chronic neck pain

Chronic Neck Pain After a Car Crash

August 4, 2018 by James Bogash

SHOULD I SEE A CHIROPRACTOR IN MESA AFTER MY CAR ACCIDENT?

Of course, my biased answer is going to be a solid yes. Most patients that come through my office as the result of a motor vehicle accident will be discharged from care when I have done everything possible to ensure that they will not be in another chiropractor’s office in 10 yrs complaining about neck pain “ever since that accident 10 yrs ago.” The bottom line is that the number of patients still experiencing symptoms years later is far too high. My advice to anyone who has been in an accident is to seek the care of a chiropractor who is going to address the soft tissues as well as the joints in your treatment plan.

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

March 23, 2015 by James Bogash

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.

Chronic Neck Pain in Active Adults: Where Should You Go?

September 18, 2014 by James Bogash

chronic neck pain in seniors and chiropractic — Photo courtesy of https://www.flickr.com/photos/bearpark/

As we age, those nagging aches and pains start to impact on your quality of life. Chronic neck pain is high on the list.

Almost since the opening of my practice I have taught a variety of classes at a senior-oriented branch of a local community college called NAILS (New Adventures In Learning for Seniors). That’s where I first met Marge. Marge secretly wanted to come in to my office for treatment because she suffered from chronic neck pain. However, she also had osteoporosis so her primary care doctor told her not to see a chiropractor because she had weak bones.

Good thing she followed his recommendations. After all, I climb on my desk and, with a Tarzan-like roar, jump onto my unsuspecting patient in an attempt to adjust their spines. When I’m really busy I just stack them on top of each other and adjust them all at once. Very dangerous for weak bones.

For the next few years, Marge continued to see me occasionally at the NAILS events and continued to suffer with neck pain based on her primary care doctor’s recommendation. At some point, however, her confidence in my ability to safely treat her overcame her primary care’s warning.

Good thing she did. I treated Marge on and off over the next 10 years or so until she passed, even visiting her in hospice when her time was near. She not only achieved wonderful relief from her neck pain, but her energy levels improved because she was no longe battling pain all day long. She even took my advice to get into yoga, which turned out bad for business because she was seen less frequently in the office after she started yoga.

The sad part is that she still spent several extra years in pain because of biased and incorrect advice from her primary care. We certainly did not treat her in the same manner we would treat a college football player or MMA fighter, but we were able to balance treatment and safety to give her wonderful results.

All of this leads up to the results of this particular study. In it, researchers looked at 241 participants aged 65 years or older with neck pain, rated at a 3 or higher (on a scale from 0–10) of at least 12 weeks duration. They were then put into three groups:

A group who were only given home exercises (standard approach)
The same home exercises along with a supervised exercise group (the basic physical therapy approach)
The final group was given the home exercises but also received manipulation for 12 weeks.

After 12 weeks of treatment, the group that received manipulation had the best results (10% greater decrease in pain compared with the home exercises alone group and 5% better results over supervised exercise plus home exercise).

As an added bonus, none of the seniors treated with manipulation in this study died or ended up with multiple neck fractures as a result of any over-zealous neck manipulations.

Not that the results of this should come as any big surprise to anyone who has seen a chiropractor before for neck pain or to any of my colleagues, but sometimes it’s nice to see it in writing. And hopefully, studies like these can keep future Marges from suffering unnecessary pain when safe and effective treatments are available.

DID YOU INJURE YOUR NECK AT WORK?

September 26, 2011 by James Bogash

Ever injured your neck in a car accident or at work? Here in AZ, many patient are sent by their employers to occupational medical clinics. The first option here is usually some medications and a “watch and wait” approach. So what’s wrong with that?

Well, if you understand injuries and the way that the soft tissues of the body work, then you know that this is probably one of the worst approaches to take. The anti-inflamatories usually used actually interfere with the healing process and the inactivity that is recommended allows the fascia at the heart of the injury tightens up. With time (and no treatment), these tight areas become permanent.

Alterations in the fascia’s ability to slide affects the muscles. The muscles then aren’t able to move properly and support the joints they are associated with. Then the joints lose movement and become painful and send pathological signals up to the brain. Quite the mess.

So, back to the original question; what’s wrong with anti-inflamatories and rest immediately after an injury? It creates an ideal situation to make the problem chronic.

Which brings us to this study, which further supports this concept, finding that in those who had a work related neck injury, they had almost 2 1/2 times the risk of having “troublesome” neck pain 6 or 12 months later. By this time the injury is much more difficult to treat to resolution.

The bottom line is that it is never a good idea to limit movement after an injury (provided a fracture or more serious injury has not occurred) and that, if possible, you should seek care sooner rather than later. And make sure you find a provider who is going to work on both the muscles, fascia AND the joints to make sure that injury has the greatest likelihood of being put behind you.