Can Whiplash Treatment Outcomes Be Predicted Early On?

21 Feb

Whiplash associated disorders (WAD) refers to a collection of neck-related symptoms that are most commonly associated with car crashes. Experts estimate that up to 50% of acute WAD-injured patients will develop some form of long-term disability. Being able to predict who is more likely to develop long-term disability is VERY important, as it can place a substantial burden on not only the patient and their family, but society as a whole.

In order to determine which risk factors may predict whether or not WAD patient is at increased risk for long-term disability, a recent study analyzed findings from twelve systemic reviews. The researchers found that higher levels of post-injury pain and disability, higher WAD grades (WAD II & III), cold hypersensitivity, post-injury anxiety, catastrophizing, compensation and legal factors, and early-use healthcare each raise the risk for ongoing disability. The research team also determined the following are NOT associated with prolonged recovery: post-injury MRI or x-ray findings, motor dysfunction, or factors related to the collision.

In essence, this study looked at prognostic factors for a “typical” acute or newly injured WAD patient and found that those with severe neck pain and anxiety, who are seeking or have sought legal advice, and who had early healthcare use are at greater risk of a prolonged recovery. The type of accident (rear-end, T-bone, front-end, crash speed), examination findings, and x-ray findings do not appear to increase the risk of becoming chronic.

These findings parallel other studies regarding the association of chronic pain and psychosocial factors prolonging recovery including non-specific chronic low back pain as well as other conditions – even carpal tunnel syndrome! The authors emphasize the need for future studies to focus on how this type of information can be used in the treatment planning of WAD patients in the acute stage in order to PREVENT the progression to chronicity.

Doctors of chiropractic often see WAD-injured patients weeks or months after their accident, after they’ve been managed by primary care as well as by various specialty services. However, some patients will elect to seek chiropractic care soon after an accident. Future studies need to focus on the outcome of care rendered by different provider types to determine if one form of care minimizes the chronicity spiral that unfortunately exists. Until then, rest assured that exercise, self-management strategies, and independence from prolonged care is the foundation and mission of the chiropractors associated with ChiroTrust!

 

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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Can Chiropractic Adjustments Help Headaches?

18 Feb

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck.

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each case.

 

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.

What Do Chiropractors Do for Shoulder Pain?

14 Feb

When people think of chiropractic care, they usually imagine back pain, neck pain, and headaches, as research STRONGLY supports chiropractic treatment for these complaints. But what about chiropractic care for shoulder pain?

In 2010 and again in 2014, the United Kingdom government published landmark studies that reviewed previously published research on various forms of treatment for MANY conditions, both musculoskeletal and non-musculoskeletal (like asthma). These reviews noted there is favorable scientific evidence for the use of chiropractic treatment with regards to shoulder-related conditions including shoulder girdle pain/dysfunction, rotator cuff pain, and adhesive capsulitis (frozen shoulder).

When doctors of chiropractic approach treatment for patients with shoulder pain, care typically focuses on restoring shoulder range of motion using various manipulative and mobilization techniques directed at the three joints of the shoulder: the glenohumeral (the ball & socket joint), the acromioclavicular (AC) joint (clavicle & scapula), and the scapulothoracic joint (shoulder blade & rib cage). Chiropractic care may also include exercise training focused on restoring motion, strength, and stability to the muscles and soft tissues surrounding the shoulder region. A host of physical therapy modalities are also utilized as adjunctive procedures in many chiropractic settings at various stages of healing following shoulder injury. The goal of care is to return patients to their normal level of everyday function.

But what about shoulder pain AFTER surgery? Can chiropractic still help? A 2018 study found that post-surgical patients who received mid-back (thoracic spine) manipulation experienced significant increases in shoulder movement (flexion and abduction) and increased subacromial space measurements (in neutral and external rotation). The authors cited other studies that reported similar improvements in shoulder mobility as well as shoulder blade (scapular) kinematics (movement & stability).

Another study looked at changes in shoulder pain, disability, and perceived recovery after two sessions of upper thoracic and upper rib manipulation in patients with shoulder pain. Here too, participants reported significant improvement in all parameters tested that persisted for up to three months.

Given the solid research support of manual therapies directed at not only the shoulder but also to the neck, upper, and mid-back spinal regions, chiropractic care for patients with shoulder pain is simply a must!

 

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.

Do Splints Help Carpal Tunnel Syndrome?

11 Feb

Carpal tunnel syndrome (CTS) is a very common condition caused by inflammation of the median nerve that runs through the palm side of the wrist. When the median nerve is pinched and irritated, numbness, tingling, and/or weakness in the hand can result.

Wrist splinting is a common recommendation given to CTS patients by all healthcare providers, including chiropractors, based on the theory that pressure increases dramatically inside the tunnel at the extremes of wrist bending, so restricting motion may allow the associated soft tissues to become less inflamed. But, does splinting actually work?

One study that included 36 participants looked at the outcomes of night-time splinting only, using a common thermoplastic neutral wrist splint. The researchers observed that the patients in the study reported improvements related to their hand/wrist symptoms at the three-month point, while after six months, the participants had also experienced improvements related to wrist function.

To determine if all splints and braces for CTS were the same or if some were better than others, a 2018 study compared the efficacy of a neutral wrist splint vs. one the incorporated a “lumbrical unit” that extended further into the hand. After six weeks, patients in both groups reported improvements related to pinch and grip strength, but the patients given the longer splint also experience statistically significant improvements related to pain and function.

What about combining nerve and tendon stretching exercises WITH wrist splinting? One study that included 51 mild-moderate CTS patients found that those who performed nerve/tendon gliding exercises (three times a day for four weeks) reported better outcomes regardless of which splint they used. A similar study found that patients who engaged in a home stretching program and who wore the longer splint were less likely to require surgical intervention.

These studies support the use of a longer splint and stretching exercises in the management of CTS. When treating patients with CTS, doctors of chiropractic typically take a multimodal approach that includes wrist splinting, specific exercises/stretches, and manual therapies in order to reduce pain and improve function in the wrist and surrounding tissues.

 

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.

What is the Best Treatment for Chronic Low Back Pain?

7 Feb

When it comes to treating patients with chronic low back pain (cLBP), doctors of chiropractic commonly use a multi-modal approach that involves manual therapies, like spinal manipulation and mobilization, combined with supervised and/or home-based exercises. Why is that?

In many cases, the superficial paraspinal muscles of patients with back pain will tighten as a reflex in an effort to restrict movement and protect the area from further injury. Unfortunately, such a restriction can result in altered movement patterns that raise the risk for further injury (and pain) elsewhere in the lower back (or even in other areas of the body). On top of that, because the superficial back muscles have abnormally assumed the job of maintaining posture, the deep muscles in the back can become deconditioned and weak, which only raises the risk for further back issues.

So, when it comes to chronic back pain, the job of a chiropractor is two-fold: restore proper joint motion to “turn off” this abnormal reflex muscle spasm and to strengthen the deep muscles so the superficial muscles can return to their normal function.

In a 2011 study, researchers randomly assigned 301 cLBP patients (adults over 65 years old with a five or more year history of chronic low back pain) to one of three treatment groups: supervised exercise therapy (SET); spinal manipulative therapy (SMT), or home exercise and advice (HEA).

Researchers monitored each participant’s progress for over a year and found that members of each group achieved similar short- and long-term improvements with respect to pain, disability, global improvement, general health status, and medication use. Though the patients in the SET group experienced greater gains with respect to trunk muscle strength, endurance, and range of motion in comparison with the home-based exercise group, the difference in results is understandable as the SET protocol was much more intensive.

Though this study did not specifically look at the effect of combining exercise and spinal manipulation for the treatment of cLBP, several guidelines that have looked at the available evidence recommend using such a multi-pronged approach for this group of patients. For example, in 2018, the Canadian Chiropractic Guideline Initiative wrote, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.”

 

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.

Can Omega-3 Fatty Acids Benefit Patients with Anxiety?

28 Jan

Omega-3 polyunsaturated fatty acid (omega-3-PUFA) consumption has been linked to reduced inflammation, a lower risk for heart attack and stroke, and even improved outcomes for patients with carpal tunnel syndrome. Here’s a benefit that may come as a surprise: ANXIETY relief!

Anxiety is the most commonly experienced psychiatric symptom, and it’s reported that it will affect one in three individuals in their lifetime. Anxiety is characterized as an inappropriate or exaggerated fear leading to distress and impairment and is often accompanied with other psychological disorders, including depression, and is associated with a lower health-related quality of life and increased risk of all-cause mortality.

Classic treatment options include cognitive-behavioral therapy (CBT) and pharmacological treatments, mainly with selective serotonin reuptake inhibitors. A common problem with treatment is potential medication side-effects (sedation and/or drug dependence), as well as time-consumption and cost factors. This often leads to a reluctance to engage in treatment, which is why these findings regarding a nutritional approach to managing anxiety are so important.

In a recent meta-analysis of data from 19 clinical trials that involved 2,240 participants from 11 countries, researchers uncovered evidence that participants who consumed omega-3 fatty acid supplements reported significant clinical improvements in anxiety signs and symptoms.

Interestingly, the researchers noted that the anti-anxiety benefits of omega-3-PUFAs were stronger in those with clinical anxiety compared with those whose conditions were classified as subclinical or borderline. The research team also observed that participants who were given a higher dose (>2000 mg/day) obtained the best anti-anxiety benefits.

Vitamin D, the “sunshine vitamin”, has also been found to improve mood, especially during the winter months. Moreover, people with low vitamin D levels (70% of Americans) may be more likely to experience anxiety.

Hence, a combined daily supplement of >2000 mg of omega-3-PUFAs AND 2000-5000 mg of vitamin D may help manage anxiety signs and symptoms.

 

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.