Musculoskeletal problems (NMS) in children are associated with both physical and psychologic consequences, and they can become barriers for participation in physical activity and sports, resulting in negative consequences for the individual’s health throughout life.

A recent study in Germany involved interviewing children (and their parents) to determine what percentage of them had NMS copmplaints. [1] The results of the study was quite surprising:

• Of the 749 children and adolescents, 622 (83%) had experienced pain during the preceding 3 months

• 30.8% of the children and adolescents stated that the pain had been present for >6 months

The reported complaints were:

• 60.5% had recurrent headaches

• 33.6% complained of limb pain

• 30.2% complained of back pain

This is a serious problem. Insufficient levels of physical activity may lead to muscle weakness and bone fragility, [2] decreased oxygen throughput, decreased arterial size, increased clottability and altered blood lipid levels, metabolic inefficiency, decreased glut transporters, obesity, type 2 diabetes, and immunologic decay. [3]

This is a powerful reason for chiropractors to educate their communities about the benefits of chiropractic care. The most recent edition of JMPT reports an incidence level for headaches and neck pain of 40% in the children they examined [4], and they found that cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache, as compared to those who did not have it.

The worst finding of this study was that there was a significant difference between the reporting of neck pain between the parents and childs reporting. It seems that of the children who reported pain, only a small fraction of their parents seemed to be aware of it.

You may want to review our Pediatrics Section for more information of value.

I hope you will find these articles of interest.

REFERENCES:

1. Pain among children and adolescents: restrictions in daily living and triggering factors
Pediatrics 2005 (Feb); 115 (2): e152-62

2. Peripheral bone mineral density and different intensities of physical activity in children 6-8 years old: the Copenhagen School Child Intervention study
Calcif Tissue Int 2007 (Jan); 80 (1): 31-8

3. A conceptual framework of frailty: a review
J Gerontol A Biol Sci Med Sci 2002 (May); 57 (5): M283-8

4. Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students
J Manipulative Physiol Ther 2009 (Oct); 32 (8): 625-34

I just read a fascinating article from the January edition of the Journal of the American Board of Family Medicine, as it documents the massive increase in costs for medical management of chronic back pain, while no significant increases in patient outcomes or disability rates have been observed, and increases in post-intervention complications (including death) are on the rise.

Thanks to Dan Murphy, D.C. for emphasizing these points!

If you do, or wish you knew more, we have a variety of nutrition resources that you may find useful:

• Our most extensive resource contains articles, arranged by condition, from the esteemed Alternative Medicine Review.

• Our Nutrition Section begins with the Supplement Section, providing non-solicitous information regarding the benefits of various vitamins, minerals and herbals.

• The Nutrient Depletion Charts reviews the nutrients depleted by a host of prescribed drugs.

I hope you will find these resources of value!

Submitted for your approval is an article written by Joseph M. Flesia, D.C. that is archived on our Chiropractic Subluxation Page. I hope you will find it of interest!

Happy Haloween, everyone!

I just had the pleasure of seeing about 800 children walk past my office this morning on the yearly Haloween Walk, sponsored by our business association.

Besides goodies for the kids, we have handouts for all the moms about the benefits of chiropractic.

And that always makes me think about the dangerous side-effects of medicine, also known as iatrogenesis or iatrogenic injury.

Many of these poor little children have been given unnecessary antibiotics.

I hope you will find both these information pages as useful resources in advising your patients who have children.

Here is a post from Dr. Vinay Goyal who heads the Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad.

Here are some H1N1 facts to consider:

The only portals of entry of the HiNi virus are the nostrils and mouth/throat. In a global epidemic of this nature, it’s almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications). This is not a Joke.    Make it a ritual habit…Make it part of your daily routine… DO NOT BE LAZY…!!

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat or bathe).

3. *Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.
 

4. Similar to #3 above, *clean your nostrils at least once every day with warm salt water*. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down the viral population.*

5. *Boost your natural immunity with foods that are rich in Vitamin C. *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.


6.* Drink as much of warm liquids as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm. 

 Thanks to Dynamic Chiropractic for permission to reproduce this article!

By Deborah Pate, DC, DACBR

A few years ago,  I wrote an article (May 22, 2006 issue of Dynamic Chiropractic) reviewing vertebroplasty as a treatment option for painful compression fractures due to osteoporosis.  [1] I felt that as chiropractors, we should be aware of the common medical procedures that are available to treat disorders we generally manage; osteoporotic compression fractures being one such entity.

From the information available at the time, vertebroplasty was considered a reasonable treatment option for painful osteoporotic vertebral compression fractures.

A recent article in the the New England Journal of Medicine has changed my impression of vertebroplasty. The article reported on a multicenter clinical trial evaluating the efficacy of percutaneous vertebroplasty for the treatment of painful osteoporotic vertebral compression fractures. [2] In the study, patients who had one to three painful osteoporotic vertebral compression fractures were randomly assigned to undergo either vertebroplasty or a simulated procedure without cement (the control group). Participants could have up to two spinal levels treated.

Participants were enrolled in the study for one year and were evaluated at entry and at one month and 12 months; and with phone calls at days one, two, three and 14, and months three and six. After month one, crossover from the placebo group to the vertebroplasty group was allowed.

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We 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 is Chapter 13 from RC’s best-selling book:
“The Chiropractic Assistant”

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 the copyright holder.

Chapter 13:   Introduction to Duties of a Clinical Assistant

The scope of practice for doctors of chiropractic is determined locally be existing statutory enactment and judicial determination in the separate states. The same is true for chiropractic assistants: scope of duties and responsibilities are determined locally be existing statutory enactment and judicial determination. The procedures described here are general. They may or may not be applicable in a particular state at this time.

THE ASSISTANT IN A CLINICAL ROLE

Interpersonal Relationships in the Clinical Setting

Interpersonal relationships are defined as interactions taking place between individuals and other individuals and groups. There are two types of interaction—actions and reactions or cause and effect. When these interactions unite individuals and groups into teams whose members mutually support one another to accomplish their goal, good interpersonal relationships are developed. Since the goal of health service is to restore a patient to physical and mental health, good interpersonal relationships among office personnel and between office personnel and patients are essential.

TEAMWORK

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This review, was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.

Executive Summary:

Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.

The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.

High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.

The results of the researchers’ analysis are as follows:

-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.

Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.

The full report can be downloaded here.

We 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 is Chapter 7 from RC’s best-selling book:
“The Chiropractic Assistant”

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 the copyright holder.

Chapter 3:   The Health-Service Role of the Doctor of Chiropractic

This chapter briefly describes the role of the doctor of chiropractic in the health care of the nation. It also introduces the reader to the rationale of clinical diagnostics, therapeutics, rehabilitation, and counseling in the chiropractic approach. Some particular areas of special interest are also described.

DIAGNOSTICS: THE ART OF DECIDING WHAT IS WRONG

The diagnostic process of a patient’s disorder begins with the recording and interpretation of the patient’s medical history. Thus, the initial interview and consultation with the patient is of utmost importance. It will direction the examinations and tests that are to follow. Every measure of observation that will substantially profile the patient is employed and recorded. A systematic and thorough physical examination is conducted using the methods, techniques, and instruments that are standard with all health professions. In addition, the doctor of chiropractic will include a postural and spinal analysis, an innovation in the field of physical diagnosis and examination.

Background

The chiropractic physician uses the standard procedures and instruments of physical and clinical diagnosis, and he is well acquainted with the need for differential diagnosis. Diagnostic radiology, especially as it pertains to the skeletal system, is a primary clinical diagnostic aid in chiropractic and has been since the early 1900s.

In addition, doctors of chiropractic are knowledgeable in the standard and special clinical laboratory procedures and tests usual to modern diagnostic science. Facilities for roentgenography (x-ray), thermography, electrocardiography (ECG or EKG), and electromyography (EMG) are standard among many other technologic advancements. Each accredited chiropractic college has a laboratory licensed to carry on clinical laboratory examinations, including such fields as cytology, chemistry, hematology, serology, bacteriology, and parasitology.

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These articles can be easily found by selecting the EDUCATION Category, on the right-hand side of this page, just below Recent Comments. We hope you will find them as valuable as we do.

We 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 is Chapter 5 from RC’s best-selling book:
“The Management of Pain and Disability: Upper Body Complaints”

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 the copyright holder.

Chapter 5:   HEADACHE

CLINICAL BRIEFING

Headache is one of the most common complaints presented in a chiropractic office. It is not unusual for a few adjustments to correct a problem for which the patient has suffered for years and sought relief from a score of allopaths in vain. Nevertheless, headache is not a simple problem. Its origin may be traumatic, inflammatory, neurologic, psychologic, vascular, endocrine, metabolic, neoplastic, degenerative, deficiency, congenital, allergic, autoimmune, or toxic.

     The Value of a Complete History

A thorough case history is mandatory. The cephalgia may be acute, chronic, transient or recurring. It may be primary or secondary. It may be unilateral, bilateral, or shifting. It may be localized or radiate from one area to another. Its course may be steady, intermittent, or throbbing. The initial site may be frontal, orbital, temporal, facial, vertex, or occipital. Its character may be perceived as a pressure, a tight band, an agonizing stabbing pain, or a dull ache. Its onset may be rapid or gradual. Its physiologic origin may be local, systemic, or be the result of noxious reflexes. In addition, its structural origin may be in the head, face, neck, cervical spine, or one or more structures far from the site of pain. Thus, a disorder in almost any function or tissue of the body may be the primary focus or a contributing factor to the complaint.

Besides the variables described above, the case history should determine duration (see Table 5.1), age of onset, frequency of occurrence, precipitating factors, aggravating factors, modes of relief, prodromata, associated symptoms, past therapy, and family tendency toward this type of headache.

The following associated complaints and findings are pertinent during differentiation:

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We 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 is Chapter 12 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”

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 the copyright holder.

Chapter 12:   THE LUMBAR AND SACRAL AREAS

Introduction

The most common symptom of the lumbar and sacral areas, by far, is pain. In
fact, back pain is one of the most prevalent symptoms in America today, second
only to headache. Its causes may be direct or referred and be the result of dysfunction or disease, either focal or general in nature.

The multiplicity of causative and effected ailments is almost endless. At
times, the cause is readily apparent. At other times, it is a frustrating determination because of the spinal column’s complex structure, weight-bearing chores, and close relationship with the nervous system and cerebrospinal circulation. The confusion can only be relieved through knowledge of the structure, function, and pathophysiology of the body that is producing the symptoms and signs, and an intelligent interpretation of all findings.

Functional Considerations

As in the thoracic spine, the movements of the lumbar spine are flexion, extension, lateral bending, and rotation. Lateral flexion is relatively free in the lumbar region, followed in order of mobility by extension, flexion, and rotation (minimal). The range of lumbar motion is determined by the disc’s resistance to distortion, its thickness (Table 12.1), and the angle and size of the articular surfaces. Most significant to movements in the lumbar spine is the fact that all movements are to some degree three dimensional; ie, when the lumbar spine bends laterally, it tends to also rotate posteriorly on the side of
convexity and assume a hyperlordotic tendency.

TRUNK EXTENSION

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We 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 is Chapter 4 from RC’s best-selling book:
“Chiropractic Physical and Spinal Diagnosis”

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 the copyright older.

Chapter 4:   BASIC MUSCULOSKELETAL CONSIDERATIONS

The skeletal system provides the body framework, shape, articulations, supports, it protects the vital organs, and it furnishes a place for muscle attachment. It provides protection for the internal organs, provides movement when acted upon by muscles, manufactures blood cells, and stores mineral salts. The muscular system moves and propels the body. In order for the skeletal and muscular systems to function properly, the nervous system gives the body awareness of its environment, enables it to react to stimuli from the environment, and allows the body to work as a unit by coordinating its activities.

Inspection, palpation, and mensuration are the three most common techniques used in examination of the musculoskeletal system. As with all systems, a knowledge of anatomy and the pathophysiology involved is essential to make the examination significant.

The-Functional-Skeleton

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We 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 is Chapter 5 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”

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 the copyright holder.

Chapter 5:   NEUROCONCEPTUAL MODELS OF CHIROPRACTIC

by Gary C. Johnson, DC

This chapter offers a review of the highlights of preceding chapters that concern subluxation syndromes and forms a foundation of thought for following chapters.

INTRODUCTION: EXPLANATION OF CONCEPTUAL MODELS

Conceptual models are collections of ideas, principles, facts, philosophy, and experiences setting our attitudes and directing our behavior. Ideas and principles include hypotheses and theories (whether right or wrong) that generate new attitudes and behavior, the spirit of invention, and the accessibility to important facts.

Scientific facts and our philosophical hierarchy of importance (priority) provide selective (choice) groupings of knowledge and thoughts, comfortably placed in support of our experiences. How we perceive what we do, why we do it, why the results, and how the results occur set attitudes and practice activities and change our minds and activities as new concepts are developed and tested.

CLASSIC CONCEPTS OF THE CHIROPRACTIC SUBLUXATION

The structural spinal fault, the associated nerve involvement, and the ensuing functional alterations comprise classic chiropractic subluxation concepts. In contrast, limited concepts of spinal biomechanical faults, modes of possible nerve involvement, and etiologic rationales of functional changes promote narrow viewpoints, disciplines, and therapeutic approaches, as well as foster empiricism and dogma. Awareness of the varied concepts of structural lesions, neuroinsults, and the causes of abnormal functional changes promotes wider perspective for intuitive practices, multifaceted observations, and fewer practices with reliance on empiricism that is dictated by dogmatic frameworks.

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