LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

manipulation

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

by

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.

Mesa Chiropractor Vs. Lumbar Disc Herniations Surgery

by

HOW CAN WE SAVE MASSIVE AMOUNTS OF $$$ ON LUMBAR DISC HERNIATIONS??

Chiropractic care in Mesa has been shown to be effective in case control and clinical studies to be an effective option for chronic and acute low back pain.  Numerous studies have shown that, if Mesa chiropractic care is the FIRST (rather than the last!!) point of entry for any musculoskeletal complaint, the cost savings are tremendous (upwards of 30%).  Looking at this study, we can begin to see how chiropractic care is a net SAVINGS, not a net expense.  Sometimes legislators have a hard time seeing this.  Researchers looked at the costs for services prior to lumbar discectomy and chiropractic care was a measly 2% of overall costs.  Based on what we know, if more people selected chiropractic care as a point of entry (driving chiropractic costs up to maybe 30%), we’d see a massive savings in the overall amount of money spent.

Read More 

Exercise or Mesa Chiropractor for Long-Term Relief of Leg Pain?

by

As usual, I have to give my “this article is going to be biased” disclaimer because back related leg pain is something I see all the time in my Chiropractic office in Mesa.

Despite the experiences of myself and countless numbers of my colleagues, chiropractic care is not well associated with the treatment of leg pain. Some of this may be because the actual research documenting chiropractic’s effectiveness for many conditions is not common.  Much of this is financial—there are too little government-funded studies on chiropractic care and we certainly do not have drug companies funding billions for chiropractic research to find out how to use less drugs in healthcare.

Which brings us to this particular study. In it, researchers compared the short (12 weeks) and long-term (52 weeks) effects of manipulation coupled with home exercise / advice to only home exercise / advice to check out the ability to reduce back-related leg pain.

While this study used the generic term “spinal manipulative therapy,” keep in mind that Mesa chiropractors perform the bulk of manipulations in the US and also perform it with the highest levels of safety.

Here’s the details of the study:

  • 192 patients were enrolled who had back-related leg pain for least 4 weeks.
  • They were put into one of the two groups above for 12 weeks.
  • Chiropractic plus home exercise had better pain improvement at 12 weeks.
  • After 52 weeks global improvement, satisfaction, and medication use were still improved.
  • Not surprisingly, no serious treatment-related adverse events or deaths occurred.

Compare the outcomes of this to treatments like steroid injections of the spine: FAR, FAR more expensive, serious risk of side effects (such as early disc degeneration, nerve damage and increased risks of spinal surgery) and very little evidence that the benefits are sustained beyond the first few months.

Of course, I DID give the disclaimer at the beginning of this article…

 

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

by

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:

  1. A group who were only given home exercises (standard approach)
  2. The same home exercises along with a supervised exercise group (the basic physical therapy approach)
  3. 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.

 

Lower Back Pain Relief with Stretching – Timing is Everything

by

In seems inherent that treatments for lower back pain relief would include stretching.  In general, flexibility is a good thing and that’s why activities like yoga are bad for a chiropractic business.

One of the more common questions I get as a chiropractor is what stretches or what exercises should be done for chronic lower back pain.  My easy answer is to strongly recommend that the patient get themselves into a yoga program and give it a try for several weeks.

To understand the benefits of yoga, you need to understand that the “30-second” warm-up stretch that we have all been taught from gym class in elementary school on is merely an attempt to avoid injury and does nothing to improve flexibility in the long run.  And flexibility is so darn important.  I’d have to say that almost all of the patients that I see in my office for treatment of chronic lower back pain have very poor flexibility.  For lack of something more specific, the lumbar region in these patients is locked up and can’t move the way it needs to.
[Read more…] about Lower Back Pain Relief with Stretching – Timing is Everything

Cervical Disc Bulge: Do I Need Surgery?

by

Disc bulge in neck
Disc bulges usually do not need surgery

Now, before I state that our office does very well with disc bulges in the neck, I need to preface this with the fact that we’ve had 2 patients in the past 6 months end up in surgery.

That being said, the vast majority of patients who have cervical disc bulges accompanied by pain in the arm due to that disc bulge that are seen in our office recover nicely. Because back and leg pain are more widely publicized, there is more knowledge about sciatica from back pain; patients frequently come in stating that his or her “Atica” or “schizophrenia” is flared up. Most of these cases are not actually true sciatica (despite what he or she has been told) but are either local pain (no leg pain) or a referred pain from the hip or sacroiliac joint.

Pain in the arm originating from the neck is also very common, but less patients who walk through the door seem to be aware of this relationship. The typical patterns of disc pain in the arm or leg follow a very typical pattern called dermatomes. The problem is that there are many other things that also cause pain into the arm such as the rotator cuff, problems in the forearm such as carpal tunnel and problems stemming from the muscles around the neck such as the anterior scalene or pec minor.

Because there are so many causes of pain into the arm, it can be challenging to nail down exactly what may be causing your problem. For me, sometimes the answer isn’t clear on the first visit or two, but rather, takes some time to clarify exactly what’s causing the pain. Disc bulges in the neck causing pain in the arm can look an awful lot like a rotator cuff referral into the arm. If I work on the rotator cuff for a visit or two and nothing changes, we shift gears towards a treatment of a disc bulge.

Treatment of a cervical disc bulge in our office involves soft tissue work (Graston, stretching, fascial work), chiropractic adjusting and traction. I’m a big fan of home traction devices as well that can allow you to treat the disc bulge several times a day (we recommend this one from Amazon: Instapark® Cervical Neck Traction).

With this approach, the vast majority of patients respond well. This particular study supports this position. In it, chiropractic researchers looked at a group of studies to get a better idea of how long it takes someone to recover from a cervical disc herniation. Here’s what they found:

  • On the down side, they found that complete recovery could take as long as 24-36 months.
  • Luckily, patients were already noting substantial improvements within the first 4-6 months.
  • Overall 83% of patients resolved completely.
  • Patients with a workers’ compensation claim appeared to have a poorer prognosis.

Before you start getting depressed about the 4-6 months timeframe, in our office, if we are going to be able to help a disc pain patient, improvement starts within a few visits and usually progresses forward from there. The use of the traction device helps.

As for the worker’s compensation portion of the equation, I wonder if the poorer prognosis has to do with less of these patients making it into chiropractic offices in a timely matter. Many primary care doctors don’t consider chiropractic for disc problems and will usually use medications and pain injections first.

Do You Limit Activities Because of Low Back Pain?

by

One of the concerns from new patients in for chiropractic care centers around movements and activities that could make the condition worse.

Quite frankly, it’s rare that the typical low back pain patient will be made worse in the long run by activities that they may do, provided that the activity wouldn’t produce low back pain in a patient who does not have low back pain. In other words, lifting and twisting while carrying a 100 pound object is not a good idea whether you have low back pain or never have in your life.

A large chunk of patients who come in with a new episode of low back pain don’t recall doing anything to bring about the episode. Sometimes the aggravating event is not as obvious (new shoes, side sleeping without a pillow between the knees, new chair, etc…) and sometimes, the patient is in my office, not because of what they did, but because of what they are NOT doing. As in moving around.

It is very common for the mere act of being a couch potato to create low back pain. So, when the new patient comes into my office and is concerned that movement may make his or her back pain worse, I reassure them that movement is a good thing. Sacroiliac conditions, for example, do way better when the patient is moving around and keeping the joint “lubricated.”

A frustrating aspect of practice for me is how often chronic low back pain patients, or those who have a tendency to “throw out” their backs, have been told to “take it easy” and limit activity by an orthopedic doctor, family practice doctor, physical therapist or even my own colleagues.

Fear of movement. It’s never a good thing.

This particular study drives this point home. Researchers looked across 17 clinical studies to see how much of an effect fear avoidance behaviors (as measured by the Fear Avoidance Beliefs Questionnaire (FABQ) or the Tampa Scale of Kinesiophobia (TSK)) had on whether or not treatment was effective. Here’s what they found:

• In patients who had up to 6 months’ duration of low back pain, high fear avoidance beliefs were associated with more pain and / or disability and a lower likelihood of returning to work.
• However, if patients were able to show a decrease in fear avoidance beliefs during treatment there was less pain and disability.
• Interventions that addressed fear avoidance beliefs led to better outcomes.
• The results were not as strong in chronic patients.

I had recently been asked to participate in a chronic pain panel for the Arizona Corporation Commission. This involved looking at case studies of chronic pain patients to see how guidelines could be effectively applied for treatment. However, I had such a hard time being non-biased looking at these studies because so many of the cases of chronic pain are actually failed cases of acute pain.

And in Arizona, very few patients ever make it into chiropractic offices in the early stages, when manipulation can be the most powerful. Most end up medicated and / or put into physical therapy. Considering that the cost of going into physical therapy treatment for non-surgical spinal conditions first here in Arizona is almost TRIPLE the cost of chiropractic care, it may be that fear avoidance behaviors are addressed intuitively by chiropractors, lowering the chance of a condition becoming chronic.

Of course, this also means that, should you come across a chiropractor who uses fear (i.e. subluxation kills and without adjusting your nervous system can’t flow) to sell you on more care, it may be time to work on your short burst activity and run the other way.

Physical Therapy or Manipulation for Chronic Low Back Pain?

by

The answer to chronic low back pain is NOT nothing. Choices for care include chiropractic manipulation or physical therapy.

I know that it seems intuitive that rehab exercises for chronic low back pain would be a good idea. However, I can’t say that I’ve ever been completely on board with this idea. While not every case of chronic low back pain does well in our office, we do pretty darn well with the vast majority of cases that come through. From years of experience, I firmly believe that advanced soft tissue techniques in competent physicians’ hands combined with manipulation is one of the strongest tools for management of chronic low back pain.

Despite this, there is a belief that patients with chronic low back pain should go to physical therapy to get rehab exercises for his or her low back pain and many primary care physicians still continue to refer patients out for physical therapy.

Always happy to find out that my practice philosophy is not shared by my office alone, I present this particular article, looking at the outcomes of 12 weeks of treatment in 199 patients with chronic low back pain (defined as more than 6 weeks’ duration) using exercise versus manipulation.

Specifically, exercised consisted of high-dose, supervised low-tech trunk exercise. As a way of measuring outcomes, researchers looked at four motion parameters in the sagittal plane and two in the horizontal plane as well as the jerk index parameter.

The group that received manipulation changed in all of the parameters measured. In addition, the manipulation group had a smoother motion pattern (reduced jerk index) at the end of the study. The exercise group, however, only improved in half of the parameters measured and there were no improvements in the jerk index.

Based on this study, a patient with chronic low back pain would be much better off seeing a provider who can do spinal manipulation. Adding the aforementioned soft tissue techniques to manipulation gives you an even greater chance of finding relief where nothing else has helped.