LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

neck pain

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.

 

Manual Therapy, Physical Therapy, or GP Care for Neck Pain – (05-23-02)

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Manual Therapy, Physical Therapy, or GP Care for Neck Pain

Of course I like to see results like this in the medical literature, but do not confuse manual therapy with manipulation. Manipulation is a procedure that takes a joint into the paraphysiologic space (NOT past the anatomical barrier) to stimulate mechanoreceptors in the joint capsule. Mobilization (as in this article) does not achieve this. Any results found with mobilization will generally be greater with manipulation. Also, keep in mind that in many states it is illegal for PTs to perform manipulation–it is a procedure reserved for physician use only.

Annals of Internal Medicine: Abstract

Read entire article here

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?

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

Whiplash Injury Changes Everything

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As a chiropractor, I have an opinion on this one. Whiplash injuries are common & so is the patient whose chronic neck pain has been present “since that accident.”

Whiplash occurs when the head gets thrown back and forth as a result of a sudden change in momentum of the head relative to the neck, resulting in strains affecting the bones, discs, muscles, nerves, or tendons of the neck.

We used to call them hyperflexion / hyperextension injuries, but more careful evaluation showed that the neck does not always go beyond it’s normal range of motion. Rather, small regions of the cervical spine undergo too much flexion and too much extension. Consider an “S” shaped spring getting crunched down from the top–there will be areas of the spring that get scrunched and areas that get stretched. This is closer to what we understand happens during a whiplash type of injury.

Because of this type of injury, studies have identified multiple problems with patients who suffer this type of injury. Fat deposits in the muscles. Change in the muscular coordination of the neck. Jaw pain. Chronic pain. All are potential outcomes following a whiplash type injury.

This particular study continues to paint a depressing picture for those who have had this type of injury. Researchers found changes in those who are suffering from chronic whiplash pain during exercise.

Normally, exercise stimulates the release of built in pain relievers (endogenous). Everyone’s heard of the experience known as “runner’s high” when these opioid-like compounds are released by the body. However, in the chronic whiplash patients, they did not experience the pain reduction associated with exercise like the normal patients did. They were more likely to have an increase in pain after they exercise rather than improvement.

So what is the solution? I’ve already mentioned my bias. I can tell you, from personal experience over 15 years of practice, that when patients get in to our office for treatment within hours of an accident, they never seem to get to the severe levels of pain that we see when compared to patients who come in days or weeks after the injury.

Regardless of where you go for treatment, make sure that all of the potentially injured tissues (ligaments, tendons, fascia, joints, etc..) are treated. Just exercising or just adjusting or just medications will likely not fully address the nature of the tissue damage that occurs in a whiplash type of injury. Only treatments that encompass both the joints (adjusting) and the soft tissues that are injured is likely to be successful at preventing your injury from becoming chronic.

If you have had a whiplash injury in the past, what did you do to fully recover? Or do you still deal with chronic pain?

NECK PAIN AND RESPIRATORY DISEASE – (03-08-10)

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Neck pain and Respiratory Disease

Of course, as a chiropractor, I have to comment on this article. Overall, while this is a small pilot study, the concept is not that hard to grasp. Some of the anterior neck muscles (notably the anterior scalenes) assist in respiration, so if there is some type of dysfunction that can affect the neck, it could very well affect breathing. Sounds like a good reason to visit your local chiropractor.

Read entire article here

MYOFASCIAL FINDINGS IN PATIENTS AFTER WHIPLASH INJURY – (05-04-09)

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A distinct pattern of myofascial findings in patients after whiplash injury

As a chiropractor that specializes in soft tissue treatment, studies like this confirm my decision to practice in this manner. Too often following whiplash type injuries patients will seek the care of a PT, their PCP or a DC. The statistics linking long term problems from whiplash injuries is frighteningly high, but I believe this is because few approaches attack the comprehensive nature of these injuries. The joints, soft tissues and the psychological impacts of the injury all need to be addressed. Without this comprehensive approach, it is likely that patients will fall into that category of long term neck pain.

Read entire article here

POOR BLOOD FLOW IN THE BRAIN LINKED TO CHIROPRACTIC CONDITION

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Can we all agree that more blood flow to the brain is a good thing?  I’m sure anyone experiencing a blood choke in ju-jitsu would agree-it’s NOT the best feeling in the world.

Increased blood flow to the brain means more nutrients, more oxygen and more removal of waste products.  These are all ideal situations and lead to increased brain health.  The converse is equally as bad.

We already know of several things that increase blood flow to the brain, such as exercise and whole body vibration.  In addition to increasing blod flow, increasing the availability of nutrients that improve the production of ATP in the mitochondria such as choline, CoQ10, Vitamin E (as mixed tocopherols–NOT straight alpha tocoperol) and alpha-lipoic acid will also result in very positive improvements in brain function and will likely lead to reductions in the risk of Alzheimer’s, Parkinson’s, dementia, hearing loss, migraines and seizures.

So what’s missing from this list?

Based on this particular study, chiropractic treatment.

Researchers looked at the effect of chronic neck and upper back pain on the blood flow in the brain (cerebral perfusion).  They found that these patients with pain had less blood flow into their brains when compared to those who did not have chronic pain.  In the worst case, those with the most severe pain had 45% less blood flow to the parietal and frontal regions of the brain.  The parietal region functions heavily in evaluation the spatial relationships within our bodies and environment, while the frontal lobe is involved in higher mental functions like personality and decision making.

Given how important these regions of the brain are, I’m thinking that 45% sounds like way too much of a loss.  Now this does not mean that you run up to your favorite dolt and poke them in the upper trapezius muscle and ask if it hurts, but certainly entertains the additional value of chiropractic care to address pain in these regions.

If the combination of soft tissue treatment, at home stretches / yoga and chiropractic adjusting can help to increase movement in this region and reduce pain, it would make sense that blood flow to the brain would improve.  This would make chiropractic care an integral component of the treatment of the above mentioned conditions like seizures, migraines and dementia.  But that’s my biased opinion…