Chiropractic Care for the Pediatric Population

5 Apr

While the typical chiropractic patient is a working-age adult, children and teenagers also experience neck pain, back pain, headaches, and other musculoskeletal conditions that may respond favorably to chiropractic treatment. In fact, a 2017 study that monitored 1,400 Danish school children for three years found that 55% experienced spinal pain during the course of the study. With the increased prevalence of sedentary behavior and obesity in the pediatric population, it’s reasonable to suggest that musculoskeletal disorders may become more common in individuals under age 18 in the coming years. To better understand the use of chiropractic care by this population, researchers in Quebec surveyed 245 chiropractors in the province.

According to the survey, pediatric patients account for less than five patient visits per week—between about .5% and 4% of a typical chiropractic practice. Among the pediatric patient population, the majority of patients were children ages 6-12 and teens aged 13-17; however, babies under 23 months of age (and under six months, in particular) are often seen in chiropractic clinics.

The data show that the most common referral source for pediatric patients is a parent, family member, or friend (presumably also a patient in the clinic), with family doctors, other chiropractors, and other healthcare professionals accounting for the remainder. Among the patients aged six and up, the most common presentations appear to be back pain and headache with conditions such as torticollis, colic/irritability, head asymmetry, motor development issues, gastrointestinal problems, sleeping difficulty, jaw/temporomandibular joint issues, and gait/walking problems being more common complaints in the under-age two patients. 

Of the doctors surveyed, 24.9% report they had attained a “Diplomate in clinical chiropractic pediatrics” meaning they had undergone post-graduate training and board examination. Additionally, 54% were active members of a pediatric and perinatal care association. The participants also noted a willingness to co-manage patients with other healthcare providers and they’d immediately refer a patient to their medical physician or hospital if they uncovered any red flags including but not limited to facture/dislocation, fever, chest pain, suicidal ideation, dehydration, persistent vomiting, persistent abdominal pain, etc.

Though the authors of the study note that specific research on chiropractic treatment in the pediatric population is lacking compared to older age groups, they report that adverse events following manual therapy are rare. For pediatric patients who do not respond to conventional treatment, a consultation with a doctor of chiropractic for evaluation may be considered for a short-term course of care to evaluate the effectiveness of treatment.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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A Different Perspective on Chronic Whiplash

30 Mar

It’s estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience long-term symptoms that interfere with their ability to carry out activities of daily living. According to experts, the economic burden associated with chronic WAD may exceed $42 billion each year. As such, many studies have sought to better understand whiplash, both from the mechanisms of injury to why some patients recover and some don’t. 

With respect to chronic WAD resulting from a motor vehicle collision (the most common cause of whiplash), factors associated with the crash itself like speed, impact direction, awareness of collision, and airbag deployment do not appear to be significantly linked to an elevated risk for chronicity. On the other hand, researchers have found that higher self-rated pain and disability, fear of movement, catastrophizing, passing coping, and low expectations of recovery are indicative of failure to fully recover. 

In a 2017 study, researchers reframed the trauma of a motor vehicle collision as an event that is both potentially injurious and distressing. When an acute injury occurs (in this case whiplash), there is often damage to various anatomical structures in the head, neck, and/or upper-mid back. Additionally, there is also a stress response associated with the overall incident (including subsequent events like a trip to the hospital and dealing with the insurance company and legal system) that can interfere with the healing process. When the combination of psychological vulnerabilities and neurobiological processes exceeds a person’s given threshold, their risk for chronic WAD rises.

This finding highlights the importance of treating the whole patient when it comes to WAD as it can affect both the body and mind. In addition to therapies delivered in the office to help the soft tissues in and around the neck to heal, doctors of chiropractic and other healthcare providers need to educate the patient and assure them that they will recover and encourage them to carry on their normal activities within pain tolerance. If necessary, the patient may need a referral to a mental healthcare professional to address psychological factors that can impede recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Chiropractic Therapy for Hip Pain and Function

25 Mar

Each year, surgeons perform hundreds of thousands of total hip arthroplasties (hip replacements), and the most common reason is osteoarthritis of the hip. This condition isn’t caused by an underlying disease, rather it’s due to wear and tear of the hip joint from everyday activities over time. Not only can osteoarthritis of the hip be painful, but it can reduce the range of motion of the joint, making it difficult to move around. Most patients seek to avoid or delay surgery as much as possible, which drives many to seek chiropractic care. The question is: what can a doctor of chiropractic do to manage osteoarthritis of the hip?

Doctors of chiropractic receive training in the application of several manual therapies of varying force, depending on the condition, patient preferences, and the practitioner’s clinical expertise. In one study that included 60 hip osteoarthritis patients, researchers used a technique called long-axis distraction mobilization (LADM) at varying levels of force and found that high-force LADM yielded superior results with respect to range of motion of the hip joint, although low- and medium-force treatment led to similar improvements in pain. 

A follow-up study by the same researchers with another group of 60 hip osteoarthritis patients found that low-force LADM performed better with respect to reducing pain sensitivity in the hip as well as the low back and knees. On the other hand, high-force LADM brought greater improvements in overall function. A systematic review from 2022 that included ten studies found that the combination of LADM with thrust manipulation and mobilization with movement (two-to-three treatments a week for two-to-six weeks) can provide even larger improvements with respect to pain and range of motion.

When managing a patient with musculoskeletal pain, chiropractors will often use a combination of several approaches—a multimodal approach—to achieve the best possible outcomes with respect to pain and function. This includes manual therapies, specific exercises, physiotherapy modalities, nutritional recommendations, and more. In addition to treatments directed at the hip itself like those listed above, doctors of chiropractic will also assess the motion of the joints in the lower back, knees, and ankle as abnormal mechanics in these areas can put added stress on the hip and affect recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Difficultly in Carpal Tunnel Syndrome Management

20 Mar

Carpal tunnel syndrome (CTS) can be a complex condition that can be a challenge to manage for several reasons.

  • There can be multiple contributing causes. Seldom is CTS the result of one traumatic event, like a broken wrist that produces instant symptoms that requires emergency surgical treatment. Rather, the condition tends to develop over time as the result of an accumulation of microtraumas that affect the tissues in the carpal tunnel and place pressure on the median nerve and hamper its mobility. To complicate matters even more, conditions like hypothyroidism, pregnancy, obesity, and the use of birth control pills can also affect the function of the median nerve, either directly or indirectly through swelling/inflammation.
  • Median nerve entrapment elsewhere. The median nerve originates in the cervical spine and travels from the neck to the shoulder and down the arm. Compression anywhere along the path of the nerve can stimulate CTS-like symptoms. Additionally, entrapment of the median nerve elsewhere on its course can often co-occur with entrapment at the wrist.
  • It might not be carpal tunnel syndrome. While we commonly associate symptoms in the hand and fingers with CTS, there are two additional nerves—the radial and ulnar—that innervate other parts of the hand and fingers. Radial and ulnar nerve entrapment can also co-occur with CTS.
  • Work can be the cause. Occupational exposure to vibration, repetitive movements, infrequent breaks, and awkward wrist postures can each increase the risk for CTS. It may not be possible for the patient to change how they perform their work, which can make recovery difficult. 
  • Some factors can’t be controlled. Women are three times more likely to develop CTS than men, which is believed to be due to females having a narrower carpal tunnel and possibly hormonal differences compared with males. The risk for CTS also increases with age. 
  • Patients often wait too long. Because CTS symptoms come on gradually, it’s easy to ignore them, and a patient may not seek care until their symptoms become so bothersome or severe that they simply can’t maintain their usual activities. Unfortunately, the longer a patient waits, the longer it may take to achieve a satisfactory resolution. In some cases, a full resolution may not be possible or surgery may be the only viable option. 

The good news is that chiropractic care can be an effective intervention for managing CTS, especially if you seek care sooner rather than later. If necessary, your doctor of chiropractic will co-manage the case with an allied healthcare provider to give you the best possible chance at recovery.

Pain Relief Chiropractic

4909 Louise Dr

Mecanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Exercises to Prevent Sports-Related Back Pain

16 Mar

According to a systematic review that included 201 studies, low back pain may affect between 10-67% of athletes at any given moment, with anywhere from 17-94% experiencing sports-related back pain each year. This broad range is due to the age, level of competition, and the specific sports included in each study. For example, the data show the risk for low back pain is higher in gymnastics, diving, weightlifting, golfing, football, and rowing. That said, what can be done to lower the risk for sports-related back pain?

In 2022, researchers recruited 70 high school volleyball players—another sport with a high prevalence of low back pain—and assigned them to one of two groups: a control group that continued their normal activities and an intervention group that performed their usual activities in addition to four weeks of stretching and exercises focused on dynamic thoracic mobility and trunk stabilization. This program, which took about ten minutes to complete, included the jack-knife stretch (to loosen the hamstrings to improve forward bending), gastrocnemius stretch (to loosen the calf muscles to enhance ankle dorsiflexion), iliopsoas stretch (to loosen the hip flexors and reduce lumbar lordosis), and trunk stabilization (front plank to strengthen the low back and gluteal muscles).

During the study, 33% of the players in the control group reported low back pain, compared with just 8.8% in the intervention group. This means the participants who worked on improving strength and flexibility were nearly four times less likely to experience low back pain. Additionally, the players in the intervention group demonstrated improved physical function with respect to back endurance; spine/back flexibility; shoulder and trunk range of motion; ankle mobility; and iliopsoas, quadriceps, and hamstring flexibility. 

The study highlights the importance of a strong and flexible core for reducing the incidence of low back pain, something that also applies to non-athletes. Doctors of chiropractic often observe deficiencies in core strength and flexibility in patients with low back pain and advise such patients to perform at-home exercises to not only aid in the rehabilitation process but also reduce the risk for a future episode of low back pain.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717)697-1888

Member of Chiro-Trust.org 

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Does Lowering Cholesterol Reduce Cardiovascular Disease Risk?

29 Jul

For decades, the public has been told that elevated cholesterol levels are a major cause of heart disease and stroke. However, in recent years, researchers have begun to question this notion.

In an article published in the BMJ (formerly the British Medical Journal) in 2020, an international group of authors discussed the controversy surrounding the use of current recommended cholesterol targets to determine who should be prescribed a statin medication (a primary tool for lowering cholesterol levels). They state the current important targets include: 1) patients who have sustained a cardiovascular event; 2) adult diabetic patients; 3) individuals with low density lipoprotein cholesterol (LDL-C) levels over 190 mg/dl; and 4) individuals with an estimated ten-year risk greater than 7.5%.

However, the authors note that a systematic review of 35 randomized control trials concluded that achieving these cholesterol target levels DOES NOT confer any additional benefit and that using these targets failed to identify many high-risk patients resulting in unnecessary treatment of low-risk individuals and vice versa. Researchers concluded that using LDL-C is questionable as an appropriate target for preventing cardiovascular disease. Further, they describe the significant discordance between well-accepted clinical guidelines and the empirical evidence gleaned from dozens of clinical trials that cholesterol lowering does not reduce cardiovascular disease (CVD) risk or mortality.

Similarly, an April 2018 Journal of the American Medical Association study called SPRINT (Systolic Blood Pressure Intervention Trial) concluded that participants over the age of 65 years old without diagnosed CVD who were taking statins at baseline had no significant differences in primary outcomes when compared to those not taking statins, with or without adjustment for nonrandom statin use and regardless of the ten-year cardiovascular event risk level based on survival/mortality.

So, what DOES increase the risk of heart disease and premature death? An important answer to this question was found in a 2019 study that looked at lifestyle factors and high-risk factors for developing atherosclerosis cardiovascular disease (ASCVD). The study concluded that high-risk lifestyle factors such as poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation, poor gut health, and psychosocial stress ALL affect numerous direct and indirect pathways that lead to ASCVD.

These are all factors linked to elevated inflammation in the body, suggesting that systemic inflammation may be a primary driver of ASCVD and strategies to reduce inflammation may be the key to reducing one’s risk for cardiovascular disease. These strategies include eating a heart-healthy diet, limiting sedentary behaviors, getting regular exercise, maintaining a healthy weight, not smoking, avoiding excessive alcohol intake, getting plenty of quality sleep each night, reducing exposure to pollutants, and managing stress. If aches and pains are affecting your ability to live a healthier lifestyle, schedule an appointment with your doctor of chiropractic.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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