LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

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Should All Patients with a Migraine See a Chiropractor in Mesa?

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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.

Should I See a Mesa Chiropractor for My Chronic Migraine Headaches?

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Why am I even asking this (it was rhetorical, by the way)?  The answer is unquestionably yes.

It never ceases to amaze me how many new patients come into my office that have been having headaches for years and have never been to a chiropractor in Mesa.  Many of these patients begin to feel better in as little as a week.  The caveat here is that you need to find a Mesa chiropractor who addresses the soft tissue (muscle, ligaments, tendons, fascia) aspect of your problem and not just adjusting.  Many times the soft tissue aspect has been present for so long that just adjusting, just exercising, just ultrasounding, just interferentialling (is that a word??), just strengthening or just adjusting is not going to be enough.

This particular study just supports this link, finding close associations between tenderness in the trapezius muscles and chronic tension headaches as well as migraine headaches that were present only on one side of the head.

Chronic Neck and Low Back Pain – Amazing Procedure Helps in ONE Day

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manipulation under anesthesia
Ded Pixto/Dollar Photo Club

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.

 

Is Mesa Chiropractic Care Dangerous for Seniors?

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Mesa Chiropractor as your back specialist
Mesa chiropractic care and seniors

This is not the first time I’ve written about Marge, my 80-something severely osteoporotic patient who was told by her PCP not to see a chiropractor in Mesa for her neck pain.

Yep. Don’t see a chiropractor.  Instead, try steroids (which is what destroyed her bones in the first place) or NSAIDs (well known to destroy joints, cause ulcers and greatly increase your risk of a heart attack or stroke).  If those don’t work, then certainly neck surgery is a safer option than those wickedly dangerous chiropractors.

I am sure that there are a large number of people out there, seniors and youngsters alike, that have been steered away from seeing a chiropractor purely out of ignorance for what we do.  I know that in my 15+ years of practice it has been a story I hear occasionally.

With Marge, I’m not sure what exactly her PCP thought I was going to do.  Maybe it involved jumping off of my desk, landing on her unsuspecting mid back region with a loud yell in the hopes of getting bones to move.  The reality is that very, very few of these doctors out there (not just PCPs, but I’ve heard it from neurosurgeons and orthopedic surgeons as well) haven’t the foggiest notion of what we do.

Knock on wood, but in my 15 (almost 16) years of practice, seeing some 5000 patients for a countless number of treatments, I have not had a serious adverse event occur.  Never fractured anything (although there have been a time or two that I really pissed off a rib with thoracic adjusting).  Never caused a stroke.  Never had anyone die from any type of treatment rendered in my office.  And I’ve never heard of it happening to a colleague (although it’s not exactly something you post of Facebook or Twitter).

In general, chiropractic care is incredibly safe.

However, were you a medical journal “title reader,” then the title of this particular article, “Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99,” would confirm everything you always thought about chiropractic care.  It’s dangerous and should be avoided at all costs because we are killing and maiming patients left and right.

I have to admit that, even for myself, when I read the title of this article I was instantly pissed off, expecting a research attempt to discredit my beloved profession.  Reading the first paragraph didn’t help much:  “to evaluate risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physician.”

Wow.  Really seems like the authors have it out for us.

Before those of you out there who have never been near mortalty wounded by a chiropractor get too upset, here’s what the researchers found:

  • Those seniors who saw a chiropractor were (are you ready for this???), 76% LESS LIKELY to experience a traumatic injury.  (Yes–that is 76%).

The conclusion is not exactly in line with the title here.  Basically, something occurs with a chiropractic visit that led to a drastically lower risk of a traumatic injury in the 7 days following the visit.

It is highly likely that the work done (stretching, adjusting, exercises) wakes up the nervous system and as a result, these patients have better balance and are therefore less likely to fall and suffer a traumatic injury.  Kind of makes sense.

The bottom line is that Mesa chiropractic care is an incredibly safe option for musculoskeletal complaints; not dangerous like your doctor incorrectly believes.

 

Chiropractic Care in the Workplace: Money Extremely Well Spent

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Employers have been getting hip on ways to increase worker productivity and jazz up the workplace.

Some have added full gyms and relaxation areas.  One large, local employer that I’m aware of now has an on-site nurse practitioner.  Overall, the addition of some level of urgent-care-ish care is becoming more and more common.  This saves the employee from having to leave work for routine visits to his or her doctor for things like ongoing prescriptions.

It also means that they don’t have to spend hours going to the doctor for urgent care stuff like sore throats, upper respiratory infections and coughs.  It works out well for everyone involved.  The employer is happy because productivity is preserved and the employee is happy because they waste less time running around to doctors’ offices.

What is notoriously, glaringly absent from these relationships is an on-site chiropractor.

Now maybe my opinion is biased (OK, OK…it’s clearly biased…), but given that the typical office or industrial worker is particularly prone to overuse injuries, it just makes sense to have a provider nearby who can most aptly handle these complaints.  And handle these complaints quickly to get the employees back to working as comfortably as possible.

It is has already been solidly shown that outside of the workplace, whether within an injured workers / worker’s compensation environment or among patients experiencing most types of musculoskeletal pain, chiropractic care is extremely cost-effective, safe and clinically effective.

In this particular study, researchers took a look at what happens when chiropractic care is offered inside of the workplace.  They looks at the claims from a single employer health plan that had employers who received chiropractic care on-site or off-site over the course of two years.  Here’s the details:

  • There were 876 on-site and 759 off-site participants.
  • The off-site group received more radiology services overall (55.5% vs 38.2%) including MRI, ultrasound, and X-rays.
  • The off-site group also had higher outpatient and ER visits.
  • The off-site group also has greater use of chiropractic care and physical therapy.

Given how darn effective chiropractic care is at already reducing imaging, outpatient visits and ER visits, to see that these numbers were EVEN less when a chiropractor was on-site gets me pretty darn excited.

If you happen to be an employer that does not yet have an on-site chiropractor (even if it was just a day or two per week) this should certainly give you cause to think that you’ve been missing an excellent opportunity to do something wonderful for your employees that is going to SAVE you money, not cost money.

So what are you waiting for??

 

Medicare Overspending and Waste: Chiropractic’s Role

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The Medicare expense is one of the larger burdens on the budget ($472 B–about 14%) and it’s not getting any better.

Every year the argument about the Sustainable Growth Formula (SGF) comes up in front of Congress.  Physicians want more money to align with an increased cost of living.  But rarely does Medicare ever take a hard look at some of the procedures they pay for and evaluate the costs versus the benefits.

I have written about the massive wastes within the spinal surgery realm of Medicare.  A specific example has to do with the increase in the more complex spinal fusions instead of simple decompressive surgeries.  Many times the cost, similar outcomes and more dangerous.

This is representative of the waste in Medicare.  I can tell you, with my built-in bias of course, that chiropractic care is one of the least appreciated services provided within the Medicare system.  Chiropractic care is a massive cost savings, NOT an add-on cost like many believe.  For non-surgical spinal complaints, it is around a 30% cost savings.  When factored into all spinal complaints, the cost savings is greater.

But how much does chiropractic care cost Medicare?  My profession was under the spotlight in 2006 when Medicare declared that a large percentage of the claims paid by Medicare were “inappropriate.”  This had little to do with the actual care and more to do with the documentation of that care.  Medicare’s rules for documentation are clear-cut, but quite lengthy and can be a challenge to dot every “i” and cross every “t.”  All of this made a little more challenging by the fact that Medicare only pays for a single service (manipulation) when done by a chiropractor.  Our office spends about 1 hour on a new Medicare patient (in general, the Medicare patient is more challenging because he or she is more likely to be on multiple medications, have had surgeries, have an increased risk of low bone density, etc…) and I get paid for about 3 minutes of this actual time.  Same thing with a recurring visit–we spend about 15 minutes and get reimbursed for that same 3 minutes.

This particular study looks into what percentage of Medicare payments went for chiropractic.  Here’s what they found:

  1. Chiropractic spinal manipulation grew 13% from 2002 to 2004, declined 5% through 2008.
  2. In 2008, 1.7 million beneficiaries (6.9%) used chiropractic services.
  3.  Chiropractic services accounted for about 1/10th of 1% of overall Medicare expenditures.

Yup.  0.1%.

For a profession that has the potential to save mass amounts of money (and already DOES), our reimbursement does not even register as a blip on the radar screen of costs.

To me, this reinforces the fact that chiropractic care is, without any doubt whatsoever, THE highest value in healthcare available.  Nothing else even comes close.

Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

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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?

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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.