DCOA - Addison

Low Back Pain and The Danger of Spinal Fusions

You may think it’s odd to discuss low back pain (LBP) from the perspective of spinal fusion because as chiropractors, we do not perform surgery and so, why discuss it? It is important that we discuss research such as this so we can make the informed treatment decisions with our patients after we’ve considered all the facts in each specific case. Now, there are certainly times when a surgical procedure for back and leg pain is necessary and appropriate for some patients; however, there are also some patients who have been told they need spinal surgery when, in fact, they may be better off NOT proceeding with surgery. Thus, the question is, what happens to those patients who elect not to proceed with surgery vs. those who do?

That question was addressed in a study where a total of 1,450 patients injured at work were followed over a two-year time frame. There were a total of 725 patients who proceeded with the fusion surgery and the other 750 elected NOT to have the surgery. A fusion surgery can be described as when two or more vertebra are fused together, usually because there are neurological problems such as shooting leg pain, weakness, and/or numbness in one or both legs. The conditions treated in this study included herniated disks, degeneration of the disk, and radiating leg pain. There were primarily three factors that were compared between the two groups: 1) ability to return to work; 2) disability (the inability to work), and 3) op**te (narcotic) drug use. Other factors compared included the need for re-operations, complications, and death.
The results showed, in general, those who proceeded with surgery had significantly more problems compared with those who did not have surgery. For example, only 26% of those who underwent surgery returned to work, compared with 67% in the non-surgery group. The total number of days off work were 1140 vs. 316 days, respectively. There were 17 vs. 11 deaths, respectively, and 27% of the surgical group required re-operations with a 36% complication rate. Also, there was a 41% increase in the use of narcotic medication with 76% continuing the use after surgery.

Again, there are times when surgery is absolutely the right choice. Those times include when there is a loss of bladder or bowel control, progressively worsening neurological symptoms in spite of non-surgical care, and of course, unstable fractures, cancer/tumor, and infections, but that’s about it! In other words, if you don’t have one of the before mentioned conditions which do require surgery, don’t be too quick to jump at the chance of “getting it fixed” with surgery. As the study suggests, the post-surgical results favor those who elected NOT to have surgery. Also, when in doubt, don’t trust the opinion of only one surgeon – always get a 2nd or even 3rd opinion. It is also very important to consider your current level of function or your ability to do your desired tasks and unless there is a significant loss in that ability, consider additional time with non-surgical treatment. The non-surgical treatment you can expect to receive from chiropractic includes (but may not be limited to) spinal manipulation, exercise training, physical therapy modalities (ice, heat, electrical stimulation, ultrasound, traction, etc.), dietary counseling, and job modification information.

Schedule a free consultation today by visiting www.AddisonBackandSpine.com

Low Back Pain & Spinal Manipulation: How Does It Work?

For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared with other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works but many of these studies include other treatment modalities or methods and the benefits are, therefore, not clearly derived only from CMT. A 2011 study attempted to clear this up and the results were very interesting!

This study included two chiropractors and two a physical therapists (PT) from Canada and the United States. What is unique about this study is that the researchers measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument both before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial two treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment).

The study found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness, and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation. The authors of the study noted the greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment.

With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking, and of course, working.

Neck Pain: Manipulation vs. Mobilization – What’s Better?

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT) when it comes to treating neck pain? To answer this question, let’s first discuss the difference between the two treatment approaches.

Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint using various methods such as figure 8, side-to-side, front-to-back, and /or combinations of any of these movements. In the neck, gentle to firm manual traction or pulling, when applied to the cervical spine, stretches the joint and disk spaces and can be included during MOB.

Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide). Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report that an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of gas release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity. As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The latter is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided. Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck” or partially displaced), it’s obviously BEST to utilize chiropractic, as chiropractors do this many times a day (for years or even decades) and know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

Back to the question: Which is better, MOB or SMT? Or are they equals in the quest of rid of neck pain? A 2012 study that included over 100 patients with “mechanical neck pain” (strain/sprain) found that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale, and two tests that measure function!

Learn more by visiting www.AddisonBackandSpine.com

Medical Doctors Recommend Non-Surgical Spinal Decompression Care for Back Pain Relief

Harvard Study: Low Back Pain Patients Significantly More Satisfied with Chiropractic Than Conventional Medical Care.

In 2002, at the 17th annual North American Spine Society meeting, three medical doctors defended chiropractic by citing a Harvard study that found low back pain patients were significantly more satisfied with Chiropractic treatments compared to conventional medical care.

After researching “myths,” co-author , Dr. Jack Zigler, MD found chiropractic education is more similar to medical education than it is dissimilar.

Dr. Zigler had integrated chiropractors into his multi-disciplinary spine center where the chiropractors screen patients for surgical versus non-surgical care.
Another co-author, Dr. Andrew Cole, MD, stated, “overall, manipulation* has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities.” (*Manipulation is one of the primary treatment techniques used by Doctors of Chiropractic.)

He also recommends spine surgeons refer their patients to chiropractors for Non-Surgical Spinal Decompression Therapy.

Learn More about Non-Surgical Spinal Decompression Therapy by visiting www.AddisonBackandSpine.com