LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Low Back Pain

THE BASIS FOR RECOMMENDING REPEATING EPIDURAL STEROID INJECTIONS – (09-01-08)

by

The Basis for Recommending Repeating Epidural Steroid Injections for Radicular Low Back Pain

It is not unusual for the “typical” low back pain patient to be referred out by their PCP for epidurals when the 1 wk trial of ibuprofen didn’t work or when physical therapy has failed. There are a large number of ESIs done in this country in patients that have never been sent to a chiropractor for treatment.

There is even evidence that suggests that patients referred for an epidural have a higher likelihood of progressing to back surgery (which is again, of questionable benefit with much risk). But what the heck…it’s only $12K or so….who cares if it works? Now that $300 course of chiropractic care–THAT we need to keep an eye on.

Read entire article here

ANOTHER TOOL FOR CHRONIC LOW BACK PAIN RELIEF

by

As a chiropractor, I obviously see my fair share of chronic low back pain patients.  If they have been managed through mainstream medicine, there’s a very good chance they’re on some, if not multiple, medications.  Currently, narcotic pain meds like Vicodin, Percocet and Oxycodone are given out like candy, despite their lack of efficacy in clinical trials.  So what good options are present to help manage the pain of chronic low back pain?  Luckily, there are options.

The first option (if you would really call it an option…) is to find a good chiropractor to be on your team.  Numerous studies have shown that, when a chiropractor is the first point of entry for any musculoskeletal complaints, the costs are much lower, while drug, surgery and imaging use is cut drastically.  A chiropractor can not only help with chronic pain in the office, but can guide you to other approaches that might help with your condition.  These may include an inversion table for low back pain or a cervical traction device for neck pain.

I have always been much more of a fan of moist heat rather than ice.  In reality, for most spinal conditions, ice and heat are going to have direct effects only about 1-2 cm beneath the surface.  The tissues that create pain such as the muscles, joints and discs of the low back are much deeper than this.  Thus, ice and heat are going to have their effects at a much deeper, indirect level.  Here ice and heat have similiar effects.

Heat wraps probably had their origins for menstrual-related pain and cramps, and then gradually expanded their use from there.  These packs (made by Thermacare, Sunbeam, etc…) use the exothermic reaction between oxygen in the air and iron in the wrap to generate hours of heat.

This particular article looks at the use of a heat wrap in chronic low back pain sufferers.   Researchers evaluated the effects of 2 hours of use of this type of heat wrap on chronic low back pain sufferrers and found a decrease in muscle activity as well as an improvement in self-report of disability, pain-related anxiety, catastrophizing, and self-efficacy.

That’s pretty powerful stuff for such a simple and safe intervention.  Now imagine what would happen when this is coupled with chiropractic care…

POOR BLOOD FLOW IN THE BRAIN LINKED TO CHIROPRACTIC CONDITION

by

Can we all agree that more blood flow to the brain is a good thing?  I’m sure anyone experiencing a blood choke in ju-jitsu would agree-it’s NOT the best feeling in the world.

Increased blood flow to the brain means more nutrients, more oxygen and more removal of waste products.  These are all ideal situations and lead to increased brain health.  The converse is equally as bad.

We already know of several things that increase blood flow to the brain, such as exercise and whole body vibration.  In addition to increasing blod flow, increasing the availability of nutrients that improve the production of ATP in the mitochondria such as choline, CoQ10, Vitamin E (as mixed tocopherols–NOT straight alpha tocoperol) and alpha-lipoic acid will also result in very positive improvements in brain function and will likely lead to reductions in the risk of Alzheimer’s, Parkinson’s, dementia, hearing loss, migraines and seizures.

So what’s missing from this list?

Based on this particular study, chiropractic treatment.

Researchers looked at the effect of chronic neck and upper back pain on the blood flow in the brain (cerebral perfusion).  They found that these patients with pain had less blood flow into their brains when compared to those who did not have chronic pain.  In the worst case, those with the most severe pain had 45% less blood flow to the parietal and frontal regions of the brain.  The parietal region functions heavily in evaluation the spatial relationships within our bodies and environment, while the frontal lobe is involved in higher mental functions like personality and decision making.

Given how important these regions of the brain are, I’m thinking that 45% sounds like way too much of a loss.  Now this does not mean that you run up to your favorite dolt and poke them in the upper trapezius muscle and ask if it hurts, but certainly entertains the additional value of chiropractic care to address pain in these regions.

If the combination of soft tissue treatment, at home stretches / yoga and chiropractic adjusting can help to increase movement in this region and reduce pain, it would make sense that blood flow to the brain would improve.  This would make chiropractic care an integral component of the treatment of the above mentioned conditions like seizures, migraines and dementia.  But that’s my biased opinion…

LOW BACK PAIN AND BEST PRACTICE CARE

by

PRIMARY CARE OFF THE LIST TO SEE FOR LOW BACK PAIN.  It doesn’t happen often, but I still have patients who ask if they should see their PCP before they see me.  Or who have seen their PCP before me.  Far too frequent the care and recommendations they receive are not in tune with the medical research.  Jumping on prescription pain meds and anti-inflammatories, no recommendation to stay active, jumping on X-rays or worse, MRIs, way too soon.  Epidurals before any conservative care is attempted.

This particular study confirms what I see in my office–PCPs are not aware of how to treat low back pain.  Heck–almost 20% in this study were given OPIOIDS for acute low back pain!!  The bottom line?  Much evidence points to the fact that chiropractors are the best, most effective and most cost-effective point of entry for any musculoskeletal problem.

WHAT ELSE CAN I DO TO HELP WITH MY SHOULDER PAIN?

by

WHAT ELSE CAN I DO TO HELP WITH MY SHOULDER PAIN?  It’s still the prevailing opinion that chiropractic care is for patients with low back pain.  However, there is much research suggesting that manipulation is effective for a variety of other conditions.

This particular study found that the addition of manipulation to a standard course of care for shoulder pain was more effective.  In my office, the addition of unique soft tissue approaches like NMR and Graston to more completely effect the soft tissues (fascia, muscles, ligaments, tendons) means that shoulder pain will be a thing of the past for most patients.  And we rarely need to use anything beyond some simple elastic tubing home exercises for recovery.

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

by

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

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

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

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

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

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

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

LIVING IN FEAR OF FLARING UP LOW BACK PAIN?

by

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

Read entire article here

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

by

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

They wait and think it will get better.

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

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

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