LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

chiropractic

Rates of Spontaneous Reporting of Adverse Drug Reactions in France – (10-03-02)

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Rates of Spontaneous Reporting of Adverse Drug Reactions in France

Lets follow the path here. The FDA can be paid to push a drug through before it has been properly studied. Within 7 years, about 20% of these drugs are then given black box warnings or removed from the market AFTER their release. And these warnings rely on input from the clinicians in the field using the drugs. Sound a little hairy so far? Well, it only gets better…this study finds that, despite greater than 100,000 (in France alone) adverse drug responses, less than 5% were actually reported. And chiropractic’s detractors try to say chiropractic is dangerous?????

Read entire article here

Lumbar Spine Fusion: Are You a Good Match?

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There is a time and place for surgery.  I think few would argue this point.  But I have seen patients have imaging, injections and surgery for cases that never should’ve been considered a surgical case.

Of course, whether or not they are a surgical case is merely my personal opinion.  Since I’m NOT a surgeon, and I’m JUST a chiropractor, I could not even begin to know which cases of low back pain are or are not surgical cases.  Given something as invasive, dangerous and permanent as spinal surgery, surgeons are the ones that can do the tests to definitively know whether or not a patient’s low back pain is surgical or not.

Spinal fusion involves slicing into the tissues surrounding the spinal column and then using either a special cement or titanium hardware to lock two (or more) spinal segments together so that they no longer move.  The costs are staggering and the recovery, from the patient’s standpoint, is a major deal.

Again, good thing the surgeons can tell when someone needs surgery or not by doing the correct tests.

Ok.  So you know where this is going.  This particular study looked at just how accurate commonly used tests were at determining whether or not someone was going to have a good outcome from a spinal fusion for low back pain.  Specifically, researchers looked across 10 studies to see whether these tests were actually useful:

  • Findings on MRI
  • Provocative discography (an irritant is injected into the disc; if it hurts, that must be the problem)
  • Facet joint blocks (the spinal joints are injected with an anesthetic; if it helps, that must be the problem)
  • Orthosis immobilization (using a brace to immobilize the lumbar spine; if it helps, the area needs to be fused)
  • Temporary external fixation (a temporary metallic brace is screwed into parts of your vertebrae)

So what did the authors say after looking at all these tools to determine is lumbar spinal fusion was going to have a good outcome?

No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.

In other words, it’s a crap shoot.

The bottom line is that, if surgery has been recommended to fuse your lumbar spine and the surgeon looks you in the eye and says he or she is confident this is the right thing to do, it’s time to find another one.  Before you go on to surgery, have you REALLY tried everything?  Has chiropractic been used?  Soft tissue treatments like Graston, ART or Fascial Manipulation?  Yoga?  Massage?  Rehab?

If you can’t answer yes to ALL of the above, it’s not time for surgery.  Surgery should be the absolute last possible option that you should consider because no one can predict the outcome for your situation.

 

Hip Pain Causes–It May Not Be What (or Where) You Think

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Nothing slows you down like pain in hips. But sometimes hip pain causes may not be coming from the hip and it takes an experienced physician to tease out answers.

First, though, this is one of those blog posts that I need to make full disclosure up front.  I’m going to be biased.  There.  Now we can move on…

As a practicing chiropractor, patients come into our office with all types of complaints.  Only rarely do they present with textbook-like cases that are as clear cut as putting together an IKEA desk (ok…so maybe a little easier than following that little guy scratching his head…).

The point is, the value in chiropractic treatment is that we understand the pain that our patients experience.  We understand that just because it hurts HERE does not mean that HERE is where the problem is.  This knowledge comes from years of study in school (chiropractors get FAR more education on the musculoskeletal system than any other physician out there) and is honed with years of clinical practice.

This is why the patient who has been getting epidurals for a year to treat her “sciatic” pain was better in 2 visits with a heel lift and some work on the hip in our office.

This is why the patient who was told they have a disc problem (because it was found on an MRI that shouldn’t have been ordered in the first place) really just had joint dysfunction in his back that was better in 2 chiropractic treatments.

It is why a long term patient who’s MRI of the shoulder led her to 2 surgical recommendations, but I explained that what she really needed was a quick steroid injection to control the inflammation caused by a vaccination.

This is why chiropactors shine at treating musculoskeletal pain.  And sometimes, our diagnosis is not really ironed out on the first visit.  I usually tell patients that, if they REALLY want to know what is causing his or her pain, I recommend autopsy.

It is common for a patient to present to our office with low back, hip and leg pain.  Believe it or not, far too commonly a diagnosis can’t be made with clear cut certainty.  An MRI can be a very bad idea here (and what do we order?  A lumbar MRI?  A hip MRI?  Xrays?).  The answer?  Diagnosis made by clinical response to treatment.

I think it’s a hip, so I treat the hip for a visit or two.  Disc problem?  We start a protocol of Flexion Distraction.  Sacroiliac joint dysfunction?  Soft tissue work, stretching and chiropractic manipulation.  If the patient gets better, I was right.  If the patient doesn’t get better, time to move to the next likely diagnosis.

That’s why they call it “practice.”

But what about that 5 minute consultation with the orthopedic or neurosurgeon (after waiting in the waiting room for 2 hours past your appointment time)?  If it takes me, a seasoned chiropractor who thinks he’s pretty good, several visits to pin down more exactly what is going on with a patient, how can it possibly be done in 5 minutes?

It can’t.  And maybe this is why surgical outcomes are so unpredictable.  I can’t tell you how many times I’ve had a patient undergo some type of surgery for something that clearly was not causing the pain.

So why all this rambling?

Of course it has to do with this particular study looking at arthritis in the upper lumbar spine and hip pain.  Researchers looked at the presence of self reported hip pain and the presence of arthritis in the upper lumbar spine in over 2800 patients aged 55+.  Here’s what they found:

  1. Those with disc space narrowing at L1/L2 (the top part of the lumbar spine) had double the likelihood of hip pain in the last month for men.
  2. For women, the increased risk was 70%.
  3. For reported chronic hip pain in men, the likelihood of having disc space narrowing at L1/L2 jump to 2.5 times more likely.
  4. Disk space narrowing at the lower levels (L3/L4/L5/S1) was not associated with hip pain.

What does this mean?

It means that if you have hip pain, you need to see a provider who understands the way the body works (hint, hint, wink, wink).  If not, you may get that hip replaced when it wasn’t the problem.

But heck–hip replacement surgery these days is a cake walk, right…?

 

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?

Chronic Lower Back Pain and Manipulation: Does It Really Work?

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Chronic lower back pain is a serious problem today, both in terms of cost of treatment and lost productivity. Plus, it just plain sucks if you’re the patient.

Let’s just get this out of the way right up front: My opinion on this article is going to be biased.  Not just because of the articles I read, but based on almost 15 years in practice.

Just today I had a new, 22 year old patient come into my office that has been having significant low back pain for over a year.  Prior to her flare up at that time, she had already been dealing with aching in her low back for years prior.  And yet, despite this, she had never been to a chiropractor.  Luckily, she did not wait until she was 35 and had 15 years of chronicity behind her.  Even after the first visit she noticed improvement and it is likely that, within a few visits, she’ll be back to 100%.

So why is this story so common?  I contend that chiropractic remains the red-headed stepchild of healthcare.  Quite frankly, when it comes to cost-effectveness and patient satisfaction, chiropractic care for both acute and chronic lower back pain rocks.  Just in case you don’t want to take my word for it, you can download my ebook on the research backing up natural approaches to chronic lower back pain here.

Let’s just play devil’s advocate for a second and say that there is no research to support chiropractors as the go-to physician for a back pain specialist.  And I do believe that this is much of the perception for the limited referrals to chiropractors from mainstream medicine.  Why should we, as chiropractors, be held to a higher standard?

By a higher standard, I mean that we don’t have billions of dollars of research supporting what we do.  Research that states, unequivocally, that chiropractic manipulation for musculoskeletal disorders is effective.  Of course, we do have research that supports what we do, although this is limited because of the lack of financial support our profession has for research.  No drug companies sponsoring our research.

So, the chiropractic profession (and alternative medicine in general) is expected to be backed up by hundreds of randomized placebo controlled studies documenting effectiveness.  Without these studies, other physicians are slow to make a referral to chiropractic care a first option.

Here’s the double standard.  I can say, with a relatively high degree of authority, that very little of what mainstream medicine does is supported by the same type of medical research that is expected of alternative medicine.  And this lack of strong research is despite literally billions and billions of dollars spent on research.  Did I say billions of dollars?

In almost all case, the second a physician adds a second prescription to a patient’s regimine, they are out of the realm of research and into guesswork.  And this is assuming that the original prescription was not for an off label use or actually has research suggesting that that particular drug was useless or even harmful.  I could go into lots of examples such as beta blockers, hormone replacement therapy and statin drugs, but lets just leave it as it is.

This particular study is yet another study supporting the use of manipulative therapy for chronic lower back pain relief.  While the study was small, the findings were very consistent with what most chiropractors see every single day in practice:

The was a definite and immediate reduction in pain intensity directly associated with spinal manipulation for chronic lower back pain (in this case, the diagnosis with chronic non-specific lower back pain) (Tweet this).

Of course, rarely does chiropractic care include just manipulation as the single and only treatment given.  Many of us use soft tissue manipulation (my personal favorite in my toolbox) and rehab to improve outcomes in patients.  Adding additional tools to chiropractic adjusting for the treatment of your pain should be the first thing you think of anytime something hurts.

I’d apologize for the bias inherent in the blog article, but I did fully disclose this bias in the beginning…

 

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

CHIROPRACTIC SERVICES PROVIDES RELIEF TO BACK SURGERY AND DISC PROBLEMS – (11-03-03)

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“Failed back surgery syndrome”

This one obviously hits home. Statistics show that 5-10% of patients undergoing back surgery for disc problems experience no relief. While these odds may seem pretty good, the number of back surgeries done in a year make the total number quite high. Roughly 10% of the population utilizes chiropractic services; it is entirely possible, based only on my personal experiences, that if utilization increased the number of patients going to surgery would drop dramatically. While chiropractic care is not always 100% affected, you can bet that, at the very worst, you will be in the same condition you presented with. You can’t say that with surgical procedures.

bmj.com Talbot 327 (7421): 985.

Read entire article here

Why You Need a Back Specialist for that Sore Lower Back

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You may think your 1st episode of a sore lower back will just go away on its own. Or, it got better without seeing a back specialist. But are these good approaches?

I thought I’d share a near taboo story with you as it relates to a recent experience of mine.  I’m almost ashamed to admit as a chiropractor, but I’ve never suffered from low back pain until recently.  Sure–the martial arts have left me with shoulder, knee, ankle, foot (including a random broken toe earlier this year), elbow and wrist problems as well as the occasional headache and neck stiffness.

But never an episode of low back pain.

My first one came pretty much out of the blue.  Sure, I’d had a pull over my left glut region with bending over fully and really stretching out that I’d been meaning to get worked out with some aggressive soft tissue work like Graston Technique.  And sure, most of the people I train with in ju-jitsu outweigh me by at least 50 pounds AND are more skilled than I am (not a good combination, in case you’re not able to figure that one out…at least for me).

But there was no single defining episode that kicked it off.  And this is pretty darn consistent with what patients who have had his or her first episode of low back pain will tell me.  Or at least that’s what they say if this is the first episode.

More often than not, the episode of low back back is not the first one the patient has experienced.  Far too often, this is just one of many low back pain episodes that has occurred over the years.

For seemingly ever, we have viewed low back pain as a single discreet entity, although those of us that treat low back pain understand it differently.  It is more of a continuim of occasional or frequent flare ups over the course of months, years or decades.

My personal belief is that these initial acute episodes turn into this recurring pattern because they were never properly treated in the first place.  Or not treated at all because the victim thought it would “go away on its own”.

Understanding what happens when you ignore that initial episode, I have made sure that, for my initial flare up of lower back soreness I have gotten competent soft tissue treatment and adjusting from the other chiropractors in my office.  My episode is not over, but I am confident that it began as a soft tissue problem–some tweak or thickening of my thoracolumbar fascia.

Left to heal on its own the mechanics would become altered, leading to some degree of joint dysfunction down the line.  I am making sure that it is fully addressed NOW, rather than letting it go to progress to the “typical” pattern of low back pain that so many seem to experience.

This particular study seems to support this notion.  Researchers questioned 589 people who were currently suffering from low back pain.  They asked about having prior episodes of low back pain and, if he or she had a prior episode, how did the current episode compare in regards to pain intensity, interference with leisure and work activities, duration of episodes, and pain extending further into the buttocks or legs.

Their findings were very consistent with what I see in my office:

  • In 73%; of respondents this was not the first episode of low back pain
  • 66.1% reported their first episode lasted less than 3 months long
  • 54% had experienced 10 or more episodes
  • 19.4% had more than 50 episodes.

In those with recurrences, 61.1% reported that at least one aspect of the pain was worse in recent episodes.

  • A mere 36.9% felt that this episode was better than the last
  • 20.5% were worse in all aspects noted above.
  • 8.6% were better or the same.

There was one last important factor teased out in the questions asked by the researchers.

In 3 out of 4 of the low back pain sufferers, the pain location changed during the episode.  Most commonly, the pain first spread further before retreating back towards the spine during recovery.  Again, a very common findings.

So what does this all mean?

First, as seen in other studies, early treatment may be critically important to prevent future episodes.  My personal bias would be seeing a chiropractor that specializes in soft tissue treatments combined with adjusting.

Second, at some point insurance needs to consider treatment for low back pain (as well as many, if not most, musculoskeletal complaints) as ongoing.  Currently, this is not the case.  Treatment for most musculoskeletal complaints is considered short term and NOT ongoing.  There currently is one middleman company that our office deals with that seems to think any type of ongoing treatment should not be authorized.

Great.  Authorize the diabetic to take insulin for 6 weeks or the hypertensive patient to take a beta blocker for 8 weeks (just kidding–we shouldn’t authorize the use of beta blockers for blood pressure at all!).  Or how about Lipitor just until your cholesterol drops below 200.

Did you seek care immediately after your first episode of low back pain, and, if so, from what type of provider?