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

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Can Having a Weak Buttocks Cause Back Pain?

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Problem: a new study found that people who have weak gluteal muscles suffer higher rates of low back pain.
Solution: (after you check with your doctor:) try one of these simple exercises to help strengthen your gluteal muscles.

https://www.youtube.com/embed/cmtfrxR7nxw/rel=0 https://www.youtube.com/embed/vIsyz9bFV2w?rel=0

Aboufazeli M et al. Comparison of Selective Local and Global Muscle Thicknesses in Females with and without Chronic Low Back Pain. Orthop Traumatol Rehabil. 2018 Jun 27;20(3):197-204.

Headache Treatment

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A recent study found that for tension headaches, spinal manipulation led to sustained improvements in pain & function…without side effects! “There was no evidence suggesting increased risk for serious treatment-related harms.”

Check out this video to learn more about how chiropractic care safely relieves tension headaches.

Skelly AC et al. Noninvasive Nonpharmacological Treatment. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jun. Report No.: 18-EHC013-EF.

Low Back Pain Treatment

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The US Agency for Healthcare Research and Quality recently published acomprehensive review of more than 218 prior studies on non-drug treatments for chronic pain. The researchers found that for chronic low back pain, spinal manipulation and exercise led to sustained improvements in pain and function. Check out this video to learn more about how chiropractic care relieves back pain.

Skelly AC et al. Noninvasive Nonpharmacological Treatment. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jun. Report No.: 18-EHC013-EF.

Achilles Tendonitis

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Your Achilles tendon is the strong fibrous band of tissue that connects your calf muscles to your heel. The tendon is named after “Achilles” who was a powerful, yet vulnerable warrior in Greek mythology. Likewise, our Achilles tendon, being the largest and strongest tendon in the body, is susceptible to injury from the high demands placed on it. (Running can generate forces over 12 times your body weight on the Achilles tendon.)

The tendon may be strained or even ruptured from excessive stretch or forceful contraction of the calf muscles. More commonly, the tendon is repeatedly overloaded and suffers tiny “micro tears.” Damage usually occurs either directly behind the heel, or near the weakest area of the tendon- one to two inches above the heel.

Achilles tendon injuries affect between 250,000 and 1 million people per year. Most are middle-aged males, between the age of 30 and 50. Interestingly, Achilles tendon injuries occur more frequently on the left side. If you have suffered a prior Achilles tendon injury, you are at greater risk of injuring the opposite side. Two-thirds of all Achilles tendon injuries involve athletes. Runners are up to 10 times more likely to suffer Achilles tendon problems. You may at increased risk if the arch of your foot is too high or too flat.

Symptoms may begin abruptly following a strain but more commonly develop slowly from repeated irritation. Morning pain and stiffness are common. Your symptoms will likely increase with activity, especially walking or running. You may notice pain when you rise up on your toes. Walking down stairs stretches the tendon and usually increases symptoms. Some patients notice that the irritated area becomes firmly swollen. Ongoing irritation to the spot on your heel where the tendon inserts can cause a painfully elevated “pump bump.”

Research has shown that conservative care, like the type provided in this office, can produce “excellent results” in over 85% of patients. Initially, you may need to limit or stop activities that cause pain. Runners may need to switch to swimming or cycling for a short period of time. Be sure to introduce new activities slowly and avoid increasing your activity by more than 10% per week. Runners should begin on a smooth, shock- absorbent surface and start at a low intensity – first increasing distance, then pace. Avoid training on hard or unlevel surfaces like hills. Make sure you warm up properly and avoid over training. Avoid wearing high heels or shoes with an excessively rigid heel tab. One of the most important and effective treatments for Achilles tendinopathy is performing “heel drop exercises” as outlined below.

If you experience any of these symptoms, give our office a call.

Chiropractic Patients Use Fewer Opioids

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A new study of over 14,000 veterans demonstrated that opioid use decreased after seeking chiropractic care. Download this infographic to learn more about how chiropractic care helps solve the opioid crisis.

Lisi AJ et al. Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care. Pain Med. 2018 Sep 1;19(suppl_1):S54-S60.

Kids – Move Away From the Television

kids

A new study of middle school students found higher rates of low back pain in adolescents who:

o Carried a heavy backpack

o Watched television daily

Stressors come in the form of too much, or too little activity. Encourage those you love to stay active without over doing it.

Paranjape S, Ingole V. Prevalence of Back Pain in Secondary School Students in an Urban Population: Cross-sectional Study. Muacevic A, Adler JR, eds. Cureus. 2018;10(7):e2983. doi:10.7759/cureus.2983.