LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

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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.

 

Hip Pain Not Related to Structural Damage – (03-08-01)

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Hip Pain Not Related to Structural Damage

Any good chiropractor could come to this conclusion without all the money spent on a study. So many times I hear patients coming in saying “My doctor told me I have arthritis.” Guess what?? If you’re over the age of 25, you’ve got arthritis. We can not always rely on X-rays for a diagnosis.

Quick Manual Treatment in Whiplash is Best – (08-21-00)

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Quick Manual Treatment in Whiplash is Best

Ask any chiropractor and they could have saved alot of money on this research project. As with any injury, the longer treatment is delayed the less likelihood of a good outcome.

Spine 2000 Jul 15;25(14):1782-1787 – In patients with whiplash-associated disorders caused by a motor vehicle collision treatment with frequently repeated active submaximal movements combined with mechanical diagnosis and therapy is more effective in reducing pain than a standard program of initial rest, recommended use of a soft collar, and gradual self-mobilization. This therapy could be performed as home exercises initiated and supported by a physiotherapist.

EXERCISE FOR CARDIOVASCULAR FITNESS AND AGING – (03-15-04)

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Cardiovascular fitness, cortical plasticity, and aging

I have said it before and say it to my elderly patients over and over again–NOTHING will keep you as young as exercise. Nothing. As a chiropractor, I feel that it is my job to remove the aches and pains so that my patients are able to exercise as much as they want to. I have several senior patients who would just have much, much higher quality of life if they would just exercise. I remember one patient in particular who had been referred to several specialists for her low back pain. She didn’t have anything really wrong–she was just severely deconditioned.

PNAS — Abstracts: Colcombe et al. 101 (9): 3316 –

Read entire article here

REVIEWS ON ACUTE LOW BACK PAIN – (08-14-03)

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Acute low back pain: systematic review of its prognosis

As a chiropractor, it is really hard to pass up an article like this one!! I can verify the findings in this an several other studies from what I see in my office. Low back pain is not a one time episode. Rather, it is a continuim of flare ups and remissions–with all the episodes essentially being one long one. However, although there are no studies to back this up to date, I see time and time again that intervention with chiropractic care can break this cycle and prevent future flare ups in the vast majority of cases.

bmj.com Abstracts: Pengel et al. 327 (7410): 323 –

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?

PROBIOTIC SUPPLEMENTATION AND DAIRY AVOIDANCE TO PREVENT EAR INFECTION – (09-24-03)

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Osteopathic Manipulation as Adjuvant Therapy in Children with Recurrent Acute Otitis Media

While I love to see articles such as this (the findings not really a big surprise to any chiropractor), it is unfortunate that any press this article receives will not extend to chiropractic. Heck–why should it? Just because DCs perform 90% of manipulations and DOs have manipulation as an elective?? Oh well. Remember to add probiotic supplementation and avoidance of dairy to manipulation and just about every ear infection should become history.

Arch Pediatr Adolesc Med — Abstracts: Mills et al. 157 (9): 861.

Read entire article here