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 massage.

Myofascial trigger points are contracted knots in muscle tissue. They are one of the most common causes of pain in the body. Most people will experience pain from trigger points at some point in there lives. Trigger point pain is usually felt as a deep achey pain. This pain may be refered In a specific pattern to other areas of the body. For example, trigger points in your hip can refer pain all the way down the leg into the foot. Trigger points will also mimick joint pain leading to misdiagnosis of arthritis. Trigger point massage therapy targets the knots specifically with focused deep work to release the area and allow the muscle to heal. Visit http://www.triggerpointmassagetherapy.info or http://www.aberdeenchiropractic.com for more information.

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How to treat a stiff, sore neck.

One of the most common issues that I treat in my clinic on a regular basis is neck stiffness and pain. This is a prevelent problem in our society in large part due to poor posture. Sitting in front of a computer at work all day, or being on you phone will eventually cause the muscles in you neck to become strained and over worked. When this happens the muscles become tight and sore. At this point all the stretching in the world won’t make a difference. A manual intervention such as trigger point massage is needed to allow the muscles to heal and function normally again.

What are trigger points.

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce at some time in your life.

Trigger points in the upper traps.

One of the most common issues that I treat on a daily basis is trigger points in the upper traps. The trapezius muscle or “traps” is a large diamond shaped muscle located in you back and neck. The upper portion of this muscle is one on the most common areas to become strained due to poor posture or emotional stress. When this

happens trigger points are sure to develop. These points will cause pain to be felt up the neck, behind the ear, and traveling to the temple. Trigger points in the upper traps are one of the most common causes of headache pain, as well as a stiff neck.

Trigger points in the diaphragm

The diaphragm is the major muscle of respiration. It’s main action is to increase the volume of the thoracic cavity during inhalation. Trigger points form in this muscle due to asthma, emotional overload, disk problems, weak abdominals, hyperventilating, smoking, and poor posture. When trigger points form they can cause a wide variety of symptoms including hyperventilation syndrome, heart and lung issues, as well as a “stitch” pain when running or exercising.