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 points in the trapezius muscle.

The trapezius muscle is a large diamond shaped muscle in your back and neck. It originates on the nuchal ligament and the spinous processes of c6-t12. It inserts on the scapular spine, acromion process, and the distal clavicle. It’s upper fibres act to elevate the shoulder and rotate the glenoid fossa upward. The lower fibres assist this motion. The middle fibres strongly adduct the scapula. This is the most common muscle in the human body to get trigger points. Trigger points in the lateral upper edge refer pain into the lateral neck and temples. Points in the mid and lower parts of the muscle refer pain into the posterior neck and shoulders. Trigger points in this muscle are a common cause of headaches.

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Elbow pain and trigger points.

Did you know that tennis elbow and golfers elbow pain can be caused by trigger points? Points located in the forearm flexor and extensor muscles can cause pain, stiffness, and weakness in the elbow, forearm, wrist, and hand. Quite often these trigger point symptoms are mistaken for inflammation of the tendons which is what a true tennis/golfers elbow actually is. Failure to address the trigger points can lead to an incomplete recovery .

Exercise of the Month: The Semi-Stiff Dead Lift

This month’s featured exercise will target your hamstrings, buttocks, and lower back.

 

Begin standing with your thumbs on your rib cage and your fingers on the crests of your hip, making sure not to approximate your fingers throughout the exercise. Stand on one leg with your knee bent only slightly. Slowly flex forward from the hips moving your chest toward the floor, making certain not to flex your back. Return to an upright position. Repeat 15 repetitions on each leg once per day or as directed.

4 Tips for Your Cooler Weather Workouts

4 tips

The temps are dropping, but that doesn’t mean you need to drop your workout routine until next spring. Cold weather workouts can be beneficial and even enjoyable if you take proper precautions. You’ll get a good dose of Vitamin D just by being outside in the sun (something we could all use more of during the winter months), and you’ll burn more calories taking your workout outdoors vs. indoors because your body works a little harder to regulate its core temperature. So, if you’re motivated to crawl out from under your warm blanket, take these four precautionary tips into consideration.

1. Have A Plan

Always check the weather forecast before going out to exercise in cooler weather. If the prediction is below 0 degrees Fahrenheit or the wind chill is dangerously low, you might want to opt for an indoor workout instead. Also, to prevent falls, map out your route ahead of time and avoid areas that may be snow-covered or icy.

2. Warm Up Properly

Stay inside for your warm up. Take 10 minutes to stationary cycle or jog in place to help get your muscles warmed up and ready for your workout.

3. Don’t Forget to Hydrate

Although you may not be drenched in sweat in the winter like you are during a summer workout, you still need to drink enough to avoid dehydration. (Plus, cold, dry air leaches more moisture from your lungs, i.e., seeing your breath).

4. Wear the Proper Equipment

Choose the right layers of clothing that will protect your skin from the wind and cold. Depending on the temperature, you might need a tight-fitting base layer (made of compression material to help wick away sweat), a middle layer for extra warmth, and an outer layer for protection from the elements (such as a windproof jacket). Choose synthetic materials for your base layer, and don’t forget about your head, hands, ears, and toes. Hats, gloves, and warm socks are a must.

As with any exercise, listen to your body and don’t push yourself if it doesn’t feel right. Cold weather may mean you have to dial back your effort just a tad until your body is acclimatized to performing in cooler temps. If you experience any pain this winter, whether it’s exercise- induced or otherwise, give us a call. Our team is ready to keep your body comfortable, regardless of the temperature.

Working Together With Your MD

Prevent

Medical physicians and chiropractors are advancing their collaborative efforts as research continues to validate the safety and utility of spinal manipulation for select musculoskeletal disorders. A recent study identified the fundamental values of a successful MD/DC relationship.

Chiropractors who work with medical physicians typically display “an evidence-based approach to patient care plus the ability to work collaboratively within a multidisciplinary team.” This MD/DC team approach has a direct positive impact on the new metrics of healthcare success:

“Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.” (1)

As next-generation chiropractors, we embody the evidence-based team approach to patient care. We are grateful for the opportunity to co-manage your cases and will work hard to maintain your trust.

Trigger point massage

Session Description

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

After treatment, it is usually recommended that the client apply moist heat to the area treated.