Chiropractic for Chronic Low Back Pain

Wednesday, April 22nd, 2015

Treating Chronic Low Back Pain with Chiropractic
.Chiropractic Video Service

Low back pain is a very common condition, and one that is very expensive for our health care system. Experts estimate that chronic back pain costs the US about $100 billion each year in direct and indirect costs. As the authors of one study wrote:

“One factor explaining these enormous costs is the high rate of recurrence and chronic disability related to low-back disorders…It has been suggested that only 10% of LBP patients generate more than 80% of the total costs related to LBP.”

Because of the enormous costs of treating chronic back pain, prevention is an important goal. This current study set out to examine the role of chiropractic in treating chronic low back pain. The authors studied 30 patients who had back pain for at least six months. All patients were subjected to a one-month control period that consisted of no treatment. This was included so that the researchers could observe the natural course of the back pain symptoms.

After this baseline period, half of the patients (Group 1) received intensive chiropractic treatment consisting of 12 treatments in one month, then no treatments for nine months. The other half of the patients (Group 2) received the same intensive treatment, but also received maintenance chiropractic treatments every 3 weeks for nine months. At the end of the nine-month period, both groups were again examined.

After analyzing the results, the authors found the following:

Pain levels were reduced in both groups of patients. The intensive month of chiropractic adjustments reduced pain, even without follow-up care.
Disability levels, however, showed a different response. For the patients with no continuing treatment, the disability levels returned to their pretreatment levels on the Oswestry. The Group 2 patients – who received maintenance care – continued to see improvement in disability scores over the whole nine months.
The following graph illustrates the differences between the two groups on disability levels:

Chronic pain and chiropractic

The authors conclude:

“This study appears to confirm previous reports showing that LBP and disability scores are reduced after spinal manipulation. It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment. Maintenance chiropractic care involving spinal manipulation combined with other treatment modalities (exercises, pain management program) should be investigated. Such combined interventions may have a critical influence on pain, disability, and return to work.”

Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics 2004;27:509-514.

Insurer finds Chiropractic reduces costs

Wednesday, April 1st, 2015

F4CP highlights data shared by Optum about the cost effectiveness of chiropractic care

f4cplogoMarch 19, 2015 — The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, points to data from Optum, a global entity that works to improve the delivery, quality and cost-effectiveness of healthcare, which concludes that spinal manipulation is the single service that—if not included during management of a nonsurgical spinal episode—will lead to higher total episode costs.

Optum data, which covered a two-year span, projected a total savings of $1.3 billion had its reported 14.7 million nonsurgical spinal episodes begun with chiropractic care.

“Musculoskeletal conditions rank amongst the costliest in healthcare and are a top concern for all stakeholders—patients and payers alike,” says Gerard Clum, DC, spokesperson for F4CP. “Doctors of chiropractic provide evidence-based, cost-effective care, which includes spinal manual care appropriate for the management of these conditions and other health concerns.”

In the U.S., DCs deliver over 94 percent of spinal manipulations and, according to Optum records, when

spinal manipulations occur within the first 10 days of a spinal episode, results include:

Reduced overall episode costs
Lower frequency of imaging, injections, prescription medications, and surgery
Experts at the F4CP assert that when chiropractic care precedes other options, specifically medical or surgical interventions, costs per episode are reduced by 40 percent.

Furthermore, chiropractic care is connected with favorable clinical outcomes and high patient satisfaction scores.

“Chiropractic care advances the opportunity for optimal outcomes across care delivery, quality, and cost,” Clum says. “In fact, according to research published in Spine, patients experiencing low-back pain who first visited a DC versus a surgeon were over 40 percent less likely to experience surgery.

Excited about the potential of emerging reports to positively impact our nation’s population, Clum concludes, “The Optum data further validates the value of chiropractic care and acceptance of the rising trend: chiropractic first, medicine second, and surgery last.

Safe Pitching

Thursday, March 26th, 2015

Young Pitchers Often Pressured to Play Despite Pain, Study Says

Majority of parents are unaware of safe throwing guidelines, researchers find

Young Pitchers Often Pressured to Play Despite Pain, Study Says
By Tara Haelle
HealthDay Reporter

TUESDAY, March 24, 2015 (HealthDay News) — Young baseball players feel pressure from parents or coaches to continue playing despite arm pain, and many parents are unaware of guidelines to reduce injury risk, a pair of recent studies found.

“Kids are playing harder and longer in more leagues than ever before,” said Dr. Paul Saluan, director of pediatric and adolescent sports medicine at the Cleveland Clinic. “Kids also are not getting enough rest in between episodes of pitching, which may lead to insufficient time to heal smaller stress injuries. Over time, these smaller injuries add up.”

The studies are scheduled for presentation March 24 at the American Academy of Orthopaedic Surgeons’ annual meeting in Las Vegas. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

The co-author of one of the studies explained how players feel. “Players who experience pain often felt their parents and coaches were frustrated with them,” said Dr. Christopher Ahmad, professor of orthopedic surgery at Columbia University Medical Center in New York City.

“Throwing with pain is a signal that injury is occurring,” added Ahmad, who is the New York Yankees’ head team physician.

In Ahmad’s study, he and his colleagues surveyed 203 healthy players, aged 8 to 18. Just under one-quarter of them had experienced a prior overuse injury, they found.

Almost half of the players — 46 percent — said they had been encouraged to continue playing with arm pain, and 30 percent said their arm pain sometimes made playing less fun.

Those most likely to report being encouraged to play despite pain had a previous overuse injury. They were also more likely to report feeling arm pain while throwing and to experience arm fatigue during games or practice.

For the second study, researchers surveyed 60 parents of baseball pitchers, aged 9 to 18. They found just over half of parents were not aware of safe pitching guidelines and did not actively monitor their child’s pitch count.

The most important aspects of safe pitching guidelines are a maximum number of recommended throws based on a child’s age and the number of days of rest needed between throwing stints, said Saluan.

“The focus has been on creating a better athlete who can throw harder, faster and more accurately than ever before,” Saluan said. “Injury prevention has taken a back seat.”

One in five parents did not know how many pitches their child threw in a typical game, but 64 percent recalled that their child had experienced pain in the upper extremities because of pitching, the survey found. For one-third of the pitchers, the pain required a medical evaluation.

“Kids who continue to pitch through pain end up with significant injuries that may have lifelong consequences,” Saluan said. “Younger pitchers who are still growing are much more vulnerable than adults to sustain an injury to the growth plates around the shoulder and elbow.”

Growth plates are the cartilage areas at the end of long bones in children’s and teens’ bodies, which allow the bones to grow until they turn into solid bone in adulthood, he said. But until then, this cartilage is a “weak point” that is sensitive to the repeated stresses caused by pitching.

Injuries to the growth plates usually heal with rest, Ahmad said. But he noted that more young pitchers are also damaging their ulnar collateral ligament, an important ligament in the elbow.

“Unfortunately, these injuries do not always heal and often require surgery,” he said.

The main causes of these injuries are specialization in playing and too much throwing without enough rest, Ahmad said. Other factors include training like adult players, playing year-round, playing on multiple teams at once, poor pitching mechanics, throwing at high velocity and throwing in showcases to impress a scout, pro team or coaches.

In the pitching study, half the young pitchers threw in at least two leagues at a time, one-quarter pitched more than nine months of the year, and just over half participated in extra showcase situations.

“We have fallen into the trap of ‘too much too soon,’” said Saluan. “This has resulted in a rise in injury rates in kids whose bodies are not prepared to handle the stresses that are encountered.”

Chiropractic reduces fatique

Wednesday, February 25th, 2015

CHIROPRACTIC CARE MAY BOOST STRENGTH, MUSCLE FUNCTION, AND PREVENT FATIGUE

New research into the effects of chiropractic care suggests that it may have an important role to play in maximising sporting performance and aid recovery from a range of conditions where muscle function has been compromised.

The New Zealand College of Chiropractic’s Centre for Chiropractic Research has recently published a study in the journal Experiment Brain Research1 which demonstrates that following a full spine chiropractic adjustment session there was an increase in the subjects’ ability to contract one of their leg muscles.
The study shows an increase in muscle electrical activity readings of almost 60% and a 16% increase in absolute force measures. There was also a 45% increase in the ‘drive’ from the brain to the muscle (the degree to which the brain can activate that particular muscle) and a small, but significant, shift in the H reflex curve (a neurophysiological measure of spinal cord excitability).

Dr Heidi Haavik, chiropractor and Director of Research at the NZCC says: `This study is the first to indicate that chiropractic adjustments of the spine can actually induce significant changes in the net excitability for the low-threshold motor units. The results of the study also indicate that spinal adjustments can prevent fatigue, so we recommend chiropractic care to be a part of medical treatment for patients that have lost tonus of their muscles or are recovering from muscle degrading dysfunction such as with stroke or orthopaedic operations.

`The results suggest that the improvements in maximum voluntary contractions following the chiropractic adjustment session are likely attributed to the increased descending drive (i.e. from the brain) and/or modulation in afferent input. These results may also be of interest to sports performers and we have recommended a similar study be conducted in a sports population.’

This work provides further evidence of the capacity of chiropractic care to address aspects of sensorimotor integration. The New Zealand College of Chiropractic’s Centre for Chiropractic Research is at the forefront of this ground-breaking neurophysiological research and is achieving these results faster due to the new Spinal Research Partnership Scheme.

The study was funded by a recent grant partnership between Spinal Research (formerly Australian Spinal Research Foundation), The New Zealand Hamblin Trust and the New Zealand College of Chiropractic. The study involved a collaboration between the Centre for Chiropractic Research and a world-renowned neurophysiologist, Professor Kemal Türker, from the School of Medicine at Koc University in Istanbul, Turkey.

References:
1 Niazi IK, Türker KS, Flavel S, Kinget M, Duehr J & Haavik H. (2015) Changes in H-reflex and V waves following spinal manipulation. Experimental Brain Research. In press. DOI: 10.1007/s00221-014-4193-5

Chiropractic care = fewer injuries

Wednesday, February 18th, 2015

Rates of Injury From Chiropractic Care Assessed in Older Adults
Among adults aged 66 to 99 years, chiropractic visit linked to lower risk of injury vs PCP assessment

TUESDAY, Feb. 17, 2015 (HealthDay News) — For older Medicare beneficiaries with a neuromusculoskeletal complaint, the risk of injury is lower after an office visit for chiropractic spinal manipulation versus evaluation by a primary care physician, according to a study published in the Feb. 15 issue of Spine.

James M. Whedon, D.C., from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., and colleagues analyzed Medicare administrative data on Medicare B beneficiaries aged 66 to 99 years with a neuromusculoskeletal complaint. The authors assessed the risk of injury within seven days for those treated by chiropractic spinal manipulation versus those assessed by a primary care physician.

The researchers found that the adjusted risk of injury was lower in the chiropractic versus the primary care cohort (hazard ratio, 0.24). The cumulative probability of injury was 40 versus 153 injury incidents per 100,000 subjects in the chiropractic and primary care cohorts, respectively. Chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy were associated with increased likelihood of injury among those who saw a chiropractic physician.

“Among Medicare beneficiaries aged 66 to 99 years with an office visit for a neuromusculoskeletal problem, risk of injury to the head, neck, or trunk within seven days was 76 percent lower among subjects with a chiropractic office visit than among those who saw a primary care physician,” the authors write.

Degenerative Disc Disease

Wednesday, February 11th, 2015

Chiropractic Provides Quick Recovery in Spinal Degeneration Patients

Spinal degeneration occurs when your discs start to lose some of their fluids, sometimes causing it to leak out through any cracks that are in their outer layer, possibly creating a bulge or rupture in the disc itself. While this can occur normally with wear and tear as you age, other factors can affect its progression as well; namely, doing hard physical labor and smoking. However, it can also begin as a result of an injury, such as slipping and falling or being involved in an auto accident.

The end result is typically pain, and sometimes osteoarthritis or spinal stenosis. As more and more pressure is put on the spinal column, it can also affect other areas of your body as your nerves can become impinged, making treating this issue a necessity for a higher quality of life. Fortunately, one study published in the Archives of Physical Medicine and Rehabilitation has found that chiropractic provides a quick recovery in patients with spinal degeneration—bringing hope to patients who are afflicted with this particular condition.

A group of researchers looked at 40 male participants in the 30 to 40 year age range that had been previously diagnosed with degenerative lumbar disease. They were divided evenly into two separate groups: one of which was the treatment group and one acting as a control group. The treatment group was then subjected to one spinal manipulation technique, whereas the control group received a placebo treatment.

To determine whether the treatment had any effect, researchers measured the subjects’ heights, perceived level of pain in their lower back, their neural mechanosensitivity, and their level of mobility. Some data was collected via manual tests conducted by researchers and some were collected by self-report of the study participant.

Researchers found that the treatment group noticed immediate improvements in “self-perceived pain, spinal mobility in flexion, hip flexion…and subjects’ full height.” Essentially, benefits were gained in every test area, even after just one treatment session.

Researchers further suggested that studies be conducted on women to determine if the same positive effects will be found. In the meantime, this is hopeful information for people suffering with spinal degeneration as relief may be just one chiropractic appointment away.

Opiod Use By Women of Child Bearing Age

Monday, January 26th, 2015

CDC: low awareness among women of birth defect risk from opioids

Pregnancy can throw up a million and one questions and niggling aspects: morning sickness, constipation and tiredness. One of the more irksome sides is the seemingly endless changing list of things to avoid. The CDC has released a report suggesting that women of childbearing age that may be in the dark about the implications of taking commonly prescribed opioids during pregnancy, and the subsequent increased risk of some birth defects.
pregnant woman with pills
Analysis showed that on average 28% of women with private health care and 39% of Medicaid-enrolled women filled an opioid prescription from an outpatient pharmacy each year.
Opioids are medications that are prescribed by health care providers to relieve moderate to severe pain, and are also found in some cough medicines. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus.

According to the Morbidity and Mortality Weekly Report (MMWR), published by the US Centers for Disease Control and Prevention (CDC), more than one-fourth (28%) of privately-insured and one-third (39%) of Medicaid-enrolled women of childbearing age filled prescriptions for opioid-based painkillers between 2008 and 2012.

“Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother,” says CDC Director Tom Frieden. “Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child. That’s why it’s critical for health care professionals to take a thorough health assessment before prescribing these medicines to women of reproductive age.”

Dr. Coleen A. Boyle, director of CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD), states:

“This highlights the importance of promoting safer alternative treatments, when available for women of reproductive age. We must do what we can to protect babies from exposure to opioids.”

The CDC researchers analyzed 2008-2012 data from two large health insurance claims datasets: one of women aged 15-44 with private insurance and another of women in the same age group enrolled in Medicaid.

The most commonly prescribed opioids between both groups of women were hydrocodone, codeine and oxycodone.

The research ‘underscores the importance of responsible prescribing’
Previous studies of opioid use in pregnancy suggest these medications might increase the risk of:

Neural tube defects (major defects of the baby’s brain and spine)
Congenital heart defects and gastroschisis (a defect of the baby’s abdominal wall)
Neonatal abstinence syndrome (NAS) from exposure to medications such as opioids in pregnancy. NAS can be experienced from symptoms of withdrawal from medications or drugs taken by a mother during pregnancy.
march of dimes infographic
If you are pregnant, speak to your doctor right away about all your medications.
Image source: March of Dimes
“Women, who are pregnant, or planning to become pregnant, should discuss with their health care professional the risks and benefits for any medication they are taking or considering,” comments Dr. Boyle. “This new information underscores the importance of responsible prescribing, especially of opioids, for women of childbearing age.”

Dr. José F. Cordero, a pediatrician, birth defects expert formerly at CDC, and a member of the March of Dimes Board of Trustees adds:

“If you are using an opioid painkiller, you should also be practicing effective birth control. If you decide to get pregnant or do become pregnant, tell your health care provider about all the medications you are taking right away. You may be able to switch to a safer alternative.”

In the US, a baby is born with a birth defect every 4.5 minutes, and a birth defect causes one out of every five deaths in the first year of life. In addition to the human toll, birth defects incur hospital-related economic costs that exceed $2.6 billion annually.

“The CDC’s ‘Treating for Two: Safer Medication Use in Pregnancy’ initiative offers information to women and their healthcare providers about medication use during pregnancy,” says Dr. Boyle.

“This initiative aims to prevent birth defects and improve the health of mothers by working to identify the best alternatives for treatment of common conditions during pregnancy and during the childbearing years,” she concludes.

Acupuncture better than drugs for sciatica

Wednesday, January 21st, 2015

Acupuncture could be better than a common drug for treating sciatica pain, a recent small study suggests. After three treatments, 57% of acupuncture patients were cured compared to just 27% of patients taking a common pain killer and 20% receiving alkaloid injections.

Researchers from China divided 90 sciatica patients into three groups receiving one of three treatments: warming acupuncture, tablets of a common drug called Nimesulide, or injections of a plant-based alkaloid used as a natural anti-shock treatment. The researchers then measured patients initial pain thresholds. Acute and chronic pain tends to lower your overall pain threshold, or the level of pain you can tolerate. As expected, the sciatica patients had lower pain thresholds compared to 300 healthy participants tested. Over time though, as patients began to recover with treatment, their pain thresholds crept upwards. Patients in the acupuncture group experienced more significant improvements; their pain threshold increased by 1.65 mA compared to 0.5 mA for the drug and 0.72 mA for the injection group.

Researchers pointed out that acupuncture could release chemicals that alter neurotransmitters to block the transmission of pain. They also suggested that the burning moxa used in warming acupuncture could dilate capillaries in the affected area and improve circulation to strengthen the analgesic effects of acupuncture. Though previous research has suggested that acupuncture can relieve back and neck pain, this study suggests it could also be beneficial for patients with sciatica.

Gluten Sensitivity

Saturday, January 17th, 2015

GLUTEN SENSITIVITY

One in 100 are gluten intolerant in the normal population. Of these only 1 in 8 is diagnosed. Most of these patients have no gastro-intestinal symptoms. That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception.

Every time the disease is clinically diagnosed in an adult,that person has for decades had the disease in a latent silent stage.Celiac Desease is the most often recognized symptomatic form of gluten intolerance. It is characterized by stomach pain abdominal cramping, diarrhea, watery stool that happens after a person has eaten food containing gluten,

Many patients have the silent or atypical form (no GI symptoms)and the condition may occur outside the intestines as myopathy ,muscle weakness, osteoporosis, debilitating fatigue.

Gluten intolerance can also be the initiating cause of dermatitis, liver disease, cardiac disease, neurological and endocrine conditions such as thyroid and adrenal problems.

The classic case of celiac disease results in inflammatory damage to the small intestine walls.

Specific gluten containing foods are all forms of wheat, rye, and barley.

Previously recognizes as a childhood problem, it is now found to adults as well with 25 % receiving the diagnosis at over 60s of age.

Thyroid disease is the second most prevalent autoimmune disorder associated with Celiac disease (after type 1 diabetes

Muscle inflammation is a common feature seen with those with mylopathy.

Many older patients that develop gluten intolerance do so as the result of digestive problems.

Studies at the Mayo Clinic have shown that cardiomyopathy can be associated with ciliac disease and that a gluten free diet can reverse the condition if diagnosed early.

Dr, Len Lenhart has studied the diagnosis and treatment of gluten sensitivity for the past twelve years. He is familiar with the diet necessary to control the symptoms resulting from gluten sensitivity.

Chiropractic versus nerve blocks

Monday, January 12th, 2015