Tag Archives: pain relief

Chiropractic Care of Children.

12 Dec
Dr. Binder & Neela

Dr. Binder & Neela

Chiropractic techniques are not limited to any particular group. We see patients of all ages, sizes, genders, ethnicities, and so on. So, is the care of children “different” than chiropractic care applied to adults? If so, how?

There are studies that review the treatment of musculoskeletal (MSK) conditions such as low back pain, non-MSK conditions such as asthma, and chiropractic care of infants, adolescents, and teenagers for a variety of conditions. The management techniques utilized by chiropractors for children vary across the profession, but typically, they are modified methods of those applied to adult patients. When one thinks of “chiropractic care,” the immediate image is that of spinal manipulation where a high velocity, low amplitude “thrust” is made and joint cavitation occurs (the release of gas creating a cracking sound similar to knuckle cracking). Chiropractic treatment can also include dietary advice, nutritional or herbal supplement recommendations, posture correction, exercise training, and the use of physiological therapeutic modalities (like electric stim, light, ice, heat, traction, ultrasound, and more). Behavioral counselling may be included, depending on the patient’s condition and the individual training the chiropractor has focused on, especially on a post-graduate level. Chiropractors, like many health care providers, have post-graduate board certification options, of which pediatrics is one of many. Looking at research for children and chiropractic, here is what the current literature base supports:

Pediatric care: There is evidence that chiropractic methods, when properly modified and applied, are safe. However, more research is needed to determine what the current practice model should be for this patient group.

Children & adolescents: There is currently research support for treatment of this patient population for some MSK conditions, particularly low back pain. Again, additional, high-quality studies are needed to further support this category.

Non-musculoskeletal care (children & adolescents): Conditions such as colic, otitis media, asthma, nocturnal enuresis (bed wetting), and attention deficit hyperactivity disorder, all require additional high-quality studies before firm conclusions can be made. At present, there is little data to support or refute the effectiveness of chiropractic care for these conditions. However, the authors do recommend that a chiropractor may play a role on the pediatric healthcare team. They suggest that it is appropriate to utilize a four to six treatment “trial” to determine effectiveness of care for a colicky infant where all other serious diagnoses have been excluded. Similarly, in cases of enuresis and asthma, chiropractic may have a role on the management team. A call for more research is a common recurring theme for the management of non-MSK conditions.

ADHD in children and adolescents: One focused systematic review reported the need for more high-quality research in this area before conclusions can be made either for or against the utilization of chiropractic care for ADHD.

Possible adverse effects: In review of (again) limited studies in this area, chiropractic care appears to have little negative issues associated with it. Serious side effects are reported as “rare.”

Bottom line: Though more research is needed, in the absence of underlying pathology, chiropractic care may be considered as part of the pediatric management team for a four to six visit trial to determine treatment effectiveness.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

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Low Back Pain: Surgery vs. Chiropractic?

12 Dec

Low back pain (LBP) is the second most common cause of disability in the United States (US) and a very common reason for lost days at work with an estimated 149 million days of work lost per year. The total cost associated with this is astronomical at between $100-200 billion/yr, of which 2/3rds are due to decreased wages and productivity. More than 80% of the population will have an episode of LBP at some point in their lifetime. The good news is that 95% recover within two to three months of onset. However, some never recover which leads to chronic LBP (LBP > 3 months), and 20-44% will have a recurrence of LBP within one year with lifetime recurrences of up to 85%! What this means is that most of us have, have had, or will have LBP, and we’ll get it again! So the question is, what are we going to do about it?

Surgery has traditionally been considered a “last resort” with less invasive approaches recommended first. Chiropractic adjustments and management strategies have traditionally faired very well when compared to other non-surgical methods like physical therapy, acupuncture, and massage therapy. But, is there evidence that by receiving chiropractic treatment, low back surgery can be avoided? Let’s take a look!

A recent study was designed to determine whether or not we could predict those who would require low back surgery within three years of a job-related back injury. This is a very important study as back injuries are the most common occupational injury in the US, and few studies have investigated what, if any, early predictors of future spine surgery after work-related injury exist. The study reviewed cases of 1,885 Washington state workers, of which 174 or 9.2% had low back surgery within three years. The initial predictors of surgery included high disability scores on questionnaires, greater injury severity, and seeing a surgeon as the first provider after the injury. Reduced odds of having surgery included: 1) <35 years old; 2) Females; 3) Hispanics; and 4) those who FIRST saw a chiropractor. Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! WOW!!! This study supports the FACT that IF a low back injured worker first sees a chiropractor vs. a surgeon, the likelihood of needing surgery in the three years after the injury would be DRAMATICALLY reduced! In fact, the strongest predictor of whether an injured worker would undergo surgery was found to be related to who they saw first after the injury: a surgeon or a chiropractor.

If this isn’t enough evidence, another recent study (University of British Columbia) looked at the safety of spine surgery and reported that (taken from a group of 942 LBP surgical patients): 1) 87% had at least one documented complication; 2) 39% of the 87% had to stay longer in the hospital as a result; 3) 10.5% had a complication during the surgery; 4) 73.5% had a post-surgical complication (which included: 8% delirium, 7% pneumonia, 5% nerve pain, 4.5% had difficulty swallowing, 3% nerve deterioration, 13.5% wound complication); 5) 14 people died as a surgical complication. Another study showed lower annual healthcare costs for those receiving chiropractic vs. those who did not. The “take-home” message is clear: TRY CHIROPRACTIC FIRST!!!

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 both presently and in the future.

 

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Carpal Tunnel Treatment Options.

12 Dec

The goal of any treatment approach for Carpal Tunnel Syndrome (CTS) is to return the patient to normal. That means addressing all OTHER health related conditions that can cause CTS such as diabetes, hypothyroidism, birth control pill use, pregnancy, rheumatoid arthritis (and many of the other related arthritic-like disorders), as well as double or multiple crush (pinched nerve) syndromes. That’s right! CTS can be caused by MANY other conditions besides simply overusing the arms and hands. When overuse PLUS any of the above mentioned conditions “gang-up” on you, managing BOTH is necessary.

One “universal” goal in CTS treatment is to reduce inflammation. This can be accomplished by several approaches: 1) STOP, reduce, and/or modify the causing activity. Examples include repetitive use of a hammer, screw driver, stapler, assembly line work, typing/computer work, driving with a firm grip on the steering wheel, bicycle riding, and MANY more! The key to successful management of CTS is to slow down, stop/rest, and for long-term success, change how the task is performed (modify the work station). 2) Wearing a cock-up wrist splint. This is usually restricted to night time use since we cannot control our wrist position while sleeping and the pressure inside the carpal tunnel “normally” doubles at the extremes of the wrist forwards or backwards. Thus, keeping the wrist straight at night significantly reduces or eliminates the numbness/tingling that can cause multiple sleep interruptions. It can also be worn during the day IF it doesn’t interfere with the person’s activity. If the activity requires frequent bending of the wrist, you’ll end up fighting against the wrist splint and that can actually worsen your CTS! 3) Ice cupping or massage. Freeze water in a Styrofoam or paper Dixie cup (like home-made popsicles) and peel away the top third to expose the ice. Rub it over the palm side of the wrist until you feel numbness. At first, it will feel Cold, followed by Burning, Aching, and finally Numbness (hence the acronym, “C-BAN”). The length of time to achieve numbness is usually three to five minutes, but make sure you quit at the point of numbness as the next stage is frostbite! 4) Anti-inflammatory nutrients. An anti-inflammatory diet is one that is rich in fruits, vegetables, lean meats, omega-3 fatty acids, and avoids glutens, omega-6 fatty acids (fast foods, etc.), and refined carbohydrates (sweets, sodas, etc.). Also, there are many REALLY GOOD nutritional supplements that can effectively reduce inflammation without the typical side-effects that affect the stomach, liver, or kidneys which are common to NSAID drugs like aspirin, ibuprofen, or Aleve. Also, NSAIDs can inhibit an important chemical (a prostaglandin) that is needed for healing, and therefore, it can actually slow down the healing process (so try the nutritional approaches first)! Nutritional options include proteolytic enzymes, Bromelain, papain, bioflavonoid, Vitamin C, Vitamin D, Vitamin E, Coenzyme Q10, and many more.

Treatment options beyond those mentioned above are typically surgical, IF you decide to go to a surgeon. However, chiropractic care includes identifying and treating the source(s) of nerve irritation, as it is often more than just nerve pinching at the carpal tunnel. Other common locations of median nerve entrapment includes the pronator teres muscle in the forearm just past the elbow on the palm side, less often at the shoulder, and again quite frequently in the neck where the nerve exits the spine. If these areas of nerve pinching are not released, recovery is less likely (with or without surgery)! Bottom line, you can always have surgery but you can’t “un-do it.” Try chiropractic first as it’s the least invasive, least costly, and often the quickest way to find relieve from CTS!

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services.

 

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Fibromyalgia Diagnosis: A Breakthrough!

12 Dec

Confirming the diagnosis of fibromyalgia (FM) is challenging, as there are no blood tests to verify accuracy of the diagnosis like so many other disorders. However, blood tests are needed when FM is suspected to “rule in/out” something else that may be mimicking FM symptoms. Also, FM is often associated with other disorders that are diagnosed by blood testing, so it is still necessary to have that blood test. So what is the CURRENT recommendation for diagnosing FM?

The American College of Rheumatology (ACR) developed criteria for diagnosing FM in 1990 and has updated it since then. The original 1990 criteria included the following: 1) A history of widespread (whole body) pain for three months or more; and 2) The presence of pain at 11 or more of 18 tender points which are spread out over the body. The main criticism regarding this approach has come from the poor accuracy and/or improper methods of testing the 18 tender points. As a result, this examination portion of the two main criteria has been either skipped, performed wrong, or mis-interpreted. This left the diagnosis of FM to be made based on symptoms alone. Also, since 1990, other KEY symptoms of FM have been identified that had previously been ignored including fatigue, mental fog (“cognitive symptoms”), and the extent of the body pain complaints (“somatic symptoms”).

As a result, it has been reported that the original 1990 approach was too strict and inaccurate because too many patients with FM were missed – 25% to be exact – by using this method. In 2010, the diagnostic approach was modified by using two different questionnaires: 1) The “Widespread Pain Index” or (WPI), which measures the number of painful body regions; and 2) the development of a “Symptom Severity” scale (SS). The MOST IMPORTANT FM diagnostic variables included the WPI score and scores of “cognitive symptoms,” which includes the “brain fog” common with FM, unrefreshed sleep, fatigue, and the  number of “somatic symptoms” (other complaints). The Symptom Severity scale (SS) incorporates these four categories and is scored by adding the totals from each category.  By using both the WPI and the SS, they correctly classified 88.1% of FM cases out of a group of 829 previously diagnosed FM patients and non-FM controls!

What’s important is that this NEW approach does NOT rely on the “old” physical exam requirement of finding at least 11 of 18 tender points. Because FM patients traditionally present with highly variable symptoms, removing the challenge of determining the diagnosis by physical examination is very important! Plus, now we can TRACK the outcomes of the FM patient to determine treatment success both during and after care. Since the 2010 approach has been released, it has been published in multiple languages and is starting to be used in primary care clinics. Recently, in July 2013, a study reported that the Modified ACR 2010 questionnaire is highly sensitive and specific for diagnosing FM, and its future use in primary care was encouraged. What is most exciting about this is that a referral to a rheumatologist may not be needed since this tool can be easily administered by primary care physicians, which include chiropractors!

In past health updates, we have discussed the need for a “team” of health care providers to best manage the FM patient. This multidisciplinary approach offers the FM patient multi-dimensional treatment strategies that encompass manual therapies, physical therapies, nutritional strategies, pharmacology, exercise, and stress management, cognitive management, and behavioral management. Now, with the release of the Modified ACR 2010 criteria, we can diagnose FM more accurately, track progress of the patient, and make timely modifications to the treatment plan when progress is not occurring. This is a “win-win” for the patient, providers/health care team, and the insurer!

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

 

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Whiplash “Basics.”

12 Dec

Whiplash is a non-medical term typically describing what happens to the head and neck when a person is struck from behind in a motor vehicle collision. Let’s look at some basic facts about whiplash:

Before cars, trains were the main source of whiplash and was called “railroad spine.”

Better terms for whiplash injuries include “cervical acceleration-deceleration” (CAD) which describes the mechanism of the injury, and/or the term “whiplash associated disorders” (WAD), which describes the residual injury symptoms.

Whiplash is one of the most common non-fatal injuries involved in car crashes.

There are over one million whiplash injuries per year due to car crashes alone.

An estimated 3.8 per 1,000 people per year have a whiplash injury.

In the United States alone, 6.2% of the population has “late whiplash syndrome” (symptoms that do not resolve at one year).

1 in 5 cases (20%) remain symptomatic at one year post-injury of which only 11.5% returned to work and only 35.4% of that number returned to the same level of work after 20 years.

The majority of whiplash cases occur in the fourth decade of life, females>males.

Whiplash can occur from slips, falls, and brawls, as well as from horse-riding, cycling injuries, and contact sports.

Injury from whiplash can occur at speeds of 15 mph or less.

In the “classic” rear end collision, there are four phases of injury (time: 300msec)

Initial (0msec) – before the collision (the neck is stable)

Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the original position but the trunk is moving forwards by the car seat. This is where the “S” shaped curve occurs (viewing the spine from the side).

Extension (150-200msec) – the whole neck bends backwards (hopefully stopped by a properly placed head rest).

Rebound (200-300msec) – the tight, stretched muscles in the front of the neck propels the head forward immediately after the extension phase.

We simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer.

Injury is worse when the seat is reclined as our body can “ramp” up and over the seat and headrest. Also, a springy seat back increases the rebound affect.

Prompt treatment is better than waiting for a long time. Manipulation is a highly effective (i.e., COME SEE US!) treatment option.

We 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 both presently and in the future.

 

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Fibromyalgia Holistic Care

9 Dec

Fibromyalgia (FM) is a very challenging condition to both diagnose and treat since there are different clinical signs and symptoms that make each patient with FM unique. Therefore, we usually make the diagnosis by excluding other possibilities. To make matters even more challenging, there are “primary” and “secondary” types of FM, or those who develop FM for no know reason (primary) vs. those whose FM arises from a known condition (secondary). Because of these challenges, there is no single treatment program to apply to all struggling FM patients. Rather, studies often suggest that a multidisciplinary “team” of health care providers be utilized in the management of patients with FM. It is recommended that EACH FM patient have their needs be uniquely treated. This month, we will look a “multimodal” approach to treating FM that incorporates a “team” approach.

For those less familiar with FM, many patients with this condition have symptoms that include fatigue, “all over” body pain, sleep problems, mood symptoms, and chronic pain. They may also have conditions including irritable bowel syndrome, palpitations, thyroid dysfunction, adrenal dysfunction, gastroenterological symptoms, chronic headaches, and MANY others. Dealing with these and other FM symptoms can have a tremendous negative impact on one’s quality of life and activities of daily living.

So as previously stated, the treatment of FM requires a comprehensive approach where the patient’s individual symptoms are targeted, as there is no “cookie cutter / one size fits all” management approach. Effective management approaches include chiropractic, allopathic, acupuncture, soft tissue therapy, sleep hygiene counseling, nutritional counseling, mind-body therapy, and dietary counciling including nutritional supplementation that target specific deficiencies determined by lab/blood tests and/or are based on the clinical history.

Treatment is centered on the human body’s deficiencies with the most important being the removal of any and all “trigger(s)” that causes inflammation in the body. Use of an anti-inflammatory herb such as ginger, turmeric, boswellia, (and others) can help until the causes are identified. A gluten-free diet is often very successful in reducing the autoimmune reaction that occurs with gluten sensitivity, which is estimated to be as high as 80% of the general population. This is NOT to be confused with gluten intolerance or celiac disease (they affect 7-10% of the general population). Once inflammation is controlled, weaning away of the anti-inflammatory supplements can be done successfully.

The hormonal levels of the body must also be in balance, especially the thyroid, adrenal, and sex hormone levels. Lab tests should include a complete thyroid panel (TSH, T3, T4, T7/free thyroxin), a salivary cortisol test (for adrenal function), and sex hormone levels (DHEA, pregnenolone, progesterone, estradiol, and, free and total testosterone). Assess and eliminate food sensitivities/allergies (gluten and dairy are most common). Nutritional supplementation should include vitamins (a multiple, omega 3 fatty acids, Vitamin D3, and Co-enzyme Q-10; minerals (calcium, potassium, magnesium), amino acids and sometimes others (case dependant)). These keep our organs functioning well, like a finely tuned machine! Care must also be taken not to over-dose as well, so let us guide you in this process – consider chiropractic your “coach” in this team-based approach!

 

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