LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Low Back Pain

CHRONIC LOW BACK PAIN TREATMENT WITHOUT SURGERY – (06-27-05)

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RCT to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain

As a chiropractor this one obviously hits close to home.  When patients ask me about surgery, I usually respond that some patients with chronic low back pain may do better with fusion.  Many more may stay the same and another chunk get worse.  The problem is we have no idea who will fall into which category.

Quite a risk considering that the patients that do worse after surgery are really, really in bad shape.  So, to find that spinal fusion is no better than an intensive rehab program (which, given that there were no DCs involved in the trial would suggest that chiropractic care was NOT part of the program) really should be the death of spinal fusion.  Don’t hold your breath on that one, though…instead, breath deep and visit your local DC..

Read entire article here

HOW DO YOU MANAGE ACUTE LOW BACK PAIN? – (02-13-06)

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Physicians’ Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines

This is one of those articles that, as a chiropractor, really gets to me. We are frequently called quacks and non-evidence based. Unfortunately, it appears that no one has the ability to throw any stones.

However, given that many studies have now shown that chiropractic care is a more cost effective approach, we can begin to see why. I know I have patients come into my office with a simple case of LBP that’s pretty clear cut, and yet they have X-rays and MRI in tow when they come in. Talk about expensive care!!!

Read entire article here

Warning–That Episode of Low Back Pain Will Likely Be Back

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As a chiropractor, this issues hits near and dear to my heart.  When someone develops an episode of low back pain for the first time in their lives, one of three things happens.  The patient ignores it hoping it will go away.  Or, they see a non-chiropractor (PCP, ortho, PT, massage therapist, etc..) for that episode.  Or, they choose to see a chiropractor.
Which one you choose may well determine what happens for the rest of your life.

The prevailing wisdom states that most cases of acute low back pain will resolve spontaneously within 4-6 weeks.  And that’s it.  No more worries.

However, what do many people do in this situation?  The typical response may include rest, maybe some ice and some type of over the counter analgesic.  If it’s not better in a few days or weeks, a trip to urgent care, the ER or the primary care physician may result with a high likelihood of these getting a morphine derivative prescription inappropriately (such as Percocet, hydocodone or Vicodin).

Let me relay a personal experience that happened recently.  My 10 year old pug got pushed down an entire flight of stairs by my 55 pound muscled pit bull mix.  I watched in horror as he literally rolled end over end and crashed on the landed.  He could barely move.  I immediately picked him up and settled him down, but he was having much difficulty with walking on both back legs and his right front leg.  Not good.  Xrays were imminent if this did not resolve quickly.

No ice.  No OTC pain meds.  I did adjust him that night.  He also refused to sit still and continued to follow me through the house as he normally did.

Within 3 days you’d have no idea anything had happened to him.

How would most of us have handled a tumble down a full flight of stairs?  Quite differently, I’m sure.  But how much of our “typical” behaviors following an episode of low back pain actually promote chonicity?  This particular study sheds some light on how untrue our assumptions about what happens to those who suffer their first episode of low back pain are.

In this study of 605 patients who sought care for an episode of acute low back pain:

  1. 8% declared sick leave
  2. 13% experienced chronic pain at 6 months
  3. 19% experienced chronic pain at 2 years
  4. At 6 months, 54% had experienced at least 1 LBP recurrence
  5. Another 47% had experienced at least one flare up in the next 18 months

These are not good numbers.  This is my personal opinion based on my own experience, but I feel that these numbers are so high because there was no actual treatment designed to address the problem.  Anti-inflammatories do not address the problem (after all–did you have inflammation and THEN an injury?) and are very, very likely to make it worse because they interfere with the normal healing process.

Rest is extremely bad for acute episodes because it allows any injury to the fascia to thicken and perpetuate the dysfunction.  Although the pain goes away, the changes to the fascia are sitting there, just waiting for the next “wrong” movement.

The answer?  Get into your chiropractor ASAP.  This is not my opinion as the evidence suggests that this produces better outcomes.  Get treatment that includes soft tissue methods combined with adjusting to address all aspects of your condition and get back to activity as quickly as possible.  Make sure you’re in the OTHER 50%…

HOW TO STOP LEG PAIN FOR GOOD

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As we get older, leg pain with walking becomes all too common.  The medical term is claudication.  The knee jerk (so to speak) reaction in medicine is to evaluate the vascular system and to see if blocked arteries are causing the problem.  However, there are two main causes of claudication.

The first is the one we have already mentioned.  Vascular claudication occurs when the patient is living a pro-atherogenic / prediabetic lifestyle.  Over time, plaque builds on the arteries going into the legs and the muscles of the legs do not have the oxygen and nutrients they need to function when the demand for oxygen increases with activity.  Exercise therapy and surgery to put a stent in the artery are two options.  Unfortunately, the outcomes from surgery, quite frankly, suck.

In this particular case, prevention is clearly the best option.

The other type of claudication is called neurogenic claudication.  This is caused when arthritis in the spine begins to shrink the opening for the nerves to come out of, a condition called spinal stenosis.  It is a slow process that creeps up over the years.

The leg pain that comes on with neurogenic claudication has some differing characteristics from the vascular type.  Pain in the legs is less predictable–sometimes it comes on after a minute, sometimes 10, sometimes 8.  The pain with vascular claudication is much more consistent with the time to onset.  Also, in neurogenic claudication, sitting down for just a minute or two can alleviate the pain quickly, while there is a recovery time in vascular claudication.

This particular study brings to light the fact that many patients with vascular claudication may also have neurogenic claudication as well (up to 76’%).  If the physicians looking for vascular claudication are NOT also looking for the spinal component of the leg pain, outcomes may not be as good.  The obvious problem here is the vascular specialist looking at the blood vessels is not all that likely to understand the need for a referral to a chiropractor (preferred) or neurosurgeon.   The patient gets stuck with incomplete treatment.

For neurogenic claudication related to spinal stenosis, a specific chiropractic treatment called Flexion Distraction can work wonders.  This requires a specialized table that applies a gentle traction to the low back, allowing some breathing room to the choked off nerves coming out of the lumbar spine.  In conjunction with chiropractic care, the use of an inversion table at home can add additional benefits to your treatment plan.

The bottom line is, anyone with pain in their legs during activity should who is pursuing help from a vascular specialist should also seek an evaluation from a chiropractor who is familiar with Flexion Distraction to evaluate and treat any neurogenic claudication that might be present as well.

RISKS AND BENEFITS OF SPINAL MANIPULATION – (04-30-07)

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A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain

Well, can’t tell you how upsetting this news is to me. Patient who were given exercises to do but did NOT receive adjustments were 8 X more likely to experience a worsening of their disability. Can I share probably one of the best kept secrets in healthcare?

Chiropractic care is more effective and more cost effective for many musculoskeletal conditions. Period. Add into that some aggressive soft tissue work and you’ve got a group of physicians that can rule the world.

Read entire article here

 

RECIPE TO CREATE A DRUG USER

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The Federal Bureau of Narcotics was formed over 80 years ago in 1930.  In 1954, President Eisenhower formed a council to battle narcotics use here in the United States.  In 1971 President Nixon coined the term “war on drugs.”  This was further strengthened by President Reagan in 1982.  Overall, untold billions of federal dollars have been spent on this effort.  Man did we get it all wrong.

We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT!  Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.

Codeine, OxyContin, Percocet, Vicodin, morphine,  Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.

It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out.  In the ER it is almost a given.  High likelihood in urgent care.  Still far too common in a primary care settings.

And then there are the non-steroidal anti-inflammatory drugs (NSAIDs).  Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?

I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is.  Arthritis /  joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.

The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year.  That’s with a “b.”  Even uncommon side effects become magnified by this volume of use.  Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.

So what does all of this have to do with this particular article?  This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year.  The results were surprising:

  1. Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
  2. Opioids were prescribed to 7.7% at 1 year from surgery
  3. Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
  4. Overall, an opioid prescriptions within 7 days of surgery made it  44% more likely to be a long term user
  5.  NSAIDs were prescribed to 0.3% within 7 days of discharge
  6. NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
  7. Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users

Wow.  Talked about generating a society that is addicted to drugs.  And while this study looks at low risk surgery, how similar would the numbers be for neck pain?  Low back pain?  Knee pain or headache?  Makes me happy to be a chiropractor.

Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?

READY FOR BACK SURGERY #2..?

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My opinion on this matter, as a chiropractor, is clearly biased.  It has been rare that a patient under our care has progressed to spinal surgery.  Clearly it happens, but far more often we get patients who have had spinal surgery prior to coming into our office and likely could have avoided surgery.

The problem with spinal surgery is that it really is a crap shoot.  Some do better.  Some notice little change.  Some do worse.  And the ones who are worse after the surgery are much, much more difficult patients to manage.  Problem:  No one knows who is going to fall into what category.  Sure–the surgeon may tell you they expect a good outcome, but these statistics frequently seem to be bloated.

This particular study gives a little bit more background on the outcomes after a lumbar decompression surgery for a disc herniation.  Researchers looked at patients who underwent lumbar decompressive surgery at non-federal hospitals in the state of Washington from 1997-2007 that had to go through a second surgery.

The first surprising aspect is just how many patients had to have a second surgery within 4 years.  The numbers ranged as high as 24% re-operation rates at some hospitals.  Given that it probably wasn’t very fun the first time around, we can all guess the second time is not a party, either.

Now, to be fair, it is not uncommon for a patient to present to our office and be successfully treated for a lumbar disc herniation.  Some of them (never figured out the percentage) even return for care within the next 4 years.  But let’s compare both the costs and the impact of surgery on a patient’s life versus 2 episodes of chiropractic care.  Funny how some insurance companies view chiropractic care as a “cost” at all, rather than the hundreds of millions of dollars we save the system.

PULLED A MUSCLE? WHY POPPING THAT ALEIVE IS A VERY BAD IDEA

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Obviously, this article is going to sound a little self serving since I am, after all, a chiropractor in Mesa with a vested interest in my patients not taking drugs of any kind unless absolutely necessary. My more inquisitive patients all seem to ask a similar question…if the body is so brilliantly designed, where do chronic musculoskeletal complaints come from?

Certainly there are injuries that are severe and result in tissue damage that is much greater in degree and have a high likelihood of producing chronic pain. Think skiing, skateboarding or snowboarding injury. High speed car crashes. Motorcycle accidents. Equestrian wipeouts. Surgery.

But what about the weekend warrior who pulls a hamstring? The 8 hour per day computer user? Or me, as a lifelong martial artist, who has had untold injuries over the decades to pretty much every potential area of my body? Why do these situations lead to chronic pain?

My personal thought (backed by lots of research and years of clinical practice) is that the development of chronicity has much to do with how we handle the immediate period after the injury or onset of symptoms. What do the vast majority of us do (which is, of course, the direction indicated by billions of dollars of advertising) in this immediate period? Rest the area and pop an over the counter pain medication or anti-inflammatory. This is arguably the worst possible combination possible.

Why?

First, let’s address the immobilization aspect. Literally within minutes of immobilization, the soft tissues surrounding the immobilized joint begin to break down. The longer that joint is kept from a full range of motion, the worse the tissue damage. Anyone who’s ever broken a bone and had it casted can attest to how much joint motion is lost once the cast comes off. Recovery time can be even longer than the immobilization time.

With tissue injury, ultimately, the size of the region affected is larger than the original injury size. Consider the swelling associated with an ankle sprain—the area of the ligament injury may actually be very small, but the entire ankle, foot and lower leg swells up to the size of a balloon and becomes discolored. Now the amount of injured tissue is much larger than the original injury and this tissue has to heal. But healing occurs in a haphazard fashion if the area is not used. I give the analogy of a leak in your bathroom faucet. You call in the plumber. He shows up with a crew that’s been drinking at the bar for half the day. They proceed to rip out half the bathroom to fix the leak and rebuild with a level of skill only a three-sheets-to-the-wind Irishman can achieve.

Our body is no different. As we heal after an injury, the new tissue, whether it is bone, muscle, ligaments, fascia or tendons, is laid down in a disorganized manner. Only as that region goes through movement do these healing tissues become stressed and become organized along the lines of force. Immobilization becomes the enemy of proper healing.

Next, let’s address the routine use of over the counter anti-inflammatories, or prescription, for that matter. All anti-inflammatory medications are, by their very nature, designed to interfere with the inflammatory process. Unfortunately, inflammation is the normal process of healing. Disrupt this and you disrupt the ability of our tissues to heal the way they were designed. Contrast this with the use of ice right after an injury. Ice works simply by reducing blood flow to the newly injured area, thus keeping the damage of the drunken plumbing crew from getting too out of hand. Arguably a good idea. But then blocking the crew from repairing the area in specific ways, like maybe taking all their crescent wrenches away from them, is going to result in improper repair.

Hopefully you can begin to understand why the combination of immobilization and anti-inflammatory medications immediately after an injury may be the first step in developing chronic pain. Repeat this cycle the next time you injure the area and the dysfunction begins to mount.

This particular study demonstrates just how bad the outcome can be when non-steroidal anti-inflammatories (NSAIDs) are used after a rotator cuff surgery tendon repair. Researchers looked at the tendon to bone healing that occurred in the presence of NSAIDs and found that every case was affected, from complete failure of healing to weakened tissue. No normal healing tissue was present when compared to the group in which no NSAIDs were used.

While this relates to surgical cases in animals, the same process is interfered with in every case of tissue injury that happens in our body when NSAIDs are used. While my opinion that you should run to your chiropractor at the first hint of any type of pain may sound self-serving, the reality is that you may be diverting the development of chronic pain.