An Open Letter to our Medical friends.


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.


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.
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 S0140-6736(18)30489-6

Back to School Health Tips from Your Chiropractor

back to school.jpg

Summer is winding down, and families across America are gearing up for the beginning of a new school year. Help your kids (or yourself) start the year off right by considering some of our healthy back-to-school tips.

Backpack Ergonomics

Although backpacks are practical, carrying around heavy books and supplies every day can cause discomfort and injury over time.

Be sure to do a quick backpack check:

  • –  Purchase a backpack that is the correct size and has compartments to help distribute the weight evenly. Packs with padded shoulder straps are a good choice as well.
  • –  Make sure to use both straps of the bag and adjust them so that there are no gaps between the straps and back.
  • –  If carrying multiple heavy books, opt to carry one or two in your arms to help redistribute the weight.

    Desk Posture

    Encourage your child to practice good posture when sitting in the classroom. Hunching over the desk for hours every day is sure to cause discomfort.

    To sit at a desk correctly, they should:

  • –  Keep their feet flat on the floor and their back against the back of the chair.
  • –  Shoulders should be relaxed.
  • –  Any computer screens, tablets, or books should be kept at eye-level to avoid moving into a

    forward head posture, which will strain the neck. Consider purchasing a desktop bookstand to help prop the book up to eye-level.

    Safely Return to Sports

    Back-to-school also means back-to-sports for many kids. Remember that if your child was inactive in their sport for a couple of months, they might need to ease back into it. Always encourage them to warm-up beforehand, stretch afterward, and keep their workouts reasonable for their conditioning level and age.

    By being proactive in your child’s health, you can help prevent problems. If your child does experience back, neck, head, or joint pain this school year, please give us a call.


Chiropractic care is shown to be safe, effective for back pain.


Chiropractic Care is a Safe and Effective Option

SATURDAY, May 19, 2018 — Chiropractic care can help ease low back pain when added to a comprehensive treatment plan, a new clinical trial has found.

Active-duty military personnel reported having fewer back problems when they visited a chiropractor along with receiving usual medical care, the researchers said.

“This study provides the strongest evidence to date that chiropractic is safe, that it’s effective and that it can be integrated into a multidisciplinary health care setting,” said lead researcher Christine Goertz. She is CEO of the nonprofit Spine Institute for Quality in Davenport, Iowa.

Still, at least one pain specialist said more research may be needed to confirm chiropractic’s value for lower back pain.

The study comes in the context of the ongoing U.S. opioid crisis. This epidemic of addiction has created an urgent need for research into pain management that doesn’t involve medications, such as chiropractic care, Goertz said.

Chiropractic care focuses on the musculoskeletal system and the nervous system, mainly as they relate to the spine, according to the American Chiropractic Association.

Chiropractors aim to reduce low back pain by restoring joint mobility and proper alignment in the spine, through a process called spinal manipulation. Controlled force is applied hands-on to individual joints of the spine, to loosen them up and to stretch or break tight muscle tissue surrounding them.

Between 8 percent and 14 percent of U.S. adults seek chiropractic care, but there has been little research into its safety and effectiveness, Goertz said.

“Chiropractic has been controversial in the past, partially because chiropractic grew up outside the conventional medical care system,” she said. “For a long time, we really didn’t have a lot of evidence supporting the outcomes that both patients and doctors of chiropractic were reporting.”

To conduct a real-world test of chiropractic’s usefulness, Goertz and her colleagues enrolled 750 back pain patients at three military hospitals across the nation.

Low back pain is one of the most common reasons military personnel seek medical care, and a condition most likely to interrupt combat duty, according to the researchers.

Study participants were randomly assigned to receive either usual medical care, or that same care along with chiropractic.

Usual medical care involved seeing a doctor, taking pain medications, undergoing physical therapy and performing exercises, the study authors noted. Patients were treated for six weeks, then tracked for another six weeks.

“We found that at every time point, those patients that received chiropractic care had better outcomes in terms of their level of pain intensity and pain-related disability,” Goertz said.

“In addition, we also found that patients who saw the chiropractor tended to be much more satisfied with the care they received, and more likely to have perceived benefit from the care they received,” she added.

However, more adverse events were associated with chiropractic care.

The group receiving usual medical care reported 19 adverse effects, mostly muscle or joint stiffness attributed to physical therapy or exercise.

But 43 adverse events were reported by those also receiving chiropractic care, with 38 of them described as muscle or joint stiffness related to chiropractic procedures.

Dr. Karan Johar, medical director of NYC Pain Specialists and an attending physician at Lenox Hill Hospital in New York City, downplayed the study.

Johar noted that the investigators did not make sure each patient received the exact same type of chiropractic or traditional medical care, making it tough to pinpoint what worked for each patient.

The diagnosis of low back pain also is very broad, adding to the lack of clarity regarding how much chiropractic care contributed to patients’ well-being, he said.

“It’s very hard to assess if that study proves that chiropractic care helps,” Johar explained.

Insurance coverage for chiropractic care varies widely, Goertz noted. For example, Medicare covers chiropractic for spinal manipulation only, and will not reimburse chiropractors for examining patients.

“The majority of payers cover chiropractic in some way or another,” she said, “but the copay can be larger than the amount of the office visit.”

Goertz hopes more studies will find medical benefit in chiropractic care and that insurance companies will “follow the evidence” and improve coverage of these services.

The trial results were published online Friday in JAMA Network Open.

More information The U.S. National Institutes of Health has more about spinal manipulation for low back pain.

Copyright © 2018 HealthDay. All rights reserved.


Trigger points in the adductor pollicis

The adductor pollicis is a muscle in the hand and acts on the thumb. It originates on the transverse head of the third metacarpal, the oblique head of the base of the second and third metacarpals, and the trapezoid and capitate bones. It inserts on the base of the proximal phalanx and ulnar sesamoid. This muscle acts to adduct and flex the thumb. Trigger points cause pain and aching along the outside of the thumb and hand, spillover pain may reach the thenar eminence.

Condition Of The Month: TOS!


Thoracic Outlet Syndrome (TOS)

The term “thoracic outlet” describes an area at the base of your neck, just above your collarbone. Some important nerves and vessels pass through this outlet on their way into your arm. Compression of these tissues causes a condition called “thoracic outlet syndrome” which results in pain, numbness or tingling in your arm.

Several different factors can cause Thoracic Outlet Syndrome, commonly referred to as TOS. Sometimes TOS is caused from tightness in the muscles of your neck and chest, other times the space between your first rib and collarbone is too small. People who have an extra rib (cervical rib) and people who have recently suffered a neck injury may have a greater chance of having this problem.

The condition is aggravated by poor posture and by occupations that promote “slouching,” i.e., computer users, assembly line workers, supermarket checkers and students. Swimmers, volleyball players, tennis players, baseball pitchers and occupations requiring prolonged overhead activity. i.e., electricians and painters are also prime candidates for TOS.

Symptoms of TOS include arm pain, numbness, tingling and possible weakness. Neck, arm and hand pain may begin slowly and are often aggravated by elevation of the arms or excessive head movement. Loss of grip strength is possible.

Conservative treatment, like the kind we provide, has been shown to be effective at treating TOS. Through our careful exam we have identified your specific sites of compression and will use some of the following treatment to help:

You should avoid carrying heavy loads, especially on your shoulder i.e., carpet rolls. Briefcases, laptop cases or heavy shoulder bags should be lightened. Bra straps may need additional padding or consideration of replacement with a sports bra.

If you or someone you know suffers from any of these symptoms, call our office today. Our team has knowledge and tools to help you feel better quickly!

Help For Those Stuck At A Desk All Day

Desk workers should periodically perform the “Brugger relief position” to help maintain good sitting posture.

Here’s how to do it:

  • Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed.
  • Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together.
  • Take a few deep cleansing breaths.

Learn more about proper workstation ergonomics in this video.

Brugger’s Relief Position

Lumbar Degenerative Spondylolisthesis

Your lumbar spine (low back) is made up of five individual vertebra stacked on top of a bone called the sacrum. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, our discs and joints can wear and become thinner from a process called arthritis. This leads to additional changes, including loosening of the ligaments that hold your vertebra in place.

The term “degenerative lumbar spondylolisthesis” means that one of your vertebra has shifted forward on top of the one below as a result of arthritis and loosening ligaments. The condition usually comes on after age 50 and affects women six times more frequently than men. Degenerative spondylolisthesis occurs most commonly at your second lowest spinal level. (L4-5)

Sometimes, spondylolisthesis develops silently, but most patients report episodes of back pain that have occurred for many years. Patients often report increased pain when standing or when rising from a sitting position. Pain tends to increase throughout the day. If your nerve openings have become narrowed, the nerves may be pinched, and you may experience pain radiating into your legs. Leg symptoms that shift from side to side are characteristic of degenerative spondylolisthesis. Leg pain and tingling are fairly common, but be sure to tell your doctor if you notice more significant symptoms, like leg numbness, heaviness, weakness, loss of bowel or bladder function, or impotence.

Studies have shown no advantage for surgery over conservative care for most cases of degenerative spondylolisthesis. Approximately one-third of patients will experience progression of symptoms over time, and only 10-15% will ever need surgery to correct the problem. Fortunately, the majority of patients will benefit from treatment and exercises to help stabilize their spine.

You will need to perform your exercises consistently for sustained improvement. You should also try to add some type of aerobic exercise to your daily routine. Stationary cycling is a very good choice, and other options include water walking and swimming. Avoid wearing high heels. You may find some benefit for your arthritic symptoms by taking 1500mg of Glucosamine Sulfate each day. Using a hot pack for 10-15 minutes directly over your lower back may provide some benefit.

A Modern Spine Ailment

Some great information from and Dr. Steven Shoshany DC


Text neck is the term used to describe the neck pain and damage sustained from looking down at your cell phone, tablet, or other wireless devices too frequently and for too long.

Text Neck

Using a mobile device often can lead to poor posture and symptoms of text neck.
Text Neck Treatment Video<spanclass=”div-video-link”></spanclass=”div-video-link”>

And it seems increasingly common. Recently, a patient came in to my practice complaining of severe upper back pain. He woke up and was experiencing severe, acute, upper back muscle strain. I told him I believe the pain is due to the hours he was spending hunched over his cell phone. Diagnosis: Text neck.

See All About Upper Back Pain

Of course, this posture of bending your neck to look down does not occur only when texting. For years, we’ve all looked down to read. The problem with texting is that it adds one more activity that causes us to look down—and people tend to do it for much longer periods. It is especially concerning because young, growing children could possibly cause permanent damage to their cervical spines that could lead to lifelong neck pain.

See Cervical Spine Anatomy and Neck Pain

What are the symptoms associated with text neck?

Text neck most commonly causes neck pain and soreness. In addition, looking down at your cell phone too much each day can lead to:

    • Upper back pain ranging from a chronic, nagging pain to sharp, severe upper back muscle spasms.
    • Shoulder pain and tightness, possibly resulting in painful shoulder muscle spasm.
    • If a cervical nerve becomes pinched, pain and possibly neurological symptoms can radiate down your arm and into your hand.

See What Is Cervical Radiculopathy?

I believe, as some studies suggest, text neck may possibly lead to chronic problems due to early onset of arthritis in the neck.

See Facet Joint Osteoarthritis


How common is text neck?

A recent study shows that 79% of the population between the ages 18 and 44 have their cell phones with them almost all the time—with only 2 hours of their waking day spent without their cell phone on hand.1

See Causes of Upper Back Pain

How is text neck treated?

First, prevention is key. Here are several pieces of advice for preventing the development or advancement of text neck:

    • Hold your cell phone at eye level as much as possible. The same holds true for all screens—laptops and tablets should also be positioned so the screen is at eye level and you don’t have to bend your head forward or look down to view it.

See Ten Tips for Improving Posture and Ergonomics

    • Take frequent breaks from your phone and laptop throughout the day. For example, set a timer or alarm that reminds you to get up and walk around every 20 to 30 minutes.
    • If you work in an office, make sure your screen is set up so that when you look at it you are looking forward, with your head positioned squarely in line with your shoulders and spine.

See Ergonomics of the Office and Workplace: An Overview

The bottom line is to avoid looking down with your head bent forward for extended periods throughout the day. Spend a whole day being mindful of your posture—is your head bent forward when you drive? When you watch TV? Any prolonged period when your head is looking down is a time when you are putting excessive strain on your neck.

See Office Chair, Posture, and Driving Ergonomics

Text Neck

Keeping the neck straight and your phone at eye level can help prevent text neck.
Neck Strains and Sprains Video

Next, rehabilitation is important.

    • Many people don’t know this, but you need to have strong core muscles—the abdominal and lower back muscles—to support your upper body, including your neck. Your core muscles usually do not get enough exercise during normal daily activities, so you need to do specific exercises to target these muscles.

See Core Body Strength Exercises

    • You also need strong and flexible muscles the neck to minimize strain on your cervical spine and help support the weight of your head. Again, your neck will not get sufficient stretching and strengthening during normal daily activities, so it is best to learn specific neck exercises with the help of a health professional.

See Neck Stretches

Some people will also benefit from a more comprehensive treatment plan, such as a combination of manual adjustments, massage therapy, and cold laser therapy.

Learn more: