Can Chiropractic Help Post-Surgical Patients?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically! GIVE US A CALL!!!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Whiplash- Can we predict long term problems?

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Low Back Pain- Is it on the Rise?

As stated last month, the prevalence of low back pain (LBP) is REALLY high! In fact, it’s the second most common cause of disability among adults in the United States (US) and a very common reason for lost days at work. The total cost of back pain in the US, including treatment and lost productivity, ranges between $100 billion to $200 billion a year! Is low back pain on the rise, staying the same, or lessening? Let’s take a look!

In the past two decades, the use of health care services for chronic LBP (that means LBP > 3 months) has substantially increased. When reviewing studies reporting insurance claims information, researchers note a significant increase in the use of spinal injections, surgery, and narcotic prescriptions. There has been an increase in the use of spinal manipulation by chiropractors as well, along with increased physical therapy services and primary care physician driven non-narcotic prescriptions. In general, LBP sufferers who are chronic (vs. acute) are the group using most of these services and incurring the majority of costs. The reported utilization of the above mentioned services was only 3.9% in 1992 compared to 10.2% in 2006, just 11 years later. The question now becomes, why is this?Possible reasons for this increase health care use in chronic LBP sufferers may be: 1) There are simply more people suffering from chronic LBP; 2) More chronic LBP patients are deciding to seek care or treatment where previously they “just accepted and lived with it” and didn’t pursue treatment; or, 3) A combination of these factors. Regardless of which of the above three is most accurate, the most important issue is, what can we do to help chronic back pain sufferers?

As we’ve discussed in the past, an anti-inflammatory diet, exercise within YOUR personal tolerance level, not smoking, getting enough sleep, and obtaining chiropractic adjustments every two weeks are well documented methods of “controlling” chronic LBP (as there really ISN’T a “cure” in many cases). You may be surprised to hear that maintenance care has good literature support for controlling chronic LBP. In the 8/15/11 issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned the article, “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcomes?” Here, they took 60 patients with chronic LBP (cLBP) and randomly assigned them into one of three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have over a one month period; 2) 12 treatments, over a one month period but no treatment for the following nine months; or 3) 12 treatments for one month AND then SMT every two weeks for the following nine months. To measure the differences between the three groups, they measured pain, disability, generic health status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and 10-month time intervals. They found only the patients in the second and third groups experienced significantly lower pain and disability scores vs. the first group after the first month of treatments (at three times a week). BUT, only the third group showed more improvement at the 10-month evaluation. Also, by the tenth month, the pain and disability scores returned back to nearly the initial baseline/initial level in group two. The authors concluded that, “To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.” Other studies have reported fewer medical tests, lower costs, fewer doctor visits, less work absenteeism, and a higher quality of life when maintenance chiropractic visits are utilized. The question is, WHEN will insurance companies and general practitioners start RECOMMENDING chiropractic maintenance care for chronic LBP patients?

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain: Surgery VS Chiropractic

Low back pain (LBP) is the second most common cause of disability in the United States (US) and a very common reason for lost days at work with an estimated 149 million days of work lost per year. The total cost associated with this is astronomical at between $100-200 billion/yr, of which 2/3rds are due to decreased wages and productivity. More than 80% of the population will have an episode of LBP at some point in their lifetime. The good news is that 95% recover within two to three months of onset. However, some never recover which leads to chronic LBP (LBP > 3 months), and 20-44% will have a recurrence of LBP within one year with lifetime recurrences of up to 85%! What this means is that most of us have, have had, or will have LBP, and we’ll get it again! So the question is, what are we going to do about it?

Surgery has traditionally been considered a “last resort” with less invasive approaches recommended first. Chiropractic adjustments and management strategies have traditionally faired very well when compared to other non-surgical methods like physical therapy, acupuncture, and massage therapy. But, is there evidence that by receiving chiropractic treatment, low back surgery can be avoided? Let’s take a look!

A recent study was designed to determine whether or not we could predict those who would require low back surgery within three years of a job-related back injury. This is a very important study as back injuries are the most common occupational injury in the US, and few studies have investigated what, if any, early predictors of future spine surgery after work-related injury exist. The study reviewed cases of 1,885 Washington state workers, of which 174 or 9.2% had low back surgery within three years. The initial predictors of surgery included high disability scores on questionnaires, greater injury severity, and seeing a surgeon as the first provider after the injury. Reduced odds of having surgery included: 1) <35 years old; 2) Females; 3) Hispanics; and 4) those who FIRST saw a chiropractor. Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! WOW!!! This study supports the FACT that IF a low back injured worker first sees a chiropractor vs. a surgeon, the likelihood of needing surgery in the three years after the injury would beDRAMATICALLY reduced! In fact, the strongest predictor of whether an injured worker would undergo surgery was found to be related to who they saw first after the injury: a surgeon or a chiropractor.

If this isn’t enough evidence, another recent study (University of British Columbia) looked at the safety of spine surgery and reported that (taken from a group of 942 LBP surgical patients): 1) 87% had at least one documented complication; 2) 39% of the 87% had to stay longer in the hospital as a result; 3) 10.5% had a complication during the surgery; 4) 73.5% had a post-surgical complication (which included: 8% delirium, 7% pneumonia, 5% nerve pain, 4.5% had difficulty swallowing, 3% nerve deterioration, 13.5% wound complication); 5) 14 people died as a surgical complication. Another study showed lower annual healthcare costs for those receiving chiropractic vs. those who did not. The “take-home” message is clear: TRY CHIROPRACTIC FIRST!!!

We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

Neck Pain and Chiropractic

Neck pain represents a major problem for people throughout the world with considerable negative impact on individuals, families, communities, health care systems, and businesses. Up to 70% of the general population will have neck pain at some point in their life. Recovery within the year from neck pain ranges between 33% and 65%, AND relapses are common throughout the life time of the neck pain patient. Generally, neck pain is more common in women, higher in high-income countries, and higher in urban regions. The greatest risk of developing neck pain occurs between 35 and 49 years of age. Since neck pain, very similar to low back pain, is very common and likely to recur over and over again, the question is, what is the best course of action regarding treatment?
A recent study on neck pain patients compared the effectiveness of manual therapy performed by a chiropractor, physical therapy performed by a physical therapist (PT), and medical care performed by medical physician (MD). The success rate determined at the seventh week was TWO TIMES BETTER for the manual therapy/chiropractic group (68.3%) compared to the medical care group. Those receiving manual therapy also had fewer absences from work compared to both the medical and PT treated groups. Lastly, both the manual therapy and PT groups used less pain relief medication compared to the medically treated group. Another study looked at the multiple approaches that chiropractors use for treating patients with neck pain to determine the “best” approach a chiropractor can use. They reported 94% had improvement or less neck pain after just one treatment when the mid-back (thoracic spine) was also adjusted. Similarly, after receiving two treatments over a one week time frame, the group receiving midback adjustments (vs. the group who did not) reported lower pain and disability scores. A similar study concluded that the best results occurred when the neck, upper back/lower neck, and mid-back were adjusted. This group, when compared to neck adjustments alone, reported greater reductions in disability scores. Thus, having the cervical spine, upper back, and mid-back all adjusted appears to yield quicker, more satisfying results than neck adjustments alone.
What about the role of exercise in the management of neck pain patients? In November 2012, a systematic review of manual therapies for nonspecific neck pain reported that the addition of neck exercises to a treatment plan provided more benefits than spinal manipulation alone. Similarly, in September 2012 (The Annals of Internal Medicine), chiropractic adjustments were compared against exercise and pain medication treatment groups involving 272 patients tracked over a one-year time frame after a 12-week treatment. Both the chiropractic and exercise groups experienced the most significant pain reduction when compared to the medication treated group with more than double the likelihood of complete pain relief. The chiropractic and exercise groups also had the best short and long term results, but ONLY the chiropractic group found the benefits to last a year or more. The authors (Bronfort, et. al) reported the success of chiropractic treatment stems from its ability to address the CAUSE of the problem rather than simply addressing the symptoms!
We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

RECOMMIT, RECHARGE and RELEASE!

   RECOMMIT, RECHARGE and RELEASE
                                   Health Care Benefits of Massage Therapy

     According to the findings of a reader survey published in the September issue of CONSUMER REPORTS where three out of four adults reported using some form of alternative therapy for general health; chiropractic, deep tissue massage, yoga and Pilates dominated the lists of helpful alternative treatments for conditions such as back pain, neck pain and osteoarthritis.

   Not surprisingly to us at LEFT HAND BACK AND BODY, the survey respondents indicated yoga, deep tissue massage and Pilates rated THE SAME as prescription medications for help with back pain.  And some of the respondents initially looked to complementary and alternative therapies upon the suggestion of their physicians!

  What this means for you is that as we continue to explore the benefits of complementary and alternative therapies such as massage therapy, don't be afraid to speak with your physician about how these options might fit into your overall wellness program. Remember also, that there is an "inner physician" or intuition that lies within you that will guide you to explore possibilities for your healing and well being.  This inner guide will activate and give you guidance if you simply open to the dynamic that our health directives and decisions are invariably in our own hands. Take some time to gather information on your own.  There are quite a few resources out there that can help you better understand the research being done on the benefits of massage therapy as well as the different techniques and modalities your massage therapist might use.

   Additionally, talk to your massage therapist openly and honestly about the benefits you want to receive from massage therapy, making sure you get all your questions answered and fully understand what you can expect.

   If you have been away from massage for a while or never had a massage, consider starting or recommitting to regular treatments with a trusted bodyworker.  This will likely recharge you and bring awareness and aliveness to your body and mind and hopefully, with time and effort, release some of those clinging old pains, strains and issues and bring you back to wholeness.  The Doctor ordered it.

In Health, Annette Bloom, RMT, NCBTMB



resource: massage therapy journal, winter 2011

How Yoga Can Help Avoid and Reduce Back Pain

Many of the postures in yoga gently strengthen the muscles in the back, as well as the abdominal muscles. Back and abdominal muscles are essential for maintaining proper upright posture and movement. When these muscles are strong, back pain can be greatly reduced or avoided. Yoga also increases blood flow, allowing nutrients to flow in, toxins to flow out, and overall nourishment of the muscles and soft tissues in the lower back.
The postures below help to decrease the stress placed on the low back by both lengthening and strengthening:

http://www.yogajournal.com/poses/491 Downward Facing Dog
http://www.yogajournal.com/poses/2466    Big Toe Pose - bend knees as much as you need to - lengthens hamstrings
http://www.yogajournal.com/poses/472   Bridge Pose to open hip flexors and lengthen the front side of the body
Yoga Journal Magazine

Juli Dabiero Clark, LeftHand Back and Body
Yoga Lover!

Gluten and you

What is gluten?

Gluten (from Latin gluten, "glue") is a protein composite found in foods processed from wheat and related grain species, including barley and rye.  Other grains, like oat and spelt, as well as processed foods can contain gluten as well without being labeled as such. Gluten gives elasticity to dough, helping it rise and keep its shape and often gives the final product a chewy texture.  these same properties are what interfere with the breakdown and absorption of other nutrients. The undigested gluten can trigger your immune system and affect the intestines, which in turn can cause abdominal pain, diarrhea, constipation, and other systems that are gastrointestinal related including headaches, fatigue and anxiety.

Gluten Intolerance vs. Celiac Disease

Celiac Disease (CD) is an autoimmune condition affecting children and adults. When people with CD eat foods that contain gluten, it creates an immune-mediated toxic reaction that causes damage to the small intestine and does not allow food to be properly absorbed. Even small amounts of gluten in foods can affect those with CD and cause health problems. Damage can occur to the small bowel even when there are no symptoms present. Celiac disease affects about 1 in 133 people, or close to 1% of the population. However, few people - some estimates are as few as 5% of the total - know they have the condition. 

Gluten sensitivity, also known as non-celiac gluten sensitivity or sometimes gluten intolerance, has been recently recognized as a stand-alone condition by the medical community.  Many believe that gluten sensitivity involves a different immune system reaction than celiac disease. A team of researchers, led by Dr. Alessio Fasano, hypothesizes that a person with gluten sensitivity experiences a direct reaction to gluten - i.e., your body views the protein as an invader and fights it with inflammation both inside and outside your digestive tract.

Certain criteria need to be met before gluten sensitivity can be confirmed. The spectrum of conditions that arise with gluten sensitivity is rather broad and includes everything from energy to brain function. Daniel Leffler, M.D., a gastroenterologist and assistant professor of medicine at Harvard Medical School states that "Gluten is fairly indigestible in all people." He also estimates that half of the 60 million people in the U.S. who suffer from irritable bowel syndrome are probably sensitive to gluten.

Will a gluten-free diet work for you?

If you have had positive blood tests for Celiac confirmed by a biopsy of the small intestine, then a lifetime commitment to a gluten free diet is right for you.  It is important to realize that the blood tests can only be positive if your diet contains gluten.  If you get tested after living gluten free for some time, there will no antibodies to gluten in the blood, and the test will not be accurate.

If you think you might have gluten sensitivity, you may want to try cutting gluten out of the diet for two weeks and see how you feel.  If you choose to do this, it's good to know where gluten can be hidden in your diet.   Some "hidden" sources of gluten include hydrolyzed vegetable protein, natural flavoring, malts and starches.  Naturally gluten free products include brown ride, quinoa and buckwheat.   When eating gluten-free you need to be careful that you're replacing the gluten-containing foods with healthy choices, like vegetables and other whole foods. If you instead go for gluten-free processed foods, like gluten-free cookies, pasta and breads that are now commercially available, there's a good chance that you will actually gain weight and develop malnutrition. 

If a two week trial is successful in reducing your symptoms, than living gluten free may be right for you.  Consulting with a nutritional expert is the correct place to start.  A comprehensive blood allergy analysis like the ALCAT test (www.alcat.com) will define your state of health and allow an expert to advise you on what food choices are best for your health.  Don't hesitate.  Call us today to schedule your appointment.

Osteoporosis

 As we age our bodies break down.  It's inevitable, and we cannot prevent it.  However, we can effect the rate at which it occurs.  

Osteoporosis occurs when the cells that break down down bone (osteoclasts) work harder than the cells that build bone (osteoblasts).  When this occurs, bone density decreases and the amount of flexible collagen in bone tissue decreases.  The end result is thin, brittle bones.  Not very appealing.  Fortunately, ample research has been done to investigate what speeds osteoclastic cell activity, and what slows it down.  Additional research has also been done on what types of situations build bone faster. 

Poor lifestyle choices can accelerate the process of osteoporosis.  Known factors include:

• Smoking
• an acidic diet (one high in grains and animal protein)
• sedentary living
• excess alcohol intake

Choices known to prevent osteoporosis include:

• regular exercise (especially weight training)
• vegetable and fruit intake (promoting an alkaline diet)
• adequate vitamin D status
• Adequate magnesium levels (400-1000 mg/day)

If you were reading the above bullet points and thought these activities are good for the prevention of just about any disease process we know of, you are right!

It's also important to remember that antacids (both prescription and over the counter) and soda will leach minerals from your bones as well. 

Until next time, get your exercise and eat those fruits and veggies- your health depends on it.