Is Chiropractic Effective?

Spinal Manipulation

Some people are still skeptical of Chiropractic and wonder if it really works or if its just "all in your head". Below are some great research articles to help show just how much Chiropractic can help all sorts of different problems.

"An Actuarial Analysis of the Impact of Chiropractic Care on the Costs of Medical Care for Patients with Common Spinal Diagnoses" indicates "that spinal patients who seek chiropractic coverage have materially lower health care costs than those who do not. The difference is consistent in all years and in between the two data sets. The difference range from 10% to 23% lower costs for those patients who sought [chiropractic] care." Milliman USA, September, 2009.

"Conclusion: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy." Clinical Rehabilitation, January, 2010.

"...best evidence synthesis suggests that therapies involving manual therapy (manipulation) and exercise are more effective than alternative strategies for patients with neck pain..." Spine, 2008.
Visit Schaffnit Chiropractic

"For chronic spinal pain in general, when compared to acupuncture and traditional medical approaches, chiropractic has generally been shown to be more effective." Journal of Manipulative and Physiologic Therapeutics, 2005.

"Low back pain patients with chiropractic coverage in their insurance plan needed less surgery and fewer x-rays than patients on the same insurance plan without chiropractic coverage." Archives of Internal Medicine, 2004.

Listed under Mayo Clinic's Top 10 Complementary Therapies is spinal manipulation. One of the criteria used at the world-renowned Clinic is"...Does it meet a need that cannot be met by conventional medicine?" Listed under BEST TREATMENTS is "Spinal Manipulation. Practiced by chiropractors,...this hands-on technique adjusts the spine to properly align the vertebrae with muscles, joints and nerves. Standout scientific evidence. At the University of California, Los Angeles, School of Public Health, a study of 681 patients with low back pain showed that chiropractic care was as effective as medical care, including painkilling drugs, in relieving discomfort." Mayo Clinic's Top 10 Complementary Therapies, Mayo Clinic College of Medicine, Amit Sood, M.D., 2008.

Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back

Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back PainThis study was published in The Spine Journal, 2010 October 2.

The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and high-quality, ethical, evidence-based spine care, including basic science and clinical investigations.

This study compared family physician-directed usual care with evidenced-based clinical practice guidelines (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks) on patients with acute low back pain.

BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.

PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.

STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.

PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks' duration. Exclusion criteria included "red flag" conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).

OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.

METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).

CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

Spine J. 2010 Oct 2. [Epub ahead of print]

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Bishop PB, Quon JA, Fisher CG, Dvorak MF.

Dr. Schaffnit's Comments:

This study reaffirms numerous published studies on the effects of chiropractic manipulation for lower back and neck pain. Chiropractic is a safe, effective and superior form of lower back pain management systems. There is no longer an “if it works” factor regarding chiropractic. The research is there, the results have always been there.

Interested in more?

Whiplash

Injury Threshold of Rear-End Collisions


This extension x-ray image
illustrates ligamentous
instability at C5-C6.
The AMA Guides2 attribute
a 25% whole-person
impairment rating to those
who meet loss of motion
segment integrity criteria
in the cervical spine.
Over the last few years, it has become clear from the scientific literature that chronic pain after a rear-end collision is due to injury of the ligaments of the spine.During a rear-end collision, the lower segments of the cervical spine are rapidly moved forward while the upper portion of the spine lags behind. This creates “shear” forces in the lower spine, which can stretch or tear the spinal ligaments.
This ligamentous injury can result in instability of the cervical spine, which in turn can cause chronic pain and a variety of other symptoms.

A new study1 from Yale University expands on our knowledge of these types of injury. The goal of the study was to determine the injury threshold for the spinal ligaments. The researchers used six human cadaver cervical spines for the experiments. On each spine, they measured the range of motion of each vertebral segment before and after each test. By doing so, they were able to determine the amount of ligament stretch that occurred during the test.

The specimens were tested at four different acceleration levels: 3.5, 5, 6.5, and 8 g. These are the acceleration levels that would be found in low speed collisions.

The authors found that the first significant increase in ligamentous stretching occurred during the 5g collision in the C5-C6 spinal segment—the same spinal segment from which most whiplash symptoms seem to originate.

As the acceleration increased to 6.5 and the 8g, the risk of injury spread to other parts of the spine. The authors sum up their findings:
"Biomechanical testing of the [specimens] before and after simulated whiplash demonstrated that the lower cervical spine had the greatest injury potential and the mode of injury was extension. The peak T1 horizontal acceleration of 5 g was determined as the injury threshold acceleration. The first injuries occurred at the C5–C6 level, as indicated by increases in the extension neutral zone. At higher accelerations, the injuries spread to all intervertebral levels of the lower cervical spine from C4–C5 to C7–T1. The extension mode of injury may suggest that the onset of subfailure injuries of the anterior longitudinal ligament and anterior anulus fibers, in addition to facet joint impingement. Clinical evidence supports these injury mechanism hypotheses."

The authors also discuss the chronic nature of such injuries:

"Chronic pain resulting from low-speed collisions may be explained by partial tears of the soft tissues, including anulus fibers, ligaments, and avascular cartilage. Because of poor blood supply, these tissues may not completely heal following injury, resulting in altered cervical spine kinematics that can lead to accelerated degenerative changes and clinical instability."

1.Ito S, Ivancic PC, Panjabi MM, Cunningham BW. Soft-tissue injury threshold during simulated whiplash: a
biomechanical investigation. Spine 2004;29:979-987.
2.American Medical Association. Guides to the Evaluation of Permanent Impairment, 5th Edition, 2000

More info here

Disc Herniation and Radiculopathy

After recently attending a workshop on lumbar radiculopathy by Dr. Mir Ali, M.D., of OAD orthopedics, spinal surgery, I was reminded just how many different treatment options there are to this complex problem. Here is an overview of Disc Herniation and its symptoms.


The disc can be viewed a lot like a jelly donut. It is somewhat circular with an outer area and a center or core (nucleus). When the core bulges into the outer layer it is a bulging disc and can press on sensitive nerve structures. When it breaks into the outer layer (like the dough but with the consistency of crab meat) it is a herniation. Sometimes it breaks totally out of the disc and becomes a free fragment which can be a serious condition causing loss of bowel or bladder function or numbness in the groin (cauda equina syndrome)-usually a surgical emergency.


What Causes a Herniated Disc? The causes are many. Basically, weakness in the outer layer of the discs or the inability of the disc to handle the pressure load of the nucleus causes the fibers to rupture allowing the nuclear material to escape its containment. Lifting improperly, traumatic injuries, coughing, sneezing, and straining activities have all resulted in disc herniations.

What are the Symptoms of a Herniated Disc?

•Pain: pain can be severe in the back and leg(s). If the pain is immediately more severe in the leg, we are concerned about a free fragment (sequestered disc). Pain is usually worse with sitting.
•Radiating sciatic pain (radiculopathy).
•Muscle weakness
•Numbness and Tingling
How are disc injuries diagnosed? An orthopedic and neurological and x-ray examination normally needs to be performed to determine other possible sources (piriformis syndrome, osteoarthritic spurring, etc.). A MRI may be necessary to establish the location and severity of the herniation.

What are my Treatment Options?

•In less severe cases, conservative management works effectively including: spinal manipulation (chiropractic), physical medicine modalities for pain control (interferential current, ice, laser, Massage Therapy), acupuncture, rehabilitation exercises, medications.
•More severe cases may require epidural steroid injections, surgical excision of the herniation, disc replacement or fusion.
•Cauda equina symptoms generally require emergency surgery.

Many other conditions may mimic a disc herniation and are effectively treated non-surgically.

In any case a through evaluation is needed by a competent healthcare professional. If you or anyone you know suffers from disc herniation please call 630-474-9500.

-Dr. Blake Schaffnit , D.C.

NSAID Use Associated With Future Stroke

September 8, 2010 (Stockholm, Sweden) — Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an increased risk of stroke in a Danish population study including only healthy individuals.
Presenting the study at last week's European Society of Cardiology (ESC) 2010 Congress, Dr Gunnar Gislason (Gentofte University Hospital, Hellerup, Denmark) said the results could have "massive public-health implications."
"First we found an increased risk of MI with NSAIDs. Now we are finding the same thing for stroke. This is very serious, as these drugs are very widely used, with many available over the counter," Gislason told heartwire. "We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully."
Cochair of the session at which the study was presented, Dr Robert Califf (Duke Clinical Research Institute, Durham, NC), agreed that the results raised a major public-health issue, especially in the US, where many NSAIDs were available without a prescription.

For the current study, Gislason and colleagues examined the risk of stroke and NSAID use in healthy individuals living in Denmark. He explained to heartwire that information on each individual in the Danish population is kept in various national registries. His team started with the whole population of Denmark aged over 10 years. To select just the healthy individuals, they excluded anyone admitted to the hospital within the past five years or those prescribed chronic medications for more than two years. This left a population of around half a million, who were included in the study. By linking to prescribing registries, the researchers found that 45% of these healthy individuals had received at least one prescription for an NSAID between 1997 and 2005. They then used stroke data from further hospitalization and death registries and estimated the risk of fatal and nonfatal stroke associated with the use of NSAIDs by Cox proportional-hazard models and case-crossover analyses.

Results showed that NSAID use was associated with an increased risk of stroke. This increased risk ranged from about 30% with ibuprofen and naproxen to 86% with diclofenac.


Risk of Stroke With Various Nsaids
NSAID
HR (95% CI) for risk of stroke

Ibuprofen
1.28 (1.14–1.44)

Diclofenac
1.86 (1.58–2.19)

Rofecoxib
1.61 (1.14–2.29)

Celecoxib
1.69 (1.11–2.26)

Naproxen
1.35 (1.01–1.79)


Gislason noted that there was also a dose-relationship found, with the increased risk of stroke reaching 90% (HR 1.90) with doses of ibuprofen over 200 mg and 100% (HR 2.0) with diclofenac doses over 100 mg. He pointed out that the results were particularly striking, given that this study was conducted in healthy individuals.

He conceded that his results could have some confounding but noted that the data were controlled for age, gender, and socioeconomic status and the patient population did not include those with chronic diseases. "We also have to think about the degree of confounding needed to nullify risk. It would have to increase risk four- to fivefold, which is very unlikely," he commented.

He said he did not find the results that surprising in view of the accumulating evidence of increased MI risk with these drugs, adding that the mechanism was probably the same. There have been several hypotheses about the mechanism linking NSAIDs with cardiovascular events, including increased thrombotic effect on platelets, the endothelium, and/or atherosclerotic plaques; increasing blood pressure; and effect on the kidneys and salt retention.

Gislason told heartwire that there is reluctance among the medical profession to limit the prescribing of these drugs. "The problem is that we don't have randomized trials, and it is very hard to change the habits of doctors. They have been using these drugs for decades without thinking about cardiovascular side effects."

He also stressed that the public needs to be protected by not allowing NSAIDs to be bought without a prescription. He has had some success in this regard in Denmark at least, where diclofenac became available over the counter recently, but after some of the MI data came out, Gislason's group campaigned the health authorities, and it has now become a prescription-only drug again. But he noted that many more NSAIDs are available over the counter in the US.

He believes the harmful effects of these agents are relevant to huge numbers of people. "If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."

These results have been partly published in Circulation: Cardiovascular Quality and Outcomes earlier this year [1]. Gislason told heart wire that the novelty of the results presented at the ESC meeting was that "we had further analyzed our data regarding specific stroke and looked at the risk of ischemic stroke, and we confirmed that the risk of ischemic stroke was substantially elevated." He added: "We are in the process of analyzing these data related to time to risk and the effect of duration of treatment on stroke risk."
-By Sue Hughes

References
1. Fosbøl EL, Folke F, Jacobsen S, et al. Cause-specific CV risk associated with NSAIDs among healthy individuals.
Circ Cardiovasc Qual Outcomes 2010; 3:395-405.

Sue Hughes is a journalist for Medscape. She joined theheart.org, part of the WebMD Professional Network, in 2000. She was previously science editor of Scrip World Pharmaceutical News. Graduating in pharmacy from Manchester University, UK, she started her career as a hospital pharmacist before moving as a journalist to a UK pharmacy trade publication. She can be reached at Shughes@webmd.net.

Did You Know?

* 1,000 capsules of Tylenol in a lifetime doubles the risk of end stage renal disease (New England Journal of Medicine, 1994).

* The new estimate for the incidence of autism is 1 in 91 US children (Pediatrics, 2009).

* Chiropractic spinal adjusting has been shown to be better than 5 times more effective than the NSAID's pain drugs Celebrex and Vioxx in the treatment of chronic neck and low back pain (Spine, 2003).

* Taking the correct drug for the correct diagnosis in the correct dose will kill about 106,000 Americans per year, making it the 4th most common cause of death in the US (Journal of American Medical Association, 1998). - It's now higher.

* Nonsteroidal anti-inflammatory drugs for rheumatoid and/or osteoarthritis conservatively cause 16,500 Americans to bleed to death each year, making that the 15th most common cause of death in the US (New England Journal of Medicine).

* In patients suffering from chronic pain subsequent to degenerative spinal disease, 59% can eliminate the need for pain durgs by consuming adequate levels of Omega-3 essential fatty acids (Surgical Neurology, 2006).

* Supplementing with vitamin D3 has the potential to reduce cancer deaths in America by 75% (Ann of Epidemiology, 2009).

* Potentially, the largest exposure of Americans to the neurotoxin mercury is through the consumption of products containing High Fructose Corn Syrup (Environmental Health, 2009).

Medical Massage

Medical massage is defined as a diagnostic and therapeutic treatment that involves stroking and pulling deep connective tissues to release the existing tension and return them to a natural alignment. May be uncomfortable and produce vasodilatation and sweating.
It is primarily the application of specific treatment protocols targeted to the specific problem the patient presents with physician's diagnosis and administered after a thorough assessment by a massage therapist. Until a specific symptom is treated with a specific set of procedures to bring about a specific outcome then massage it is not "medical massage". Medical massage is useful in addressing conditions such as:
Pain associated with bulged or injured spinal disks (medical massage cannot 'fix' the disk, but can help alleviate much of the pain associated with the injury).


Sciatica
Migraines/headaches
Carpal Tunnel
Piriformis Syndrome
Rotator Cuff injuries
Pain associated with pregnancy
Constipation
Range of motion issues
Fibromyalgia
Back and Neck pain
Plantar Fasciitis (involving pain in the foot)
Repetitive use injuries such as those listed and Tennis elbow, Golfer's elbow
TMJ
Pain associated with restricted fascia
Pain associated with postural imbalances
Muscle cramps
Restless Legs Syndrome
Sports injuries
Work Injuries
Auto Injuries
Edema (swelling)
Thoracic Outlet Syndrome (numbness/tingling in hands/arms)
Doctors prescribe medical massage to treat a variety of musculoskeletal problems. Medical massage may be used as part of a physical therapy program to build strength and increase flexibility, and a wide variety of other physical problems.

Find out more at