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.

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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

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.

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Headaches, its a pain in the neck

Great article on headaches and conservative care of them:

One of the most common ailments encountered by doctors is headache. More than 40 million people in this country suffer from severe headaches, according to the Center for Disease Control, and the number is increasing steadily. The majority of these people are women between the ages of 18 and 45 years, but many men also are affected. Unfortunately, many headaches are misdiagnosed and people continue to suffer, often becoming reliant on various medications to function in everyday life.

One of the most common of these headaches is called the cervicogenic headache. The term cervicogenic simply means that the headache is caused by the cervical spine (the seven bones that make up the neck). These headaches are typically more severe on one side of the head than the other and can cause pain at the base of the head, the temples and behind the eyes. They can last from hours to weeks and often are accompanied by pain and stiffness of the neck or shoulders.

Common daily activities such as driving, reading, gardening, sports, watching television, sleeping and even everyday stress can all contribute to the wear and tear on the joints of the neck. When these joints stop working properly they can become a source of constant irritation to the nerves and lead to pain.

Research into cervicogenic headaches has been gaining a lot of steam in recent years, which is good news for sufferers. Only 10 years ago, the idea that headaches could be caused by the neck was a foreign concept. The cervical spine (neck) is now thought to be one of the most common causes of headache. The real transition in thinking occurred in 1995 when a group of medical doctors and researchers at Syracuse University established the neck as the cause of a significant number of headaches. According to Peter Rothbart, M.D. and president of the World Cervicogenic Headache Society:
“We couldn’t believe it at first. We’ve been able to put together a scientific
explanation for how neck structure causes headaches — not all headaches, but a significant number of them. It’s true that chiropractors have been saying this for years.”

It’s interesting that many of the patients I see who suffer from these headaches come to my office for other reasons. Neck pain, back pain, numbness or tingling in the arms or fingers, and pain in the shoulders or between the shoulder blades are among the most common. Only through questioning the patient does it come to light that they’re also suffering from chronic headaches; headaches they believe are migraines and thus
totally unrelated to their other symptoms. These headaches can show up years after an auto accident or fall, or may be the result of years of activity such as sports, physical labor, or daily wear and tear. As their headaches continue, people begin to sleep poorly, feel tired and moody, and lack
energy. Overuse of headache medications can further complicate the problem by producing more severe headaches called “rebound headaches.”


Chiropractors have been helping patients successfully with headaches for decades now. Not all headaches are cervicogenic headaches, but many are. In most cases, with reduction of headache comes better sleep, increased energy, a better sense of health and well being, and a return to normal activity. Perhaps most important, people become less reliant on medications and are less likely to be subject to the serious side effects that come with them. A healthy diet, exercise, and good posture can go a long way in preventing their return.

– (Originally published in the Puget Sound Consumer, June 2005)

If this interested you visit our website at http://www.gechiropractic.com