LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Low Back Pain

Chronic Neck and Low Back Pain – Amazing Procedure Helps in ONE Day

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manipulation under anesthesia
Ded Pixto/Dollar Photo Club

As a practicing chiropractor, I see patients who have had chronic problems improve just about every day.  Despite how successful we are at treatment, there are still patients that we can’t help.

At least not in the office.  And not while the patient’s conscious.

There is a little-known procedure called manipulation under anesthesia (MUA) that involves a team of physicians in a surgical center working in a unique matter to help patients who have lost all hope at responding to any other treatment.  Some of these are surgical candidates who want to avoid the pain, rehab and uncertainty of invasive surgery.  Some of these are not surgical candidates because they don’t have a specific “lesion” to go in and fix surgically.

And, quite frankly, the results from surgery in clinical trials for back and neck pain are not exactly stellar.  The research study results from pain management procedures like epidural injections is even worse.  This from someone who reads a LOT of medical literature.

One anesthesiologist that I worked with called MUA “yoga in a can.”  Which pretty much sums it up.  So much of the problems that I see in my office are linked to poor movement.  Movement at the individual spinal level (let’s say L5-S1 as an example) or movement of the spine as a whole (the entire lumbar spine, for example).  While it is not common, it is rare for me to see someone with good flexibility who is very active to have low back and neck pain.

This is one of the reasons why yoga is so bad for a chiropractic practice.  Because it gets the spine moving.

I’ve been doing MUAs for almost a decade now and have seen some amazing results.  What I have never seen is a negative outcome.  I’m not saying that I haven’t seen patients not respond, but I can honestly say I’ve never had a patient get worse after an MUA.  Try asking a surgeon if he or she has ever had a bad outcome.

Even better, people who have observed or assisted with the procedure (there are any number of videos available on Youtube.com) all state that it looks like it would feel REALLY good after.  Ever heard anyone observing spinal surgery say the same thing??

Some conditions respond better than others.  For neck pain and headaches, the procedure is darn near a miracle (check out one of my patient’s testimonials by clicking here).  Shoulder problems, especially frozen shoulder, respond so well that insurance actually recognizes this as a condition they will pay for.  Low back pain generally relates to how “tight” the patient is in the first place.  Highly flexible patients may not respond as well to manipulation under anesthesia from my experience, but patients who have very little flexibility will do very well.

The problem with MUA is that there is just not enough money to fund good quality clinical studies.  For spine surgery, if a device manufacturer is charging $1,000 for a single screw, they’ve got the money to throw around on a study or two.  That leaves research on MUA in the realm of case studies.

Which brings us to this particular article.  In it, researchers looked at 30 patients with chronic neck and back pain who had failed to respond to conservative therapy underwent a SINGLE MUA by a single chiropractor.  Here’s the details:

  • A mere 2 weeks after the MUA procedure, 52% of the patients reported improvement.
  • At four weeks, this number was 45.5%.

While I would prefer to see this number at 100% response, we all know this isn’t realistic.  But having almost 50% of the patients who were likely at their wit’s end from pain and loss of quality of life respond from a SINGLE session of MUA is nothing to disregard.

At this point I would like to add that many of the MUA protocols recommend 3 sessions of MUA.  It is likely that, while still not 100%, the number of patients who responded to MUA would go up.  In addition, because of my personal background with soft tissue treatments like Graston, I utilize these procedures during the MUA with the hopes that outcomes will be even better.

Make no mistake about it-manipulation under anesthesia IS a surgical procedure, although it is non-invasive.  There are costs involved and risks of anesthesia.  But when balanced against constant pain, loss of quality of life and the risk of surgery, it seems a simple decision.

 

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?

 

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.

 

Have You Had Your CT Scan Today? 5 Tips You Need to Know

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Statistically, the answer is probably yes because we are handing these out like candy.  Fill up at Quik Trip and you can have your windshield repaired and a CT scan ordered.

I recently had a patient with a headache that was not responding as expected.  Her PCP ordered a CT scan.  Not an MRI.  When I told her she needed to get him to order a MRI instead, his office noted that they do not order MRIs.  What????  For her situation, there was absolutely no reason for a CT scan over the MRI.  As a matter of fact, the only reason to order a CT over the MRI is when we need rapid information, such as an intracranial hemorrhage after head trauma.  Or maybe if some type of bone growth is suspected.  Also, you can’t do an MRI when any type of metal is in the body such as a pacemaker or spinal fusion.

Other than these limited situations, MRI preferable to CT scans.  Despite this, CT scans are now coming in cereal boxes and kid’s meals in the drive thru.  In an ER setting the argument is usually that CT scanning is much quicker (read = you can make more money off of it), which is why ERs only use CT scanners.  And some will say that the initial cost of purchasing the scanners is much cheaper for the CT scan over the MRI.  This may be a good argument for a hospital, but NOT for a physician ordering from an imaging center with access to both.

So why all the frustration on my part?

Because the radiation associated with CT scans has been estimated to contribute to some TWENTY NINE THOUSAND cancers per year in the US alone.

That makes this discussion incredibly relevant to your long-term health, since it’s highly likely you’ve had a CT scan done before.  The article noted above was published over 5 years ago, so this has been plenty of time for physicians to change their addiction to ordering CT scans.  Heck, you could practically hear the screeching of the brakes immediately after this study was published.

Turns out that the screeching sound was actually the tires squealing as the number of orders for CT scans took off at full speed.  Yup, according to this review article, there were just over one million CT scans order in England in 1996-97.  By 2012-13 this number had jumped to a whopping five million.  Even worse, for 2013-14, there was a 13% increase with no sign of “plateauing.”

How are these numbers even possible???

I know that I often complain that it seems like most physicians don’t keep up with medical literature, but geez-o-Pete.  We’re talking 5 years since the concerns started to rise that one of the CT scan side effects included a large increase in cancer risk.   Despite this, we still have physicians ordering these scans.  Even worse, they are ordering them for situations where an MRI would be an even better choice or (even worse, in my opinion) they are ordering them for situations where they should not be ordered.  This happens an awful lot for conditions like headaches, shoulder pain and back pain.

So what should you do?

  1. Avoid the ER if at all possible.  Try urgent care or find a good chiropractor.  If you do go, make sure they feel the CT scan is absolutely, positively needed and the benefits of obtaining the scan outweigh the increase in cancer risk from ionizing radiation.
  2. If your doctor is ordering a CT, have a discussion with him or her about ordering a MRI instead.  There is no radiation with a MRI.
  3. Just like in the ER, if your doctor is ordering a CT scan, make darn sure the imaging itself is actually needed.  All too often a CT scan is done as a shot in the dark.  Imaging should be done to help confirm a diagnosis, NOT to fish around for ideas.
  4. If you have an ultrasound done, it many cases it is NOT necessary to order a CT scan on top of this just to confirm what the ultrasound found.  It’s ridiculous.
  5. If a CT scan is absolutely determined to be the best option (if you have a pacemaker, for instance). then check with your doctor and the radiologist about ways to lower the radiation exposure for the test (such as imaging ONLY the area of concern).

For a full review of the Committee of Medical Aspects of Radiation’s 16th report you can click here to read more about it.

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.
[Read more…] about Lower Back Pain Relief with Stretching – Timing is Everything

Do You Limit Activities Because of Low Back Pain?

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One of the concerns from new patients in for chiropractic care centers around movements and activities that could make the condition worse.

Quite frankly, it’s rare that the typical low back pain patient will be made worse in the long run by activities that they may do, provided that the activity wouldn’t produce low back pain in a patient who does not have low back pain. In other words, lifting and twisting while carrying a 100 pound object is not a good idea whether you have low back pain or never have in your life.

A large chunk of patients who come in with a new episode of low back pain don’t recall doing anything to bring about the episode. Sometimes the aggravating event is not as obvious (new shoes, side sleeping without a pillow between the knees, new chair, etc…) and sometimes, the patient is in my office, not because of what they did, but because of what they are NOT doing. As in moving around.

It is very common for the mere act of being a couch potato to create low back pain. So, when the new patient comes into my office and is concerned that movement may make his or her back pain worse, I reassure them that movement is a good thing. Sacroiliac conditions, for example, do way better when the patient is moving around and keeping the joint “lubricated.”

A frustrating aspect of practice for me is how often chronic low back pain patients, or those who have a tendency to “throw out” their backs, have been told to “take it easy” and limit activity by an orthopedic doctor, family practice doctor, physical therapist or even my own colleagues.

Fear of movement. It’s never a good thing.

This particular study drives this point home. Researchers looked across 17 clinical studies to see how much of an effect fear avoidance behaviors (as measured by the Fear Avoidance Beliefs Questionnaire (FABQ) or the Tampa Scale of Kinesiophobia (TSK)) had on whether or not treatment was effective. Here’s what they found:

• In patients who had up to 6 months’ duration of low back pain, high fear avoidance beliefs were associated with more pain and / or disability and a lower likelihood of returning to work.
• However, if patients were able to show a decrease in fear avoidance beliefs during treatment there was less pain and disability.
• Interventions that addressed fear avoidance beliefs led to better outcomes.
• The results were not as strong in chronic patients.

I had recently been asked to participate in a chronic pain panel for the Arizona Corporation Commission. This involved looking at case studies of chronic pain patients to see how guidelines could be effectively applied for treatment. However, I had such a hard time being non-biased looking at these studies because so many of the cases of chronic pain are actually failed cases of acute pain.

And in Arizona, very few patients ever make it into chiropractic offices in the early stages, when manipulation can be the most powerful. Most end up medicated and / or put into physical therapy. Considering that the cost of going into physical therapy treatment for non-surgical spinal conditions first here in Arizona is almost TRIPLE the cost of chiropractic care, it may be that fear avoidance behaviors are addressed intuitively by chiropractors, lowering the chance of a condition becoming chronic.

Of course, this also means that, should you come across a chiropractor who uses fear (i.e. subluxation kills and without adjusting your nervous system can’t flow) to sell you on more care, it may be time to work on your short burst activity and run the other way.

Physical Therapy or Manipulation for Chronic Low Back Pain?

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The answer to chronic low back pain is NOT nothing. Choices for care include chiropractic manipulation or physical therapy.

I know that it seems intuitive that rehab exercises for chronic low back pain would be a good idea. However, I can’t say that I’ve ever been completely on board with this idea. While not every case of chronic low back pain does well in our office, we do pretty darn well with the vast majority of cases that come through. From years of experience, I firmly believe that advanced soft tissue techniques in competent physicians’ hands combined with manipulation is one of the strongest tools for management of chronic low back pain.

Despite this, there is a belief that patients with chronic low back pain should go to physical therapy to get rehab exercises for his or her low back pain and many primary care physicians still continue to refer patients out for physical therapy.

Always happy to find out that my practice philosophy is not shared by my office alone, I present this particular article, looking at the outcomes of 12 weeks of treatment in 199 patients with chronic low back pain (defined as more than 6 weeks’ duration) using exercise versus manipulation.

Specifically, exercised consisted of high-dose, supervised low-tech trunk exercise. As a way of measuring outcomes, researchers looked at four motion parameters in the sagittal plane and two in the horizontal plane as well as the jerk index parameter.

The group that received manipulation changed in all of the parameters measured. In addition, the manipulation group had a smoother motion pattern (reduced jerk index) at the end of the study. The exercise group, however, only improved in half of the parameters measured and there were no improvements in the jerk index.

Based on this study, a patient with chronic low back pain would be much better off seeing a provider who can do spinal manipulation. Adding the aforementioned soft tissue techniques to manipulation gives you an even greater chance of finding relief where nothing else has helped.