LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Chiropractic Care

Exercise or Mesa Chiropractor for Long-Term Relief of Leg Pain?

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As usual, I have to give my “this article is going to be biased” disclaimer because back related leg pain is something I see all the time in my Chiropractic office in Mesa.

Despite the experiences of myself and countless numbers of my colleagues, chiropractic care is not well associated with the treatment of leg pain. Some of this may be because the actual research documenting chiropractic’s effectiveness for many conditions is not common.  Much of this is financial—there are too little government-funded studies on chiropractic care and we certainly do not have drug companies funding billions for chiropractic research to find out how to use less drugs in healthcare.

Which brings us to this particular study. In it, researchers compared the short (12 weeks) and long-term (52 weeks) effects of manipulation coupled with home exercise / advice to only home exercise / advice to check out the ability to reduce back-related leg pain.

While this study used the generic term “spinal manipulative therapy,” keep in mind that Mesa chiropractors perform the bulk of manipulations in the US and also perform it with the highest levels of safety.

Here’s the details of the study:

  • 192 patients were enrolled who had back-related leg pain for least 4 weeks.
  • They were put into one of the two groups above for 12 weeks.
  • Chiropractic plus home exercise had better pain improvement at 12 weeks.
  • After 52 weeks global improvement, satisfaction, and medication use were still improved.
  • Not surprisingly, no serious treatment-related adverse events or deaths occurred.

Compare the outcomes of this to treatments like steroid injections of the spine: FAR, FAR more expensive, serious risk of side effects (such as early disc degeneration, nerve damage and increased risks of spinal surgery) and very little evidence that the benefits are sustained beyond the first few months.

Of course, I DID give the disclaimer at the beginning of this article…

 

Degenerative Disc Disease in the Back; Mesa Chiropractic Shines YET Again

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The preconceptions surrounding chiropractic care are legendary. For those who have seen a Mesa chiropractor, the advantages are usually clear.

For those who have never been to a chiropractor in Mesa, however, there are a long list of fears and incorrect ideas.  Unfortunately, many physicians outside of chiropractic share the same fears and misconceptions.  If these erroneous thoughts were non-existent, I personally think the musculoskeletal health of this country (and globally) would be in a much better state.

One of these misconceptions deals with chiropractic care being useful only for acute, non-specific low back pain.  Neck pain, disc injuries, arthritis of the spine, knee pain, shoulder pain, carpal tunnel—none of these are on the list of generally acceptable conditions that chiropractic can treat.  However, these conditions and more are seen quite commonly in our office.

There is research on the effectiveness of Mesa chiropractic care for some of these conditions but it is usually limited to manipulation only, yet many musculoskeletal conditions have a pretty significant soft tissue component to can’t be addressed with joint manipulation.

So anytime I see a study that shows a positive effect with manipulation alone, I can feel confident that, which the addition of competent soft tissue work, the outcomes in real life (outside of a research study) are going to be pretty darn good.

All of this leads me to this particular study.  In it, researchers looked at 40 men who had been diagnosed with degenerative lumbar disease at L5-S1.  These men were divided into an adjustment group, who only received a single adjustment (L5-S1 “pull move”) or into a control group with no treatment.  They were then evaluated for various outcomes, including:

  • Participants’ height using a stadiometer (that height bar thingee on your doctor’s scale)
  • Perceived low back pain (measured using a a10 point VAS scale)
  • Neural mechanosensitivity (how much tension was in the nerves using a passive straight-leg raise
  • The amount of spinal mobility in flexion (measured using the finger-to-floor distance test)

If you understand chiropractic care, you will not be surprised to find that all of these measurements were improved in the chiropractic treatment group over the placebo group.

It would be easy for detractors to say that this was a single treatment that really doesn’t mean anything long-term.  The easy response to this would be to ask what medical treatment for degenerative disc disease is anything other them temporary?  And how many of these have a very small list of only minor side effects?

The answer is, of course, none of them.  Even if chiropractic care provided no long-term benefit in this situation, if you suffer from chronic low back pain, even a single days’ relief is valuable.  And none of this looks into whether or not a course of chiropractic care can have more long-lasting effects, but I can tell you from personal experience that the results can be very strong.

So if this fits you and you have not been to a chiropractor in Mesa, what are you waiting for?

 

Chronic Neck Pain in Active Adults: Where Should You Go?

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chronic neck pain in seniors and chiropractic
Photo courtesy of https://www.flickr.com/photos/bearpark/

As we age, those nagging aches and pains start to impact on your quality of life.  Chronic neck pain is high on the list.

Almost since the opening of my practice I have taught a variety of classes at a senior-oriented branch of a local community college called NAILS (New Adventures In Learning for Seniors).  That’s where I first met Marge.  Marge secretly wanted to come in to my office for treatment because she suffered from chronic neck pain.  However, she also had osteoporosis so her primary care doctor told her not to see a chiropractor because she had weak bones.

Good thing she followed his recommendations.  After all, I climb on my desk and, with a Tarzan-like roar, jump onto my unsuspecting patient in an attempt to adjust their spines.  When I’m really busy I just stack them on top of each other and adjust them all at once.  Very dangerous for weak bones.

For the next few years, Marge continued to see me occasionally at the NAILS events and continued to suffer with neck pain based on her primary care doctor’s recommendation.  At some point, however, her confidence in my ability to safely treat her overcame her primary care’s warning.

Good thing she did.  I treated Marge on and off over the next 10 years or so until she passed, even visiting her in hospice when her time was near.  She not only achieved wonderful relief from her neck pain, but her energy levels improved because she was no longe battling pain all day long.  She even took my advice to get into yoga, which turned out bad for business because she was seen less frequently in the office after she started yoga.

The sad part is that she still spent several extra years in pain because of biased and incorrect advice from her primary care.  We certainly did not treat her in the same manner we would treat a college football player or MMA fighter, but we were able to balance treatment and safety to give her wonderful results.

All of this leads up to the results of this particular study.  In it, researchers looked at 241 participants aged 65 years or older with neck pain, rated at a 3 or higher (on a scale from 0–10) of at least 12 weeks duration.  They were then put into three groups:

  1. A group who were only given home exercises (standard approach)
  2. The same home exercises along with a supervised exercise group (the basic physical therapy approach)
  3. The final group was given the home exercises but also received manipulation for 12 weeks.

After 12 weeks of treatment, the group that received manipulation had the best results (10% greater decrease in pain compared with the home exercises alone group and 5% better results over supervised exercise plus home exercise).

As an added bonus, none of the seniors treated with manipulation in this study died or ended up with multiple neck fractures as a result of any over-zealous neck manipulations.

Not that the results of this should come as any big surprise to anyone who has seen a chiropractor before for neck pain or to any of my colleagues, but sometimes it’s nice to see it in writing.  And hopefully, studies like these can keep future Marges from suffering unnecessary pain when safe and effective treatments are available.

 

Lumbar Disc Herniation; Do I Really Need Surgery?

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In general, most patients think that the diagnosis of a lumbar disc bulge means that surgery is inevitable.  This couldn’t be further from the truth.

There are so many misconceptions that revolve around low back pain that it’s always hard to decide where to start.  I have covered many of these issues in the past such as:

The list is much longer, but these are probably the top two concerns when it comes to low back pain.  It is rare that a MRI actually finds anything useful that actually relates to your current symptoms.  It is clear, however, that a MRI sets in motion a serious of events leading to epidurals and surgery.

That’s not to say that surgery is not a viable option for disc problems.  As successful as our office usually is treating disc problems, there have definitely been patients who have not responded to care and ended up in surgery, but it’s been a handful.

When someone does have a bona fide disc bulge that is creating his or her current symptoms, a very common concern centers around permanent nerve damage.  And it’s a very real concern.  Nerves don’t like pressure on them and if the pressure is sustained for a period of time permanent damage can occur.  For this reason, many surgeons will urge patients with a disc bulge to undergo surgery before this nerve damage occurs.

While pain in the leg is usually the first sign of nerve involvement (not all leg pain comes from a disc injury–the patterns associated with disc injury are very specific), muscle weakness takes some time to show up.  When this muscle weakness progresses, surgeons are quick to recommend surgery.

But, even at this stage of the game, is surgery for a lumbar disc bulge really needed?  This is the exact question asked by the authors of this particular study.  In it, researchers looked at  150 patients with sciatica due to a lumbar disc herniation and whose symptoms also included a moderate or severe muscle weakness to see how much of a difference having early surgery (versus more prolonged conservative care) had on the recovery of the muscle strength.  Here are the details:

  • In seven (10%) of the 70 patients who were assigned to early surgery the leg pain resolved even before surgery could be performed.
  • 32 patients (40%) of the 80 assigned to conservative care ended up having surgery because of severe pain.
  • While the muscle strength recovered faster in the surgery patients, by 26 weeks there was no difference in muscle recovery between the surgery and no-surgery group.
  • At the 1 year mark, complete recovery of muscle strength occurred in 81% of surgical patients and 80% of non-surgical patients.

The results from this study clearly indicate that muscle strength recovery is no different between those who have surgery and those who don’t.  Just like what I see in our office, some patients are in too much pain and decide for surgery, although the 40% number makes me wonder what “conservative care” really consisted of for the number to be that high.

Another very important tidbit that researchers discovered had to do with factors that led to a lower likelihood of having muscle strength actually return.  These were:

  • Those with a severe muscle weakness at the beginning were 540% more likely to still have weakness after a year.
  • Those with a lumbar disc herniation that took up more than 25% of the space in the spinal canal had a 640% higher chance of not experiencing any muscle strength recovery after a year.

The take home message is that, even with muscle weakness that occurs as the result of a lumbar disc bulge, your likelihood of recovery is just as good whether or not you have surgery.  The only two factors that would make your situation more dire would be a more severe muscle strength loss and a larger disc bulge.  Aside from that, if the pain is no unbearable, odds are that you are better off not going through the pain and risk of future problems that come from surgery for a lumbar disc bulge.

 

Chiropractic: The Red-Headed Stepchild of Injured Workers’ Care

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chiropractic care for injured workers
Photo courtesy of https://www.flickr.com/photos/pamhule/

As a practicing chiropractor here in sunny Mesa I can tell you that seeing injured workers in my office is a rare event.

Even rarer is a patient who was injured at work who was sent in by his or her HR department to my office for care.  Almost always it is a current patient who was injured at work and wants to be seen in our office for care because they know how effective we are.

It is rare for me to get frustrated over anything, but having a representative for a patient’s workman’s comp insurance tell me “we don’t refer to chiropractors” just irks me to no end.  Even worse is an existing patient who comes in for care of a work injury and then is told, ILLEGALLY, that they can’t come into our office for care.  The worker is scared to go against his or her employer, even after assurances by us that they can see us for treatment.

Here in AZ, with a few self-funded exceptions, patients all have a right to see the provider of their choice.  They may be required to make a single visit to a provider that is chosen by the employer, but that is all they have to do.  However, once they have seen a provider twice, that provider controls all care for the course of the injury.

So the patient sees the provider that the employer requires.  That provider (which is almost always one of the two larger occupational or urgent care clinics that use PTs for treatment) then coerces the patient to come back for another visit under one pretense or another and they get them back in quick.  Frequently the next day.

The patient ends up falling into the scheme and is NEVER given his or her rights, which would be to see a chiropractor if he or she chose to.

I would just be whining and complaining in this article if it weren’t for one important fact…

It’s a very, very bad idea to NOT see a chiropractor first or at least have one on the care team as soon as possible.  Why?  Here are a few of the reasons:

  1. The alternative is far more costly.
  2. Patients take longer to get back to work and are more likely to become disabled.
  3. Medications that actually promote chronicity are more likely to be used.
  4. Patients are generally not as happy with the care they receive.

As a chiropractor one would think that I’m just being petty and biased.  But regular readers of the Rantings know that I can back up everything that I put in writing.  This is no exception.

In this particular study, researchers looked at 14,787 injured workers over the course of 8 years to evaluate care patterns for low back pain.  They identified 5 distinct patterns of care for the injured workers:

  1. Information and Advice (59% of injuries): The first 6 weeks basically consisted of information gathering or advice seeking but no overriding pattern.  This included simple office visits, laboratory tests, emergency department or hospital visits, talk therapy, or visits involving imaging (x-ray, ultrasound, CT, or MRI) but no other procedures.
  2. Complex Medical Management (2% of injuries): Included more than a single visit to a physician for nerve blocks, surgeries, or comparable procedures.  This is expensive and fragmented care and runs completely contrary to the way low back pain should be managed.
  3. Chiropractic (a paltry 11%):  Self-explanatory.  Used by the most intelligent injured workers (ok…so I made this part up).
  4. Physical therapy (11%):  Self-explanatory.
  5. Dabble (17%): Workers who had one visit to a non-chiropractic physician, chiropractic physician or PT, or at most one visit to two or more of these categories.

Overall, being good at math, it looks like 89% of the injured population were not under the care of a chiropractor.  Keep this in mind as we go through the rest of the study.  I know that here in AZ, this low percentage is likely a result of steerage by the insurance company, HR employees who do not understand how effective chiropractic care is, as well as the schemes played at the patient’s expense by other providers that treat injured workers.

After identifying the 5 patterns, researchers looked at well accepted guidelines for the treatment of low back pain that is backed up by medical research.  There were 11 guidelines that were used to evaluate the 5 treatment patterns, but here are some snippets to think about:

  • Early use of (MRI) has been linked to prolonged disability, higher medical costs, and greater use of surgery at the same time finding no benefit on health or disability outcomes for low back pain.
  • Chiropractic has been shown to lead to lower likelihood disability recurrence over non-chiropractic physicians and physical therapists.
  • In addition, chiropractic care with shorter duration (likely meaning more effective chiropractic care that seeks to get the patient better ASAP) also leads to shorter disability duration.
  • More frequent and stronger dosages opioids leads to longer claim durations.  Worse, the likelihood for a catastrophic claim (total cost of $100,000 or more) when spinal surgical procedures were performed increased 10-fold when treatment included opioid use.

It goes without saying that chiropractic care is the antithesis of opioid use.

With all this in mind, here are a few snippets from the study:

  • Care to injured workers that was in line with 10 of 11 guidelines led to lower total costs.
  • Of the five patterns, complex medical management followed the guidelines the worst in regards to imaging, surgeries, and medications as well as having the highest total costs.
  • Complex management was also linked to the highest rates of prescriptions for four of the seven drug classes—opioids, other pain medications, SSRI/SNRI/tricyclics, and anxiolytics/sedatives/hypnotics.
  • The PT group was highest in NSAIDs, muscle relaxants, and oral steroids.
  • Chiropractic care was on the opposite end of the spectrum, leading to the most alliance with accepted guidelines, lower total costs and the lowest prescription rates in all seven classes of drugs.
  • Previous treatment choices by injured workers influenced future choices for another injury.  This means that, if someone did NOT choose chiropractic care for an initial work injury, if they got injured again they were not likely to seek chiropractic care for the second episode.

There is really not much more to say.  Except that maybe all of this information is not new and is consistent with the findings from a large handful of other studies.  Hopefully you can understand my frustration with the care of injured workers here in Arizona, as well as the extreme confusion when it comes to chiropractic care being treated as the red-headed stepchild of healthcare when, in reality, we really rock when it comes to doing what we do.

By avoiding or discouraging chiropractic care for injured workers here in AZ, workers are not getting the best and most cost-efficient care possible.  That, quite frankly, is a travesty.

 

Lower Back Pain Relief with Stretching – Timing is Everything

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In seems inherent that treatments for lower back pain relief would include stretching.  In general, flexibility is a good thing and that’s why activities like yoga are bad for a chiropractic business.

One of the more common questions I get as a chiropractor is what stretches or what exercises should be done for chronic lower back pain.  My easy answer is to strongly recommend that the patient get themselves into a yoga program and give it a try for several weeks.

To understand the benefits of yoga, you need to understand that the “30-second” warm-up stretch that we have all been taught from gym class in elementary school on is merely an attempt to avoid injury and does nothing to improve flexibility in the long run.  And flexibility is so darn important.  I’d have to say that almost all of the patients that I see in my office for treatment of chronic lower back pain have very poor flexibility.  For lack of something more specific, the lumbar region in these patients is locked up and can’t move the way it needs to.
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Steroids and Your Tendons: Shocking Research

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Dangers of steroid injections
Photo courtesy of http://www.freeimages.com/profile/zeathiel

Most are aware that steroids are not good for us.  Steroids are bad for bones.  Bad for diabetes.  Bad for tendons.  But just HOW bad?

The standard recommendation for steroid injections into a tendon, such as the shoulder, elbow or Achilles tendon is no more than 3.  Anything past that and you increase the risk of a tendon rupture.  Basically, it is well accepted that steroids weaken tendons.  Which, considering that the idea of any type of therapy is to improve the situation, this seems odd to me.  Giving a therapy to provide temporary relief that will only increase the risk of future damage just doesn’t make sense to me.

I can honestly say that there have been very, very few situations in my years of practice that I have felt a steroid injection was a necessity.  And don’t think you’re safe if you have a local injection directly into an area such as the shoulder.  Research has shown that the injection site doesn’t matter; an injection into the buttocks is just as effective as a direct shot into the supraspinatous tendon.  This means that the steroid is spreading throughout your body, effecting every single tissue in your body.

The same holds true for oral steroids taken for any reason; respiratory, pain, inflammation.

But it’s just once, right?  Can’t really hurt anything, can it, so long as I keep the injections to the recommended 3 doses…?

Nope.  The results of this particular study should be a massive eye-opener to everyone.  In this study, researchers looked at the cellular effect of the steroid dexamethasone on hamstring tendons.  They found that steroids trigger a process called cell senescence.  Senescence means to “grow old” and basically indicates that an organism is coming to the end of its lifespan.  Cellular senescence has a similar meaning, indicating that a cell has ceased to function fully, has stopped dividing and is basically nearing the end of its life.

Interestingly, dosage would not likely make a difference.  Steroids work by acting on a receptor at the surface of a cell and there are only a certain amount of receptors available.  For this reason, a low steroid dose can be powerful enough to fill up all the receptors.  A high dose is not necessary.

Some would argue that this was a “test-tube” (in vitro) study, it is not likely to happen when oral steroids are used to treat something like shoulder pain.  The researchers took this into account and looked at actual tissue biopsied from shoulder surgery and found the same cell signals that trigger this cell senescence.  In other words, it’s real.

Worse, it’s irreversible.  As in permanent.

I have stated time and time again that I am certain that the way we are treating musculoskeletal injuries and pain in medicine today is completely setting us up for problems in the future.  Anti-inflammatories and steroids have consistently shown in the research that they damage the very tissues we are trying to protect.

Personally, despite many injuries over the past 20 years (ripped off extensor tendon of left 4th digit, left radial head dislocation, shoulder pain, neck pains, low back pain, episodes of knee pain) I have never even considered anything other than natural approaches.  Most often, this involves advanced soft tissue techniques like Graston combined with chiropractic adjusting.  And it has served me well over all this time.  And maybe this approach is why I don’t deal with any chronic problems despite many severe acute injuries.

While this may seem entirely self-serving, do not let any ache or pain go and definitely do not try to “suppress” it with any type of anti-inflammatory, steroidal or not.  Avoid the couch after most injuries–maintaining movement to the best of your ability is almost always your best option and ensures that scar tissue is less likely to form.

 

Can Supplements Help with Mild Traumatic Brain Injuries?

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As a chiropractor, I am familiar with mild traumatic brain injuries following head traumas and car accidents.

I was very surprised at the information I covered in a previous blog post on post concussive brain injury that can be read by clicking here.  That research study pointed out just how common these types of injuries were after motor vehicle collisions.  Far more common than I would have thought, and I see car accident patients all the time.

Anyone who has experienced a brain injury following a crash knows how frustrating it can be.  I usually tell patients it can last anywhere from a few months to a year or more.  Symptoms can include:

  • Headaches
  • Difficulty thinking clearly
  • Short term memory loss
  • Irritability
  • Anxiety
  • Problems sleeping
  • Dizziness

Given how disrupting this can be to life, anything that can be done to shorten or decrease the severity of these symptoms is a good thing.  This particular article looks at just this question.  In it, the author evaluates the ability of the omega 3 fatty acid DHA (docoshexaenoic acid) to impact symptoms of post concussive disorder.  Given that the cell walls of our brain are made up of fats, this makes sense.

Here’s a summary of the benefits of DHA on post concussive syndrome:

  • There is evidence that DHA in the diet provided either before or after brain injury improves certain outcomes like spatial learning and memory.
  • Early evidence also suggests that DHA can positively influence aspects of the damaging pathway that occurs after brain injury.

While this is a review and not a study, the mechanisms certainly make enough sense to suggest that it may help for post concussive syndrome.  Looking deeper, it would make sense to suggest that regular use of DHA, in addition to all the other benefits, could protect your brain in the event of a head injury.

The bottom line is that if you participate in any contact sport or your son or daughter participates in a contact sport fish oil supplementation should be on the list.  While I can’t guarantee that it will help protect your brain in the event of brain injury, given the cost and safety of fish oil supplementation, it certainly makes sense.