LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Chiropractic Care

STEROID INJECTIONS FOR LOW BACK PAIN? DID YOU GET AN MRI FIRST?

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Medicine has somehow managed to create a culture around low back pain.  Maybe it was unintentional.  Maybe it was ignorance.  Maybe it was willfully done to support the “system.”  Whatever the reason, it costs society massive amounts of money on waste.

Usually not a month goes by when some patient is told by their PCP that they should stop seeing a chiropractor (sometimes after only 1 or 2 visits) and see a PT or get an MRI or both.  Worse, there are many times that a chiropractor does not even become a part of the equation.  The costs when a chiropractor is NOT involved skyrocket.  Here in AZ, a patient seeing their PCP first may end up costing some 30% more.  If they manage to self refer to a PT, the costs are almost TRIPLE.

The reasons for this are multiple, but the bottom line is that we are experts at low back pain and are very good at controlling care.  This means that we infrequently order X-rays and rarely order MRIs.  I know that, in our office, if the patient’s low back pain and leg pain looks an awful lot like sciatica from a disc bulge, why the heck would I order an MRI if I already have a very good idea of what is going on?

This particular study has some interesting findings.  Researchers looked at patients getting an epidural for low back pain with leg pain (lumbosacral radiculopathy) and whether or not they actually needed an MRI before the procedure.  What???  Of course you need an MRI before someone sticks a very long needle into the most sacred of regions in your spine!!  Or do you..

Here are the findings when comparing 2 groups of patients, one group where the MRI was used to guide the epidural procedure and a second group where the MRI was NOT used:

  • Slightly less leg pain in the MRI group at 1 month
  • No differences in pain or function at 3 months
  • After 3 months, only 35% in group 1 and 41% in group 2 showed improvement
  • In non-MRI patients who received a different injection than that proposed by an independent physician (basically a 2nd opinion, but this doctor did actually look at an MRI of the patient), the outcomes were not quite as good as those whose procedure matched that the MRI findings
  • Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an epidural after the MRI was reviewed

So, the bottom line is that MRI made very little difference in the outcomes of the epidural.  Further, a little under 2/3 of the patients received no long term benefit from the whole process.  All for the price tag of around $10K.  Give a good chiropractor $10K to work with and we’ll have the vast majority of patients competing for the Ironman Triathlon in 6 months….

LIVING IN FEAR OF FLARING UP LOW BACK PAIN?

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Low back pain is highly prevalent in society today. Most studies suggest that about 80% of the population will experience low back pain at some time in their lives. For some, it is a few days of being careful how we move. For far too large a percentage of others, this pain passes into chronicity. So what creates the different outcomes?

Read entire article here

ARE STEROIDS BAD FOR MY BONES?

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Most people are aware that long term use of steroids is bad for the bones and can lead to osteoporosis. But what about short term use? What about use for a year? A day?

Steroids are used to control inflammation. Our body produces its own cortisol (as opposed to the synthetic cortisone), but this is under very tight regulation with feedback loops. Of course, with poor lifestyle changes and chronic stress this balance can get disrupted and create dysfunction.

This particular study gives us a better idea of just how little it can take to begin to destroy our bones with the use of steroids to control inflammation. Long term use of steroids is typical in many conditions such as lupus and rheumatoid arthritis. Short term use is also used far too common in musculoskeletal complaints like shoulder, neck and low back pain.

It is established the the risk for osteonecrosis in long term (>1 year) use of steroids increased the risk an incredibly massive 212,200 times (OR 212.2). I have personally never seen an odds ratio this high before. To put this in some degree of perspective, one would have to smoke maybe 20 packs of cigarettes through a hole directly in the trachea for 100 years to increase your risk this much for lung cancer.

While this study focused on the use of steroids for lupus and RA, we can begin to see how short term use of steroids for musculoskeletal conditions are largely inappropriate.

 The risk of osteonecrosis was quite striking and most often affected the hip. Researchers identified some very interesting trends. The first set of items they looked at was how long ago someone who experienced bone death was exposed to steroids. Oral, injected or IV did not appear to be different. In other words, you took a course of steroids for low back pain last week—how much did this affect you vs taking a course 3 years earlier….

  •  Use ONE day to 90 days ago risk was increased 580%
  • ½ year to 1 year increased 890%
  • More than 2 years earlier 430%

 Can we begin to see that routine use of steroids (for conditions that would very likely respond well to chiropractic care) can increase the risk for serious long term consequence even years later?

 So, while my opinion as a chiropractor is clearly biased, the decision to use a non-drug effective alternative to any musculoskeletal complaint continues to be strongly supported by the medical literature.

THINK YOU SHOULD WAIT AND SEE IF YOUR LOW BACK PAIN GOES AWAY?

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Low back pain will affect some 80% of us in our lifetimes. For some, it the first episode ever. For others, it’s the second or third or fourth episode in as many years. Others seem to “throw out” their back just by sneezing. So what do most people do when they experience an episode of low back pain?

They wait and think it will get better.

I always envision an episode of Family Feud where Richard Dawson poses the question…”Name something commonly heard in a chiropractor’s office.”  The first family would throw out, “I thought it would go away!!” and this flips over as the number one answer on the board and the crowd goes wild..

I used to say that my opinion that waiting it out was a bad idea was biased. Not so much so anymore. Multiple studies have come out finding that delays in seeking treatment can produce worse outcomes and a greater likelihood to progress to chronic pain. And given that chiropractors are, based on the evidence, the best first choice for care of musculoskeletal complaints, you should, of course, see a chiropractor NOW.

This particular article looks at what happens if someone with symptoms stemming from a lumbar disc herniation wait to seek care. Those that waited at least 6 months had a worse outcome than those that did not, confirming what we already knew…

 

DID YOU GET THIS AFTER A WHIPLASH?

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As a chiropractor, I obviously have seen many whiplash patients.  And sooner is always better.  I’ve found that the sooner I see a patient after the trauma (even the same day of the accident) that better the outcome.  But not everyone seeks care after an accident.

There are multiple reasons why not seeing a chiropractor after trauma is a bad idea.  The obviously one is that the damage from the trauma needs to be controlled and then the healing process needs to be guided.  There are clearly long term problems that occur following improperly treated whiplash injuries.  These include:

 Even if you do not have more than some minor stiffness after the accident, it is still wise to get an evaluation.  This does not mean that you need extensive care, but a few visits can go a long way towards fixing any imbalance that occurred as a result of the trauma. 

If someone does not seek an evaluation after trauma, it is possible that problems will creep up months later, again because of an imbalance created.  This particular study lends support to this idea.

The jaw (temporomandibular joint, or TMJ) generally does not get directly injured in a car accident.  However, it is very susceptible to imbalance between the muscles in the back of the neck (injured during whiplash) and the muscles that open the jaw. 

24% of the patients in this small study developed jaw pain some time after the accident.  Even more interesting, those who experienced low-speed accidents were more likely to suffer jaw pain.  Is this because they chose NOT to get care immediately after the trauma??

DID YOU INJURE YOUR NECK AT WORK?

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Ever injured your neck in a car accident or at work?  Here in AZ, many patient are sent by their employers to occupational medical clinics.  The first option here is usually some medications and a “watch and wait” approach.  So what’s wrong with that?

Well, if you understand injuries and the way that the soft tissues of the body work, then you know that this is probably one of the worst approaches to take.  The anti-inflamatories usually used actually interfere with the healing process and the inactivity that is recommended allows the fascia at the heart of the injury tightens up.  With time (and no treatment), these tight areas become permanent.

Alterations in the fascia’s ability to slide affects the muscles.  The muscles then aren’t able to move properly and support the joints they are associated with.  Then the joints lose movement and become painful and send pathological signals up to the brain.  Quite the mess.

So, back to the original question; what’s wrong with anti-inflamatories and rest immediately after an injury?  It creates an ideal situation to make the problem chronic.

Which brings us to this study, which further supports this concept, finding that in those who had a work related neck injury, they had almost 2 1/2 times the risk of having “troublesome” neck pain 6 or 12 months later.  By this time the injury is much more difficult to treat to resolution.

The bottom line is that it is never a good idea to limit movement after an injury (provided a fracture or more serious injury has not occurred) and that, if possible, you should seek care sooner rather than later.  And make sure you find a provider who is going to work on both the muscles, fascia AND the joints to make sure that injury has the greatest likelihood of being put behind you.

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I CAN’T SEE A CHIROPRACTOR–I’VE HAD SURGERY!

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This is certainly a phrase I’ve heard many times in the community.  Usually someone stating that there is nothing that chiropractic can do to help them because they’ve already had surgery.

Obviously, seeing a chiropractor BEFORE the surgery in the hopes of avoiding the surgery altogether is the preferred method, but should you miss that opportunity, fret not.  Somehow, when patients unfamiliar with chiropractic care envision a treatment session in a patient who has had surgery or maybe has osteoporosis, it involves the chiropractor jumping off from the desk to deliver a ninja-like adjustment.

I know that in our office, with the heavy soft tissue approach, we have been able to provide significant relief to those patients who have had surgery and who thought that there was nothing that could be done to help with their pain levels.

While this study is a case series and involved lumbar surgeries (the best response being those with the more invasive surgeries), we have seen both neck, ankle, wrist, shoulder, knee and low back surgeries that did not resolve the complaint but responded well to care in our office.

So, next time you hear someone say that they can’t see a chiropractor because they’ve had surgery, point out this study.

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BUT CHIROPRACTORS WANT YOU TO COME BACK IN FOREVER…

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As a chiropractor, I obviously have an opinion on this one.  My profession has had a tendency to get dirt flung at it in the past.  We’ve always been treated as the red headed stepchild of healthcare despite very strong evidence that we are damn good at treating patients effectively and saving money while doing it.

But what about those chiropractors that want you to come back endlessly week after week after month after month, even after the pain’s gone?

Personally, in our office I always explain to patients that, so long as they avoid gravity, stress and computers they’ll probably be just fine going forward.  After all, chiropractic care is an intervention–I’m doing something to the patient that they can’t do themselves.  I do not believe that, in a perfect world, we should need any type of intervention.  But, given the reality of our lifestyles, however, my biased opinion is that some degree of regular care is good.

That may mean weekly for those with decades of musculoskeletal “baggage” from decades of improperly treated pain.  Or every month or every few months for the average person.  This has always seemed to work out well, although this has been limited to my own experiences and opinion.

Now this particular study adds some evidential weight to my personal experiences.  This looked at patients with chronic low back pain.  Basically, the participants in this study who were seen for an initial course of chiropractic care but were seen every other week after the initial trial of care did better after 10 months than those who did not receive the regular care.

Maybe we’re not so crazy after all… 

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