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Joint Trauma:
Perspectives of a Chiropractic Family Physician
The Chiro.Org Blog
Clinical Monograph 8
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur.
The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.
Table 1. Synovial vs Mechanical Causes of Joint Pain
| Feature |
Synovitic
Lesions |
Mechanical
Lesions |
| Onset |
Symptoms fairly consistent, during use and at rest. |
Symptoms arise chiefly during use |
| Location |
Any joint may be involved. |
Primarily involves weight-bearing joints. |
| Course |
Usually fluctuates. Episodic flares are common. |
Persistently worsening progression. No acute exacerbations. |
| Stiffness |
Prolonged in the morning. |
Little morning stiffness. |
| Anti-inflammatory effect |
Aided by cold and other anti-inflammatory therapies. |
Anti-inflammatory therapy of only minimum value. |
| Major pathologic features |
Negative radiographic signs or diffuse cartilage loss, marginal bony erosions, but no osteophytes. |
Radiographic signs of cartilage loss and osteophyte developments |
Periarticular Lesions
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Lower Back Trauma (Lumbar Spine and Pelvis)
The Chiro.Org Blog
Clinical Monograph 24
By R. C. Schafer, DC, PhD, FICC
Although it may be easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the other parts. We should also keep in mind that an axial kinematic chain of weight-supporting segments extends from the occipital base to the soles of the feet.
Because the number of professional papers concerning the cause and diagnosis of low-back pain is voluminous, emphasis herein is placed on points that the author believes are important but not often emphasized in popular literature.
BACKGROUND
A wide assortment of muscle, tendon, ligament, bone, nerve, and vascular injuries in this area is witnessed during posttrauma care. As with other areas of the body, the first step in the posttrauma examination process is knowing the mechanism of injury if possible. Evaluation can be rapid and accurate with this knowledge.
Low-back disability rapidly demotivates productivity and athletic participation. The mechanism of injury is usually intrinsic rather than extrinsic. The cause can often be through overbending, a heavy steady lift, or a sudden release –all which primarily involve the muscles. IVD disorders are more often, but not exclusively, attributed to extrinsic blows and intrinsic wrenches. An accurate and complete history is invariably necessary to offer the best management and counsel.
Initial Assessment
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The First Domino:
Chiropractic Before Spinal Surgery for Chronic Low Back Pain
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
University of Pittsburgh Medical Center Health Plan mandates conservative care before even considering surgery for chronic Low Back Pain cases.
By Peter W. Crownfield
The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain.
As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”
Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members “understand the pros and cons of surgery and high-tech radiology.” It is the first reported implementation of such a policy by a health care plan.
Putting a Clamp on the Soaring Rates of Spine Surgery
According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, “We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process.”
The update also noted, “Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.”
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Posttraumatic Subluxation-Fixation Implications
Etiology, Effects, and Common Coincidental Factors
The Chiro.Org Blog
Clinical Monograph 5
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
The kinetic aspects of spinal biomechanics are an important consideration in traumatology since the totality of function is essentially the sum of its individual components. However, although reminders are frequently given, the multitude of causes and effects of an articular subluxation complex (spinal or extraspinal) will not be detailed here that is primarily directed to chiropractic clinicians and advanced students who are well acquainted with standard hypotheses. For a detailed description, the reader is referred to Schafer RC: Basic Principles of Chiropractic: The Neuroscience Foundation of Clinical Practice. Arlington, Virginia, American Chiropractic Association,.1990.
Basic Implications
The biomechanical efficiency of any one of the 25 vertebral motor units, from atlas to sacrum, can be described as that condition (individually and collectively) in which each gravitationally dependent segment above is free to seek its normal resting position in relation to its supporting structure below, is free to move efficiently through its normal ranges of motion, and is free to return to its normal resting position after movement. The degree of fixed derangement (subluxation-fixation) of a bony segment within its articular bed and normal range of motion may be an effect in the range of microtrauma to macroscopic damage. Regardless, it is always attended by some degree of mobility dysfunction; neurologic insult; and overstress of the muscles, tendons, and ligaments involved and their respective mechanoreceptors.
Once produced, the lesion becomes a focus of sustained pathologic irritation in which a barrage of impulses streams into the spinal cord where internuncial neurons receive and relay them to motor pathways. The contraction that provoked the subluxation initially is thereby reinforced, thus perpetuating both the subluxation and the pathologic process engendered. Sensory reflex phenomena can also be involved, and they frequently are. The nerve impulse creates a multitude of cellular reactions and responses besides those of even the most intricate, subtle, and variable sensations and motor activities. Once this is appreciated, we must add the complexities of trophic effects, neuroendocrine interrelations, biochemical affinities, proprioceptive buildup, summation increments, facilitation patterns, the input of the ascending and descending reticular activating mechanisms, genetic neurologic diatheses, synaptic overlaps, demoralization and disintegration of synaptic thresholds, the neurologic spread and buildup, reflex instability, predisposition to sensorial aberrations, undue cerebrovisceral or viscerocerebral interactions, psychosomatic overtones, and those many phenomena that science is only beginning to understand or are beyond our present understanding. This underscores that the quality and sometimes quantity of nerve function relates directly or indirectly to practically every bodily function and contributes significantly to the beginning of physiologic dysfunction and the development of pathologic processes.
Structural Imbalance
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  By Frank M. Painter, D.C. in Announcement on May 16th, 2012 at 7:59 pm
Happy 100th Birthday to Studs Terkel
The Chiro.Org Blog
Because I live outside of Chicago, our local national public radio channel played a 2-hour show about Studs on what would have been his 100th birthday.
I knew he was a colorful character, but had no idea he had been blacklisted by McCarthy for supporting Worker’s rights in the 50s, or was involved in the voting rights and school segregation struggles of the 50s and 60s.
Here are some links to amazing troves of Terkel Trivia. Enjoy!
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Shoulder Girdle Trauma
The Chiro.Org Blog
Clinical Monograph 16
By R. C. Schafer, DC, PhD, FICC
The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.
BACKGROUND
Shoulder pain can arise from either local or systemic causes. Jaquet points out that about 95% of all shoulder disorders are due to four conditions: (1) adhesive capsulitis
(2) simple tendinitis,
(3) tendinous perforation and rupture, and
(4) hyperalgesic calcareous tendinitis.
Note that three of these four conditions are tendinous in origin, but tendon inflammation is not as common in the shoulder as it is in the elbow and wrist. However, because all tendons are relatively avascular, all are subject to chronic trauma, microtears, slow repair, and aging degeneration.
As in so many musculoskeletal disorders, thorough investigation of the history of shoulder pain may reveal that trauma did not initiate the first attack or an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides direct injury, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin.
You may also enjoy our page on:
The Shoulder Girdle
Deciphering Shoulder Complaints
Shoulder pain has a high incidence. Cailliet says that it ranks third to low-back and neck pain. Despite its prevalence, posttraumatic shoulder pain can be deceiving. Accurate diagnosis is not an easy task. For example, there may be unavoidable occupational stress in the clinical picture that is aggravating the condition and delaying healing. How should the patient react when a doctor says “avoid overhead work” and the patient makes his living as a painter or pipe fitter of ceiling sprinkler systems? Temporary rest can be provided but not permanent relief from such occupational stress. It may have taken the patient many years of effort to reach his present status. This is not easily put aside. Counsel the patient thoroughly -from his or her viewpoint.
Normal mobility is extensive. The glenohumeral joint alone expresses abduction, adduction, elevation, extension, external rotation, flexion, horizontal abduction, horizontal adduction, and internal rotation. Thus, a thorough knowledge of shoulder kinematics, neurology, angiology, myology, and kinesiology is required for proper treatment to be applied.
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By Frank M. Painter, D.C. in Cervical Spine on May 15th, 2012 at 1:36 pm
Cervical Spine Trauma
The Chiro.Org Blog
Clinical Monograph 22
By R. C. Schafer, DC, PhD, FICC
The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. 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);
(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);
(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and
(4) dangerous (eg, unstable fracture-dislocation, spinal cord or nerve root injury).
Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerves 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 rupture is present.
You may also enjoy our:
Chronic Neck Pain and Chiropractic Page
Prevalence
Because of its great mobility, relatively small structures, and weight-bearing role, the cervical spine is a frequent site of severe spinal nerve injury and subluxation/fixations. 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.
Continue reading …
Soft-Tissue Neck Trauma
The Chiro.Org Blog
Clinical Monograph 15
By R. C. Schafer, DC, PhD, FICC
The mechanical relationship between the head and neck has been crudely compared to a brick attached to a flexible rod. As the structural mass of the head is so much greater than that of the neck, it is no wonder that injuries of the neck are so prevalent. Even the person with a short neck and well-developed neck muscles and ligaments is not free of potential injury.
BACKGROUND
The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, and spinal cord, and as a site for lymph and endocrine glands. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.
Anterior injuries are more common to the head and chest as they project further forward, but a blunt blow from the front on the head or chest may cause an indirect extension or flexion injury of the cervical spine and soft tissues of the neck. In any neck injury, the injury may not be the product of a single force. For example, while extension, flexion, and lateral flexion injuries are often described separately, rotational, compressive, tensile, and shearing forces are invariably part of the picture.
The anterior and lateral aspects of the neck contain a variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle.
After neck injury, a careful neurologic evaluation must be conducted, and every examination should begin with a thorough case history. See Table 1. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg s sign should be conducted, along with superficial and tendon reflex tests.
You may also enjoy our:
Chronic Neck Pain and Chiropractic Page
Table 1 Typical Questions Asked During the Investigation of Joint Pain
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The Foundation of Biomechanical Evaluation Following Injury
The Chiro.Org Blog
Clinical Monograph 9
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
The study of human biomechanics includes the mechanical principles involved, the physiologic considerations of muscle length-tension relations, and an understanding of the controlling neuromotor mechanisms and the sensory feedback apparatus, reflecting both locomotor activity and cerebral function. Applied biomechanics is the application of the practical principles of mechanics (the study of forces and their effects) to the body in movement and at rest.
The more biomechanics are understood, the better musculoskeletal disorders in sports and the workplace can be appreciated. The same can be said of physical work and recreational activities. The athlete is constantly attempting to improve performance by applying biomechanical principles to specific movements. The same is true for ergonomics in the workplace. From the viewpoint of the doctor, knowledge of the mechanisms involved in an injury is necessary to evaluate an injury accurately.
PERTINENT BIOMECHANICS
From a pure musculoskeletal standpoint, the human body is a mechanical device. All mechanical devices are subject to wear during use that reflects their history of destructive forces. Unique to living tissue is its ability to heal, adapt, and strengthen, which provides a dialogue between catabolic and anabolic forces. While machines convert thermal or chemical energy into mechanical energy, muscle tissue transforms nutrients directly into mechanical energy without a thermal intermediary. Body energy enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work.
Practical Concepts
The body’s kinetic energy is reflected in its velocity, and its potential energy is reflected in its position. Work is the result of a force acting through a distance. Power relates to the time element and the work accomplished. There is a close association in the same unit of time between the work accomplished by a weight lifter and that of a sprinter.
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By Frank M. Painter, D.C. in Documentation on May 2nd, 2012 at 12:20 pm
Medicare Documentation Requirements:
The Hurdle That Continues to Block Our Progress
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic ~ April 9, 2012
By David Seaman, DC, MS, DABCN,
Albert J. Luce, DC and
Anthony Hamm, DC, FACO, DABFP
At present, the chiropractic profession has difficulty being compliant with Medicare documentation requirements. The 2009 report from the Office of the Inspector General reported the following: “Distinct from the undocumented claims, 83 percent of reviewed chiropractic claims failed to meet one or more of the documentation requirements.
Concerning treatment, file reviewers reported that only 76 percent contained some form of treatment plan, 43 percent lacked treatment goals, 17 percent lacked objective measures, and 15 percent lacked the recommended level of care.” [1]
In January 2011, the California Chiropractic Association reported the following on its Web site: [2] “Palmetto GBA has released the results of its review of chiropractic Medicare claims and found an “unacceptable” error rate of 68 percent for Northern California and 77 percent for Southern California. These results are very troubling, as Congressional leaders have threatened to remove chiropractic from Medicare if the profession [does] not improve its billing practices.”
Perhaps two primary issues may be at work. Either an inaccurate message is being delivered to chiropractors regarding appropriate Medicare documentation requirements and/or chiropractors are misinterpreting the message. Let’s attempt to clear up some of the confusion, outline documentation requirements based on several Medicare publications, and provide a flow chart for easy visualization of the required process.
Refer to MEDICARE DOCUMENTATION SIMPLIFIED Chart
What Does Medicare Want?
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By John in Legal Issues on April 23rd, 2012 at 1:31 pm
Source Litigation and Trial
Scientists, even those in the “hard” sciences that are based primarily on empirical observations and mathematical analysis, have their own dogmas, prejudices, incentives, and conventions. That’s of course not to say that science is bad or wrong or useless — the only reason you can read this on your computers is because thousands of scientists over the years came to exactly the right conclusions about electricity, metallurgy, chemistry, mathematics, quantum theory, and information theory — but just to admit the obvious, which is that scientists are people and science happens under many of the same constraints as every other social endeavor. As much as we’d like to trust scientists as objective experts whose assertions should be accepted ipse dixit (a phrase that dates back to Pythagorus and is today routinely used by lawyers trying to discredit their opponent’s expert), the truth is that courts shouldn’t be afraid to look at scientists as people and evaluate them accordingly.
Continue reading…
By Frank M. Painter, D.C. in Neurology on April 22nd, 2012 at 2:21 pm
Use It or Lose It: Dancing Makes You Smarter
The Chiro.Org Blog
SOURCE: Richard Powers
For centuries, dance manuals and other writings have lauded the health benefits of dancing, usually as physical exercise. More recently we’ve seen research on further health benefits of dancing, such as stress reduction and increased serotonin level, with its sense of well-being.
Then most recently we’ve heard of another benefit: Frequent dancing apparently makes us smarter. A major study added to the growing evidence that stimulating one’s mind can ward off Alzheimer’s disease and other dementia, much as physical exercise can keep the body fit. Dancing also increases cognitive acuity at all ages.
You may have heard about the New England Journal of Medicine report on the effects of recreational activities on mental acuity in aging. Here it is in a nutshell.
The 21-year study of senior citizens, 75 and older, was led by the Albert Einstein College of Medicine in New York City, funded by the National Institute on Aging, and published in the New England Journal of Medicine. Their method for objectively measuring mental acuity in aging was to monitor rates of dementia, including Alzheimer’s disease.
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By Frank M. Painter, D.C. in Health Promotion on April 17th, 2012 at 8:54 pm
B Vitamins Slows the Rate of Brain Atrophy
in Mild Cognitive Impairment
The Chiro.Org Blog
The Oxford Project to Investigate Memory and Ageing (OPTIMA) published the results of a key aspect of their study in the online journal Public Library of Science ONE in 2010. In this arm of the study, they investigated the effect of B-vitamin supplementation on various parameters of brain aging and associated cognitive function. The study group consisted of 168 individuals over the age of 70 with mild cognitive impairment.
The treatment group was given daily supplementation of the following B vitamins: folic acid (800 mcg), vitamin B12 (500 mcg) and vitamin B6 (20 mg). The main outcome measured was change in rate of whole brain atrophy on MRI investigation after 24 months of supplementation compared to the placebo group.
Study results showed that the group taking the B-vitamin cocktail experienced a 30-percent slower rate of brain atrophy, on average, and in some cases patients experienced reductions as high as 53 percent. Greater rates of atrophy were associated with lower cognitive test scores.
The authors also observed that, in the control group, the the degree of atrophy was directly related to elevated homocysteine levels.
Homocysteine-lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial
PLoS One. 2010 (Sep 8); 5 (9): e12244
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By Frank M. Painter, D.C. in Chiropractic Care on April 16th, 2012 at 11:30 am
Maintaining a Vitalistic Perspective in Chiropractic in the Postmodern Era
The Chiro.Org Blog
SOURCE: J Chiropractic Humanities 2005; 12: 2-7
By Cheryl Hawk, DC, PhD, CHES
Professor and Director of Clinical Research at Logan College of Chiropractic
Objectives: To discuss concepts of postmodernism with respect to the opposing worldviews of vitalism and mechanism, and to present an argument for a viable role for vitalism in chiropractic philosophy and research.
Discussion: Vitalism is only problematic if we begin with the assumption that a mechanist worldview or paradigm is the correct way to explain the world. In postmodern thought, a multiplicity of worldviews may coexist. One view is no more valid or correct than another and these divergent views are judged best by their utility under various circumstances. Exploring clinical practices and methodologies, such as whole systems research, arising from a vitalistic perspective could lead to innovations in both patient care and research, if pursued with flexible non-dogmatic thinking.
Conclusion: Vitalism, approached in a responsible and intelligent manner, may afford the chiropractic profession opportunities to further improve patient care and make contributions to new knowledge.
INTRODUCTION
The 2003, the World Federation of Chiropractic conference convened a panel to address this question: “Is vitalism a strong foundation or quicksand for the chiropractic profession?” As one of the panelists, in order to address what I believed this question was really asking, it was necessary to first deconstruct the question, that is, to examine its underlying assumption. [1]
This underlying assumption is that a mechanist worldview or paradigm is the correct way to explain the world. Based on this assumption, anything that does not fit this worldview would be a potential threat to our profession’s credibility and, therefore, must be modified to fit this view or jettisoned. Vitalism, which entails a different way of perceiving the world, poses such a threat.
This assumption must be examined rather than simply accepted. Only then will it be possible to make a conscious choice of which worldview we want to function within and then thoughtfully and responsibly adhere to the principles of that worldview.
DISCUSSION
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Chiropractic and Health Care Reform:
An Uncertain Future or an Opportunity?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Claire Johnson, DC, MSEd and Lori Byrd, MS
The United States is currently experiencing a health care crisis. Much of the current health care system focuses limited resources on the treatment of disease, and very few resources are aimed at primary and secondary prevention.
Although 70 percent of factors influencing health are environmental and behavioral, and only 10 percent of the factors attributed to health are associated with access to health care, the actual reimbursement for health services accounts for 96 percent of the $2.3 trillion spent each year. [1] Thus, we need to take a closer look at health care reform and how doctors of chiropractic will approach this changing landscape.
In March 2010, the Patient Protection and Affordable Care Act was law signed into law. The intention of the act is to put “in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.” [2] However, it is not exactly clear how this will be done or if the promised goals will be met, especially during this time of reduced funding and economic crises.
Chiropractic is one of the largest complementary and alternative medicine professions, and one of the largest licensed health care professions in the United States. [3-4] It is considered to be a holistic and wellness-oriented profession, traditionally not using drugs or surgery to help patients maintain health. Care typically incorporates wellness, lifestyle and prevention approaches with patient management, and focuses on the body’s natural ability to heal itself. Services provided by doctors of chiropractic have demonstrated high patient satisfaction, cost-effectiveness and parity compared to other types of care for similar conditions.
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Spinal Manipulative Therapy and Its Role in the Prevention, Treatment and Management of Chronic Pain
The Chiro.Org Blog
SOURCE: J Canadian Chiro Assoc 2012 (Mar);56 (1):5-7
Dr. John Srbely DC, PhD
Assistant Professor, Department of Human Health and Nutritional Sciences, University of Guelph.
E-mail: johnsrbely@gmail.com
CCRF Professorship in Spine Mechanics and Human Neurophysiology
College of Biological Sciences
University of Guelph
Chronic pain is a worldwide epidemic. It is characterized as “pain that persists beyond normal tissue healing time” [1] and is physiologically distinct from acute nociceptive pain. The current research estimates the prevalence of chronic pain in the general population to be anywhere from 10–55%, [2] predominantly affecting the adult population. Studies indicate that the prevalence of chronic pain in the over-60 age group is double that for younger adults. [3] Furthermore, over 80% of elderly (over 65) adults suffer from some form of painful chronic joint disease [4] and greater than 85% of the general population will experience some form of chronic myofascial pain during their lifetime. [5]
Chronic pain has substantial impact on sufferers, often citing significant impairments in physical, social and psychological function. [6] Many patients suffer from progressive health and physical deterioration owing to sleep and appetite disturbances, anxiety, depression, decreased physical energy and activity as well as excessive use of medication.6 Chronic pain often leads to social withdrawal, impaired personal relationships and job loss.1 Recent estimates suggest that 50–85% of adults report some degree of pain that may interfere with daily activities and quality of life. [7]
Chronic pain sufferers are five times more likely to utilize health care services than non-pain sufferers. [8] Conservative figures estimate that the annual cost of managing chronic pain in the United States currently exceeds $40 billion annually. [9] Of greatest concern is the fact that the ratio of the over-65:under-65 segments of the population is projected to double by 2050, [10] promising to make chronic pain one of healthcare’s foremost challenges in the future.
You may also enjoy our:
Chronic Neck Pain and Chiropractic Page
Aging population
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By Frank M. Painter, D.C. in Announcement on April 8th, 2012 at 12:38 pm
By John in Research on April 6th, 2012 at 12:50 pm
Hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis.
Source Science Daily
Scientists have made a landmark discovery that could help women minimize or even avoid the risk of having a baby born with congenital birth defects. The study is published April 5 in the international journal Cell.
The scientists, from universities in Australia, Japan, Canada and the United States, including Arizona State University, show for the first time how “nature” and “nurture” interact to increase the severity and likelihood of developing birth defects, including abnormalities in the heart, kidneys, brain, limbs and cranio‐facial regions (cleft palate).
They show how hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis, a malformation of the spine that affects around 1 in 1,000.
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ACOEM Recognizes the Value of Chiropractic for Chronic Spinal Pain
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
Tina Beychok, Associate Editor
Pain is the most prevalent health condition among U.S. workers and the most expensive in terms of lost productivity. Recent studies suggest more than six in 10 adults over the age of 30 experience chronic pain. Furthermore, health care expenditures for back and neck pain have risen to more than $80 billion a year in the U.S. – a dramatic increase over the past eight years, without evidence of improved health. In addition to the costs of lost productivity, an estimated $64 billion per year is lost due to workers continuing to work, even though pain reduces their job performance. This phenomenon is called “presenteeism.”
Unfortunately, workers’ comp can be a quagmire of contradictory and insufficient rules and regulations as to what treatments are and aren’t covered. The American College of Occupational and Environmental Medicine (ACOEM) has been in the process of revising its Occupational Medicine Practice Guidelines, which have not always taken a positive view of chiropractic manipulation. In fact, the second edition of the guidelines, released in 2005, was heavily criticized by some in the chiropractic community. [1]
ACOEM’s latest chronic pain guidelines (a chapter of the overall guidelines) may represent a step in the right direction in terms of recognizing the value of chiropractic care. The guidelines actually recommend manipulation for chronic, persistent low back or neck pain and cervicogenic headache. [2] This is significant because in the past, the guidelines failed to recommend manipulation, even when other treatment strategies (medication, etc.) were rated as less effective.
Continue reading …
By John in News on April 3rd, 2012 at 3:45 pm
Source Salt Lake Tribune
Texas is on its way to expressly banning chiropractors from treating conditions such as thyroid disorders and diabetes.
Calling chiropractors who solicit diabetics with “secret” treatments “hucksterism,” the Texas Board of Chiropractic Examiners has been working on new rules since 2010. The questionable ads run by Texas chiropractors were similar to ones currently appearing in Utah, said Yvette Yarbrough, the board’s executive director.
Texas’ new rules may allow chiropractors to co-manage such diseases through nutrition and exercise. But she anticipates that the new rule will ban “outright treatment” of diabetes, thyroid disorders, Attention Deficit Hyperactivity Disorder, asthma and other conditions.
The proposed rule is part of an ongoing battle between the Texas Medical Association and chiropractors. Medical doctors say chiropractors are illegally treading on their turf.
“Everybody wants to practice medicine but nobody wants to go to medical school,” said David Bragg, the medical association’s attorney. “Chiropractors are excellent marketers. … They believe chiropractic is the answer. Texas law doesn’t agree with that.”
Tyce Hergert, public relations chairman for the Texas Chiropractic Association, said chiropractors should be able to help patients through nutrition and exercise.
“As far as sitting down with a patient that has diabetes, going over their diet, [offering] lifestyle coaching,” he said, “we have plenty of training in that.”
Radiologic Manifestations of Spinal Subluxations
The Chiro.Org Blog
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.
This is Chapter 6 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
These 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 6: Radiologic Manifestations of Spinal Subluxations
This chapter describes the radiologic signs that may be expected when spinal subluxations are demonstrable by radiography. Through the years, there have been several concepts within the chiropractic profession about what actually constitutes a subluxation. Each has had its rationale (anatomical, neurologic, or kinematic), and each has had certain validity contributing to our understanding of this complex phenomenon.
Kinetic Intersegmental Subluxations
Segmental hypomobility, also called a “fixation subluxation” by many clinicians, may affect one or several motor units.
It is characterized by reduced motion of the “Spinal Motion Unit” (Please refer to Spinal Anatomy 101), which has been forced to the extreme of a range of motion (eg, flexion, extension, etc). See Figure 6.14. Stress views or videofluoroscopy are necessary to depict this and other kinetic subluxations radiographically, but motion palpation and some orthopedic tests may reveal their presence clinically.
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By Frank M. Painter, D.C. in Cancer on March 28th, 2012 at 1:08 pm
Regular Vitamin and Mineral Supplementation Lowers Colon Cancer Risk More Than Eighty Percent
The Chiro.Org Blog
Source: Natural News
Researchers, just publishing in the Canadian Journal of Physiology and Pharmacology (CJPP), have found that a diet enhanced with vitamin and mineral supplementation can lower the risk of developing precancerous colon cancer lesions by up to 84%. Colon cancer is the second most common form of the disease affecting men and women in the US, with nearly 150,000 new diagnoses each year.
The Full Text article describes how animals that were fed a high-fat, low fiber diet, while also being exposed to a carcinogen, developed pre-cancerous lesions of the colon along a pathway similar to that found in humans.
The group of animals that underwent a similar treatment and diet, but were also provided a daily vitamin and mineral supplement, demonstrated an 84% reduction in the formation of pre-cancerous lesions which did not develop into tumors.
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By John in public health on March 24th, 2012 at 8:28 pm
Source NY Times
The Obama administration must warn drug makers that the government may soon ban agricultural uses of some popular antibiotics that many scientists say encourage the proliferation of dangerous infections and imperil public health, a federal magistrate judge ruled on Thursday.
The order, issued by Judge Theodore H. Katz of the Southern District of New York, effectively restarts a process that the Food and Drug Administration began 35 years ago, but never completed, intended to prevent penicillin and tetracycline, widely used antibiotics, from losing their effectiveness in humans because of their bulk use in animal feed to promote growth in chickens, pigs and cattle.
The order comes two months after the Obama administration announced restrictions on agricultural uses of cephalosporins, a critical class of antibiotics that includes drugs like Cefzil and Keflex, which are commonly used to treat pneumonia, strep throat and skin and urinary tract infections.
Siobhan DeLancey, an F.D.A. spokeswoman, would not say whether the government planned to appeal. “We are studying the opinion and considering appropriate next steps,” she said.
In a separate move, the F.D.A. is expected to issue draft rules within days that ask drug makers to voluntarily end the use of antibiotics in animals without the oversight of a veterinarian.
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By Frank M. Painter, D.C. in Asthma on March 19th, 2012 at 12:55 pm
The Chiropractic Care of Patients with Asthma: A Systematic Review of the Literature to Inform Clinical Practice
The Chiro.Org Blog
SOURCE: Clinical Chiropractic 2012 (Mar); 15 (1): 23–30
Joel Alcantara, Joey D. Alcantara, Junjoe Alcantara
International Chiropractic Pediatric Association, Media, 327 N Middletown Rd, Media, PA 19063, USA
Introduction Estimates place some 300 million people worldwide suffer from asthma with 180,000 deaths attributed to the disease. The financial burden from Asthma in Western countries ranges from $300 to $1,300 per patient per year. In the United States, asthma medication costs between $1 billion and $6.2 billion per annum. With an increasing prevalence of 50% every decade, there is no question that the burden of asthma is tremendous. The prevalence of complementary and alternative medicine (CAM) use amongst adult asthmatics ranges from 4% to 79% whilst, in children, it ranges from 33% to 89%. Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults. As with other chiropractors, the authors aspire to the principles of evidence-based practice in the care of asthma sufferers. Recent systematic reviews of the literature places into question the effectiveness of chiropractic. To assuage the discord between our clinical experience and those of our patients with the dissonant literature, we performed a systematic review of the literature on the chiropractic care of patients with asthma.
Methods Our systematic review utilized the following databases for the years indicated: MANTIS [1965–2010]; Pubmed [1966–2010]; ICL [1984–2010]; EMBASE [1974–2010], AMED [1967–2010], CINAHL [1964–2010], Index to Chiropractic Literature [1984–2010], Alt-Health Watch [1965–2010] and PsychINFO [1965–2010]. Inclusion criteria for manuscript review were manuscripts of primary investigation/report published in peer-reviewed journals in the English language involving the care of asthmatic patients.
Results The studies found span of research designs from non-experimental to true experimental studies consisting of 3 randomized controlled clinical trials (RCTs), 10 case reports, 3 case series, 7 cohort studies, 3 survey studies, 5 commentaries8 and 6 systematic reviews. The lower level design studies provide some measure of evidence on the effectiveness of chiropractic care for patients with asthma while a critical appraisal of 3 RCTs revealed questionable validity of the sham SMTs involved and hence the conclusions and interpretations derived from them. The RCTs on chiropractic and asthma are arguably comparison trials rather than controlled clinical trials per se.
Conclusion Chiropractic may offer an alternative care approach for asthmatic patients. Future investigations of this conservative care approach for patients with asthma should pave the way for higher-level design studies such as randomized controlled clinical trials.
From the FULL TEXT Article:
Introduction
Estimates place some 300 million people worldwide suffer from asthma with 180,000 deaths attributed to the disease. The financial burden from Asthma in Western countries ranges from $300 to $1,300 per patient per year. In the United States, asthma medication costs between $1 billion and $6.2 billion per annum. With an increasing prevalence of 50% every decade, there is no question that the burden of asthma is tremendous. The prevalence of complementary and alternative medicine (CAM) use amongst adult asthmatics ranges from 4% to 79% whilst, in children, it ranges from 33% to 89%. Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults. As with other chiropractors, the authors aspire to the principles of evidence-based practice in the care of asthma sufferers. Recent systematic reviews of the literature places into question the effectiveness of chiropractic. To assuage the discord between our clinical experience and those of our patients with the dissonant literature, we performed a systematic review of the literature on the chiropractic care of patients with asthma.
Discussion
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By Frank M. Painter, D.C. in Chiropractic Care on March 15th, 2012 at 11:13 am
Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’
The Chiro.Org Blog
SOURCE: Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6
Lyndon G Amorin-Woods and Gregory F Parkin-Smith
Background: A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.
Discussion: This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called ’3-Questions Model’;
Summary: Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
From the FULL TEXT Article:
Development of the 3-questions Model
The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.
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