For patients with chronic low back pain (cLBP), treatment guidelines recommend a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to avoid an initial surgery unless it’s absolutely indicated. That means, unless there is loss of bowel or bladder control or retention (which represents a medical emergency) or if there is progressive neurological motor and sensory loss, one can safely avoid surgery and conservatively manage the condition.
Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up!
Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone.
The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care.
The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone.
The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.”
Can Chiropractic Help The Post Surgical Patient
Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek eras that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember?
Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! So, the questions this month are: How successful IS spinal surgery? What about all those patients who have had surgery but still have problems – can chiropractic still help them?
A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches (like chiropractic care) are the most effective treatment choice. They report the success rate of spinal fusions for DDD is only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. The authors of the review wrote, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it… Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for ten years following artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.
So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!
Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!
People of all ages suffer from neck pain, and many frequently turn to chiropractors for care because it’s been found to be one of the most effective and efficient forms of treatment available, and it carries minimal side effects! It has been projected that by 2030, nearly one in five residents in the United States will be 65 or older. Currently, approximately 14% of the patients treated by chiropractors are 65 or older, making it one of the most frequently utilized forms of complementary and alternative care used by older adults. What kind of care can a senior citizen expect when seeking treatment from our Stuart, FL chiropractor? Let’s take a look…
Musculoskeletal pain—pain in the neck, back, arms, and/or legs—drives the majority of elderly patients to chiropractors. While low back and neck pain are the most common complaints, it’s not unusual for patients to also have one or two other conditions (or more) that they did NOT know chiropractic care could help. In fact, common “goals” for managing every patient (not just the elderly) include services related to patient assessment, maintenance of health, and prevention of illness, in addition to treatment of illness or injury. Common chiropractic treatment approaches include spinal manipulation and/or mobilization, nutritional counseling, physical activity/exercise, and (especially important for the elderly population) fall prevention.
We will now focus on neck pain as it relates to the elderly population and the various chiropractic management strategies that might be encountered by an elderly patient. Common reasons patients present regarding the neck include limited movement, stiffness, and pain. Neck pain can also interfere with sleep, as finding a comfortable position in bed can be quite challenging! Lifting, carrying, and playing with grandchildren is a very common issue for either causing a new complaint or irritating an existing one. Neck pain may also interfere with reaching and lifting. Thus, activities like yard or garden work may become more difficult and less enjoyable. Neck pain is often associated with headaches, which can make daily tasks even more challenging.
When an elderly patient visits a chiropractor at Coastal Medical and Wellness Center for the first time or for a new complaint, he/she can expect to fill out some initial paperwork, as well as provide a history of the main complaint and any lesser complaints. This may also include providing a family and medical history. The examination usually includes general observations, palpating or feeling for muscle tightness, tenderness, warm/cool, range of spinal motion (neck, back, extremities), orthopedic tests, neurological tests, and possibly x-rays. Treatment of the neck may include massage or mobilization to loosen up the neck, manipulation to free up restricted joint motion, and even exercise training. The goal of treatment is to improve neck motion, activity tolerance, and quality of life (less pain, improved sleep, etc.). So, whether you are 10, 20, 50, 70, or 90 years old, give our Stuart, Fl chiropractic office a chance to help you manage your neck pain!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Sinus headaches refer to pain in the head, typically in and around the face. Most of us are knowledgeable about two of our four sinuses: the frontal (forehead) and maxillary (our “cheek bones”). The other two sinuses (called ethmoid and sphenoid) are much less understood. Many patients ask our Stuart chiropractor about sinus problems, as all of us have had a stuffy nose due to a cold and have felt this pain in our face and head. Those of us who have suffered from sinus infections REALLY know how painful sinusitis can get! This month, let’s take a look at our sinuses and what we can do to self-manage the problem.
First, an anatomy lesson… As stated above, there are four paired, or sets, of sinuses in our head: Maxillary: Pain/pressure in the cheekbones, sometimes referring pain to the teeth. These drain sideways (if you lay on your side, the side “up” drains down into the downside maxillary sinus and into the nose). Frontal: Pain/pressure in the forehead. These drain downward (when we’re upright, looking straight ahead). Ethmoidal: Pain/pressure between and/or behind the eyes. These drain when we lean forwards. Sphenoidal: Cause pain/pressure behind the eyes, top of the head and/or back of the head (which can be extreme). These drain best when lying face pointing down towards the floor, but they can be stubborn to drain!
Sinusitis, or rhinosinusitis, by definition is an inflammation of the sinus lining (mucous membrane) and is classified as follows: Acute – a new infection which can last up to four weeks and are divided into two types: severe and non-severe; Recurrent acute – four or more separate acute episodes within one year; Subacute – an infection lasting 4-12 weeks; Chronic – infections lasting >12 weeks; and Acute exacerbation of chronic sinusitis – recurring bouts of chronic sinusitis.
One cause of sinusitis can include a “URI” (upper respiratory tract infections) most often in the form of a virus (such as rhinovirus—there are over 99 types have been identified—or better known as “the common cold”). Bacteria can also cause a sinus infection. These infections tend to last longer and can follow a viral infection. A third cause is a fungal infection. These are more common in diabetic and other immune-deficient patients. Chemical irritants such as cigarette smoke and chlorine fumes can also trigger sinusitis. Chronic sinusitis in Stuart fl can be caused by anything that irritates the sinuses for >12 weeks (viruses, bacteria, environmental irritants, tooth infections, and more). Allergies are also a common cause of sinusitis whether they are environmental and/or food/chemical induced.
Chiropractic care for sinusitis includes primarily symptomatic care with sinus drainage techniques such as facial and cranial bone manipulation/mobilization, lymphatic pump and drainage techniques, instruction in self-stretch of the sinuses (such as an outward pull of the cheek bones in different positions of the head), nutritional counseling (such as 1000mg of vitamin C every 2-4 hours) and anti-inflammatory herbs and vitamins (see prior Health Updates), cervical and mid-back manipulation, training in nasal saline rinsing (Nasaline, Nettie Pot), moist heat (towels, steam), and of course, chicken soup! Co-management with your primary care doc may be needed at times, if medications are warranted.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Cliff Atwell, B.S., D.C.