Can Chiropractic Help the Post-Surgical Patient?

9 Dec

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!

Chiropractic and Pregnancy

9 Dec

Chiropractic techniques are applied to MANY patient types, from infants and children to 80, 90, and even 100 year-olds! Obviously, gender is not a factor as both men and women seek chiropractic care and receive similar positive benefits. But, what about chiropractic care for the pregnant female patient? Are there reasons chiropractic should be avoided? What are some special concerns or reasons for considering chiropractic treatment? Let’s take a look!

The American Pregnancy Association defines chiropractic as follows: “Chiropractic care is health maintenance of the spinal column, disks, related nerves and bone geometry without drugs or surgery. It involves the art and science of adjusting misaligned joints of the body, especially of the spine, which reduces spinal nerve stress and therefore promotes health throughout the body.” Regarding safety, they state, “There are no known contraindications to chiropractic care throughout pregnancy. All chiropractors are trained to work with women who are pregnant. Investing in the fertility and pregnancy wellness of women who are pregnant or trying to conceive is a routine care for most chiropractors.”

You may ask, “Why should I consider chiropractic care when I’m pregnant?” During pregnancy, there are biological changes that occur in preparation for bringing a newborn into the world. During this nine-month process, the stresses and stain on the spinal column (as well as the feet, ankles, knees, and hips) occur at such a fast pace that the body cannot always physically adapt and compensate quickly enough and problems in muscles and joints can occur. When this happens, the body compensates movements instinctively, and walking differently and/or moving in a compromised, altered manner, can lead to other issues that may be more challenging to address, especially during pregnancy. Spinal joint dysfunction can include misalignment, movement dysfunction (either too much or too little), and more. Due to the growing fetus, the protruding abdomen increases the curve in the low back, which changes the mid-back and neck curve as well. Changes in the pelvis, especially during the third trimester (last 3 months) of pregnancy in preparation for delivery can affect pelvic alignment and sacroiliac joint function. These postural adaptations often require management that no other profession addresses as directly as chiropractic! Sometimes, pelvic misalignment may reduce the room or amount of space available for the developing baby (called “intrauterine constraint”). This may make it more challenging for the baby to achieve the best position for delivery and possibly affect the birthing process for both the baby and mother. There may also be benefits from simply keeping the spine well aligned and functioning by reducing stress or strain on the nervous system since the spinal cord and associated nerve roots are housed by the spine, and autonomic functions are affected as well. Other potential benefits of receiving chiropractic care during pregnancy include (but are not limited to) maintaining a healthier pregnancy, controlling symptoms of nausea, reducing the time of labor and delivery, relieving back, neck or joint pain, and possibly preventing a potential C-section.

The types of treatments you can expect when you visit us include many of the usual chiropractic treatment approaches that you are used to receiving. These include (but are limited to) spinal adjustments, soft tissue technique, massage therapy, exercise considerations, nutritional counciling and more. Special considerations include a method called the Webster Technique, that according to a July/August 2002 JMPT published study, reported an 82% success rate in moving a breach presenting baby to vertex (normal).

 

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