LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Neck Pain

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…

The Answer to Obamacare Contained in 4 Simple Facts

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Just in case you thought I was going to get political, get your disappointment over with now.  Or at least, not Republican versus Democrat political.

This blog is not long enough, nor do I have the time to point out all that is wrong with the current concept of the Affordable Care Act.  But I can help illuminate one glaring problem.  “Health care” in this country just costs too damn much.  The waste, fraud and abuse is at epic proportions and nothing short of the downfall of medicine as we know it will change this.  There’s just too much money invested in the machine for anyone with any shred of reality left to believe otherwise.

However, amidst the financial carnage lies an answer to at least some of the woes we can identify.  This particular set of “woes” is wrapped up in what those in the insurance industry like to call “non-surgical spinal care.”  At one of the largest (if not THE largest) health insurance companies in the US, orthopedics is the number one cost driver.  Of the orthopedic expenses, the single largest line-item cost is non-surgical spinal care, sitting at about 45% of overall orthopedic costs.  This number is so large, not because of the massive costs of treating a case of back pain, but rather because of the sheer volume of cases of non-surgical spinal complaints.

So what if you could shave a small percentage, maybe 30%, off the top of this large chunk of orthopedic costs?  The direct cost savings are in the billions of dollars.  DIRECT only.

Given my bias, by now you should know that I’m talking about chiropractic care for the management of non-surgical spinal complaints.  The data encompassing millions of episodes of musculoskeletal complaints (yes–millions) leaves chiropractors at the top of the hill as far as the most cost-effective provider to manage this type of case.  This occurs mainly because the average DC can truly manage the care.  Only a small percentage of cases presenting to a chiropractors office FIRST will need to leave that office for his or her episode.  Contrast this with PCPs, PTs, ERs and orthopedic doctors.  Very few of these providers can manage these cases within his or her office alone (BTW–writing a prescription would be considered to have another provider, in this case the pharmacy, involved, driving up costs).

Sadly, only 28% of these cases start with a chiropractor.  Worse, if a chiropractor is not part of the initial treatment, less than 7% of the time will that patient end up in a chiropractic office.

The bottom line is that chiropractic care is the only treatment path that follows the best evidence of spinal care, meaning:

  1. Imaging should NOT be used at the initial stages of treatment (orthopedic doctors order imaging at a very high rate).
  2. Opioids are not recommended as the first line medication (PCPs will frequently lead with Percocet or Vicodin).
  3. Injections should never be used in the initial stages of a back pain episode.
  4. Manipulation is added in almost every case seen in a chiropractor’s office.

Here’s a bonus.  Remember when I said that chiropractic care led to a DIRECT 30% savings?  This does not include the indirect cost savings which can include:

  • Additional cost savings when comparing chiropractic care treatment in surgical spinal care episodes
  • Practically unfathomable savings due to less drugs and less side effects from these drugs (I’ve written an entire eBook on the side effects of NSAIDs)

So here’s the real problem.  Despite the evidence, chiropractic care remains the truly hidden gem of healthcare.  Even looking at this particular study that suggests that mainstream medicine is getting WORSE at managing back pain, me and my colleagues are still limited to being heroes in our own little offices, rather than across the healthcare spectrum.  But there is an answer over the horizon…

The employers.  Yes, it may very well be that the members of your HR department could help change the face of health care.  Imagine that.  Going forward, the group that truly wants to save money on health care is the employers.  They truly have the most to lose with treatments that run completely opposite of what the medical literature suggests is the best care pathway.

I guess only time will tell how it is going to play out.

 

18 US Women Per Day Die From Common Drug: 3 Scary Stats

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For those of you into math, that’s about 550 deaths per month, or more than a Boeing 747 could hold.  Imagine the heat on the FAA if one was dropping out of the sky monthly.  Would you fly?

For those of you following the Rantings, you can begin to guess that it is prescription opioids I’m talking about.  Not just OxyContin and morphine, but also Percocet and Vicodin.  They are handed out like candy in urgent care and the ER and concern has been raised to the equivalent of a Homeland Security threat level RED.  Earlier this year, the FDA reached out to providers asking them to increase their training in the prescribing of this dangerous class of drugs.

If the FDA has to politely ask providers to better understand the use of these drugs (this IS, after all, the regulatory agency tasked with protecting the public), one has to assume that the education required to prescribe these drugs may be lacking.

Scary.  And profoundly upsetting because I am, after all, a chiropractor.  I can’t count how many times over the years that a patient came in for a problem that was resolved in a visit or two, and yet had been given opioids after an urgent care or ER visit.  Completely avoidable had the patient been steered towards chiropractic treatment.  We remain a profession at the red-headed-stepchild level and yet hold the answers to many of the ills in medicine today.

With that intro, we need to move on to this particular article, which highlights just how dangerous this class of drugs has become.  Researchers looked at opioid deaths from 1999 to 2010 in women.  Here’s what they found:

  1. Nearly 48,000 women died of prescription painkiller overdoses  between 1999 and 2010.
  2. Deaths from prescription painkiller overdoses increased over 400%, compared to 265% in men.
  3. For every woman who dies of a prescription painkiller overdose, 30 go to the ER for misuse or abuse.

Despite these numbers, I still have patients coming into my office every week who have been given prescriptions for this class of drugs.  Much like the decades long delay that occurred to get pediatricians to stop giving antibiotics for ear infections, these statistics seem to be falling on deaf ears.

The next time a provider wants to given you a prescription of Percocet or Vicodin for some type of new-onset musculoskeletal disorder (neck pain, shoulder pain, low back pain…) but does NOT recommend seeing a chiropractor, maybe it’s time to find a new provider that keeps your best interests in mind.

 

Manual Therapy, Physical Therapy, or GP Care for Neck Pain – (05-23-02)

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Manual Therapy, Physical Therapy, or GP Care for Neck Pain

Of course I like to see results like this in the medical literature, but do not confuse manual therapy with manipulation. Manipulation is a procedure that takes a joint into the paraphysiologic space (NOT past the anatomical barrier) to stimulate mechanoreceptors in the joint capsule. Mobilization (as in this article) does not achieve this. Any results found with mobilization will generally be greater with manipulation. Also, keep in mind that in many states it is illegal for PTs to perform manipulation–it is a procedure reserved for physician use only.

Annals of Internal Medicine: Abstract

Read entire article here

Back, neck, and shoulder pain in Finnish adolescents – (10-10-02)

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Back, neck, and shoulder pain in Finnish adolescents

From a business standpoint, this ain’t such bad news. Unfortunately, there is currently no shortage of adults with musculoskeletal pain and we don’t need to add children to this already-too-long list. Children experiencing pain at this age does not bode well for future musculoskeletal health. If these kids do not get proper care now(i.e. chiropractic….), future episodes will generally increase in severity. It is possible that this increase is from a combination of factors, including decreased physical activities, heavier backpacks in school (I know this is a problem in the US, not sure if the same problem exists in Finland) and a more pro-inflammatory diet with more animal products and less fresh fruits and veggies.

bmj.com Abstracts: Hakala et al. 325 (7367): 743 –

Read entire article here

Spinal manipulative therapy is an independent risk factor for vertebral artery dissection – (05-29-03)

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Spinal manipulative therapy is an independent risk factor for vertebral artery dissection

Had to comment on this one. With the risks that some researchers have stated, patients would be dropping dead left and right in my office alone. Other, more favorable researchers doing very large studies (this one had 171) have estimated that 1 chiro in 40 will experience a cerebral-vascular incident in THEIR LIFETIME OF PRACTICE. When we talk deaths, there are literally less than 100 on record over the past 50 years or so. Compare this to NSAIDs, a common therapy for neck pain. Conservatively, 16,000 deaths PER YEAR. And a quick search on PubMed did not produce ANY articles showing benefit of NSAIDs in neck pain. And yet these researchers have started a cascade of controversy that states that risks of spinal manipulation outweighs benefits. Talk about double standards!!

Neurology — Abstracts: Smith et al. 60 (9): 1424

Read entire article here

Pinched Nerve in Neck? What To Do for a Herniated Disc in Neck

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You didn’t spar with Tyson. No high speed car accident. No parachuting incident. Rather, you woke up with neck pain. It’s got to be a pinched nerve in your neck.

This is another one of those posts I’m going to be very biased about.  But only because I’ve been practicing chiropractic for the past 15 years (has it been that long??) and have seen countless cases with my own eyes.

Basically, there are two paths to go down when it comes to neck pain.  Chiropractic and not-chiropractic.  Sound pretty simple?  It is.

But first, we need to clarify something.  Just because your neck hurts, and hurts bad, does NOT mean that you have a pinched nerve in your neck.  Quite frankly, this entire description is somewhat outdated, as we know that it is not common for a disc bulge in the neck or low back to actually contact the exiting nerve root directly.  It seems like everyone thinks that, just because they have pain in their neck, that it has to be due to a pinched nerve somewhere.

Let me ask you this–ever had a muscle cramp up in the middle of the night?  Hurts like H-E-double hockey sticks, doesn’t it?  No pinched nerve involved there, just pain receptors firing from the muscle contracting too tightly.  Why can’t we relate this same phenomena to neck pain?

There are many, many pain generators in the spine.  Muscles, ligaments, tendons, the outer edge of the disc, the facet joints, the joint capsule, the enthesis (where the tendon inserts into the bone) and probably ten other tissues I’m forgetting right now.  When you have neck pain or low back pain, it could be stemming from any one of these tissues and likely more than one.  Whenever patients look at me and demand an exact explanation as to what is causing their pain I usually suggest autopsy.

Because of this, it is very difficult to tell what the exact cause of your pain is .  If a provider looks you in the eye and tells you it’s the disc or the facet joint or the muscles, they’re lying to you and themselves.

So if we don’t know the exact cause of your pain, how can surgery be guaranteed to work?  It can’t.  It is usually a crap shoot, with no way to tell whether you will benefit or be harmed by the procedure.

Clearly, the chiropractic route for a pinched nerve in the neck does not suffer from this need for specificity in tissue treatment.  I know that treatment in our office is designed to address as many of the potential pain generators as possible.  More of a figurative shotgun approach.

The research clearly shows that seeing a chiropractor first for your neck pain starts you down a distinct path that only rarely leads to expensive imaging, spinal injections and surgery.  Contrast that to all other types of providers including primary care doctors, orthopedic surgeons and pain management doctors.  And, believe it or not, seeing a physical therapist first for your pain is going to be one of the most expensive options because they rarely are able to handle to case on their own and almost always refer out to another provider (thus increasing the costs).

All of this leads to this particular study.  One would think that, given the stones thrown at chiropractic care over the decades about being voodoo and pseudoscience, mainstream medicine has all of their ducks in a row when it comes to something as vitally invasive as cervical spine surgery.

Not quite.

Researchers looked at all the available studies comparing cervical spinal surgery to conservative care up until June 2011.  How many did they find that really met the criteria of a good study without a strong bias?  Given that the device manufacturers have made billions of dollars on spinal surgery, this number should be in the hundreds at least, right?

Nine measly studies that compared surgery to conservative care.  Nine.  Only a single study had a low risk of bias (Tweet this).

Knowing this, are you willing to put your neck on the line (literally!) to have surgery?

TOOLS REVIEW FOR CERVICAL SPONDYLOTIC SURGERY – (05-02-02)

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Review of Surgery in Cervical Spondylotic Radiculomyelopathy

Of course, as a chiropractor, this one hits close to home and brings to mind the accusations that chiropractic is not effective. Personally, I feel that chiropractic (and natural medicine) is held to a higher standard. Ironically, these approaches are well up to the task, while traditional medical therapies typically are not. There have been numerous reviews on the effectiveness of manipulation for both neck and low back pain showing varying levels of effectiveness, and here we see a review article that finds evidence lacking for one of orthopedic surgeons main tools for neck pain.

Lippincott Williams & Wilkins – Spine –

Read entire article here