26). Herniated lumbar disc. Clinical Evidence. Retrieved from http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence
2. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal Manipulative Physiological Therapy 32(9), 765-771.
3. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal Manipulative Physiological Therapy, (32)9, 723-733.
4. BenEliyahu, D. J. (1996). Magnetic resonance imaging and clinical follow-up: Study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal Manipulative Physiological Therapy, 19(9), 597-606.
Subluxation vs. Disc Herniation
Old Paradigms & New Technology; The pathway for Chiropractic as "Spinal Primary Care Providers"
by Mark Studin DC, FASBE(C),DAAPM, DAAMLP
Studin, M (2012) Subluxation vs. Disc Herniation Old Paradigms & New Technology; The pathway for Chiropractic as "Spinal Primary Care Providers," The American Chiropractor, 38, 40-42
Chiropractic utilization in the United States remained static at 12.1 million from 2003 until 2006 as reported by Davis, Brenda and Williams in 2010. This represents 4.12% of the population considering the 2003 population reported by the Encyclopedia of the Nations. Davis et. al. also reported that in the early 1990's chiropractic utilization was 7.7% of the United States adults realizing a net loss of utilization of 3.58% in just a decade. The reasons are many and in spite of the growing interest in the utilization of complementary and alternative medicine (CAM) nationwide with chiropractic the largest CAM provider, the numbers are still dwindling. The chiropractic profession must take an honest look at the numbers and realize that it can no longer be "business as usual" or risk the utilization to continue dwindling until we no longer make the positive impact on society that we currently do.
Fiore in 2012 reported that accurate diagnosing was critical to the success of the chiropractic profession in order to be credible in the healthcare community. He also reported that many chiropractors hide behind the definition of chiropractic "...art, science and philosophy of locating and correcting nerve interference..." and continued on to say "This allows the chiropractic profession to have great latitude...but does not excuse us from making an incorrect diagnosis." In order for us to understand the spinal related problem or any pain, we must not create a correct hypothesis, we must conclude an accurate diagnosis before we construct a prognosis and treatment plan. According to Frank Zolli DC, the Dean of the University of Bridgeport College of Chiropractic for over 20 years "every chiropractic student during their doctoral training learns at the most basic level of training that you must have an accurate diagnosis and then create a prognosis before you treat your patient." Dr. Zolli continued by saying that this is taught in every CCE accredited chiropractic college.
With the advent of new and not so new technology, we no longer have to hypothesize or theorize. It's called the MRI and every licensed doctor of chiropractic in the United States has within their scope, the ability to refer a patient for an MRI (with the exception of Medicare as the Federal Government through their actions and regulations have much less regard for the well-being of our seniors.) Chiropractors have to realize that technology takes away much of the hypothesizing and allows us to conclude with a great degree of certainty an accurate diagnosis; the foundation of the treatment plan.
When we look at disc issues, this gives the chiropractic profession a universal platform to becoming and being considered by medicine the "Spinal Primary Care Providers." Back pain, inclusive of disc pathology is a thorn in the sides of most primary care providers (PCP's) and a diagnosis they universally refer to orthopedic surgeons for lack of a better alternative. The orthopedic surgeon is centered on surgery with their $225,000+ malpractice costs and summarily dismiss most non-surgical cases to physical therapists, who in turn render much poorer outcomes according to Cifuentes et. al in 2011 for back related issues compared to chiropractic care.
Cifuentes concluded that chiropractic care during the disability episode resulted in:
24% Decrease in disability duration of first episode compared to physical therapy
250% Decrease in disability duration of first episode compared to medical physician's care
5.9% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care
30.3% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care
19% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care
43% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care
According to the U.S. Department of Health and Human Services in 2008 there were 490.41 million visits to primary care medical doctors (PCP's) in the United States, where almost every United States citizen has visited a primary care doctor across multiple healthcare platforms. The penetration of PCP's nationally is somewhere between 95-100% of the population where chiropractic is 4.12% of the population. Understanding the penetration and influence PCP's have over the population and the positive "evidenced based chiropractic results" that medicine has long asked for, the chiropractic profession is now poised to become the "Spinal Primary Care Providers" with one proviso.
We need to take our place as spine specialists and not just subluxation specialists to conclude accurate diagnosis and converse in a language that is universal and inclusive to both chiropractic and medicine. In order to do that, we need to learn disc and spinal pathology as a beginning.
When utilizing MRI, there has to be a criteria or protocol for ordering a scan and then an understanding of the findings. This author has long held that in the presence of a significant radiculopathic or any myelopathic finding an immediate MRI is warranted BEFORE you create a prognosis and treatment plan. In short; don't touch the patient until you know what the diagnosis is. This protocol has been well documented in the literature as evidenced by the Fish, Koboyashi, Chang and Pham who also concluded that symptomatic radiculopathic findings or central canal stenosis (as found in myelopathies) require MRI for conclusive diagnosis prior to treatment.
When interpreting MRI's it is imperative that each doctor be proficient in interpreting their own film. Lurie et. al reported in 2009“…the specific morphology of the herniation was not reported by the radiologist in 42.2% of cases” meaning that general radiologists inaccurately report what is wrong with your patient almost half the time and you are often delivering a "high velocity thrust" known as an adjustment/manipulation with wrong information. It is here that you start to become the spine specialist and can guide the PCP in their referral pattern based upon your clinical excellence. The best of the best read their own MRI images, no different than the spine surgeons who will not operate unless they have firsthand knowledge that they know is accurate. We are no different.
When interpreting MRI images it is important to understand accurate nomenclature. This following was reported by Bailey in 2005:
Disc Bulge: Synonymous to disc degeneration.
Author's note: a circumferential degeneration over time evidenced by a thinning of the disc with the nucleus pulposis still within the confines of the annulus. The disc bulge or expansion must cover greater than 50% of the disc circumference and is usually close to 100% of the circumference.
Annular Tear: Tear or fissure in the annular fibers, either radially or concentrically
Author's note: The outer 1/3 of the annular fibers are innervated by the A, B and C fibers commonly known as the recurrent meningeal nerve and as reported by Lee et. al. can cause pain in either annular tears or irritated degenerative discs
Herniation: Displacement of the disc beyond the limits of the disc space
Author's note: Tear in the annulus where the nucleus pulposis material goes outside the confines of the nucleus
Focal Herniation: Less than 25% of the disc circumference
Author's note: Where the herniation covers 25-50% of the disc circumference
Broad Based Herniation: Between 25-50% of the circumference of the disc circumference
Author's note: Where the herniation covers 0-25% of the disc circumference
Protrusion Type Herniation: Author's note: Where the base is greater than the apex in any plane
Extrusion Type Herniation: Author's note: Where the apex is greater than the base in any plane
According to Robert Peyster MD, DABR-NR Neuroradiologist, Chief of Neuroradiology, State University of New York at Stony Brook; herniations are traumatically induced.
McMorland et al.'s (2010) found that 60% of surgical candidates had successful outcomes with chiropractic as an alternative to surgery. The evidence shows chiropractic highly effective to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. What about the other 40%?
Over the last 23 years, Magdy Shady MD, Neurosurgeon, Neuro Trauma Fellow has worked with this author to develop a clinical protocol to determine when chiropractic was indicated in a disc herniation patient. If there is room anywhere around the cord or root, then adjusting/manipulation is a clinically indicated first line treatment. In the absence of any room around the cord or disc, then chiropractic, based upon the increase in intrathecal pressure created in the adjustment/manipulation puts active chiropractic care in the second position after the disc has been reduced leaving room.
Over the decades, that protocol has been followed strictly to the benefit of 1000's of patients, where surgery was needed only in a small population of those patients and the first line treatment was either bed rest, cryotherapy or anti-inflammatory medication managed by the neurosurgeon until chiropractic was indicated via a combination of a follow up clinical evaluation and MRI.
Knowing the difference between aggressive chiropractic treatment or waiting a few days or weeks until the swelling has reduced is a result of making an accurate diagnosis, prognosis and treatment plan. That is also the foundation for relationships with PCP's and being part of a healthcare team involving multiple disciplines where the chiropractor is the "Spinal Primary Care Provider" and coordinator of healthcare.
The PCP's appreciate the relationship because it relieves them of the spinal related patients constantly ending up in their offices like a "revolving door" because orthopedics and physical therapy is not the solution and often only serves to delays the exacerbations that end up in the PCP's office over and over.
Becoming expert in disc pathology and reading MRI's is the first step towards becoming a spine specialist and tapping into the 95-!00% of the population cared for by PCP's. Having control over an accurate diagnosis and orchestrating the triaging of the patient puts chiropractic in the epicenter of spinal related care and relives the PCP's of what consider a "burden to their practice.".
It can no longer be business as usual and by becoming proficient in disc, MRI and spine does not change how you care for your patient, nor the philosophy in which you practice. There is room in the both the subluxation and structural models of practice. This level of clinical excellence simply makes you a better doctor and opens doors to allow you to become part of the healthcare team in your community and will ultimately increase awareness and utilization of cost-effective chiropractic management of non-surgical spinal conditions.
References:
1. Davis, M., Sirovich, B., Weeks, W., (2010)Utilization and Expenditures on Chiropractic Care in the United States from 1997 to 2006, Health Research and Education Trust, 45(3) , 748-761
2. United States Population (2012), Encyclopedia of the Nations, Retrieved from: http://www.nationsencyclopedia.com/Americas/United-States-POPULATION.html
3. Fiore, J., (2012) Subluxation vs. Herniation: A New Paradigm for Chiropractic, The American Chiropractor 34(8), 14-18
4. Primary Care Workforce Facts and Stats No. 1, The Number of Practicing Primary Care Physicians in the United States, (2008) U.S. Department of Health and Human Services, Retrieved From: http://www.ahrq.gov/research/pcwork1.htm
5. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.
6. Fish, D., Kobayashi, H., & Pham, Q. (2009). MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. American Journal of Physical Medicine & Rehabilitation 88(3), 239-246
7. Lurie, J. D., Doman, D. M., Spratt, K. F., Tosteson, A. N. A., & Weinstein, J. N. (2009). Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Spine, 34(7), 701-705.
8. Lee, J. M., Song, J. Y., Baek, M., Jung, H. Y., Kang, H., Han, I. B., Kwon, Y. D., & Shin, D. E. (2011). Interleukin-1β induces angiogenesis and innervation in human intervertebral disc degeneration. Journal of Orthopedic Research, 29(2), 265-269
9. Bailey, W., (2005) A practical guide to the application of AJNR guidelines for nomenclature and classification of lumbar disc pathology in Magnetic Resonance Imaging (MRI), Radiology, 12(2) 175-182
10. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.
Urinary Incontinence May Improve With Chiropractic Care
A 6 year "Case Report" study of 21 Cases
81% of chiropractic case showed improvement
Urinary incontinence (UI), according to Cuthbert and Rosner (2012) "occurs when there is leakage of urine that is involuntarily, most commonly in older patients. Incontinence affects 4 of 10 women and 1 of 10 men during their lifetime, and about 17% of children younger than 15 years. A large postpartum study of the prevalence of UI found that 45% of women experienced UI at 7 years postpartum. Thirty-one percent who were initially continent in the postpartum period became incontinent in the future" (pg 50.)
According to Holroyd-Leduc et. al (2010) "Urinary incontinence (involuntary leakage of urine) is of high priority to older women. In a survey of 2,500 women aged 55–95, 64% reported that urinary incontinence was of great concern to them but only 25% perceived that it was being adequately addressed by their healthcare providers. The prevalence rate of urinary incontinence is up to 55% among older women.. Urinary incontinence is associated with poor quality of life, poor self-rated health, social isolation, depressive symptoms, decline in instrumental activities of daily living and out-of-pocket expenses. The majority of older women with urinary incontinence remain under-treated" (pg 228.)
Cuthbert and Rosner addresses co-morbidities (other problems) of pelvic pain and imbalances and Holroyd-Leduc et. al cites sensory involvement in addition; both conditions that have historically responded well under chiropractic care.
Cuthbert and Rosner reported in a study of 21 patients, that were followed for 6 years that in 48% of the case, the UI symptoms resolved totally, another 33% considerably improved and a further 19% slightly improved. That equates to 81% of the case studies showing improvement with urinary incontinence. Comparatively, Holroyd-Leduc et. al reported that 50% improved with pharmacological trials.
Based upon the prevalence of urinary incontinence in our population and the conclusion that the vast majority of the population is being undertreated, the public must take an honest look at treatment choices.
Chiropractic, based upon the results shouldn't be considered an alternative choice, but the first line of care with no side effects to consider from medications.
References:
Scott, C., Rosner A., (2012) Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report, Journal of Chiropractic Medicine, 11 (1) pp 49-57
Holyrod-Leduc J., Straus. S, Thorpe K., Davis D., Schmaltz H., Tannenbaum C, (2010) Translation of evidence into a self-management tool for use by women with urinary incontinence, Oxford Journals, 40 (2) pp 227-233
Low Back Pain:
Chiropractic outperforms muscle relaxants by 24%
Chiropractic Adjustments vs. Muscle Relaxants
Courtesy of: Sayville Immediate Chiropractic Care,
Dr. Frank Gomez, Chiropractic Physician
www.sayvillechiropractor.com
No Appointment Necessary - (631) 991-3492
by Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, "Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, "What works? What's proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible."
Muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain. According to Chou (2010), " The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension headache or back pain." They are drugs that has been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, "Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution"(p. 1978).
Chou (2010) also stated that, "Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects" (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:
More common
Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness
Less common
Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression; shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes
Less common or rare
Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation; diarrhea; excitement, nervousness, restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)
Rare
Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin (http://www.drugs.com/cons/skeletal-muscle-relaxants.html).
When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to a chiropractic spinal adjustment.
Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.
Within that group of 457% falls patients cared for by muscle relaxants.
Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores" (p. 396). This was done in "blinded, randomized clinical trials [which] are considered the gold standard of experimental design" (Hoiriis et al., 2004, p. 396).
We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
REFERENCES
1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E.(2006).Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.
2. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.
3. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4) 387-402.
4. van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine, 28(17), 1978-1992.
5. Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html
6. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.
Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584
Chiropractic Works!!!
1. 87% of low back pain patients improved under chiropractic care
2. 94% of acute neck pain (Torticollis) patients got better under chiropractic care
3. Chiropractic prevents arthritis
4. 90% of lumbar disc patients got better with chiropractic care
5. Chiropractic reverses aberrant sensory issues and improves motor control
6. Chiropractic increases balance and prevent falls
7. Chiropractic has been deemed safe for children
8. Chiropractic is 457% more effective than Medicine for chronic low back pain
9. 83% of dizziness sufferers improved under chiropractic care
10. Chiropractic certified 75% more effective than drug therapy for headaches and migraines
11. 85% to 100% of headache sufferers got better with chiropractic care
Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584
Brain Function (Sensorimotor Cortex) Increases with Chiropractic Care
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
Based upon 2010 research, chiropractic care is critical in the rehabilitation of muscular dystrophy, Duchenne muscular dystrophy, myasthenia gravis, Parkinson's disease, fibromyalgia, multiple sclerosis, Huntington's disease, stroke victims and all other neuro-muscular diseases.
This "groundbreaking" research is imperative for every patient, rehabilitation facility and hospital to understand and integrate chiropractic into the care regimen and to be done concurrently with the rehabilitation treatment of these patients. Patients suffering with these disorders now have a better chance of regaining their lives.
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://www.learningrx.com/sensory-motor-integration-faq.htm)
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/ sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. This alters the way the central nervous system responds to motor training
2. A chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. This explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. This explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. Muscular dystrophy
2. Duchenne muscular dystrophy
3. Myasthenia gravis
4. Parkinson's disease
5. Fibromyalgia
6. Multiple sclerosis
7. Huntington's disease
8. Stroke victims
9. All other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics,33(4), 261-272.
Chiropractic Saves Federal and Private Insurers
$15,897,840,000 and Adds $692,160,000 in Wages to Americans
It was reported by Zigler in 2011 that 200,000 spinal fusion surgeries are performed each year, just in the United States alone. An equal number of microdiscectomies are performed as reported by Mayer (2006), which is considered by many to be a conservative number. Let's consider the chiropractic impact of exposing the public to treatment that could avoid needless surgeries, using the 400,000 disc surgeries as a conservative number, not to mention how this could change the unnecessary cost to government and private insurers and lost revenue to both governmental agencies and workers from absenteeism. Allen and Garfin (2010) reported that spine-related health care expenditures totalled over $97.5 billion (2011 inflation adjusted), a 65% increase from 1997. With an aging population, this trend, based on the biomechanics of the aged, will continue.
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
The study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates. Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.
Let's do the math. If we take the 400,000 disc surgeries (adding cervical surgeries to the equation) done each year as discussed in the opening paragraph and apply McMorland et al.'s (2010) findings that 60% of surgical candidates had successful outcomes with chiropractic as an alternative to surgery, 240,000 patients yearly could avoid needless surgery if they sought chiropractic care.
According to Sherman, Cauthen, Schoenberg, Burns, Reaven and Griffith in 2010, the 2010 inflation adjusted amount per case in Medicare dollars is $13,243.82 per patient once you take into consideration the complications, but exclude many other variables such as repeated MRI's, myelograms, and many hospital charges. Allen and Garfin (2010), taking into account total charges, including mean hospital charges for a single level, uncomplicated, minimally invasive surgery, reported the cost to be $70,159 for all payors. They also went on to report that for 2-level disc surgeries the complication rate increased by 25% with significantly more costs.
If you consider 240,000 preventable surgeries at $70,159 per patient, that equates to $16,838,160,000 healthcare dollars that did not have to be spent. MEDSTAT, as reported by Chiropractic Lifecare of America (2009), estimated that the average cost of chiropractic care per patient per case is $3,918 (2011 inflation adjusted dollars.) If you take this amount and apply it to the 240,000 unnecessary surgeries, you have a net savings of $66,241 per patient. The net savings to the Medicare system and private insurers is $15,897,840,000.
According to Fayssoux, Goldfarb, Vaccaro, James (2010) who studied the indirect costs associated with surgery for low back pain, the average lost productivity related to absenteeism resulted in lost wages of $2,884 per patient for the first postoperative year. "The findings demonstrate the significant, though not surprising, impact of spinal disability on productivity, and the importance of including measurement of lost productivity and return to work..." (Fayssoux et al., 2010, p. 9). This equals an additional $692,160,000 in wages to Americans per year by taking the necessity of absenteeism out of the equation with no surgeries to recover from.
Chiropractic offers solutions to the federal government, local government, and public and private insurance companies by avoiding unnecessary surgeries. Chiropractic offers solutions to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
References:
1. Zigler, J. (2002). Lumbar artificial disc surgery for chronic back pain. spine-health. Retrieved fromhttp://www.spine-health.com/treatment/artificial-disc-replacement/lumbar-artificial-disc-surgery-chronic-back-pain
2. Allen, R. T., & Garfin, S. R. (2010). The economics of minimally invasive spine surgery: The value perspective. Spine, 35(Suppl. 26), 375-382.
3. Mayer, H. M. (Ed.). (2006). Minimally invasive spine surgery: A surgical manual. Germany: Springer.
3. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.
4. Sherman, J., Cauthen, J., Schoenberg, D., Burns, M., Reaven, N. L., & Griffith, S. L. (2010). Economic impact of improving outcomes of lumbar discectomy. The Spine Journal, 10(2), 108–116.
5. Chiropractic Lifecare of America. (2009). The MESTAT Project. Learning. Retrieved from http://www.clahealthcare.com/learning/index.html
6. Fayssoux, R., Goldfarb, N. I., Vaccaro, A. R., & Harrop, J. (2010). Indirect costs associated with surgery for low back pain—A secondary analysis of clinical trial data. Population Health Management, 13(1), 9-13.
Arthritis Prevention and Chiropractic
Chiropractic prevents arthritis in accident victims, the elderly and the sedentary
According to the Arthritis Foundation (2007), "Forty-six million [46,000,000] Americans are currently living with arthritis, the nation's leading cause of disability, and we are all paying a high price for it. The Centers for Disease Control and Prevention (CDC) announced that the annual cost of arthritis to the United States economy was $128 billion in 2003 and increased by $20 billion between 1997 and 2003.
CDC attributes the dramatic increase to the aging of the population, predominantly baby boomers, and increased prevalence of arthritis. CDC also estimates an additional 8 million new cases of arthritis will be diagnosed in the next decade" (http://www.arthritis.org/cost-arthritis.php).
Arthritis, A.D.A.M., Inc. (2010, February 5), "...is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis...
Causes, incidence, and risk factors
Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.
You may have joint inflammation for a variety of reasons, including:
- An autoimmune disease (the body attacks itself because the body immune system believes a body part is foreign)
- Broken bone
- General wear and tear
- Infection (usually cause by bacteria or viruses)...
With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:
- Being overweight
- Previously injuring the affected joint
- Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers and construction workers are all at risk)
Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223). With hypomobility (less mobility or movement), adhesions occur in a joint (the region where 2 bones connect).
According to A.D.A.M., Inc. (2010, March 30), "Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together. As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces.
Causes, incidence, and risk factors
Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body...Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.
Adhesions may form around joints such as the shoulder...or ankles, or in ligaments and tendons. This problem may happen:
- After surgery or trauma
- With certain types of arthritis
- With overuse of a joint or tendon
Symptoms
Adhesions in joints, tendons, or ligaments make it harder to move the joint and may cause pain...Adhesions in the pelvis may cause chronic or long-term pelvic pain.
Signs and tests
Most of the time, the adhesions cannot be seen using x-rays or imaging tests" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462).
Over time, with a sedentary lifestyle as seen in many portions of the population and increasingly with the elderly, joints become hypomobile. Hypomobility is also seen in trauma-related cases and repetitive use injuries, such as reading while looking down for extended periods, carrying heavy items, holding the phone between one's shoulder and ear, prolonged use of hands, wrists, back and neck, excessive use of computers, etc. As time progresses, internal scar tissue or adhesions continue to develop and further increases the loss of mobility.
According to Cramer, Henderson, Little, Daley and Grieve in 2010, previous studies have shown that this hypomobility causes degeneration of the joints that connect the bones, which results in arthritis. As time goes on, both the adhesions (internal scar tissue) and arthritis increase. Therefore, with the persistent sedentary lifestyle and no chiropractic care for the hypomobility, the arthritis will get worse over time.
Cramer et al. (2010) also reported that according to their laboratory studies, chiropractic adjustments increase the "Z gap" or spacing between the joints/bones and increase mobility of the joints. As a result, the adjustments prevent further development of adhesions, degeneration and osteophytes, which is the arthritic process. In short, chiropractic adjustments prevent arthritis.
Regardless of the timing of the beginning of chiropractic care, it conclusively increases mobility and prevents loss of mobility, preventing the development of internal scar tissue (adhesions) and, therefore, arthritis.
This breakthrough research that affects approximately 1 in 7 Americans is also draining our economy with its $128 billion price tag. While not all arthritis is a result of hypomobility, much of it is. If every person was under chiropractic care, we could not only positively affect the lives of every American, we could potentially rescue the economy of the United States and every other country and insurer in the world that assumes risk for an aging and hypomobile society.
References:
1. Arthritis Foundation. (2007, January 17). Cost of arthritis increases to $128 billion annually. Retrieved from http://www.arthritis.org/cost-arthritis.php
2. A.D.A.M., Inc. (2010, February 5). Arthritis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223
3. A.D.A.M., Inc. (2010, March 30). Adhesion. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462
4. Cramer, G. D., Henderson, C. N. R., Little, J. W., Daley, C., & Grieve, T. J. (2010). Zygapophyseal joint adhesions after induced hypomobility. Journal of Manipulative and Physiological Therapeutics, 33(7), 508-518.
Brain Function (Sensorimotor Cortex) Increases with Chiropractic Care
Chiropractic care improves brain function and the body's motor or movement ability
Research findings that redefine care for every rehabilitation patient for all motor disorders
Based upon 2010 research, chiropractic care is critical in the rehabilitation of muscular dystrophy, Duchenne muscular dystrophy, myasthenia gravis, Parkinson's disease, fibromyalgia, multiple sclerosis, Huntington's disease, stroke victims and all other neuro-muscular diseases.
This "groundbreaking" research is imperative for every patient, rehabilitation facility and hospital to understand and integrate chiropractic into the care regimen and to be done concurrently with the rehabilitation treatment of these patients. Patients suffering with these disorders now have a better chance of regaining their lives.
According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" (http://www.learningrx.com/sensory-motor-integration-faq.htm)
According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).
According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/ sensory-motor-integration-faq.htm).
The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.
In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:
1. This alters the way the central nervous system responds to motor training
2. A chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level
3. This explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation
4. This explains the mechanism of overuse injuries and chronic pain conditions
The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:
1. Muscular dystrophy
2. Duchenne muscular dystrophy
3. Myasthenia gravis
4. Parkinson's disease
5. Fibromyalgia
6. Multiple sclerosis
7. Huntington's disease
8. Stroke victims
9. All other neuro-muscular diseases
On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.
The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.
Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.
Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.
References:
1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html
2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill
3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm
4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics,33(4), 261-272.
Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
By Mark Studin DC, FASBE(C), DAPM, DAAMLP
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
References:
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584
Lower Back Pain
Courtesy of: Sayville Immediate Chiropractic Care,
Dr. Frank Gomez, Chiropractic Physician
www.sayvillechiropractor.com
No Appointment Necessary - (631) 991-3492
1. 87% of low back pain patients improved under chiropractic care
2. 94% of acute neck pain (Torticollis) patients got better under chiropractic care
3. Chiropractic prevents arthritis
4. 90% of lumbar disc patients got better with chiropractic care
5. Chiropractic reverses aberrant sensory issues and improves motor control
6. Chiropractic increases balance and prevent falls
7. Chiropractic has been deemed safe for children
8. Chiropractic is 457% more effective than Medicine for chronic low back pain
9. 83% of dizziness sufferers improved under chiropractic care
10. Chiropractic certified 75% more effective than drug therapy for headaches and migraines
11. 85% to 100% of headache sufferers got better with chiropractic care