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

More Hip Mobility Work

Hip mobility work is often under appreciated but required for athletes and the general public. Better hip range of motion will lead to better athletic performance, less pain, better mobility and a better quality of life. Check out a great little routine here. As always, check with your therapist, trainer or coach before starting this kind of routine to make sure it is appropriate for you.

Be sure to follow Eric @BeEliteDaily for more great content like this.

Athletic Rotational Force

Building athletic rotational force is key to power production in almost every sport. Here’s a great example of the kind of programming it takes to get it done. Medicine balls are a great tool when used correctly.

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Herniated Disc

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A herniated disc refers to a disc lesion in the spine, which can cause local symptoms and can sometimes radiate to the legs or arms depending on the location of the lesion. This condition can occur gradually or as a result of a false movement. The hernia is usually located in the lower back or the neck. It sometimes appears in the thoracic region (middle of the back).

The intervertebral discs may be damaged due to poor lifting technique, repetitive intense activity or excessive body weight. A combination of several factors can contribute to the development of a herniated disc.

With age, the discs lose their gelatinous property, decreasing the size of the disc and the space between the vertebrae. Therefore, the spine may become more prone to injury and less mobile.

Treatment of disc injuries consists of Class IV Laser Therapy, management of any biomechanics stresses in the area and exercise rehabilitation to address any weaknesses that can be putting undue stress on the area. 

#LaserTherapy
#BackInjuries
#Winnipeg
#Chiropractic
#DiscInjury
#Arthritis

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Heel Spurs

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The heel spur is a small bony point that forms at the insertion of the plantar fascia on the heel. It is generally associated with plantar fasciitis secondary to significant and repetitive stress on the plantar fascia.

Obesity and frequent wearing of high heels are important risk factors. Athletes are also at risk if their training is excessive.

Treatment of heel spurs consists of Class IV Laser Therapy, management of any biomechanics stresses in the area and exercise rehabilitation to address any weaknesses that can be putting undue stress on the area. 

#LaserTherapy
#FootInjuries
#Winnipeg
#Chiropractic
#PlantarFasciitis
#Arthritis
#FootPain

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Tight Mid Back?

Have a tight mid-back? This is an excellent movement to relieve tight and sore areas and improve overall mobility of the thoracic (middle part of your) back.

Start in a pain free range of motion and build more and more range as you relax tight muscles, mobilize joints and expand the range of connective tissues. Be sure to follow The Prehab Guys for more great content like this.

Make It Fun!!!

Getting your athletes to buy in to a proper warm up/prep can be a challenge at times. Using something like the routine above can make it a fun, competitive pre-game activity that gets them loose and gets their competitive juices flowing.

Make it fun for the athlete and you’ll see results faster!

Be sure to follow Austin for more great tips like this!

Hammer Toe

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Hammer toe is a progressive condition that usually affects one of the three toes in the middle of the foot. The toe gradually bends back on itself and this causes a hammer-like deformity.

As the condition progresses, the joint becomes less mobile and the tendons shorten, making the toe stiff. A callus or corn on the top of the flexed toe may also develop.

Wearing shoes that are too small can trigger or worsen the condition. Osteoarthritis, rheumatoid arthritis, and diabetes can also cause hammer toes.

Treatment of Hammer Toe consists of Class IV Laser Therapy, management of any biomechanics stresses in the area and exercise rehabilitation to address any weaknesses that can be putting undue stress on the area. 

#LaserTherapy
#FootInjuries
#Winnipeg
#Chiropractic
#ToeInjury
#Arthritis
#FootPain

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Hallux Valgus (Bunion)

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Hallux valgus is defined as a deformity that occurs at the base of the big toe, which deviates towards the other toes.

This condition, commonly called a bunion, is often associated with joint stiffness. It usually causes pain and in some cases an alteration of the normal biomechanics of walking.

Wearing narrow, pointy shoes, such as high heels, can cause this condition to develop over time.
Also, a limitation of the extension of the ankle is often compensated by a walk with rotation of the foot towards the outside. This induces lateral pressure on the big toe which, over time, can contribute to the appearance of hallux valgus. Structural foot abnormalities such as flat feet or increased hallux length can also contribute.

Treatment of bunions consists of Class IV Laser Therapy, management of any biomechanics stresses in the area and exercise rehabilitation to address any weaknesses that can be putting undue stress on the area. In a worst case scenario, surgery is often considered but only after all conservative options have been exhausted. 

#LaserTherapy
#FootInjuries
#Winnipeg
#Chiropractic
#ToeInjury
#Arthritis

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