SO MY DOCTOR WHIPS OUT THIS NEEDLE…It is far too frequent that patients tell me that they have had steroid injections for this pain or that. Elbow, shoulder and knees seem to be the most common sites. Its frequent use suggests that the doctor giving the injection thinks that there are little safety concerns (other than localized injection issues) and it’s always worth a try. However, this really indicates that they may know little about soft tissue healing and the nature of chronic pain. Cortisone is an anti-inflammatory, and yet, if you looked at the tissues involved in, let’s say tennis elbow, under the microscope you would see very little inflammation. So what the heck is the point of the steroid? Further complicating this is that steroids interfere with normal healing mechanisms. This review supports this, finding that steroids help in the short term, but actually make conditions worse in the long run. Bottom line…skip the injection and find a chiropractor that uses Graston (like me!).
Neck Pain
Neck Pain Chiropractor Mesa AZ
Chronic Neck Pain and Car Crashes –
I DON’T WANT TO MILK THE SYSTEM AFTER SOMEONE REAR-ENDED ME… A not uncommon response after getting into an accident that is not your fault is to think that getting care is just “milking” the system. Because of this, some people will actually forgo care for their injuries, be they major or minor. Never a good idea. It may require only a simple visit or two or a more lengthy course of care, but leaving an injury go without treatment is never a good idea. It is becoming clearer through current research that the time to begin treatment of an injury is NOW. This especially applies to soft tissue techniques like Graston. Anything past immediate may be less than ideal (I’m not saying I’d come out to the crash site if you called our office, but…). This goes for car accidents or any other type of injury. Sooner is better. Of particular note in this study is that, whether participants in this study had neck pain or not, they suffered a loss of quality of life! This is serious and yet another reason to seek the care of a chiropractor sooner rather than later. I think I know a good one… Read More…
Knee Pain Chiropractor Mesa AZ
Don’t Wait, Pain Gains
SHOULD I WAIT TO SEE IF MY PAIN GETS BETTER FIRST? It is very common for someone who has injured themselves, be it their back, shoulder, neck, knee or spleen (ok…maybe not really the spleen), to wait and see if the pain goes away. Sometimes is does, but sometimes this is the beginning of what will ultimately develop into chronic pain. I can tell you that, from my chiropractic perspective, that the sooner someone comes in to see me after pain begins, the sooner they recover. If someone comes in within a week or so, many times we can knock out the problems in just one visit (for established patients that understand the way we treat soft tissues). This particular study finds that, at least for low back pain, not getting relief within the first 3 months and being afraid to move too much for fear of worsening the injury were risk factors for chronicity. I can tell you that these are factors we address heavily with every patient. Many patients are still told to restrict activities for a period of time until they get better. This is usually very bad advice. Read More…
Chronic Neck Pain After a Car Crash
SHOULD I SEE A CHIROPRACTOR IN MESA AFTER MY CAR ACCIDENT?
Of course, my biased answer is going to be a solid yes. Most patients that come through my office as the result of a motor vehicle accident will be discharged from care when I have done everything possible to ensure that they will not be in another chiropractor’s office in 10 yrs complaining about neck pain “ever since that accident 10 yrs ago.” The bottom line is that the number of patients still experiencing symptoms years later is far too high. My advice to anyone who has been in an accident is to seek the care of a chiropractor who is going to address the soft tissues as well as the joints in your treatment plan.
Should I see a Mesa AZ Chiropractor After My Car Accident?
Of course, my biased answer is going to be a solid yes.
Most patients that come through my office as the result of a motor vehicle accident will be discharged from care when I have done everything possible to ensure that they will not be in another chiropractor’s office in Mesa in 10 yrs complaining about neck pain “ever since that accident 10 yrs ago.”
The bottom line is that the number of patients still experiencing symptoms years later is far too high. My advice to anyone who has been in an accident is to seek the care of a chiropractor in Mesa who is going to address the soft tissues as well as the joints in your treatment plan.
Should All Patients with a Migraine See a Chiropractor in Mesa?
Ok..given my bias everyone probably knows my answer here when it comes to chiropractic in Mesa.
It never ceases to amaze me when a patient has had headaches for years or even decades that have never been to a chiropractor. Given the evidence, it really should be considered malpractice (lack of informed consent) for a neurologist to NOT refer to a doctor of chiropractic for an evaluation of any headache patient.
And yet the referral to a chiropractor who specializes in soft tissue treatment of the neck almost never happens. It is the migraine sufferer that loses out.
Just how common is neck pain in migraine headache sufferers? This particular article looks at this question in 113 migraineurs, who had headache frequencies ranging from episodic to chronic migraine. These headaches sufferers were examined by headache medicine specialists to confirm the diagnosis of migraine and rule out both cervicogenic headache and fibromyalgia.
For each attack over the next few months, sufferers recorded the whether nausea was present as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe). Here’s what they found:
- There were 2411 headache days, 786 of which were migraines.
- The majority of migraines were in the moderate pain stage.
- Regardless of the intensity of headache pain, neck pain was a more frequently present than was nausea.
- Those diagnosed with chronic daily headache were more likely to have neck pain.
So what does this mean? From a standard migraine approach, this means that, although the presence of nausea is a characteristic of a migraine headache, neck pain (which is not a characteristic) is actually more common.
From my standpoint of almost 20 years of treating migraine patients, we have totally, absolutely missed the ball. Since most headache specialist do not touch the patient and wouldn’t even know how to treat problems in the neck is he or she found them, these patients are mis-diagnosed.
I can’t tell you how many times I’ve had patients come in with a diagnosis of “migraine” only to have the headaches go away with soft tissue treatment of the neck structures combined with manipulation. These were NOT migraines. Migraines generally do not respond as well to manual therapies, but most often need a lifestyle overhaul to manage the headaches.
The bottom line? Neck pain is strongly associated with headaches. If you have headaches, it is absolutely essential for you to find a chiropractor competent in soft tissue treatment to see if this will help.
Having Orthopedic Surgery? You NEED to Know this Scary Risk
Everyone knows that there are risks associated with any surgery. But the risks that you know about are the obvious ones.
Problems with the anesthesia such as aspiration pneumonitis or respiratory failure. Problems with the surgery itself such as excessive blood loss, damaging the spinal cord or spinal nerves, infection or blood clots.
But what if there was something more insidious that can occur? Something that won’t kill you today or tomorrow, but waits in the shadows until years later?
Before I tell you what this scary thing is, I do need to point out that there is a time and a place for orthopedic surgery. But this should only be considered as an absolute last option. All too often we THINK something is a last option.
But time and time again research proves that this is just not true. Some examples:
- More people are having knee replacements, but NOT because of more arthritis
- Most people with a torn knee meniscus will not need surgery
- Arthritis of the spine is not directly related to pain and should NOT be a reason for surgery
- After one year, sciatic patients who have no surgery fare no better than those who do
- Chronic low back pain patients who had fusion fare no better than those who don’t
This list is much longer, but you get the idea. There are an uncountable number of orthopedic surgeries done every year that were unnecessary. Which would be fine if there weren’t dangerous risks associated with orthopedic surgery and the chance that you will be no better after the surgery, or worse, in more pain after the surgery.
Side note–these comments do not apply to trauma-induced orthopedic surgeries–in these cases there are usually no options for avoiding an emergency surgery after trauma.
All of this brings me to this particular study. In it, researchers looked at a scary side effect of orthopedic surgery called myocardial necrosis. As you may be able to tell from the name, this is a condition were the heart muscle dies as a result of the stress on the heart from the surgery. This bad effect from surgery is well known and characterized for short term mortality after orthopedic surgery.
What is not as well-known is what happens in the long term. To get a better idea of how often this happens, researchers looked at levels of troponin (a protein found in the heart; elevated troponin levels are a sign that damage to the heart has occurred) immediately after orthopedic surgery and whether this related to long term death in hip, knee, and spine surgery 3 years later. Here’s the details:
- There were 3,050 surgeries with an average age of 60.8 years.
- Myocardial necrosis occurred in 179 cases (5.9%) and heart attacks in 20 (0.7%).
- In those patient who experienced myocardial necrosis, 16.8% of them did not survive in the long term (3 years).
- In those who had normal troponin levels around the time of surgery only 5.8% did not survive.
- To put it clearer, those orthopedic surgery patients who had higher levels of troponin were 233% more likely to die in the long term evaluation, while those who had a heart attack after the surgerys were 351% more likely to die.
Now certainly, if you had a heart attack just after your orthopedic surgery you’d know about it. But myocardial necrosis may not have been fully explained to you if it had been identified. Either way, if you DO end up having orthopedic surgery, it may makes sense to push your surgeon to run troponin levels along with everything else to get an idea about whether or not you’re going to be around in the next 3 years.
Seems simple enough.
Chronic Neck and Low Back Pain – Amazing Procedure Helps in ONE Day
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.