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Source Chiropractic Care Information The Foundation for Chiropractic Progress, a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, points to the role of the team Doctors of Chiropractic (DCs) in optimizing functionality, endurance and overall conditioning. Recent Report Highlights Growing Dangers of Anti-Inflammatory MedicationsSOURCE: Dynamic Chiropractic ~ January 29, 2012 By James P. Meschino, DC, MS In the Sept. 27, 2011 posting of the Biomedical Central Journal: Family Practice, R.J. Adams and colleagues commented on concerns raised by the common prescribing of nonsteroidal anti-inflammatory medications, particularly with respect to their important and sometimes fatal adverse side effects. They state, “Non-steroidal anti-inflammation drugs (NSAIDs) are one of the most common causes of reported serious adverse reactions to drugs, with those involving the upper gastrointestinal tract (GIT), the cardiovascular system and the kidneys being the most common. Much of the focus on NSAID adverse effects has been on GIT consequences, with good reason. A U.S. study found the rate of deaths from NSAID-related GIT adverse effects is higher than that found from cervical cancer, asthma or malignant melanoma.” [1] They also point out that frequent use of NSAIDs increases risk for high blood pressure, chronic heart failure, as well as serious cardiovascular events (with certain NSAIDs). Studies show that the risk of suffering these adverse side effects is increasing among the elderly and those with co-morbidities. The researchers cite recent evidence suggesting that the burden of illness resulting from NSAID-related chronic heart failure may exceed that resulting from GIT damage. [1] Adams, et al., also cite evidence from a recent Danish population study, which suggests increased cardiovascular mortality among people without a prior history of heart disease, but who frequently use NSAIDs. This seems to be particularly true for diclofenac and ibuprofen. However, the baseline cardiovascular risk of people in this study was not reported. The researchers also note that NSAIDs promote the rapid deterioration of renal function. As such, national medical guidelines recommend avoidance of nephrotoxic drugs, including NSAIDs, in people with chronic kidney disease. [1] Acetaminophen It’s not only NSAID medications, such as drugs containing aspirin, ibuprofen, indomethacin, diclofenac, COX-2 inhibitors, that raise concerns regarding frequent and significant side effects, but also for acetaminophen-containing medications. The National Kidney & Urologic Diseases Information Clearinghouse (a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) posted the following precautionary notes about acetaminophen on its Web site:
Continue reading … As has been (not so) widely reported, the National Advisory Committee on Institutional Quality and Integrity (NACIQI) of the US Department of Education met on December 14, 2011 to consider the Council on Chiropractic Education’s petition for renewal of recognition. The process of continuing the recognition of an existing agency is generally unremarkable, often requiring only 15 minutes or so of discussion. This proceeding involving CCE was anything but routine, with four hours of public comments, agency responses, and deliberations. In the end the Department of Education staff identified over 40 compliance issues that the CCE needs to address within the next year. These areas of deficiency exceeded the norm for re-accreditation violations. Chairman Wickes referred to the quantity of citations as “an embarrassing number.” The CCE expects an official letter from NACIQI approximately 90 days from the hearing date and they expect to be granted a maximum of 12 months from the date of this document to address the identified deficiencies. The Council predicts a deadline of March 2013 to complete a compliance report to NACIQI’s committee liaison.
Recently Updated Reference Guide to Dr. Richard C. Schafer’s Materials
These learned articles by Dr. Schafer can also be found again easily by selecting the EDUCATION Category, on the right-hand side of this page, just below Recent Comments. We hope you will find them of interest. Our thanks to ACAPress for access to these materials! Cervical Spine TraumaWe would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress. CHAPTER 4: CERVICAL SPINE TRAUMA The cervical spine provides musculoskeletal stability and supports for the cranium, and a flexible and protective column for movement, balance adaptation, and housing of the spinal cord and vertebral artery. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region. BACKGROUND Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders. COMMON INJURIES AND DISORDERS OF THE CERVICAL SPINE Cervical spine injuries can be classified as (1) mild (eg, contusions, strains); Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerve as they exit with the C2—C4 spinal nerves. The C1 and C2 nerves are especially vulnerable because they do not have the protection of an IVF. Radicular symptoms are rarely evident unless an IVD protrusion or herniation is present. PREVALENCE Because of its great mobility and relatively small structures, the cervical spine is the most frequent site of severe spinal nerve injury and subluxations. A large variety of cervical contusions, Grade 1—3 strains and sprains, subluxations, disc syndromes, dislocations, and fractures will be seen as the result of trauma. The most vulnerable segments to injury are the axis and C5—C6 according to accident statistics. Surprisingly, the atlas is the least involved of all cervical vertebrae. In terms of segmental structure, the vertebral arch (50%), vertebral body (30%), and IVD (30%) are most commonly involved in severe cervical trauma. While the anterior ligaments are only involved in 2% of injuries, the posterior ligaments are involved in 16% of injuries. EMERGENCY CARE In the emergency-care situation, the patient with spinal cord injury must be treated as if the spinal column were fractured, even when there is no external evidence. Immediate and obvious symptom of spinal cord injury parallel those of fractures of the spinal column. The establishment of an adequate airway takes priority over all other concerns except for spurting hemorrhage.
Continue reading … DCs as Leaders in Health and Wellness: Part I: Utilizing the Practice-Based Research Network to Show Evidence of Chiropractic’s EfficacySOURCE: JACA Online By Jay S. Greenstein, DC
As national health care reform takes hold, health care provider groups are staking claim to their slice of the health care pie. In fact, even in our own profession, there is an ongoing debate as to the role doctors of chiropractic will play. Should we be primary care physicians in the medical home (see www.foundation4cp.com/files/cp-medicalhome.Pdf) and/or accountable care organizations (ACO)? Should we alter our scope of practice to include prescription rights? Should we focus primarily on the spine? While the debate rages on the aforementioned questions, I personally believe that the profession can rally around an even more important concept: Chiropractic must be the leading profession in health and wellness. We can be the cultural authority on this topic regardless of the answers to the questions above. In fact, most of us already perceive ourselves as health and wellness providers. But what does the evidence suggest? The evidence for Ds improving the overall health of our patients is paltry compared with the evidence supporting chiropractic for low-back pain. When was the last time you saw an article in a peer-reviewed journal that said, “Doctor of chiropractic services improve overall health metrics in patients compared to medical doctors”? Anecdotally, we see this in our practices every day. Sharing stories with colleagues about how we helped our patients not only heal from their back pain but also become truly healthier is a daily occurrence. We must now turn those stories into evidence. Our profession needs evidence based on the rest of the world’s standards of what constitutes high quality research. That’s where the practice-based research network (PBRN) comes in. Practice-Based Research Network The PBRN, according to the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), is “a group of ambulatory practices devoted principally to the primary care of patients, and affiliated in their mission to investigate questions related to community-based practice and to improve the quality of primary care.” Fortunately, the chiropractic profession has Cheryl Hawk, DC, PhD, a highly- regarded researcher at Logan College of Chiropractic, who, along with researchers at Parker University and Texas Chiropractic College, has built a new PBRN for chiropractic. This PBRN is named ICON, the Integrated Chiropractic Outcomes Network. There is a great need for this initiative, as well as a great need for every DC in the country to participate in this practice-based research initiative. I recently had the opportunity to sit down with Dr. Hawk to ask her about ICON.
Continue reading … ICA Files Suit in New Mexico Court of Appeals Seeking A Stay on Illegal State Chiropractic Board ActionsActing on behalf of concerned members in New Mexico and out of concern for the integrity and credibility of the chiropractic profession at large, on December 21, 2011 the International Chiropractors Association (ICA) filed an extensive memorandum in support of a motion to stay what is being held to be illegal actions on the part of that state’s Board of Chiropractic Examiners. In its memorandum of explanation, ICA’s attorneys argued that it was important for the court to carefully consider the urgent issues of the letter of the law and the protection of both the public and chiropractic practitioners and prevent the “New Mexico Board of Chiropractic Examiners from implementing its new rule establishing an advanced practice formulary to include dangerous drugs and drugs to be administered by injection…and implementing its new rules establishing a certain course of training to certify advanced practice chiropractic physicians to administer and prescribe dangerous drugs and drugs to be administered by injection” because such actions were outside their authority under the law. On August 30, 2011, at an official rulemaking hearing and meeting, the New Mexico Chiropractic Board adopted new rules to greatly expand the chiropractic formulary to include certain dangerous drugs and drugs to be administered by injection that had not been approved by either the New Mexico Medical or Pharmacy Boards as specifically required by state law. At that same hearing, lawyers representing the State of New Mexico were very clear in their advice that the Board was acting outside their authority and should not proceed. The Chiropractic Board ignored those admonitions and acted to adopt a new formulary anyway. ICA representatives were present at both the August and December Board meetings and, in concert with New Mexico DCs, urged the Board to act only within the rules established by statute but to no avail. At their meeting of December 13, 2011, the New Mexico Chiropractic Board denied all requests to stay the implementation of the new rules pending appeal. ICA received official documentation of the New Mexico Chiropractic Board’s official denial of a request to stay the controversial rules on January 5, 2012. Having exhausted all administrative remedies, ICA is seeking the protection of the courts in the face of the Board’s questionable actions.
Continue reading … The Relationships Between Measures of Stature Recovery, Muscle Activity and Psychological Factors in Patients with Chronic Low Back PainSOURCE: Manual Therapy 2012 (Feb); 17 (1): 27-33 ~ FULL TEXT BY: Lewis S, Holmes P, Woby S, Hindle J, Fowler N. Institute for Performance Research, Manchester Metropolitan University, Crewe CW1 5DU, United Kingdom. ABSTRACT: Individuals with low back pain (LBP) often exhibit elevated paraspinal muscle activity compared to asymptomatic controls during static postures such as standing. This hyperactivity has been associated with a delayed rate of stature recovery in individuals with mild LBP. This study aimed to explore this association further in a more clinically relevant population of NHS patients with LBP and to investigate if relationships exist with a number of psychological factors. Forty seven patients were recruited from waiting lists for physiotherapist-led rehabilitation programmes. Paraspinal muscle activity while standing was assessed via surface electromyogram (EMG) and stature recovery over a 40-min unloading period was measured on a precision stadiometer. Self-report of pain, disability, anxiety, depression, pain-related anxiety, fear of movement, self-efficacy and catastrophising were recorded. Correlations were found between muscle activity and both pain (r=0.48) and disability (r=0.43). Muscle activity was also correlated with self-efficacy (r=-0.45), depression (r=0.33), anxiety (r=0.31), pain-related anxiety (r=0.29) and catastrophising (r=0.29) and was a mediator between self-efficacy and pain. Pain was a mediator in the relationship between muscle activity and disability. Stature recovery was not found to be related to pain, disability, muscle activity or any of the psychological factors. The findings confirm the importance of muscle activity within LBP, in particular as a pathway by which psychological factors may impact on clinical outcome. The mediating role of muscle activity between psychological factors and pain suggests that interventions that are able to reduce muscle tension may be of particular benefit to patients demonstrating such characteristics, which may help in the targeting of treatment for LBP. From the FULL TEXT Article Discussion: In line with previous research, there was a trend for patients with LBP to have higher muscle activity and delayed stature recovery compared to asymptomatic individuals, although this was not significant when comparing to a matched control group, and the effect size of 0.42 for the comparison of muscle activity (0.71 for the comparison with the total, unmatched, patient group) was less than the average effect size of 1.14 during standing reported in a recent meta-analysis of 20 studies (Geisser et al., 2005). The patient group also scored significantly higher on anxiety and depression than the asymptomatic individuals.
Continue reading … For Neck Pain, Chiropractic and Exercise Are Better Than DrugsSOURCE: The New York Times ~ 1-03-12 By ANAHAD O’CONNOR
The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best. But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics. “These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.” Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.
Continue reading … Stabilizing The Pelvis, Using the Modified Kemps and Straight Leg Raise Tests And PIRDr. Leonard Faye reminds us in Chapter 6 of Schafer’s text “Motion Palpation” that: The picture on the left is the best picture I have found that displays the Modified Thomas Test. This test is is a very effective way to assess the length of 2 different muscles. When the patient holds their knee to their chest, the following 2 things should become immediately apparent:
If the psoas is shortened, it pulls the thigh into (some degree of) flexion, so the thigh cannot fully extend. This shortens your gait. Recalling that the origin of the psoas includes the lower thoracic vertebra, the lumbar segments I-IV, and the neighboring intervertebral discs, you can see why shortness would destabilize the lumbar and pelvic joints. Also… if the psoas is in contraction, the gluts may become inhibited by reciprocal inhibition. If the quadriceps are shortened, it draws the leg into extension. Because portions of the quads originate on the pelvis, a shortened quads also distorts normal pelvic motion.
Continue reading … Source NY Times Higher blood levels of omega-3 fatty acids, vitamin B, vitamin C, vitamin D and vitamin E are associated with better mental functioning in the elderly, a new study has found.Researchers measured blood levels of these nutrients in 104 men and women, whose average age was 87. The scientists also performed brain scans to determine brain volume and administered six commonly used tests of mental functioning. The study is in the Jan. 24 issue of Neurology. After controlling for age, sex, blood pressure, body mass index and other factors, the researchers found that people with the highest blood levels of the four vitamins scored higher on the cognitive tests and had larger brain volume than those with the lowest levels. Omega-3 levels were linked to better cognitive functioning and to healthier blood vessels in the brain, but not to higher brain volume, which suggests that these beneficial fats may improve cognition by a different means. Higher blood levels of trans fats, on the other hand, were significantly associated with impaired mental ability and smaller brain volume. The lead author, Gene L. Bowman, a researcher in neurology at Oregon Health and Science University, said that the study could not determine whether taking supplements of these nutrients would decrease the risk for dementia. But he added: “What’s the harm in eating healthier? Fish, fruits, vegetables all have these nutrients, and staying away from trans fats is one key thing you can do.” Source CNN NEW YORK (CNNMoney) — Doctors in America are harboring an embarrassing secret: Many of them are going broke.This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists. Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource. “A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances. Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame. Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. “And we still barely made payroll last paycheck,” he said. “Many of us are also skimping on our own pay.” Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. “Our total revenue was down about 9% last year compared to 2010,” he said.
Continue reading … Brain Impact: Concussions, Chiropractic and New LawsSOURCE: Dynamic Chiropractic
By Robert “Skip” George, DC, CCSP, CSCS On Oct. 23, 2011, San Diego Chargers offensive guard Kris Dielman suffered a concussion during a football game against the New York Jets with 12:31 left to play. He landed hard on the ground after a wicked collision with a Jets linebacker, then got up, wobbled and went back to playing the rest of the game, taking several more hits to the head. Neither the Chargers training staff nor the NFL referees recognized how serious his head injury was as he “waved off” his sideline training staff to return to the huddle. On the flight home to San Diego after the game, Dielman suffered a “grand mal” seizure and will most likely not play for the rest of the season. Magnitude of the Problem
Concussions are getting much-needed attention in the press, especially given the short- and long-term cognitive loss, early-onset dementia, physical disability and even death resulting from traumatic brain injury (TBI). Chronic traumatic encephalopathy is a chronic, degenerative neurologic disease linked to repetitive head trauma and is known as an invisible killer that can make a 35-year-old brain look more like 80 years old. There are 250,000 concussions annually in football alone. The prevalence in high-school and college athletics is a major concern, especially considering how big, fast and strong high-school and college athletes have become, and how their play emulates the professionals. This “evolution” is exacting a terrible toll regarding TBI in not only football, but also soccer, hockey, wrestling, water polo and cheerleading.
Three Purdue University professors tracked 21 football players from Lafayette Jefferson High School in Indiana. For two years they kept a record of every hit in practice and during games. They found that half of the players had neurophysiologic changes from contact. They also discovered that the repetitive hits the players were receiving had a cumulative effect on the brain and resulted in brain wave changes that mimicked concussion, even when the contact did not result in a concussion! Concussion Basics What is a concussion? It can be defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” or “an immediate and transient loss of neuronal function secondary to trauma.” Signs and symptoms include but are not limited to thinking deficits, lack of sustained attention; amnesia; confused mental status; dazed look / vacant stare; slurred or incoherent speech; vomiting; nausea; emotional liability; slow motor or verbal response; memory deficits; poor coordination; dizziness; headache; restlessness; nervous weakness; exhaustion; and irritability.
Continue reading … A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back PainSOURCE: Evid Based Complement Alternat Med [Epub 2011 Nov 24] ~ FULL TEXT Andrea D. Furlan, Fatemeh Yazdi, Alexander Tsertsvadze, * Anita Gross, Maurits Van Tulder, Lina Santaguida, Joel Gagnier, Carlo Ammendolia, Trish Dryden, Steve Doucette, Becky Skidmore, Raymond Daniel, Thomas Ostermann, and Sophia Tsouros Clinical Epidemiology Methods Centre, Ottawa Hospital Research Institute, University of Ottawa Evidence-Based Practice Center, Box 208, Ottawa, ON, Canada K1H 8L6 Background: Back pain is a common problem and a major cause of disability and health care utilization. Purpose: To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources: Records without language restriction from various databases up to February 2010. Data Extraction: The efficacy outcomes of interest were pain intensity and disability. Data Synthesis: Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions: CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments. Introduction: Back pain is a general term that includes neck, thoracic, and lower-back spinal pain. In the majority of cases, the aetiology of back pain is unknown and therefore is considered as “nonspecific back pain”. Back pain is considered “specific” if its aetiology is known (e.g., radiculopathy, discogenic disease). Although back pain is usually self-limited and resolves within a few weeks, approximately 10% of the subjects develop chronic pain, which imposes large burden to the health-care system, absence from work, and lost productivity [1]. In a recent study, the direct costs of back pain related to physician services, medical devices, medications, hospital services, and diagnostic tests were estimated to be US$ 91 billion or US$ 46 per capita [2]. Indirect costs related to employment and household activities were estimated to be between US$ 7 billion and US$ 20 billion, or between US$25 and US$ 71 per capita, respectively [3–5]. One study published in 2007 showed that the 3-month prevalence of back and/or neck pain in USA was 31% (low-back pain: 34 million, neck pain: nine million, both back and neck pain: 19 million) [6].
Continue reading … Chiropractic Management of Post-concussion Headache and Neck Pain In a Young Athlete and Implications For Return-To-PlaySOURCE: Topics in Integrative Health Care 2011, Vol. 2(3) By: Mark T. Pfefer, RN, MS, DC, Stephen R. Cooper, DC, Angela M. Boyazis Objective: Each year there are an estimated 1.6 to 3.8 million sports-related brain injuries; 136,000 of which occur in young athletes in the course of high school sports. The purpose of this article is to discuss the management and outcome of a post-concussive headache and neck pain in a young athlete and implications for return to play. Clinical Features: A 16-year-old male athlete presented to a chiropractic clinic complaining of neck pain and daily headaches from a concussion while playing football 5 weeks previously. Intervention and Outcome: A short course of diversified-type cervical and thoracic manipulation was applied with significant relief after the second treatment and resolution of symptoms after 5 visits performed over 2 weeks. The athlete was able to participate in a graduated return to play. Three months post-SRC the athlete was able to return to full game play symptom free. Conclusion: Chiropractors who see athletes in their practices should be aware of SRC and return to play guidelines. Introduction Recently attention has been focused on sports-related concussions (SRC), in part due to the untimely concussion-related deaths of high school athletes, cognitive problems in professional football players, and head injuries sidelining professional hockey players for extended periods of time. Understanding the signs and symptoms of SRC and appropriate return-to-play recommendations is imperative to the safety of all athletes and young athletes in particular. Each year in the United States, there are an estimated 1.6 to 3.8 million sports-related brain injuries; [1] 136,000 of which occur in young athletes in the course of high school sports. [2] However, these statistics may be grossly underestimated. McCrea and colleagues [3] found over half of a sample of high school football players did not report a head injury, even though it had occurred. One of the reasons for this is a failure of athletes to recognize their injury as significant. Delany and coworkers [4, 5] found that only 18.8% to 23.4% of concussed players in the Canadian Football League, and Canadian university football and soccer players realized they had sustained a concussion. Another factor in the underestimation of SRCs is the reporting of head injuries to untrained personnel, such as coaches or parents, who in turn may fail to recognize a concussion. [3, 6, 7]
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