LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

chiropractic

Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

by

Sciatica.  Knee osteoarthritis symptoms.  While these two conditions seem a world apart, there is something they have in common:  Bad advice.

Both of these conditions have solid research on things that you should and should not be doing to help you recover.  The “should” category involves exercise and moving around.  Almost always with musculoskeletal pain, moving around is better and staying sedentary is a very bad idea.  While my opinion is clearly biased on this one, the acceptable medication approach to most musculoskeletal complaints involves the use of NSAIDs like ibuprofen.  Strong pain medication like opioids (Vicodin, Percocet) should not be used, especially initially, and fall into the “should not” category.

In the “should not” category is also imaging.  While plain X-rays may be appropriate to evaluate for osteoarthritis symptoms, advanced imaging like MRI and CT scan should not be ordered unless certain red flags are present.

All of this is well supported by the medical research over the past 10 years or so.  But one of my continued frustrations with all branches of medicine is just how rare it is for doctors to actually crack open medical journals.  The research itself suggests that doctors are, in general, about 19 years behind the medical literature.  That means that this particular article, looking at just how well primary care doctors understand the current recommendations for sciatica and osteoarthritis symptoms, won’t grace the typical doctor’s eyes for two more decades.

Basically, they won’t know that they don’t know until around 2033.

Just in case you think I’m being a little too facetious, let’s look at what researchers found in the study:

  1. Despite the clear benefit, less than 1/3 of physicians would give exercise advice (30.2% for osteoarthritis, 32.8% for sciatica).
  2. Overall, though, at least newer docs were more likely to give advice on exercise (39.6% of newer physicians versus 26.0% of older docs for sciatica / 20.8% for osteoarthritis).
  3. Newer physicians were less likely to order tests like CBC or CMP (9.4% vs 21.9%) or a urinalysis (4.2% vs 16.7%).
  4. For osteoarthritis, X-rays were more often ordered by newer physicians (85.4% vs 69.8%).

Overall, these numbers reflect poorly on the typical primary care doctors’ ability to handle common musculoskeletal complaints.  For my entire chiropractic practice life I have been confronted with patients and people in the community that ask whether they should see his or her primary care doctor or a chiropractor first.  The evidence is very clear–seeing a chiropractic physician first is the best option that will be more likely to lead you down a path with the best and most efficient outcomes.

But clearly I’m biased.

Surgery for Lumbar Degenerative Disc? How About Doing it a 2nd Time?

by

The decision to undergo any type of spinal surgery is a difficult one for everyone.  But what if you had to consider not one, but a SECOND surgery as well?

Turns out, there is a large chance this may be the case.  (Spoiler alert: I’m a chiropractor whose main goal is to keep patients out of surgery)

First of all, the realities.  If I had a dollar for every time someone told me he or she had lumbar degenerative disc problems and was going to avoid surgery at all costs, I’d be doing this post from my own island in the Caribbean.

Most of those who informed me of this goal have that tone of inevitability to the voice.  Like there is no other option except to delay the surgery.  This could not be further from the truth.  I just had a conversation yesterday with a young doctor who informed me that he had L5-S1 disc degeneration and would love to be more active in the martial arts to try to stabilize his spine and avoid surgery, but every time he tried to train, it flared up his low back.

This doctor had not tried seeing a chiropractor competent in advanced soft tissue techniques that has a high likelihood of giving him almost complete relief.  So of course I gave him some resources to find a doctor who might be able to help.  There is no guarantee that this would help, but it would be foolhardy to even consider surgery without trying.

But what about all those other patients who incorrectly think there are no other options?  The ones who stress about whether or not to have surgery on his or her low back?  This decision alone is challenging.

But what if the risks of having to have a second surgery were high enough so that this same contemplative patient really needs to be deciding if he or she can undergo TWO surgeries, not just one?

You know I wouldn’t be asking this question if it didn’t have anything to do with this particular study.

In it, researchers looked at the risk of having a second surgery when the first one was done for stable (without a spondylolistethesis) lumbar disc degeneration over the next five years.  Here’s what they found:

  1. The resurgery rate was 4.7% at 3 months,
  2. 7.2% at 1 year,
  3. 9.4% at 2 years,
  4. 11.2% at 3 years,
  5. 12.5% at 4 years,
  6. 14.2% at 5 years.
  7. Based on this trajectory, they calculated a reoperation rate of 22.9% at 10 years.
  8. Reoperation rate was not different between decompression and fusion surgeries.

Wow.  Over a 1 in 5 chance you’re going to have to go under the knife a second time, with all the additional costs, downtime and rehab.  Worse—outcomes after a second surgery are worse than after the first surgery.

Not a rosy picture.  But heck—don’t see a chiropractor—we’re all quacks and dangerous to boot.

 

Cervical Bulging Disc? 6 Reasons to See a Chiropractor

by

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…

Wyeth suppresses research on pill, programme claims – (03-26-01)

by

Wyeth suppresses research on pill, programme claims

The third generation conctraceptive pill has been proclaimed as the “safest yet,” and yet evidence seems to be mounting that, on the contrary, the risk of thromboembolism is higher than ever before with this new pill. It appears that the manufacturers had evidence that this generation pill was producing higher risks for DVT, but the evidence was suppressed and never made it into the major medical journals. But be careful, chiropractic is dangerous and unscientific and herbal medicines will kill you.

bmj.com van Heteren 322 (7286): 571

Read entire article here

The Answer to Obamacare Contained in 4 Simple Facts

by

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.

 

Knee pain and osteoarthritis in older adults: a review – (01-15-01)

by

Knee pain and osteoarthritis in older adults: a review

This article summarizes the high level of elderly persons afflicted with knee pain that affects their daily life. I will use this as an intro into the anecdotal success of chiropractic in many cases of knee pain. Because many cases of knee pain are actually not knee problems, but rather problems with the pedal foundation (feet) or hips, chiropractic can be very effective in relieving and preventing knee pain. There have been several patients who never would have developed knee pain if someone had noticed how flat-footed the patient was and recommended foot orthotics 10 years prior…

Ann Rheum Dis — Abstracts: Peat et al. 60 (2): 91

Read entire article here

Conflict of Interest in the Debate over Calcium-Channel Antagonists – (01-15-01)

by

Conflict of Interest in the Debate over Calcium-Channel Antagonists

This review wonderful illustrates the problem with research today. “Money talks” is all too true, and the pharmaceuticals hold lots of it. The chiropractic profession has frequently been looked upon as unscientific by the medical community. The same holds true for natural therapeutics. Well, people in glass houses….

Special Article — NEJM 1998; 338: 101-106

Read entire article here

Arthroscopic Sx for Knee OA No More Effective Than Sham Sx – (03-18-01)

by

Arthroscopic Sx for Knee OA No More Effective Than Sham Sx

Think the surgeons are going to like this one? With more and more studies coming out on the effectiveness (or lack of) of surgery we are starting to see that one of the most important factors for surgery is only doing surgery on patients that meet strict criteria for that specific surgical procedure. The rates certain types of surgery in the US fare exceed that of other countries. This particular article actually did surprise me a little. The old “roto-rooter” for the knee may not be an effective approach. Of course, I am somewhat biased in this regard, and know that knee pain can respond very well and rapidly with chiropractic therapy…

(article) In a study of 180 patients with osteoarthritis of the knee, Houston surgeons found that those who received “sham” arthroscopic surgery reported as much pain relief and improved mobility as patients who actually underwent the procedure. In fact, the group that did not receive surgery reported better short-term functioning compared with the other patients, Dr. Bruce Moseley, Jr. reported here at the annual meeting of the American Academy of Orthopedic Surgeons. It has been unclear why arthroscopic surgery for knee osteoarthritis helps some people with the condition. Dr. Moseley and his colleagues at Baylor College of Medicine, in Houston, decided to test whether arthroscopic surgery might be associated with a placebo effect. After 2 weeks, patients assigned to sham surgery were doing better than the true surgery patients–probably, Dr. Moseley said, because they had been spared the trauma of surgery. After 2 years, the groups had made similar gains in walking and stair climbing, and their pain had eased to comparable degrees. Because all patients received pain-killing drugs and none underwent physical therapy after their actual or sham surgery, Moseley credited the placebo effect for helping the sham-surgery group. “I was surprised,” he said, noting that when colleagues first proposed the possibility to him, he discounted it. While this research is not the final word on arthroscopic surgery for knee arthritis, Dr. Moseley said it does suggest it may be time for surgeons to take a closer look at it. “We, as surgeons,” he said, “may need to put our time into finding better and more effective treatments.”