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

Condition Of The Month

Achilles Tendonitis

achilles

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.

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Trigger points in the vastus Lateralis

The vastus lateralis muscle is one of the quadriceps muscles of the thigh. It originates on the greater trochanter, intertrochanteric line, and linea aspera of the femur. It inserts on the Patella via the quadriceps tendon and tibial tuberosity via the patellar ligament. It’s main function is to extend the knee. Trigger points in this muscle refer pain all along the lateral thigh and into the lateral knee.

Trigger points In the rectus abdominis muscle.

the rectus abdominis muscle is your “six pack” muscle. It originates on the pubic bone, and inserts on the costal cartilage of ribs 5-7, and the xiphoid process of the sternum.its main actions are to flex and rotate the spine, and to increase intra-abdominal pressure. This muscle is often tight in people who slouch, or have a posteriorly tilted pelvis. In people with an anteriorly rotated pelvis this muscle is often weak and needs to be strengthened. Trigger points in this muscle refer pain into the mid and lower back

Text Neck Caution

TXT Neck.jpg
Winter break for your kids might mean more time being spent on their electronics than usual. Be cautious of the dangers of excessive tech use and the stress that’s being put on your child’s neck and back when they’re sitting down, or looking down at a phone or tablet for a long time. This type of strain/injury happens so frequently nowadays that it even has a name “Text/Tech Neck”.
 
The best way to avoid this is to limit tech use or practice good posture when they do use their devices.

Tips to Stay Healthy During the Holidays

Holiday Tips 2018

The holiday season is here, which means our daily routines will be disrupted by festive get- togethers, cookies, pies, traveling, and shopping. It can be stressful just thinking about it, but we have some tips to help you stay on top of your healthy habits throughout the season – without feeling overwhelmed.

Practice Healthy Nutrition

  • –  Drink plenty of water, especially if you’ll be consuming alcoholic beverages at a holiday party. Water will help you avoid dehydration and as a bonus, may also help fill you up so don’t overindulge.
  • –  Use a smaller plate to help you maintain healthy portion sizes.
  • –  Don’t force yourself to eat everything. Choose only the things you most enjoy.
  • –  Take the focus off of food. At your next family gathering, prepare a game or activity that doesn’t involve overindulging in food or alcohol.

    Keep Moving

  • –  Don’t neglect your workouts. Make them a priority – even more so during this busy season.
  • –  If you’re traveling during the holidays, be aware of how much you’re sitting. Excessive sitting is detrimental to your health in many ways. Try to get up and move around at least once every hour, whether you’re traveling by car or plane.

    Relax

  • –  Make sure to strive for the recommended amount of sleep, which is 7-8 hours each night for adults.
  • –  De-stress using a healthy method that works for you – whether that be meditation, exercise, or a warm bath and a book. You’ll enjoy this busy season much more when you have a clear mind.
  • –  Lastly, listen to your body. Stress, whether it be mental or physical, will take a toll on your health. If you need a pre or post-holiday tune-up, we’re always here to help.

Trigger points in the adductor pollicis muscle.

The adductor pollicis muscle is a key mover of the thumb. This muscle has two heads. The transverse head originates on the third metacarpal. The oblique head originates on the base of the second and third metacarpals and the capitate and trapezoid bones. This muscle inserts on the base of the proximal phalanx and ulnar sesamoid. Adduction and flexion of the thumb are the main actions it produces. Trigger points cause an aching pain along the outside of the thumb and hand. Pain can also be felt in the thenar eminence in extreme cases.