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

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.


  • –  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.

Conservative Management of Headaches

HA C Spine

Headaches affect almost half of the population. 15-25% of all headaches are referred from the cervical spine and are classified as “cervicogenic”. (1,2) The pathophysiology of cervicogenic headache is debatable, but the anatomical basis is thought to be a convergence of sensory neurons in the upper cervical spinal cord that allows bidirectional referral of pain between the neck and head. (3) More recently, anatomists have identified myodural bridges connecting the dura to the suboccipital musculature. These bridges employ both passive and active tensioning of the spinal cord; with obvious implications for mechanically generated headaches. (4-6)

Two recent randomized controlled clinical trials have highlighted the effectiveness and safety of chiropractic management for headaches.

o “Cervical spinal mobilization increased cervical range of motion and induced immediate headache relief (in patients with cervicogenic headache).” (7)

o “Adverse events were mild and transient, and severe or serious adverse events were not observed. Local tenderness was the most common, reported by 11.3% and 6.9% of the manipulation group and the placebo group, respectively.” (8)

This new data adds to a growing list of support for employing spinal manipulation for headache sufferers. I hope that you will consider recommending chiropractic care for your appropriately screened patients. We are honored to be your partner in co-managing patients and will work diligently to provide tools that resolve problems quickly and safely.

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.

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.