Archive for October, 2009

There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain.  Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.”  But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history.  In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today.  Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care.  Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):

 

1)      Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437.  http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml

 

2)      Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada.  http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml

 

3)      Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870

 

4)      Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up.  British Medical Journal 1995 (Aug 5);   311 (7001):   349–351  http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml

 

5)     Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1);   29 (1):   79–86.  http://www.ncbi.nlm.nih.gov/pubmed/14699281

 

At this clinic, we are most appreciative to have the opportunity to provide care to our patients and strive to make the experience highly satisfying.  If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our services.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and, in the future.

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Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury.  So the question on deck is, which of the health care services best addresses the injured whiplash patient? 

 

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25).  The authors state conventional [medical] treatment utilized in whiplash care, “is disappointing.”  The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome.  The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment.  They separated patients into one of 3 groups:  Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit”; Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement”; Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.”

 

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:

Group 1

24%   Asymptomatic

24%   Improved by Two Symptom Grades

24%   Improved by One Symptom Grade

28%   No Improvement

Group 2

38%        Asymptomatic

43%        Improved by Two Symptom Grades

13%        Improved by One Symptom Grade

6%          No Improvement

Group 3

0%     Asymptomatic

9%     Improved by Two Symptom Grades

18%   Improved by One Symptom Grade

64%   No Improvement

9%     Got Worse

 

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2).  The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened.  The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3).  Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

 

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!

There are many conditions that can be attributed to specific causes with a clear origin and means of diagnosis.  However, there are also conditions that are obscure and can only be diagnosed by eliminating other, more common conditions.  Fibromyalgia (FM) is one of those conditions where the degree of pain and disability can be profound and life quality interrupting, yet all the tests come back negative and there are no other conditions to explain the collection of symptoms.  It is at that point when the diagnosis of fibromyalgia is typically made.

 

FM is typically a chronic (symptoms have been present for at least 3 months) condition where the patient complains of widespread, generalized muscle, ligament and tendon pain accompanied with fatigue and multiple tender points on the body that hurt with only light pressure. To be considered “widespread,” it usually affects both sides of the body and is both above and below the waist.  It occurs in approximately 2% of the population in the US and women are 3-4 times more likely to develop FM.  The risk of FM increases with age and can be secondary to other physical or emotional trauma, or it can occur all by itself.  No obvious pattern usually exists as signs and symptoms can vary depending on weather, stress, physical activity, and even the time of day.

 

Sleep quality is an issue that seems well agreed upon as regardless of the number of hours in bed, the deep, restorative stages of sleep are seldom reached.  Other sleep disorders frequently associated with FM include sleep apnea and restless leg syndrome. 

 

Causation for the most part is unknown but genetics (family traits), infections (can trigger or worsen FM), and after physical or emotional trauma (eg., post-traumatic stress disorder) have been linked to FM.  An explanation as to why it hurts so much centers around a theory called “central sensitization.” This is basically a low threshold for pain because of increased sensitivity in the brain to the incoming pain signals.  Certain chemical (neurotransmitters) changes in the brain have been identified resulting is hypersensitivity creating an overreaction to pain signals. 

 

The American College of Rheumatology has established two diagnostic criteria that include 1) widespread pain lasting at least 3 months, and 2) at least 11 out of 18 positive tender points using just enough pressure to whiten the fingernail bed.  There are no direct blood tests to confirm a diagnosis of FM but other conditions can affect or cause FM can be diagnosed with blood testing.  These include thyroid disease (thyroid function blood tests), inflammatory arthritis such as rheumatoid (ESR), and a complete blood count to assess anemia and infection.

 

We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their chiropractic care.  We realize that there are many healthcare options available.  If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist.  The resulting symptoms of numbness/pain in the wrist, index, third, and forth fingers, multiple sleep interruptions, frequent shaking and flicking of the hand/fingers, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, the inability to perform work duties – especially fast, repetitive work tasks can have a devastating effect on a person’s quality of life.

 

While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA).  This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS.  The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA.  This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period.  Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study.  The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach.  This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group.  Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.

           

Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results.  Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed.  This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible.  Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side.  Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed.  A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation.  These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained. 

 

Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS.  Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt.  The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist.  The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients.  We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. If you, a friend or family member requires care for CTS, we would be honored to offer our services.