Chiropractic Manipulation: A New Study Regarding Headaches

Posted by admin on June 4, 2012 with 0 Comments

Chiropractic Manipulation: A New Study Regarding Headaches

Headaches are a common complaint in patients presenting for professional care, including chiropractic management.  Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain.  This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head.  When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain.  Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple.  Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location.  When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches.  The word “chronic” means at least 3 months of headache pain has been present.  This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized.  Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals.  There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches.  Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients.  Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

Chiropractic Education

Posted by admin on June 3, 2012 with 0 Comments

Chiropractic Education

Many people seem surprised to find out that the chiropractic education process is so extensive. I usually reply, “…whether you’re planning to become a chiropractor, medical doctor, or dentist, it takes four years of college followed by and additional 4-5 years of additional education (med school, dental school, chiropractic college) simply because there is that much to learn about the body to become a competent health care provider.

Hence, depending on the area of interest a person has in the health care industry, it takes a similar amount of time to complete the educational program.

DID YOU KNOW…

  • The initial step is completing a typical “pre-med” undergraduate or college degree.
  • Courses including biology, inorganic and organic chemistry, physics, psychology, various science labs, as well as all the liberal art requirements needed to graduate are included in the undergraduate education process.
  • Many states now require 4 years of college in addition to the 4 to 5 academic years of chiropractic education to practice in their particular state.
  • Once entering a chiropractic university, the same format exists as most health care disciplines.
  • The basic sciences are covered in the first half of the educational process after which time successful completion of the National Boards Part I examination is required to move into the second half – the clinical sciences.
  • From there, internships, residency programs, preceptorship programs become available to the chiropractic student.
  • Once graduated, residence programs including (but not limited to) orthopedics, neurology, pediatrics, radiology, sports medicine, rehabilitation, internal medicine, and others are options. Many various Masters and doctorate programs in specialty areas are also available.

This chart shows the similarities between three health care delivery approaches, DC, MD, and DPT (doctor of physiotherapy). Curriculum Requirements For the Doctor of Chiropractic Degree (DC) in comparison to the Doctor of Medicine Degree (MD) and the Doctor of Physical Therapy Degree (DPT):

*Does not include hours attributed to post-graduation residency programs.

AS YOU CAN SEE, THE ACTUAL NUMBER OF AVERAGE CLASSROOM AND CLINICAL STUDY HOURS PRIOR TO GRADUATION IS EVEN HIGHER FOR CHIROPRACTIC COMPARED TO THE MD AND DPT CURRICULUM.

It should be noted that this does not include additional educational training associated with residency programs, which are available in the three disciplines compared here.

At one of the chiropractic colleges, the academic core program or Clinical Practice Curriculum consists of 308 credit hours of course study and includes 4,620 contact hours of lecture, laboratory and clinical education.

There are 10 trimesters of education arranged in a prerequisite sequence.

The degree of Doctor of Chiropractic (D.C.) is awarded upon successful completion of the required course of study.

In order to receive a degree, a student must have satisfied all academic and clinical requirements and must have earned no less than the final 25 percent of the total credits required for the D.C. degree, allowing up to 75 percent of the total credits through advanced standing.

The academic program may be completed in three and one-third calendar years of continuous residency. Graduation, however, is contingent upon completion of the program in accordance with the standards of the College, which meet or exceed those of its accrediting agencies.

In addition to courses included in the core curriculum, a variety of procedure electives are available to the students. These electives are designed to complement the study of adjustive procedures included and facilitate investigation of specialized techniques.

As a doctor of chiropractic, we are committed to providing the highest quality care available to our patients. We coordinate care with other doctors when appropriate in quest of reaching the goal of our helping our patients in the most efficient, economic, and evidence-based approach possible.

Chiropractic Care For Low Back Pain

Posted by admin on June 2, 2012 with 0 Comments

Chiropractic Care For Low Back Pain

What Does the Research Say?

There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain.  Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.”  But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history.  In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today.  Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care.  Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):

  1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437.  http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml
  1. Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada.  http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
  1. Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870
  1. Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up.  British Medical Journal 1995 (Aug 5);   311 (7001):   349–351  http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml

Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1);   29 (1):   79–86.  http://www.ncbi.nlm.nih.gov/pubmed/14699281

Carpal Tunnel: Results of a Clinical trial of Two Treatments

Posted by admin on June 1, 2012 with 0 Comments

Carpal Tunnel: Results of a Clinical trial of Two Treatments

Carpal tunnel syndrome occurs when the median nerve, which starts at the neck and runs from the forearm into the hand, becomes compressed or squeezed at the wrist. In some cases there may also be compression at the spine.

The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger), as well as impulses to some small muscles in the hand that allow the thumb and fingers to move.

A recent study in the Journal of Manipulative and Physiological Therapeutics compared two different conservative treatments for patients with mild to moderate carpal tunnel symptoms. One treatment was the Graston technique, which uses an instrument to rub the forearm, wrist and hand areas to breakdown scar tissue and adhesions. In the other treatment a chiropractor applied deep pressure by hand to the same areas. These treatments are thought to release tight muscles and myofascial restrictions.

The patients got the treatments twice each week for four weeks followed by one treatment a week for two additional weeks. The patients also did at-home stretching exercises. They did not use common conservative treatments such as wrist splints and anti-inflammatory medications.

After both interventions, there were objective improvements to nerve conduction latencies (nerve function), wrist strength, and wrist motion. The patient symptoms of pain also improved, and both groups reported high satisfaction with the care they received.

Despite surgery being in widespread use in the US for carpal tunnel syndrome, it is important for conservative treatments to be tried prior to an invasive operation.

The surgical complication rates are low but when they do occur, can be devastating. In addition to direct surgery costs, one has to also consider disability payments (not working), and rehabilitation that may take several weeks. These costs can be substantial. For this reason, many medical doctors recommend conservative treatments first.

Of all the conservative options, manual therapy by a chiropractor is an excellent choice. It comes without the side effects associated with long-term use of medications.

A comprehensive examination by a Doctor of Chiropractic can determine if your carpal tunnel symptoms are likely to respond to care. He or she can also advise on at-home stretching exercises that can be done to help recovery. In some cases, hidden spinal and neck problems can influence carpal tunnel symptoms, and be the key to treating the cause vs. the symptom.

Carpal Tunnel Syndrome – What Can You Do For It?

Posted by admin on June 1, 2012 with 0 Comments

Carpal Tunnel Syndrome – What Can You Do For It?

Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?”  As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like CTS:

  1. A thorough history is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive.  Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
  2. A Physical Exam to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
  3. Treatment can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
  4. Home Therapies are the main topic for this Health Update. What can YOU do for CTS?

Here are some of the things that you, the CTS sufferer can self-manage:

A Carpal tunnel splint is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.

Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as: A. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand) B. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand). C. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch! D. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times. E. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table– elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times. F. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed. G. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down. H. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the doorframe, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.

Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.

Carpal Tunnel Syndrome – Chiropractic vs. Medical Treatment

Posted by admin on June 1, 2012 with 0 Comments

There are many patients who suffer from Carpal Tunnel Syndrome (CTS).  In fact, CTS is one of the most common work related injuries.  In spite of multiple studies that show the benefits of chiropractic treatment with patients suffering from CTS, many medical doctors are unaware of the studies and still tell their patients that chiropractic treatment is either ineffective, or may actually harm them.  This unsupported ill advice can easily result in the patient not even considering chiropractic care as a potential effective form of treatment.  This can be especially damaging to a patient who cannot tolerate anti-inflammatory medications such as Ibuprofen, Aleve, or aspirin.  In fact, side effects secondary to stomach pain (gastritis and/or ulcer) can be quite common, especially at the recommended dose of 2400 mg / day.  Moreover, if poor tolerance to these medications exists and a unsatisfying response to conservative medical treatment occurs, the “next step” offered to the patient may be surgery. Surgery that may have been avoidable had chiropractic treatment been considered on an equal par to non-surgical medical care.

There are several studies available that will enlighten those who simply are not aware of the effectiveness of chiropractic care in the treatment of CTS.  In 1998, a 91 patient group was divided in half and treated for 9 weeks by either a non-surgical medical approach or by a chiropractic treatment approach. The medical approach included the use of 800 mg of Ibuprofen, 3x/day for 1 week, 2x/day for 1 week, and 800mg as needed to a maximum of 2400 mg/day dose for 7 weeks, as well as the use of a nighttime wrist splint.  The chiropractic group utilized manipulation of the bony joints and soft tissues of the spine and upper extremity for 3x/week for 2 weeks, 2x/week for 3 weeks, and 1x/week for 4 weeks, in addition to ultrasound over the carpal tunnel and a wrist splint at night.  It was reported that BOTH the medical and the chiropractic patient groups did equally well stating, “significant improvement in perceived comfort and function, nerve conduction and finger sensation.”

In 2007, two different chiropractic approaches were compared and found to both be equally effective in improving nerve conduction, wrist strength, and wrist motion as well as patient satisfaction and daily activity function.  These improvements were maintained for 3 months in both groups equally as well.  Another study reported significant improvements in strength, range of motion, and pain after chiropractic treatment was given to 25 patients diagnosed with CTS.  The majority of the patients reported continued improvements for 6 months or more. There are other studies but I think the point is obvious – chiropractic treatment helps patients with CTS.

The type of treatment that one may receive when being treated by a chiropractor includes manipulation of the bony joints of the neck and upper extremity.  The objective of this is to improve the mobility of the joints and loosen the muscles through which the nerves pass, particularly, the median nerve that runs through the carpal tunnel and innervates the 2nd to 4th fingers. There are several exercises of both stretching and strengthening types that strive for similar goals.  Physical therapy modalities such as low-level laser therapy have reported beneficial results.  Other modalities such as ultrasound, interferential current (IFC), ice massage/cupping over the tunnel, and others may also be utilized.  Nighttime wrist splints or braces also help to keep the wrist straight so that prolonged bending of the wrist at night is not possible.  There may be other treatment approaches that your chiropractic physician may suggest on an individual case basis.

Carpal Tunnel Syndrome (CTS) What Does Research Show?

Posted by admin on June 1, 2012 with 0 Comments

So often we hear, “…well if it’s so good, show me the proof!”  Chiropractic case management of CTS has been well established for many years.  And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS.  If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”

J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment.  The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine.  Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, &  800 mg as needed for 7 wks) plus a night wrist splint.  Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.

2)  Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520

CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting.  Also,   soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures.  Also, a significant reduction in pain and distress ratings was reported.

3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5

In 1973, Upton and McComas first proposed the presence of the “double crush syndrome.” Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., “double crush syndrome” was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.  The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.

Car Accidents and Mild Traumatic Brain Injury

Posted by admin on June 1, 2012 with 0 Comments

When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal.  Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt.   When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events.  Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, “…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!”

Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.

As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash.  This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident.  When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.

The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.

The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.

Do What You Love, and Love What You Do

Posted by admin on April 5, 2011 with 0 Comments

You are never given a wish without also being given the power to make it come true. You may have to work for it, however.
Richard Bach

Do you suffer from the Monday Morning Blues?
It’s amazing how many people begin their day – not with a sense of inspiration, but with resignation, depression, and even desperation. Their alarm clock rings and instead of leaping out of bed filled with thankfulnes for another day of life, their thoughts plummet into despair as they realize their day is filled with tasks labeled “Must Do” – none of which are things that they love to do!

Statistics reveal that many people feel so despondent about geting up and facing their daly toils and responsibilities that more people suffer from heart attacks at seven o’clock on Monday morning than at any other time of the week. This could be termed the “Monday morning heart attack blues.” And if that many people are having heart attacks from the thought of work, imagine how many people are making themselves sick in other ways.

The irony is that it’s just as simple to fill your day with things you love to so as it is to fill your day with things you must do, need to do, or dread doing! We sometimes forget that we have the power to create the life we love. In fact, when we listen to the wisdom of our intuition, or inner voice, we discover that we are most fulfilled when we’re doing what we love, and loving what we do.

Dr. John DeMartini – Count Your Blessings

Beware the risks in prescription drugs

Posted by admin on February 16, 2011 with 0 Comments

Modern medicines can work miracles, but hazards are associated with them also.

Is that Prozac you’re taking? For what reason? The drug has been approved mainly as an anti-depressant. But despite reports of drastic side effects, some doctors prescribe it to treat weight loss.

And is that Seldane in your cabinet? Do you know that when taken with certain antibiotics, this anti-allergy drug can produce heart problems? Does your doctor even know that? Better make sure; the combo can kill you.

More that 1.5 billion prescriptions are written each year. Most are safe, but adverse reactions cause 659,000 hospitalization annually, costing $27 billion. Prescription error is the second-leading cause of malpractice suits, accounting for more than $250 million in settlements.

The elderly are most vulnerable. The Journal of the American Medical Association reports that 25% of all older Americans are prescribed at least one “inappropriate and dangerous drug” each year. Other studies say that 3,300 older Americans die of ulcers caused by arthritis medication each year and 1,500 from hip injuries suffered during drug-induced falls.