Keep Your Spine in Shape

Your spine is the backbone of your entire body – literally and figuratively. That means poor spine health can negatively impact you from head to toe. How can you keep your spine in shape? Let’s learn more about this critical anatomical structure and take a look at some of the simple strategies you can employ to ensure a healthy spine and a healthy body.

Exercises (to Do and Not to Do): Since we’re talking shape here, let’s start with a few exercises that help promote spinal health in the form of proper posture – along with a few that promote poor posture and put the spine at risk. First, a strong core supports the spine, whereas a weak core can lead to pain and injury. To build the core, think planks, bent-leg knee raises, stability ball exercises, ab curls, medicine ball slams and other exercises that strengthen the core muscles (remembering to keep your spine protected at all times by avoiding rounding the back / neck). On the other hand, avoid exercises / movements that unduly stress the spine: slumping while sitting and bending forward immediately after sitting come to mind, as do exercises that make you prone to rounding your back (traditional sit-ups, toe-touches, etc.).

Sleep Matters: Your sleep position and the overall quality of your sleep play a big role in spinal health. The ideal position for the spine during sleep places you on your back with a pillow between your legs. As you might imagine, lying on your stomach is the worse position. Your pillow and mattress also matter, so make sure you choose the right ones for you, or your spine will let you know with neck and/or back pain. (Talk to your chiropractor for suggestions.)

healthy spine - Copyright – Stock Photo / Register Mark

Nutrition Essentials: Believe it or not, certain foods promote a healthy spine (and vice versa). For example, adequate water intake is necessary to nourish not only the body’s cells, but also the spinal intervertebral discs, which consist primarily of water at birth. As you might imagine, water helps keep the discs (and thus the spine) from getting stiff and subject to injury.  In addition, an anti-inflammatory diet is key to preventing back pain and other spine problems due to inflammation. Think foods such as omega-3 fish and lean proteins, fresh produce, avocado, olive oil, and various spices while reducing intake of pro-inflammatory foods (most fast foods and processed foods, sugar-laden sweets, etc.).

Chiropractic Care: No conversation about spine health would be complete without mentioning chiropractic, an entire health care profession founded on the principle that a healthy, properly aligned spine has far-reaching effects on the entire body. Research asserts chiropractic’s effectiveness in treating back painneck pain and various other musculoskeletal conditions, and the goal of periodic chiropractic care is to maintain spinal health, optimize the body’s self-healing capacities, and thus prevent pain from returning. If you haven’t been to a chiropractor yet, what are you waiting for? If you’ve visited one, but haven’t returned in awhile, remember: your spine – and your entire body – deserve it.

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Three Reasons to Choose Chiropractic

When you’re suffering low back pain, shoulder pain or any number of similar musculoskeletalconditions, who gets the call: your medical doctor or your doctor of chiropractic? Your choice of health care provider in those situations could make a big difference, and research is continuing to prove it.According to the latest study, chiropractic care is at least as effective as medical care for certain musculoskeletal conditions, while reducing health care costs and leaving patients more satisfied with the results.

The authors of the study, published in theJournal of Manipulative and Physiological Therapeutics (JMPT), went so far as to state that for certain musculoskeletal conditions, visiting an MD first instead of a DC may actually be a mistake:

“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others.”

easy - Copyright – Stock Photo / Register Mark

The study sample included 403 patients who saw medical doctors and 316 patients who saw doctors of chiropractic as the initial health care providers for their spinal, hip or shoulder pain complaint. Four months following care, all patients completed a questionnaire that evaluated pain on that day and four months earlier (11-point scale); satisfaction with care received and the results of that care (5-point scale from “very satisfied” to “very unsatisfied”); and other variables. The researchers evaluated related costs of care by reviewing an insurance claims database.

“Patients initially consulting MDs had significantly less reduction in their numerical pain rating score and were significantly less likely to be satisfied with the care received and the outcome of care.” What’s more average per-patient costs over the four-month period were significantly lower in patients who initially consulted DCs ($368 difference compared to MD care).

JMPT Editor-in-Chief Claire Johnson, DC, MEd, emphasized the importance of the latest findings: “Comparative studies – in other words, research that compares the outcomes between two different providers or modalities – are rare for chiropractic care,” she said. “Thus, this study … is especially important if payers and policy-makers are to better understand the ‘triple aim’ as it relates to chiropractic. Specifically, this study helps us better understand what type of care provides better patient satisfaction, is more cost effective, and improves population health.”

The answer, suggests an increasing body of research, is chiropractic care.

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Pain Pills Don’t Go Away After Back Surgery

We can debate the necessity of spine surgery until the proverbial cows come home, but a few concerning realities are becoming apparent: it’s performed far too frequently and it doesn’t mean your pain will go away. In terms of the latter point, a recent study in the peer-reviewed journal Pain found that patients who took prescription opioid pain meds before undergoing lumbar (lower back) fusion surgery were overwhelmingly likely to continue opioid use long term following surgery.

Among nearly 2,500 adult patients who underwent fusion surgery, almost half used opioids long term (at least four prescriptions filled in seven months) prior to surgery. Among those presurgical users, a whopping 77 percent continued use long term following surgery, while 14 percent continued use on a periodic basis. Only 9 percent discontinued opioid use or used them postsurgically for only a short period of time. Of the 77 percent who continued long-term use, 45 percent actually had their dosage increased following surgery. And to top it all off, 13 percent of patients who did not use opioids before surgery became long-term users after the procedure.

pain relief - Copyright – Stock Photo / Register Mark

So, is spine surgery failing to take away the pain, or is opioid use a hard habit to break? Both probably deserve equal blame. That’s why nondrug, nonsurgical options – such as chiropractic care – for back pain are landing front and center in the health care conversation. If you’re experiencing back pain, schedule a visit with a doctor of chiropractic as your first provider choice. Why? Because research suggests back pain patients who see a chiropractor first are far less likely to undergo spine surgery compared to patients whose first contact is with a spine surgeon. Less chance of surgery, less chance of addictive pain medication; now that’s a win-win for your health.

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A Drug-Free Way to Treat Headaches: Chiropractic Care

More Americans complain about headaches than any other health condition, including back pain; in fact, approximately 45 million Americans say they suffer headaches each year. That’s one in every six people or more than 16 percent of the population. More than 8 million Americans visit their doctor seeking relief for symptoms of headaches each year. Unfortunately, the most popular treatment is over-the-counter pain relievers or prescription medication.

There is some good news when it comes to headaches. There are safe and effective natural solutions available to help reduce or eliminate the symptoms of various headache types. For example, chiropractic treatment is a highly sought-after alternative treatment for the debilitating effects associated with headaches. Let’s learn about that headache you may be suffering from and how chiropractic can help you get rid of it.

Headaches 101

Tension headaches: The most common type of headache is the tension headache. It is estimated that 80-90 percent of the U.S. population suffers from tension headaches at some point in their lives. There are two primary types of tension headaches:

  • Episodic: Headaches appear occasionally, usually less than 15 times per month.
  • Chronic: Headaches occur more than 15 times per month or on a consistent basis.
A Drug-Free Way to Treat Headaches - Copyright – Stock Photo / Register Mark

Tension headaches are intimately connected to abnormal posture, muscular tightness, joint stiffness, and restricted range of motion in the body. To obtain optimum health and function, it is important to remember that everything is connected and everything matters. Dysfunctional patterns of movement and posture affect how much tension and stress your body holds. The body must compensate for these dysfunctional patterns by any means necessary, and it accomplishes this by altering tension points.

Muscles attach to anchor points on bone and act as primary movers and stabilizers for your body. Mover muscles are used get you from point A to point B, such as a getting up out of a chair. Stabilizer muscles control that movement so you don’t fall down while standing up. Abnormal posture and altered tension points on bone anchors puts too much wear and tear on muscles and joints. Your brain and nervous system must compensate for this dysfunction by altering blood flow, muscle movement patterns and breathing. These alterations often lead to tension headaches.

Migraines: The second most common type of headache is the migraine headache. Approximately 16-17 percent of the population complains of migraines. These headaches are far more debilitating than the tension-type headaches. More women than men suffer from migraine headaches, leading researchers to believe there may be a hormonal component to migraines. The majority of migraine sufferers report some sort of trigger that kicks of their headaches (food, drink, smell, etc).

How Chiropractic Can Help

Chiropractic care can help alleviate the symptoms of tension and migraine headaches by improving and restoring normal postural patterns. Chiropractic treatment is aimed at normalizing muscle tension, restoring joint range of motion, and stabilizing the body to reduce abnormal stressors. Optimizing postural control of the head and neck reduces the workload your muscles must apply just to keep your head up during the day. Proper spinal alignment and muscle control helps give the body a fighting chance of avoiding a tension headache.

Proper breathing is essential to relaxation, blood flow, and oxygen supply to the brain and body. Abnormal posture, which can include such dysfunctions as rounded shoulders, neck forward over the shoulders, slouched positions and tightness in the hips from sitting all day, decrease lung capacity. This decreased capacity alters how much you breathe, how often, and from where.

Headache sufferers tend to breathe more from their chest and shoulders as opposed to their diaphragm. This leads to repeated elevation of the shoulders and upper back muscles hundreds of times a day, leading to increased tension in the head and neck. Chiropractic restores function to the spine, ribs, and hips to maximize breathing and good postural control. Better breathing equals better health.

If you’re suffering from headaches and are tired of taking pain-relieving medication day after day, your doctor of chiropractic will work closely with you to determine likely triggers for your headaches and make subtle changes in your activities of daily living to empower you to take back control of your life.


By Perry Nickelston, DC, FMS, SFMA

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Three Reasons to Choose Chiropractic

When you’re suffering low back pain, shoulder pain or any number of similar musculoskeletal conditions, who gets the call: your medical doctor or your doctor of chiropractic? Your choice of health care provider in those situations could make a big difference, and research is continuing to prove it. According to the latest study, chiropractic care is at least as effective as medical care for certain musculoskeletal conditions, while reducing health care costs and leaving patients more satisfied with the results.

The authors of the study, published in the Journal of Manipulative and Physiological Therapeutics (JMPT), went so far as to state that for certain musculoskeletal conditions, visiting an MD first instead of a DC may actually be a mistake:

“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others.”

easy - Copyright – Stock Photo / Register Mark

The study sample included 403 patients who saw medical doctors and 316 patients who saw doctors of chiropractic as the initial health care providers for their spinal, hip or shoulder pain complaint. Four months following care, all patients completed a questionnaire that evaluated pain on that day and four months earlier (11-point scale); satisfaction with care received and the results of that care (5-point scale from “very satisfied” to “very unsatisfied”); and other variables. The researchers evaluated related costs of care by reviewing an insurance claims database.

“Patients initially consulting MDs had significantly less reduction in their numerical pain rating score and were significantly less likely to be satisfied with the care received and the outcome of care.” What’s more average per-patient costs over the four-month period were significantly lower in patients who initially consulted DCs ($368 difference compared to MD care).

JMPT Editor-in-Chief Claire Johnson, DC, MEd, emphasized the importance of the latest findings: “Comparative studies – in other words, research that compares the outcomes between two different providers or modalities – are rare for chiropractic care,” she said. “Thus, this study … is especially important if payers and policy-makers are to better understand the ‘triple aim’ as it relates to chiropractic. Specifically, this study helps us better understand what type of care provides better patient satisfaction, is more cost effective, and improves population health.”

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Pain Pills Don’t Go Away After Back Surgery

We can debate the necessity of spine surgery until the proverbial cows come home, but a few concerning realities are becoming apparent: it’s performed far too frequently and it doesn’t mean your pain will go away. In terms of the latter point, a recent study in the peer-reviewed journal Pain found that patients who took prescription opioid pain meds before undergoing lumbar (lower back) fusion surgery were overwhelmingly likely to continue opioid use long term following surgery.

Among nearly 2,500 adult patients who underwent fusion surgery, almost half used opioids long term (at least four prescriptions filled in seven months) prior to surgery. Among those presurgical users, a whopping 77 percent continued use long term following surgery, while 14 percent continued use on a periodic basis. Only 9 percent discontinued opioid use or used them postsurgically for only a short period of time. Of the 77 percent who continued long-term use, 45 percent actually had their dosage increased following surgery. And to top it all off, 13 percent of patients who did not use opioids before surgery became long-term users after the procedure.

pain relief - Copyright – Stock Photo / Register Mark

So, is spine surgery failing to take away the pain, or is opioid use a hard habit to break? Both probably deserve equal blame. That’s why nondrug, nonsurgical options – such as chiropractic care – for back pain are landing front and center in the health care conversation. If you’re experiencing back pain, schedule a visit with a doctor of chiropractic as your first provider choice. Why? Because research suggests back pain patients who see a chiropractor first are far less likely to undergo spine surgery compared to patients whose first contact is with a spine surgeon. Less chance of surgery, less chance of addictive pain medication; now that’s a win-win for your health.

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Get in Great Shape Without Ever Leaving Your House

Turn off the infomercials, ditch the gym membership and put down the get-fit-quick gadgets; it’s time to get in the best shape of your life the old-fashioned way, right from the comfort of your own home. Believe it or not, some of the best exercises can be accomplished using household “equipment” commonly used for other purposes. Here are four great exercises to get you started:

1. Chair dips: The chair is one of the most versatile pieces of exercise equipment available in your home, which is ironic since it’s primarily used for sitting. In this case, we’re using it to work the triceps – the large muscle group at the rear of the upper arm – while working the abs / core at the same time. To perform chair dips, sit in a chair with sturdy arms. Grasp the arms and slowly raise your buttocks off the chair, straightening your arms as you do so. Then lower yourself back down and repeat. Keys: Keep your back straight; keep your elbows in a fixed position so you are working the triceps exclusively; keep your core tight.

2. Stair chest presses: All it takes is a set of stairs and you can get the top and bottom of your chest – the pectoral muscles – in great shape. You’re actually doing push-ups, but instead of the standard way, you’re using the stairs to incorporate one of two simple variations: hands up (feet on the floor, hands facing up the stairs) or the more challenging hands down (hands on the floor, feet on the stairs). Keys: As with any push-up, keep your head, back and buttocks in a straight line; position your hands just slightly past shoulder width and at chest level, so as to avoid stressing the shoulders. This is particularly important with the reverse (hands down) press.

home exercise - Copyright – Stock Photo / Register Mark

3. Box / table jumps: Any hard surface that can survive your body-weight and won’t be damaged by repeatedly jumping on it will work for this great exercise, a plyometric maneuver that strengthens the legs, buttocks and core. The exercise is simple: Bend your knees, swing your arms slightly, and hop up onto the surface; then hop back down and repeat. You choose the height of the item you’re jumping on. Keys: Pick a stable surface. (A metal bench or short concrete wall will work, as will some step stools, as long as they’re stable / durable); progress gradually and carefully from short-jump heights to larger heights; focus on balance.

4. Laundry Lifts: As any hard-working mom – and yes, the occasional dad – will tell you, housework can be quite a workout. Beyond carrying clothes to and from the laundry room, which can be exercise aplenty, especially if you have to navigate flights of stairs, try a few laundry lifts to work your upper body and shoulders. Raise a laundry-filled basket (preferably with handles) over your head repeatedly, or in front of your face, starting at shoulder level; you can even lie on a bench or other surface and do laundry-basket presses (similar to bench presses) to work your chest. Keys: Whenever lifting weight over your head, go slowly and don’t overload; for shoulder presses, press up without locking out your elbows; for chest presses, lie on a surface that allows your elbows the most room for movement to give your chest the stretch it needs (a bench is best because you can lower the laundry basket all the way to your chest without your elbows hitting the floor).

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Back Surgery: Too Many, Too Costly and Too Ineffective

There’s an 80 percent chance you’ll suffer back pain during your lifetime, for which your medical doctor will likely recommend over-the-counter pain medication or prescription medication to relieve the pain temporarily. Depending on your doctor’s assessment and how you respond, they may even consider you a candidate for spine surgery at some point, an increasingly likely (and dangerous) option.

Then there’s chiropractic, which research and experience show is the safest, most effective option for most cases of back pain. Unfortunately, too many people end up in a medical doctor’s office instead of a chiropractor’s office, which accounts for the rampant use of medications and surgery for back pain, particularly here in the U.S. Here’s why back surgery – and medical management of back pain in general – is too frequent, too costly and too ineffective, and why chiropractic care should be your first option when dealing with back pain.

Too Many, Too Costly

Research suggests that of the 500,000-plus disk surgeries that are performed annually (a significant increase of late), as many as 90 percent are unnecessary and ineffective. Richard Deyo, MD, a professor at Oregon Health and Science University, notes, “It seems implausible that the number of patients with the most complex spinal pathology [has] increased 15-fold in just six years” and mentions one strong motivation includes “financial incentives involving both surgeons and hospitals.”

broken back - Copyright – Stock Photo / Register Mark

A study conducted by Deyo and Cherkin in 1994 compared international rates of back surgeries and discovered that the rate of American surgery is unusually excessive and directly attributed to the supply of spine surgeons: “The rate of back surgery in the United States was at least 40 percent higher than any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per-capita supply of orthopedic and neurosurgeons.”

On the Top 10 list of diseases in America, “back pain” stands at number eight, which according to Forbes.com costs over $40 billion annually for treatment costs alone. Other estimates that include disability, work loss and total indirect costs range between $100 and $200 billion per year. Back pain sent over 3 million people to emergency rooms in 2008 at a cost of $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals.

What accounts for these staggering costs? We know one thing: Doctors and hospitals are making huge profits off the backs (no pun intended) of unsuspecting patients who are not told there may be better and cheaper ways to solve their back pain with chiropractic care or other non-invasive methods. Back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications. Just take a look at these per-surgery costs for various types of back surgeries:

  • Anterior cervical fusion: $44,000
  • Cervical fusion: $19,850
  • Decompression surgery: $24,000
  • Lumbar laminectomy: $18,000
  • Lumbar spinal fusion: $34,500

Dr. Deyo found the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter. When combined with surgical costs, medications, magnetic resonance imaging (MRI), rehabilitation and disability, the average spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion and $112,000 for a cervical fusion.

Fortune 500 companies spend over $500 million a year on avoidable back surgeries for their workers and lose as much as $1.5 billion in indirect costs associated with these procedures in the form of missed work and lost productivity, according to a two-year study by Consumer’s Medical Resource (CMR). The study, “Back Surgery: A Costly Fortune 500 Burden,” found that one out of three workers recommended for back surgery said they avoided an unnecessary procedure after being given independent, high-quality medical research on their diagnosed condition and treatment options. In addition, patients who refused surgery and opted for alternative and less invasive procedures to treat their back pain reported experiencing healthier and more personally satisfying outcomes.

Too Ineffective

Back surgery “has been accused of leaving more tragic human wreckage in its wake than any other operation in history,” according to Gordon Waddell, MD, director of an orthopedic surgical clinic for over 20 years in Glasgow, Scotland. “Low back pain has been a 20th century health care disaster,” said Waddell. “Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

In 2010, researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in the hopes of resolving their low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, only 26 percent of those who had surgery had returned to work, compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and 27 percent required another operation. Permanent disability rates were 11 percent for patients undergoing surgery, compared to only 2 percent for patients who did not undergo surgery. In what might be the most troubling finding, researchers determined there was a 41 percent increase in the use of painkillers, with 76 percent of surgery patients continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.

Surgical Hand with Scalpel - Copyright – Stock Photo / Register Mark

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs do not work, according to the study’s lead author, Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. His study concluded: “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers’ compensation setting is associated with a significant increase in disability, opiate use, prolonged work loss, and poor return-to-work status.”

Commenting on the procedure in general, Dr. Nguyen said, “The outcomes of this procedure for degenerative disc disease and disc herniation make it an unfortunate treatment choice.”

In 1994, the U.S. Public Health Service’s Agency for Health Care Policy and Research (AHCPR) conducted the most thorough investigation into acute low back pain in adults and came to the following conclusion in its Patient Guide: “Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”

In his 2009 article, “Overtreating Chronic Back Pain: Time to Back Off?” Dr. Deyo speaks of the shortcomings of medical spine treatments in the U.S.: “Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction. Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”

Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., agreed with his frustration:

“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate … There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs – there is little evidence that patient outcomes have improved … Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions.”

Chiropractic: The First Option for Back Pain

According to Pran Manga, PhD, a health economist, “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.” He is not alone in his assessment. Numerous international and American studies have shown that for nonspecific back pain, manipulation is heads above all other treatments. In fact, Anthony Rosner, PhD, testifying before the Institute of Medicine, stated: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”

Chiropractic care not only has catapulted to the top of the list for back pain care; chiropractic patients are also extremely positive about their treatments. TRICARE, the health program for military personnel and retirees, evaluated patients’ response to chiropractic care. The enormously high patient satisfaction rates astounded the TRICARE administrators, with scores that ranged from 94.3 percent in the Army. The Air Force tally was also high, with 12 of 19 bases scoring 100 percent; and the Navy also reported ratings in the 90 percent or higher. Even the TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88.54, which was 10 percent “higher than the overall satisfaction with all [health care] providers.”

T.W. Meade, MD, of the Wolfson Institute of Preventive Medicine in London, surveyed patients three years after treatment and found that “significantly more of those patients who were treated by chiropractic expressed satisfaction with their outcome at three years than those treated in hospitals – 84.7 percent vs. 65.5 percent.”

The Treatment of Choice

The truth is now emerging. There is broad agreement internationally that surgery should not generally be considered until there has been a trial of conservative nonsurgical care. Here are a few of the many examples supporting chiropractic’s use as the first-line treatment for back pain:

Dr. Manga conducted two studies in the 1990s and noted, “There should be a shift in policy now to encourage the utilization of chiropractic services for the management of low back pain, given the impressive body of evidence on the effectiveness and comparative cost-effectiveness of these services, and on the high levels of patient satisfaction.”

An editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine in 1998 noted that “spinal manipulation is the treatment of choice”: “The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain … Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.”

William Lauerman, MD, chief of spine surgery and professor of orthopedic surgery at Georgetown University Hospital, stated: “I’m an orthopedic spine surgeon, so I treat all sorts of back problems, and I’m a big believer in chiropractic.”

Dr. Deyo has mentioned chiropractic as a solution: “Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems.”

Dr. Waddell also suggests chiropractic care as a solution: “There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute low back pain.”

And Jo Jordan, PhD, has written that spinal manipulation may be the “lone ray of light” for back pain treatment.

Be Safe, Not Sorry

In 2006, doctors performed at least 60 million surgical procedures of all types; one for every five Americans. No other country does nearly as many operations. Not only are surgeries rampant, but many are being shown to be ineffective and dangerous.

According to Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical care is now the third-leading cause of death in the U.S., causing 225,000 preventable deaths every year as tools to make them safer go unused.

So, what’s the take-home message? Most people experience back pain, and much more often than not, it’s caused by something that doesn’t require extreme intervention, like a tumor, fracture, infection, etc. When back pain strikes, chiropractic is a great first choice, but too many people end up taking medication – or even worse, they end up in a vicious cycle of medical care that eventually can lead to the operating room – for back pain that could have been managed conservatively in the overwhelming majority of cases. That’s something to think about the next time your back hurts.

By J.C. Smith, MA, DC

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A Win-Win With Chiropractic

Imagine low back pain that lasts a few days or a few weeks. That’s the type of pain most people experience when they suffer low back pain, and while it’s not pleasant, it has an end point – a resolution, particularly if a chiropractor gets involved. You’ve probably suffered this type of back pain (acute) before, since 80 percent of people experience back pain at some point in their lives.

Now imagine low back pain that doesn’t seem to go away, lasting 12 weeks or longer, even after the initial injury or cause has been treated. That’s chronic low back pain. Fortunately, a chiropractor can also help chronic LBP and does it without medication, particularly prescription opioids, which account for well over 100 deaths a day due to abuse / misuse (and counting).

pain relief - Copyright – Stock Photo / Register Mark

A study published in The Spine Journal reviewed multiple studies and found spinal manipulation, commonly utilized by doctors of chiropractic, is an effective option for chronic low back pain, reducing pain and disability compared to exercise and other strategies. Another study, this one published in the Journal of Alternative and Complementary Medicine, concluded that LBP patients who received chiropractic care were 55 percent less likely to fill an opioid pain prescription than patients who did not receive chiropractic care.

Chiropractic: good for low back pain and a solution for the opioid epidemic. Now that’s a win-win for patients in pain and the health care system in general.

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What to Do About Whiplash

Whiplash is the most common injury associated with motor vehicle accidents, affecting up to 83 percent of those involved in collisions, and is a common cause of chronic disability.The Quebec Task Force (QTF) on Whiplash Associated Disorders defines whiplash as “bony or soft tissue injuries” resulting “from rear-end or side impact, predominantly in motor vehicle accidents, and from other mishaps” as a result of “an acceleration-deceleration mechanism of energy transfer to the neck.” It is estimated that as many as four per 1,000 people may experience a whiplash-related injury and associated pain syndromes. The overall economic burden of whiplash injury, including medical care, disability and sick leave, is estimated at a staggering $3.9 billion annually in the U.S. alone.

The mechanism of injury suggests that whiplash may occur as a result of hyperextension (excessive backward bending) of the lower cervical spine (neck) in relation to a hyperflexion (excessive forward bending) of the upper cervical vertebrae, producing a force of impact “whipping” through the body. The result is soft-tissue damage, inflammation and muscle spasm.

whiplash skeleton - Copyright – Stock Photo / Register Mark

Whiplash is associated with a wide variety of clinical symptoms including neck pain, neck stiffness, arm pain, jaw pain, headaches and paresthesias (tingling/numbness), problems with memory and concentration, and psychological distress. Symptoms of whiplash may not present until several weeks after the causative incident. Frequently people experience little pain and discomfort in the early stages. However, after several weeks the body begins to manifest symptoms. It is this delayed onset of symptoms and lack of early treatment intervention which may cause the condition to become chronic and debilitating.

Whiplash Prevention

While a whiplash injury may be unavoidable if you’re involved in a crash, there are simple but effective precautions you can take to minimize the risk. As they say, an ounce of prevention is worth a pound of cure.

Head restraint: If more than one person uses a car, it is better to adjust the head restraint for each driver and make sure that it’s positioned according to the convenience of each driver. Not adjusting the head restraint for each driver greatly increases the likelihood of injury. The head restraint must be locked when driving. If the head restraint is not locked, it may move during an accident, taking away protective support when needed most and resulting in substantial injuries to the neck.

Evidence suggests that being the driver increases the chances of head injury by double and also shows that women suffer from whiplash injuries more than men because they tend to sit more upright and closer to the steering wheel. A study by Brian Stemper, PhD, assistant professor of neurosurgery at the Medical College of Wisconsin in Milwaukee, found: “Auto head restraints positioned less than 2.4 inches (6 cm) from the back of the head kept ligament stretch within the physiologic range – meaning that no injury would occur. However, as the restraint distance increased beyond 2.4 inches, the ligaments began to exceed failure thresholds, meaning that whiplash injury was more likely to occur.”

Seat belt: Although the seat belt in and of itself will not prevent whiplash, it does help to prevent your body from lurching completely forward during a car crash, even a low-impact crash. The simple act of buckling up is responsible for approximately a 60 percent reduction in accident fatalities. So buckle up to save your life and protect your neck.Neck exercises: Whiplash affects the neck muscles. The stronger the muscles, the less affected by sudden movement your neck will be. Engage in neck exercises to strengthen the soft tissues of the neck. Exercise won’t prevent whiplash, but it can make you less susceptible to the forcible forward and backward neck jolts. Isometric resistance exercises for the neck are easy to do and highly effective in strengthening the supportive musculature of the neck. Your doctor can provide you with specific neck-strengthening exercises.

Treatment Options

Whiplash injuries are difficult to treat for many reasons. Complex interactions of psychosocial, legal and physical factors make effective treatment highly variable. However, there are many therapeutic options available to help whiplash related injuries. Initial treatment traditionally includes a soft cervical collar to restrict cervical range of motion and prevent further injury. Overall rest and motion restriction may hinder progress in the long run, so it is best to seek out professional help in resolving symptoms. That’s where your chiropractor comes in.

Chiropractic: Chiropractors are the single largest group of practitioners treating whiplash injuries, and they do it well: For example, one study found chiropractors were effective at relieving whiplash pain more than 90 percent of the time. Chiropractic care focuses on relieving soft- tissue spasm, inflammation and pain by restoring proper motion in the spinal column. Due to the force impact of whiplash, the spinal column can misalign and cause pain. By performing manipulation to the spinal column, chiropractic can help restore normal function and movement to the affected areas.

neck adjustment - Copyright – Stock Photo / Register Mark

Depending on their treatment style and your specific case, your chiropractor may decide to utilize additional treatment options in addition to chiropractic, either in their office or via a referral. Here are some of those potential treatments, all with the single goal of relieving your pain and managing your whiplash symptoms in the most effective way possible – and without requiring pain-relief medications, which are perhaps the most common “treatment” option for whiplash sufferers, despite the fact that they provide only short-term relief and may create more problems than solutions in terms of the potential side effects.

Acupuncture: An ancient system of healing developed over thousands of years in Eastern countries such as China, acupuncture is a treatment in which fine needles are applied to specific acupuncture points in order to relieve symptoms of both physical and psychological conditions. Acupuncture has proved to be a particularly effective in relieving the neck pain and other symptoms associated with whiplash injuries. In some cases, acupuncture has helped in the treatment of whiplash patients suffering long-term symptoms where conventional approaches showed little improvement.

Massage Therapy: Massage is one of the most effective therapies for releasing muscle tension and restoring balance to the musculoskeletal system. Massage therapy can help relax the muscles, increase and maintain range of motion, decrease stress and tension, increase circulation, and prevent and break down scar-tissue formation. Ideally, therapy should start as soon as the acute, inflammatory phase is over (about 72 hours after the injury). A massage technique called cross-fiber friction can be used to encourage the body to lay down the connective tissue in the same direction as the originally damaged tissue. This proper alignment causes smaller amounts of the connective tissue to be needed and allows for a fuller range of motion upon recovery.

Physical Therapy: Physical therapy is an effective treatment option for whiplash, especially when combined with other treatments, such as bracing.Physical therapy techniques can help restore proper function and movement of damaged tissues. Physical therapy includes both passive and active treatments. Passive treatments help relax you and your body. They’re called passive because you don’t have to actively participate. You’ll probably start with passive treatments as your body heals and/or adjusts to the pain. But the goal of physical therapy is to get into active treatments. These are therapeutic exercises that strengthen your body so that your spine has better support.

Laser TherapyLaser therapy is a safe, non-invasive and very effective treatment for speeding the healing process of damaged tissue, reducing pain, muscle spasms and inflammation from whiplash injuries of the neck and back. Laser therapy is a bio-stimulator that helps the body heal itself, sending healing photon (light) energy to injured tissue, which in turn creates a series of chemical reactions that accelerate the body’s natural healing mechanisms. Properly administered laser treatments help decrease pain and inflammation, help generate new and healthy cells, improve nerve function, increase the speed, quality and tensile strength of tissue repair, and improve blood circulation to the tissues, all for the treatment of pain.

When it comes to whiplash, be proactive in your prevention strategy and treatment options. Educate yourself about the options available to you and work closely with your health care professional to ensure maximum benefits from therapy. Knowing your options is the foundational key to reaching your goal of getting back to health. Whiplash can be a difficult condition to recover from; however, with your chiropractor in your corner and an array of conservative treatment options at their disposal, you’re in the best of hands.


Recovering From Whiplash: Key Action Steps

If you or someone you know is suffering from whiplash, here are some action steps to take:

  • Schedule an appointment with your chiropractor, who can evaluate the severity of your condition and get you on the road to recovery immediately. Your chiropractor will likely recommend some or all of the following:
  • For at least 2-3 weeks, avoid activities that bring on or worsen your pain and stiffness.
  • Don’t lift or carry anything heavy or participate in sports.
  • Do not sit for long periods of time.
  • Use an orthopedic head support pillow while sleeping.
  • If possible, stay active by taking short walks.
  • If you have pain when you move your head or the pain involves your shoulders or arms, your doctor may recommend a soft neck collar or a natural pain reliever.
neck pain - Copyright – Stock Photo / Register Mark

While recovering and under care, contact your chiropractor if any of the following occurs:

  • Neck pain and stiffness return after they initially went away.
  • Neck pain is so severe that it interferes with your daily activities.
  • The pain spreads to your shoulders or arms.
  • You have numbness, tingling, or weakness in your arms or legs.
  • You have problems with your bladder or bowels.
  • Headaches become severe and do not resolve.

Take the Whiplash Quiz!

While most people are familiar with the term whiplash and generally know that it’s primarily a consequence of motorvehicle accidents, you may be surprised to learn how easily a whiplash injury can occur and how severe the consequences can be. Take this short quiz and then check your answers.Question 1: Most (80 percent) of whiplash injuries occur with a vehicle collision speed (range) of only:

A 1-5 mph
B 6-12 mph
C 10-25 mph
D 15-30 mph

Question 2: According to early human crash testing (conducted at UCLA) that simulated real-world rear-impact collisions, how does the human head respond to a crash compared to the vehicle?

A The volunteer’s head was subjected to 2 1/2 times the acceleration of the vehicle.
B The volunteer’s head was subjected to about 1/2 the acceleration of the vehicle.
C The volunteer’s acceleration was roughly equivalent to stepping off a curb.
D In low-speed collisions (under 8 mph), no acceleration of the human head can be measured.

Question 3: Regarding the outcome of whiplash injuries, which of the following statements is most accurate?

A The vast majority of whiplash injuries resolve in about six weeks.
B The vast majority of whiplash injuries resolve in 6-12 weeks.
C About 25-50 percent of whiplash injuries fail to resolve completely.
D Whiplash injuries rarely resolve completely.

Question 4: Of the following variables, which is considered to be a risk factor for poor outcome in whiplash trauma?

A Female gender.
B Advanced age.
C Nonawareness of impending impact.
D All the above have been shown to be risk factors for poor outcome.

By Dr. Perry Nickelston

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