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

Chiropractic: Prevention Is Key to Avoid Back Pain.

Chiropractic: Prevention Is Key to Avoid Back Pain.

The American Chiropractic Association offers these suggestions to help protect your back and improve your spinal health: maintain a healthy diet and weight, exercise regularly, maintain proper posture, avoid prolonged inactivity or bed rest, quit smoking, and use good body mechanics when lifting.

 

American Chiropractic Association, August 2014

 

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Diet: Experts Say a Little Fat & Sugar OK for Kids if Diet Is Healthy.

Diet: Experts Say a Little Fat & Sugar OK for Kids if Diet Is Healthy.

Children’s eating habits are a growing concern due to the high prevalence of childhood obesity in the United States and other Western countries. A leading group of pediatricians suggests that a little sugar and fat is okay in a child’s diet if it helps them eat more fruits and vegetables. Researcher Dr. Robert Murray comments, “Think of sweeteners, fat, salt, and spices as ways to make nutrient-rich foods more palatable to children.”

 

Pediatrics, February 2015

 

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Health Alert: Frequent Sauna Use Linked to Reduced Risk of CVD.

Health Alert: Frequent Sauna Use Linked to Reduced Risk of CVD.

After reviewing twenty years of data concerning 2,315 Finnish men, researchers found that those who used a sauna at least two to three times per week were 22% less likely to experience sudden cardiac death, 23% less likely to experience fatal coronary heart disease (CHD), had a 27% lower risk of cardiovascular disease (CVD) death, and had a 24% lower risk of all-cause mortality during the course of the two-decade study. The authors write, “This study provides prospective evidence that sauna bathing is a protective factor against the risk of sudden cardiac death, fatal CHD, fatal CVD, and all-cause mortality events in the general male population. Our results suggest that sauna bathing is a recommendable health habit, although further studies are needed to confirm our results in different population settings.”

 

JAMA Internal Medicine, February 2015

 

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Laser Therapy For Knee Pain

Laser Therapy For Knee Pain
Laser Therapy For Knee Pain

Those who have knee pain, whether acute or recurring, may find relief in cold laser therapy. This type of laser therapy is a non-invasive procedure that uses a class IV laser to stimulate the affected area and alleviate pain. Research has shown that it can be efficacious in alleviating knee pain whether it’s caused by injury or chronic conditions. Researchers think the lasers aid in healing because they may:

  • Improve circulation
  • Stimulate natural painkillers called endorphins
  • Improve cell regeneration
  • Encourage new tissue growth 

Those who have knee injuries, as well as those who have a knee injury caused by trauma, may be able to benefit from laser therapy. Bone on bone knee pain can be eliminated with a combination of LLLT and physical therapy. The LLLT reduces the irritation and subsequent inflammation of arthritis while the physical therapy strengthens the surrounding muscles and ligaments so that pressure on the joint is reduced.

An injured knee joint can heal faster when LLLT is applied because the body’s healing mechanisms are stimulated and circulation increases. Other types of pain that can be helped with LLLT include:

  • Bursitis
  • Tennis elbow
  • Carpal tunnel syndrome
  • Fibromyalgia

The time it takes to heal and how long the benefits lasts will vary by the individual. Currently, there is no cure for arthritis or similar bone diseases. However, LLLT can provide relief from the symptoms and improve quality of life for those who have a degenerative bone disease in their knees. For some, the use of LLLT can enable them to begin to exercise and lose weight, which can often alleviate much of the knee pain of arthritis and other conditions.

If you have knee pain and would like to try laser therapy in Winnipeg, feel free to contact us at 204-586-8424.

Hip Osteoarthritis

Hip osteoarthritis is a condition that can cause stiffness that limits joint range of motion. Over time, certain hip movements become limited, usually causing pain and alteration of normal biomechanics. Your muscles must therefore work harder during movement, generating a feeling of muscle tension.To date, the exact causes of osteoarthritis have not been fully identified. It is completely normal to have a mild level of osteoarthritis with age. However, the more advanced stages of osteoarthritis can affect the ability to carry out daily and physical activities. An exacerbation of symptoms usually occurs during a period when the level of physical activity has been drastically increased. Direct trauma to the hip can increase the symptoms of osteoarthritis.

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Structures involved

At the hip, the joint affected by osteoarthritis is the ​acetabulofemoral joint,​ formed by the p​ elvic ​bone and the ​femur​ bone. It is mainly cartilage damage combined with the presence, in some cases, of slight bone spurs in the joint that appear to be responsible for the restriction of movement. Over time, some muscles in the hip area may become tighter to compensate for the joint restriction.

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Signs & Symptoms that you may experience

Each person will react differently to osteoarthritis and management will depend on its stage. Hip osteoarthritis can produce, but is not limited to, local pain in the groin area, edema and stiffness in certain hip movements. Repetitive hip movements during walking or other sports activities, prolonged standing and sleeping with direct pressure may cause pain.

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Developments

Osteoarthritis of the hip is a progressive condition that cannot be cured, which means that the range of motion may decrease over time. An active lifestyle and a rehabilitation plan may however slow the progression of this condition and make it easier to manage the symptoms.1
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▶​ ​WHAT TO DO

Painful episodes

Relative rest is a good way to prevent your symptoms from getting worse. A few days of rest while reducing activities that cause significant pain​ m​ ay be necessary, but it is very important to avoid deconditioning. A quick return to your daily activities, light cardiovascular exercises that do not cause an increase in pain, joint mobilization exercises and hip muscles strengthening exercises will allow for better recovery.

Rehabilitation

Follow your therapist’s advice. This will help you manage the various stages of the healing process and increase the odds of success. Your therapist will accompany you during your rehabilitation program in order to improve your hip joint range of motion, regain flexibility, muscle strength and endurance, and functional state.

According to the principles of hip osteoarthritis rehabilitation, improving joint range of motion should be an integral part of the treatment plan. A program to improve joint range of motion and flexibility, as well as specific muscle strengthening is common to control the symptoms of hip osteoarthritis.

▶ ​WHAT TO AVOID

Do not rely solely on a passive treatment approach. Each phase of the rehabilitation process is important. Patients who actively participate in their treatment plan tend to recover more quickly. Keep in mind that pain is not always a good indicator of joint or tissue damage. A significant level of pain does not necessarily imply a more advanced stage. As soon as you feel better and the pain is well under control, introduce, in collaboration with your therapist, light mobility and strengthening exercises based on your tolerance. Remember that exercise is an excellent way to manage pain associated with osteoarthritis.

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Exercise: Improves Cognitive Function in Women!

Exercise: Improves Cognitive Function in Women!

Regardless of age, females who are highly physically fit have faster neural reaction times than their less fit peers. Near infrared spectroscopy scans showed that physical fitness is associated with greater cerebral oxygenation, which may be the underlying mechanism for the observed elevations in brain function.

 

Frontiers in Human Neuroscience, February 2015

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Wellness/Prevention: Mindfulness Helps Seniors Sleep Better.

Wellness/Prevention: Mindfulness Helps Seniors Sleep Better.

Mindfulness practices encourage individuals to focus their attention on the present, instead of the past or future, and to take an objective look at their thoughts and emotions. A new study finds that mindfulness meditation may help older adults get a better night’s sleep. In the study, those who learned mindfulness practices slept better within six weeks and also showed a greater reduction in depression symptoms and daytime fatigue. Co-author Dr. Adam Spira writes, “Cognitive behavioral therapy is highly effective… What I found most interesting about this [mindfulness] approach is that it’s a non-drug option, and it’s accessible to the community at large.”

 

JAMA Internal Medicine, February 2015

 

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Exercise: Moderate Exercise Can Help Women’s Hearts.

Exercise: Moderate Exercise Can Help Women’s Hearts.

Just a few bouts of moderate exercise each week can reduce a middle aged woman’s risk for heart disease, blood clots, and stroke by 20% when compared with women who do little or no exercise. Moderate exercise examples include walking, gardening, and cycling. Lead author Dr. Miranda Armstrong concludes, “To prevent heart disease, stroke and blood clots, women don’t have to be super athletes or strenuously exercise daily to experience the benefits of physical activity.”

 

Circulation, February 2015

 

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