An Open Letter to our Medical friends.

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In the past year, many trusted medical establishments including the FDA (1), CDC (2), Joint Commission (3,4), JAMA (5), and The American College of Physicians/ Annals of Internal Medicine (6) have encouraged medical providers to prescribe spinal manipulation as a first line treatment for acute, subacute, and chronic low back pain.

Most recently, The Lancet echoed that endorsement, and provided a unique perspective:

The reduced emphasis on pharmacological care recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked. These guidelines endorse the use of exercise and a range of other non- pharmacological therapies, including massage, spinal manipulation, and acupuncture.

Gaps between evidence and practice exist, with limited use of recommended first- line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence. (7)

Unfortunately, personal experience skews our perception of each other’s merit, i.e., we primarily see each other’s failures since the successes don’t need to seek additional care. Regardless of our professional degree, we all have failed cases mixed into our many clinical successes. We must not lose sight of the evidence supporting each other’s overwhelming proven value for a given diagnosis. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, we will help more patients than either working alone.

We are honored for the opportunity to co-manage your patients.

 

References
1. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
3. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in
2018 Comprehensive Accreditation Manual for Hospitals.
4. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
5. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
6. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Published Online March 21, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30489-6

Trigger point pain from the sternalis muscle

The sternalis muscle is a little known muscle located at the sternum. This muscle seems to be vestigial in that it doesn’t have a known function. In originates on the superior portion of the sternum and the upper part of the pectoralis muscle. It’s insertion is the cartilage of ribs 3-7, or sometimes the sheath of the rectus abdominis, or the lower part of pectoralis major. Even though this muscle doesn’t seem to have a purpose anymore it can still harbour trigger points. These points will cause pain to be felt intensely deep in the sternum, with spillover pain radiating down the inside of the arm.

The Link Between Posture and Shoulder Motion

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Bottom Line:

Your shoulder is one of the most complex joints in your body. It is surrounded and supported by a complex network of nerves, tendons, muscles, and ligaments. Many of these structures tie back to your spine or mid-back and neck. Your posture, or position, directly impacts the motion of your shoulder and scapula. Long hours at a desk or computer can lead to postural changes and muscle imbalances. Poor posture and a forward head position can lead to “upper cross syndrome.” Upper cross syndrome is an imbalance of the muscles in your upper back, neck, and shoulder that can lead to neck, back, and shoulder pain with restricted range of motion. 

Why it Matters:

Whether it’s working at a computer, long hours in a car, or using a tablet/smartphone, just about everyone is susceptible to developing upper cross syndrome. However, you don’t need to suffer or change your career to find relief. A combination of Chiropractic adjustments, stretching, and specific postural exercises can make a huge impact on your ability to stay happy and healthy. Taking short breaks every 20-30 minutes to lightly extend your arms and move your neck through a comfortable range of motion will help your body “reset” while working. Also, periodic Chiropractic adjustments will help you maintain an optimal range of motion and reduce restrictions that can occur in your spinal joints. 

– The shoulder is one of the most complex joints in the human body.

– Your posture greatly impacts the ability of your shoulders to move through their full range of motion.

– It’s important to address the neck and mid-back when treating a shoulder injury.

Next Steps: 

Upper cross syndrome is one of the most common conditions we see in our practice. Far too many people suffer from pain for years before discovering Chiropractic care. Millions of people end up taking medications just to get through the day. Like you, we believe there is a better way. Take a flyer for our upcoming workshop and share it with a friend at work. We are excited to share how the challenges of upper cross syndrome can be overcome without drugs or surgery! 

Science Source: 

Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache. JMPT 2004 MedicalNewsToday.com 

Supraspinatus trigger points

The supraspinatus muscle is one of the muscles that makes up your rotator cuff. It attaches from the scapula to the humerus. It functions mainly to laterally rotate the arm as well as stabilize the shoulder joint. It also assists in abduction of the arm. This muscle can often harbour stubborn trigger points. These points refer pain into the shoulder, down the arm, into the elbow, and even into the forearm if irritated enough. These points can be effectively treated with trigger point massage therapy.

Trigger points in the pectoralis major muscle.

A very common muscle to become overloaded and damaged, and thus develop trigger points, is the pectoralis major muscle. This is the muscle that makes up the chest. It’s main functions are adduction and internal rotation at the shoulder. Poor rounded shoulder posture is a common cause of pec tightness and trigger points. trigger points in this muscle will produce pain felt into the front of the shoulder, the chest, and down the medial arm. If these symptoms occur in the left pec it can mimick heart pain. In women, these points can be a cause of breast pain and nipple hypersensitivity.