LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Shoulder Pain

Neck Pain Chiropractor Mesa AZ

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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

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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…

Having Orthopedic Surgery? You NEED to Know this Scary Risk

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orthopredic surgery and troponin
lenetsnikolai / Dollar Photo Club

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:

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.

 

Steroids and Your Tendons: Shocking Research

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Dangers of steroid injections
Photo courtesy of http://www.freeimages.com/profile/zeathiel

Most are aware that steroids are not good for us.  Steroids are bad for bones.  Bad for diabetes.  Bad for tendons.  But just HOW bad?

The standard recommendation for steroid injections into a tendon, such as the shoulder, elbow or Achilles tendon is no more than 3.  Anything past that and you increase the risk of a tendon rupture.  Basically, it is well accepted that steroids weaken tendons.  Which, considering that the idea of any type of therapy is to improve the situation, this seems odd to me.  Giving a therapy to provide temporary relief that will only increase the risk of future damage just doesn’t make sense to me.

I can honestly say that there have been very, very few situations in my years of practice that I have felt a steroid injection was a necessity.  And don’t think you’re safe if you have a local injection directly into an area such as the shoulder.  Research has shown that the injection site doesn’t matter; an injection into the buttocks is just as effective as a direct shot into the supraspinatous tendon.  This means that the steroid is spreading throughout your body, effecting every single tissue in your body.

The same holds true for oral steroids taken for any reason; respiratory, pain, inflammation.

But it’s just once, right?  Can’t really hurt anything, can it, so long as I keep the injections to the recommended 3 doses…?

Nope.  The results of this particular study should be a massive eye-opener to everyone.  In this study, researchers looked at the cellular effect of the steroid dexamethasone on hamstring tendons.  They found that steroids trigger a process called cell senescence.  Senescence means to “grow old” and basically indicates that an organism is coming to the end of its lifespan.  Cellular senescence has a similar meaning, indicating that a cell has ceased to function fully, has stopped dividing and is basically nearing the end of its life.

Interestingly, dosage would not likely make a difference.  Steroids work by acting on a receptor at the surface of a cell and there are only a certain amount of receptors available.  For this reason, a low steroid dose can be powerful enough to fill up all the receptors.  A high dose is not necessary.

Some would argue that this was a “test-tube” (in vitro) study, it is not likely to happen when oral steroids are used to treat something like shoulder pain.  The researchers took this into account and looked at actual tissue biopsied from shoulder surgery and found the same cell signals that trigger this cell senescence.  In other words, it’s real.

Worse, it’s irreversible.  As in permanent.

I have stated time and time again that I am certain that the way we are treating musculoskeletal injuries and pain in medicine today is completely setting us up for problems in the future.  Anti-inflammatories and steroids have consistently shown in the research that they damage the very tissues we are trying to protect.

Personally, despite many injuries over the past 20 years (ripped off extensor tendon of left 4th digit, left radial head dislocation, shoulder pain, neck pains, low back pain, episodes of knee pain) I have never even considered anything other than natural approaches.  Most often, this involves advanced soft tissue techniques like Graston combined with chiropractic adjusting.  And it has served me well over all this time.  And maybe this approach is why I don’t deal with any chronic problems despite many severe acute injuries.

While this may seem entirely self-serving, do not let any ache or pain go and definitely do not try to “suppress” it with any type of anti-inflammatory, steroidal or not.  Avoid the couch after most injuries–maintaining movement to the best of your ability is almost always your best option and ensures that scar tissue is less likely to form.

 

Had a Rotator Cuff MRI? 4 Things to Know Before Surgery

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There are times when I wish MRI and CT scans were never invented.  I can’t tell you how many times I’ve had to explain to patients that what was found on the MRI that his or her PCP ordered has absolutely nothing to do with the pain currently experienced.

Low back, knees and shoulder seem to be the worst.  I certainly have ranted in the past about the massive overuse of technology and medical imaging in medicine today.  As strange as it may be, the pathway is very clear:  Having a MRI makes that person more likely to undergo  epidurals and surgery.  Having an epidural leads to surgery as well.  So, unless you’re willing to go under the knife, don’t even consider an MRI.  The ONLY time to order advanced imaging is when your provider thinks that there is a high likelihood that the information obtain will make an important change in your treatment plan.

Imaging is not used just to confirm what a physician has already determined.  It’s really not that hard to determine if someone has a disc problem or if someone with advanced arthritis is dealing with spinal stenosis.  If signs point to a disc problem, why on Earth would you waste the time and resources to order an MRI at that point?  Just treat the condition as if it’s a disc (which, in our office, would involve flexion / distraction technique).

Now, if you don’t respond within expected timeframes (30 days is a safe bet) or if your condition worsens while getting treatment, then imaging becomes more important to see if some underlying factor is affecting your response to treatment.  Our office is pretty conservative when it comes to ordering advanced imaging.  I’d say that I personally order an MRI less than a handful of times per year.  However, it seems like at least this same number of times each month we’re requesting the results of an MRI or CT scan that was ordered by another provider and probably shouldn’t have been.

This is when I have to battle against the perception that a MRI or CT scan is exact and answers all questions.  Far too often, a MRI comes back with some type of disc bulge, and yet the patient has absolutely no signs that a disc is involved in his or her condition.  Only rarely does an MRI ordered by another provider come back with valuable information that changes the treatment we’re doing in the office.

All this would be fine if MRIs and CTs didn’t come with significant problems beyond the cost.  CT scans, despite still being handed out like candy (had a patient in yesterday whose son was given a head CT recently in the ER when an MRI would have been a better choice to look at the brain) have a tremendous amount of radiation exposure associated with them and have been linked to some 14,500 cancer deaths per YEAR.  MRIs, as mentioned, begin the dangerous pathway towards more invasive treatment measures and surgery.

All of this brings us back to this particular study.  Researchers looked at a group of postmenopausal women with NO shoulder pain and compared them with premenopausal women with no shoulder pain to see what there rotator cuffs looked like in an MRI.  Here’s what they found:

  1. 8.9% had full-thickness tears (mainly localized in the supraspinatus tendon of the dominant side) in the postmenopausal group.
  2. Non-painful, full thickness tears in the premenopausal group was 3.1%.
  3. Women with tears were more likely to have higher BMI, higher fasting glucose and lower HDL cholesterol.
  4. Overall, higher BMI and lower levels of HDL cholesterol increased the risk of having a tear.

Wow!  Quite a few take home messages.  First, we need to see that a decent size chunk of females, both pre and postmenopausal, have complete thickness rotator cuff tears that are painless.  I can’t tell you how important that little factoid is.  Just because you see a tear on a MRI does NOT mean that this is the problem.

Second, lifestyle choices (as evidenced by cholesterol and BMI relationships) played a large role in the tendon damage.  This isn’t really hard to envision since tissue healing and inflammation are going to be effected by the choices we make.

So, just because you have shoulder pain does NOT mean that you need to have an MRI (and X-rays are just short of worthless for shoulders anyway…) unless you have failed a course of conservative care, which, in my clearly biased opinion, would involve a chiropractor who does advanced soft tissue techniques…

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.

 

Frozen Shoulder Symptoms-Is Surgery Your Best Option?

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Manipulation under anesthesia, or MUA, is a procedure where a patient is stretched and adjusted under general anesthesia.  It is a well accepted treatment for conditions such as frozen shoulder.

I have personally been doing MUA for almost a decade, so I can speak from experience.  Basically, a patient is put under general anesthesia and turned into a yoga master by a team of two experienced physicians.  Orthopedic doctors usually limit themselves to frozen shoulder and post-knee-arthroplasty adhesions.  Chiropractors do MUA for frozen shoulder and post-TKA adhesions as well, but also for chronic low back pain, hip pain, neck pain and headaches.

While insurance unfortunately does not typically pay for MUA for headaches, I can tell you, again from personal experience, that this procedure works exceedingly well for chronic headaches related to neck pain and tightness.  You can view one of our patient’s testimonials on MUA for chronic neck pain and headache by clicking here.

Our clinic is always looking for ways to make any treatment more effective, so this particular article was of particular interest.

Researchers compared arthroscopic surgery for frozen shoulder symptoms to an MUA combined with a local steroid injection given at the same time as the procedure.

Not surprisingly, the outcomes for the MUA for frozen shoulder were superior to those of the surgical procedure.  Further, when you compare how the MUA patient feels the next day compared to the arthroscopic surgery patient, it is night and day.

I remember one patient who had such restricted range of motion of his right shoulder that he couldn’t even put his hand on his chest for the Pledge of Allegiance.  It had been that way for some 25 years (he just “thought it would get better..”).  After 3 back to back days of MUA, he was in my office 2 days later ecstatic that he could almost completely lift his arm up to his head.  He noted he was a little sore, but that was the extent of his post-MUA symptoms.

For any of you who have had arthroscopic surgery on your shoulder, it probably wasn’t quite the same experience…

Sadly, few patients with shoulder pain that does not respond well to conservative therapy (and most of them will) will ever even know that Manipulation Under Anesthesia is even an option for them.

Ultimately, the authors of this study suggest that MUA for frozen shoulder symptoms should be the FIRST procedure done.  If the MUA is not effective, the surgical procedure can still be done, which has happened with only a single patient in the MUAs that I have done for shoulder pain.

If you had surgery on your shoulder, was Manipulation Under Anesthesia ever given to you as an option instead of surgery?

 

Therapeutic Exercise and Orthopedic Manual Therapy for Impingement Syndrome – (06-09-03)

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Therapeutic Exercise and Orthopedic Manual Therapy for Impingement Syndrome

Since I treat a lot of shoulders in my practice this one strikes home. Sometimes common sense ain’t so common in medicine. Almost every shoulder patient I have seen in my office at some point had been given exercises to do. So long as they did them religiously, the problem stayed at bay. As soon as the exercises stopped the symptoms returned. It seems quite obvious to me that this is not fixing the problem–it is just compensating for it. Soft tissue techniques aimed at reducing scar tissue and restoring normal biomechanics is essential. I remember one patient with a complete tear of the supraspinatous tendon. With careful attention to the biceps tendon, this patient has full pain-free use of his shoulder despite the full tear.

Read entire article here