LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Chiropractic Care

To Cut or Not to Cut: Very Long Term Outcomes of Spinal Fusion Surgery

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Over time, surgeons have moved to more and more complex procedures.  But whether these lumbar spine surgeries are better is still in question.

Initially, spinal surgeries were less complicated with procedures like laminotomies and laminectomy, but surgeons (at least under Medicare) have been moving towards more complex procedures that are more expensive with a higher rate of complications.  The problem with the vast majority of studies on the outcomes of surgery look at very short-term, usually no longer than 1 or 3 years.  The re-surgery rate is known to be as high as 23% after 10 years.

So, if you didn’t have a repeat surgery, what can you expect after 10 years, and will you outcomes be any better than under the care of a competent physician who truly understands low back pain (like maybe a chiropractor….)?  This is the question that was asked in this particular study.  Researchers followed 473 patients with chronic low back pain of at least 1 year’s duration who were all considered candidates for spinal fusion.  The average follow-up was 11 years.  The patients were put into one of two groups:

  1. Lumbar spine fusion with either instrumented or noninstrumented fusion.
  2. Nonoperative treatment that included multidisciplinary cognitive-behavioral and exercise rehabilitation.

Keep in mind that true management in the #2 scenario above is not done by the average practitioner.  Rather, this is a comprehensive approach encompassing both your mental state, the way you related (or don’t relate) to your pain as well as the physical treatments that can go a long way towards reducing the level of pain.

So what did the researchers find out after 11 years about the differences between spinal fusion and the comprehensive approach?

Nothing.

Yup.  No difference in the long run.  And this does not take into account the fact that a lumbar fusion will lead to further degeneration of the levels above and below as well as the chance that the surgery will not relieve the original symptoms it was attempting to address.

The bottom line is that surgery really should absolutely, positively be your last resort.  And THEN you still try something else before surgery.  You need to make sure that you can look yourself in the eye 6 months after surgery and tell yourself that you tried everything else before surgery.  And yes, this DOES include chiropractic.

 

Have a Muscle Injury? Don’t Neglect This Therapy

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massage for sports injuries
Advanced soft tissue techniques important after sports injuries

You decide that, after a decade of watching all 600 UFC fights from the couch, to start Krav Maga. While it sounded like a good idea, the following day you call into work because you can’t move.

The first home remedies to cross your mind include rest (which is what got you into this mess in the first place), ice and half a bottle of ibuprofen.  While this may be what everyone thinks we should do, I would suggest that none of the choices are part of the best way to handle most injuries.  I have addressed how bad of an idea the anti-inflammatory approach is many times in the past (all of which can be summarized in my eBook on NSAID dangers, which can be found by clicking here).

But, rather than pointing out what you should NOT do, this article is focused on what you should do.  And while it may seem a little self-serving, I do have this particular article to back up what I have to say and give it some validity.  Basically, the authors discuss the path of muscle injury and repair.  Specifically, they mention two hormones produced by our bodies: transforming growth factor (TGF)-β1 amd vascular endothelial growth factor (VEGF).

These two hormones may play a role in increasing blood flow to injured muscles and lowering the risk of scar tissue (fibrosis) from developing after an injury, and the authors suggest that massage may benefit muscle injuries by increasing the levels of these repair hormones.

Since our office combines advanced soft tissue techniques with manipulation, my self-serving advice would be that, after any type of muscle injury the standard approach of rest, ice and ibuprofen should be scrapped and you should make an appointment with your local chiropractor.

But, of course, my opinion is extremely biased.

 

Is Chiropractic Care Required for Neck Pain?

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Maybe “required” is a strong word, but is it possible that negative changes occur with neck pain that can only be fixed by chiropractic adjusting?

As always, this is the time for my disclaimer:  As a chiropractor, my viewpoint on this topic is clearly biased, but very well informed.

It seems like most of medicine jumps on a short course of anti-inflammatories and muscle relaxers for non-specific neck or back pain.  Give it a few days of medications and see what happens.  If the patient doesn’t get better, than consider referring out for (most likely) PT or chiropractic care.  If they do get better, everything’s great.  Or is it?

Are there changes that occur either from neck pain, or that lead to neck pain that are at a much deeper level than just symptoms?

I know that, for far too long my profession has promoted the “bone out of place” theory about chiropractic adjusting.  However, this is just not how things work and I think many of my colleagues just found it easier to described what we do in overly simplistic terms.  Closer to reality is what is called the “dysafferentation” model.  Joints like to move and are surrounded by a massive amount of receptors that fire off to the brain when we move.

That’s why we can close our eyes and still touch our noses with our fingertips.  When we have an injury, or spend too much time in a single position at the computer for hours each day or we wake up with severe neck pain, the input from these receptors surrounding the affected joints will slow down.  This means less input into your brain from these receptors.   The brain doesn’t like this and sends a signal out to your pain centers that something is wrong.

At this point, what do you think that any type of medication, regardless of the class it is in, will do to fix this loss of input to the brain?  The correct answer is a big fat nothing.

So what does all this have to do with this particular study?  While a small study, it raises some very interesting questions about neck pain and how what kind of an impact chiropractic care has.  Here’s a summary:

  • Patients had subclinical neck pain, or minor neck pain for which they had not yet sought treatment (specifically, intermittent neck pain such as mild neck pain, ache, and/or stiffness experienced over at least 3 months’ duration)
  • Patients demonstrated  a 19% decrease in reaction time as well as a decrease in cerebellar inhibition (CBI–the brain was no longer reacting the way it was supposed to be).
  • Follwoing a keypad based exercise to increase moto sequence learning, there was a decrease in CBI following chiropractic manipulation.
  • The control group also had a 25% improvement in task performance, but no changes to CBI.

While the article itself gets a little technical, the bottom line is that, in these patients with mild, occasional neck pain, the neurological system is no longer functioning the way it is supposed to.  Additionally, chiropractic adjusting has a positive impact on the nervous system in these patients.

While no hard conclusions can be drawn from this, I would suggest, in my very biased opinion, that NO cases of neck pain can be properly addressed without the use of chiropractic adjusting.  Medications alone, which is a common route of treatment, does nothing to fix the negative changes in the nervous system that are present in neck pain patients.

 

Surgery for Lumbar Degenerative Disc? How About Doing it a 2nd Time?

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The decision to undergo any type of spinal surgery is a difficult one for everyone.  But what if you had to consider not one, but a SECOND surgery as well?

Turns out, there is a large chance this may be the case.  (Spoiler alert: I’m a chiropractor whose main goal is to keep patients out of surgery)

First of all, the realities.  If I had a dollar for every time someone told me he or she had lumbar degenerative disc problems and was going to avoid surgery at all costs, I’d be doing this post from my own island in the Caribbean.

Most of those who informed me of this goal have that tone of inevitability to the voice.  Like there is no other option except to delay the surgery.  This could not be further from the truth.  I just had a conversation yesterday with a young doctor who informed me that he had L5-S1 disc degeneration and would love to be more active in the martial arts to try to stabilize his spine and avoid surgery, but every time he tried to train, it flared up his low back.

This doctor had not tried seeing a chiropractor competent in advanced soft tissue techniques that has a high likelihood of giving him almost complete relief.  So of course I gave him some resources to find a doctor who might be able to help.  There is no guarantee that this would help, but it would be foolhardy to even consider surgery without trying.

But what about all those other patients who incorrectly think there are no other options?  The ones who stress about whether or not to have surgery on his or her low back?  This decision alone is challenging.

But what if the risks of having to have a second surgery were high enough so that this same contemplative patient really needs to be deciding if he or she can undergo TWO surgeries, not just one?

You know I wouldn’t be asking this question if it didn’t have anything to do with this particular study.

In it, researchers looked at the risk of having a second surgery when the first one was done for stable (without a spondylolistethesis) lumbar disc degeneration over the next five years.  Here’s what they found:

  1. The resurgery rate was 4.7% at 3 months,
  2. 7.2% at 1 year,
  3. 9.4% at 2 years,
  4. 11.2% at 3 years,
  5. 12.5% at 4 years,
  6. 14.2% at 5 years.
  7. Based on this trajectory, they calculated a reoperation rate of 22.9% at 10 years.
  8. Reoperation rate was not different between decompression and fusion surgeries.

Wow.  Over a 1 in 5 chance you’re going to have to go under the knife a second time, with all the additional costs, downtime and rehab.  Worse—outcomes after a second surgery are worse than after the first surgery.

Not a rosy picture.  But heck—don’t see a chiropractor—we’re all quacks and dangerous to boot.

 

One of Every Four Americans Has a Musculoskeletal Condition – (07-24-00)

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One of Every Four Americans Has a Musculoskeletal Condition

So why don’t more people see a chiropractor?? Chiropractors have the training and skills to address just about ANY musculoskeletal condition and effectively treat it.

Musculoskeletal injuries and disorders in the US population have reached epidemic proportions, costing US $254 billion annually, and affecting 1 of every 4 people, according to a report released at the launch of the Bone and Joint Decade. The United Nations, the World Health Organization, and 22 countries have proclaimed the years 2000-2010 as the Bone and Joint Decade, and President Clinton has issued a letter of support for this global initiative to raise awareness of musculoskeletal health, stimulate research, and improve quality of life for people with these conditions.

Will I Need Surgery for My Carpal Tunnel?

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There are some conditions that we have been conditioned to believe need surgery.  Knee meniscus injuries, disc herniations, rotator cuff tears. Carpal tunnel is on the list as well

I recently had a new patient come into my office on a Monday.  He’s 66 and had been scheduled for shoulder replacement surgery 4 days later on Thursday, with the other shoulder to follow a few months later.  Not an easy surgery nor an easy recovery.

However, he started to develop numbness over both of his hands, with the numbness covering all 5 fingers.  He mentioned to his orthopedic surgeon that he did not think he could manage the rehab from the shoulder with his hands being this numb.  So this man has an NCV test done (a nerve conduction velocity test that can tell how well the nerves in your arms or legs are firing) that came back with a diagnosis of carpal tunnel syndrome.

I pretty sure that every NCV test report I have ever read comes back with carpal tunnel.  Even the ones done on the legs…  I think it is just a factor of how much we use overuse our hands in daily life on the computer, texting and writing.

So, with the NCV in hand, the surgeon cancels the shoulder surgery and slides a carpal tunnel surgery in place instead.  So now this patient is facing 4 surgeries in the next 6 months or so.

For those of you shaking your heads in disbelief, let me reaffirm your wonder.  No conservative care.  No rehab.  No splinting.  No injections.  Nothing.  Just straight to the knife.

For those who are not well versed in anatomy let me give you a little tidbit on what fingers the median nerve (the nerve affected by carpal tunnel) feeds.  Basically, it’s the thumb and next digit (technically, it’s the lateral 2.5 digits, but most patients can’t notice the ½ so they just note numbness over the thumb and adjacent 2 fingers).  It does NOT feed the palm—the superficial palmar branch of the median nerve branches off just before the carpal tunnel.

Now that you’ve brushed up on your anatomy, we can go back to my patient.  Remember when I said his entire hands were involved?  That is absolutely, positively not consistent with carpal tunnel syndrome and is usually more related to the shoulder (subscap trigger point referral or anterior scalene or pec minor impingements).  That’s not to say this gentleman did not have  carpal tunnel, but the picture was far more complex.

I explained all of this to the patient as well as giving my opinion that surgery was completely inappropriate without at least a trial of some type of conservative care.  We treated him that first day and left the decisions up to him.

Needless to say, he canceled his surgery, we saw him again on Wednesday and on Friday, before he was treated, he was shocked that the numbness in his hands was completely gone and was asking what we might be able to do for his shoulders.  There’s a chance I’m going to have one pissed off orthopedic surgeon on my hands.

This doesn’t mean that he was cured after 2 visits, but it certainly means we’re on the right track.  But all of this leads back to this particular article, looking at how much injections for carpal tunnel work or don’t work.

Three groups (37 patients each) of patients received 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo injections for carpal tunnel.  All of these patients had been given a splint to help treat his or her carpal tunnel and it was unsuccessful.  Here’s the results:

  1. At 10 weeks those who got the injections did better (36% @ 80 and 12% @ 40).
  2. One year later, there were no differences between the groups.
  3. The 1-year rates of surgery were 73%, 81%, and 92% in the 80, 40 and placebo groups.

Basically, 75% of the carpal tunnel syndrome patients in this study had surgery.  That pretty much means that injections for carpal tunnel suck at actually fixing the problem.

Lest the carpal tunnel sufferers out there begin to despair, let me throw in a few comments.

First, the is much evidence that both NSAIDs and steroids actually interfere with healing.  It may very well be that the injections themselves will prevent long term healing.

Second, the carpal tunnel is a tight tunnel, made of bone on one side and the steel-like flexor retinaculum on the other side.  Through this tunnels, 9 tendons and one tiny little soft nerve run.  When the tendons swell, the median nerve is smashed like a toddler stuck in an elevator with the entire defensive line of the Vikings.  So we put blinders on and try to control the swelling with drugs or injections, and when that fails we just go in there and make some snips, so the swelling can continue without creating a problem.

But what caused the swelling in the first place?  While it seems like the obvious question, it’s almost never asked.  In my experience, fascial / muscular problems in the forearm (both the front and back side) create a situation where the tendons are put under increased strain and begin to swell, creating the symptoms known as carpal tunnel.

ANY treatment of carpal tunnel has to address this aspect of the problem.  If not, treatment is doomed to fail from the start.  And this does NOT involve exercise; rather, it involves competent soft tissue work to the forearm and shoulder if needed.

In this study, all that the patients received was splinting, which does nothing to fix the problem but just allows the swelling to go away for a short period of time.  It was doomed to fail from the start.

Cervical Bulging Disc? 6 Reasons to See a Chiropractor

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Going to a chiropractor for run of the mill neck pain seems like a good idea, but what about something more severe like a cervical bulging disc?

An honest to goodness true cervical bulging disc creating pain in the arm are not really as common as many think.  I can’t tell you how many times I’ve seen a patient with leg or arm pain who thought, or had been told, that his or her symptoms were from a bulging disc get complete resolution of the arm or leg pain in maybe 2 or 3 visits.  These cases were obviously not disc bulges, but are often mistaken for a disc bulge by someone who does not know what to look for.

Oddly, our clinic recently had 4 cervical disc bulge patients come in a row.  Just odd how that works out.  And these were clear-cut, no need to waste money on an MRI, disc bulges in the neck.  Bakody’s sign and all (a situation where the patient finds the most relief by putting the affected hand on top of the head to find relief).  The fear in a patient’s eyes when you tell them they have a disc bulge is almost palpable, which is why I very quickly launch into the “these types of cases rarely need surgery” speech.

Somewhere along the way the dogmatic belief that disc bulges all require surgery got started and society never seemed to have gotten the message that this is rarely the case.  Certainly over the years I’ve had patients who, despite pulling out all the stops and doing everything we can, have still progressed to surgery.  But this usually not the case.  In our office we treat with soft tissue techniques to address the muscle, ligament, tendon and fascial problems, in office traction as well as home traction units or pillows and manipulation.

Manipulation???  Of a neck that has a disc bulge?

Yep.

Along with the dogma of the obligatory surgery mentioned above, “they” seemed to have created the dogma that chiropractors can’t treat disc bulges.  Good thing no one ever told me this little tidbit.

And, just in case you think I’m alone in this crazy belief that chiropractic manipulation can help a disc bulge in the neck, I present this particular article.  Researchers took 50 patients with a MRI confirmed cervical bulging disc and had them undergo cervical spinal manipulation for treatment.  Here’s the results:

  1. At 2 weeks, 55.3% were “improved.
  2. At one month the number rose to 68.9%.
  3. At 3 months a respectable 85.7% were improved.
  4. As early as one month, decreases in neck pain, arm pain, and Neck Disability Index (NDI) scores were seen.
  5. Of the patients who had initially been identified as subacute or chronic, 76.2% were improved at 3 months.
  6. On top of all of this, NO adverse events were reported.

Keep in mind this is just chiropractic spinal manipulation and not the full arsenal of tools that the typical chiropractor would bring into play.  These numbers are solid and, although the study was small, certainly adds to the concept that chiropractic care absolutely should be initiated early on for any patients with a cervical bulging disc.  But of course, I’m just a little biased…

Is the Chiropractic Subluxation Theory a Threat to Public Health? – (05-03-01)

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Is the Chiropractic Subluxation Theory a Threat to Public Health?

It still amazes me that articles like this show up in medical journals. We have pharmaceutical drugs responsible as the 4th to the 6th leading cause of death (depending upon whom you talk to..) and we still get articles like this. Go figure. Every day I hear stories from patients of things that have been done to them or given to them that stumps me. Just two days ago a patient’s 1 1/2 year old son was put in the hospital for rotativrus and given ANTIBIOTICS!! How about probiotics instead? Let’s destroy this poor child’s developing immune structure and possibly set him up for atopy and asthma; and yet DC’s are the threat? Makes me wonder how an article like this makes it through the peer review process for publication.

Scientific Review of Alt Med 5(1):45-53, 2001 Many chiropractors treat patients with spinal adjustments based on the theory that correction of vertebral subluxations will restore and maintain health. This paper explores the controversy surrounding the practice of chiropractic and discusses some of the dangers associated with inappropriate use of spinal manipulation. Treatment of infants and children by subluxation-based chiropractors who do not endorse such medically accepted procedures as immunization or use of antibiotics is especially a cause for alarm. Explaining the scientifically rejected chiropractic subluxation therapy and describing some of the questionable treatment methods based on this theory, a veteran chiropractic reformer concludes that if the chiropractic profession fails to abandon the false premise upon which it is based, it will remain controversial and some aspects of chiropractic treatment will continue to be a threat to public health.