Chiropractic Facts

Chiropractic Facts

Chiropractic care has been known to help many people suffering from a wide variety of nerve/muscle/joint-related conditions. If the chiropractor examines a person and finds joint dysfunction, nerve irritability and/or connective tissue abnormalities related to the problem area, it is likely that chiropractic care will help.

Chiropractic services are in high demand. Tens of millions of Americans routinely opt for chiropractic services and this number is rapidly growing. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program.

Chiropractic utilizes a "hands on" active approach. The principle treatment is adjustment/ manipulation of the spine and supportive soft-tissue techniques. There is a focus on lifestyle counseling, prevention, and patient responsibility for health (for example, in the areas of posture, diet, exercise, stress-reduction, etc.).

All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted in stroke or spinal cord injury. To be safe, always inform your primary health care provider whenever you use chiropractic or other pain relief alternatives.

Doctors of chiropractic provide effective, low-cost health care for a wide range of conditions. Studies conducted according to the highest scientific standards and published by organizations not affiliated in any way with chiropractic institutions or associations continue to show the clinical appropriateness and effectiveness of chiropractic care. One of the most recent, funded by the Ontario Ministry of Health, stated emphatically that:

The process of chiropractic adjustment is a safe, efficient procedure which is performed nearly one million times every working day in the United States. There is a singular lack of actuarial data that would justify concluding that chiropractic care is in any way harmful or dangerous. Chiropractic care is non-invasive, therefore, the body's response to chiropractic care is far more predictable than its reactions to drug treatments or surgical procedures. Of the nearly one million adjustments given every day in this country, complications are exceedingly rare. Perhaps the best summary statement on the subject of safety was published in 1979 by the Government of New Zealand which established a special commission to study chiropractic. They found:

"The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record."

Neck Pain Facts

Neck Pain Facts

Neck pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Often neck pain episodes will get better on their own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

Back and neck pain are the most common chronic pain conditions. Back and neck pain can arise from soft tissues, bony parts of the back and neck, and joints holding the spine in alignment. It can arise directly or indirectly from the discs in the back or neck, and it can occur when nervous tissue, normally protected by the bones of the vertebral spine, is compressed by those bony elements.

The most common symptoms of neck pain are pain, stiffness, muscle spasm, clicking and grating, numbness or tingling, dizziness and/or blackouts.

Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatic. Neck pain is also referred to as cervical pain.

Back Pain Facts

Back Pain Facts

Patients who have symptoms of nerve or spinal cord compression should not undergo chiropractic manipulations until cleared to do so by a medical doctor. Furthermore, there are rare problems, such as infections and tumors of the spine, that should not be treated by chiropractors. Unfortunately, there are stories of patients who undergo manipulations of the spine and sustain devastating complications because of nerve injury. These cases are rare, but it is important that there is a good understanding of the cause of back pain before initiating manipulations of the spine.

The chiropractic approach is to find the cause of the pain and treat it directly. This may involve

realigning the spine or extremities by chiropractic adjustments, physiotherapy for the muscles

and ligaments, rehabilitative exercises, or a combination of these. Sometimes the doctor of

chiropractic will suggest exercises or activities to prevent a reoccurrence of the problem.  This

may provide a long term solution to the condition through prevention. Chiropractic spinal manipulation is proven to be a safe, effective, and affordable treatment option. Chiropractic care reduces pain, restores normal range of motion, and decreases the need for medication. 

A chiropractor first takes a medical history, performs a physical examination, and may use lab tests or diagnostic imaging to determine if treatment is appropriate for your back pain. The treatment plan may involve one or more manual adjustments in which the doctor manipulates the joints, using a controlled, sudden force to improve range and quality of motion. Many chiropractors also incorporate nutritional counseling and exercise/rehabilitation into the treatment plan. The goals of chiropractic care include the restoration of function and prevention of injury in addition to back pain relief.

For chronic low back pain, prospective RCT compared: (1) chiropractic spinal manipulation therapy (SMT) plus trunk-strengthening exercises with (2) chiropractic SMT plus trunk-stretching exercises and (3) trunk-strengthening exercises combined with an NSAID (drug). Enrollees (174) were measured for low back pain, disability, and functional health status at 5 and 11 weeks.

THE ECONOMIC BURDEN OF WAD

THE ECONOMIC BURDEN OF WAD

Little is known about the individual and societal economic burden of WAD. For instance, little is known about the prevalence of long-lasting work disability due to WAD, which probably the most costly part. This burden is probably largely dependent on the legislation in different countries. In 2002, an independent and temporary Commission on whiplash-related injuries was informed in Sweden, initiated by the four largest motor vehicle insurers. The mandate of the 3-year commission was an examination of the problems of WAD from road safety, medical care, insurance and societal aspects. One of the conclusions of the final report was that the yearly cost for society and for the insurance industry was approximately SEK 1.5 billion (US$201 million), while projected costs (i.e. what new cases of WAD arising in a particular year will cost society and insurers by the time the person reaches retirement age) amounted to SEK 4.6 billion (US$648 million). These calculations were based on an annual incidence of 30,000 WAD cases (324 per 100,000 inhabitants) in the year 2002. Since the report’s publication, the number of WAD cases have decreased dramatically to about 16,000 claims in 2008 (173 per 100,000 inhabitants), which, of course, has an impact on the overall costs.

Comparable data has not been found, but there is some evidence from a study that addressed the incidence of WAD in 10 European countries. The administrative data suggests that the total claims cost in Switzerland was 500 million Swiss francs (US$467 million). Switzerland’s population is 80% that of Sweden. Expenditures in addition to the claims cost was not reported in that study.

SUMMARY

In summary, as in almost all other diseases and injuries, factors that are involved in the risk or prognosis of WAD are multifactorial and constitute a web of biological, psychological and social components.

REFERENCES

1.      Crowe H. A new diagnostic sign in neck injuries. Calif Med 1964; 100:12-13.

2.      Gay J. Abbott K. Common whiplash injuries of the neck. JAMA 1953; 152:1698-704.

3.      Benson BW, Mohtadi NG, Rose MS, Meeuwisse WH. Head and neck injuries among ice hockey players wearing full face shields vs half face shields. JAMA 1999; 282(24):2328-32.

4.      Versteegen GJ, Kingma J, Meijler WJ, ten Duis HJ. Neck sprain not arising from car accidents: a retrospective study covering 25 years. Eur Spine J 1998;7(3):201-5.

5.      Lorish TR, Rizzo TD, Jr., Ilstrup DM, Scott SG. Injuries in adolescent and preadolescent boys at two larger wrestling tournaments. Am J Sports Med 1992;20(2):199-202.

6.      Spitzer WO, Skovron ML, Salmi LR, et al. Scientific Monograph of the Quebec Task Force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 1995;20(8 Suppl):1S-73S.

7.      Holm LW, Carroll LJ, Cassidy JD, Ahlbom A. Factors influencing neck pain intensity in whiplash-associated disorders in Sweden. Clin J Pain 2007;23(7):591-7.

8.      Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A re-examination of the whiplash-associated disorders (WAD) as a systematic illness. Ann Rheum Dis 2005:1337-42.

9.      Berglund A, Alfredsson L, Jensen I, et al. Occupant- and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol 2003;13(1):66-72.

10.   Bylund P-O, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine 1998;23(9):1023-8.

11.   Versteegen GJ,Kingma J, Meijler WJ, ten Duis HJ. Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994. Eur Spine J 1998;7(3):195-200.

What is a traumatic event?

What is a traumatic event?

A traumatic event occurs when the forces experienced during the various stages of the collision are greater than what is tolerable or is beyond the stress/strain threshold for the specified region of the body or type of tissue. These forces may cause minor (AIS 1 level) injuries, having no risk of fatality, and at the same time may present the occupant with sub catastrophic injuries, including strains, sprains, contusions, bruising and swelling and resultant symptoms and findings consistent with a WAD. Just because an injury or the cause of a patient’s subjective complaints is not objectively seen does not mean that it doesn’t exist. Unfortunately, current technology is not sensitive enough to detect some types of injuries. More severe injuries may also occur, resulting in more obvious injuries, including fractures, bleeding, organ disruption, and death.

Rear-end Collisions

Rear-end Collisions

Over the past half-century, hundreds of research studies have sought to detail the mechanisms involved in rear-end collisions. These studies have involved use of live objects (in low-speed rear-end impacts), cadeveric simulations, accelerometry, electromyography, and mathematical modeling. As a result of these studies, we have a better understanding of rear-impact dynamics, but controversy remains. The experts do agree on one point--cervical dynamics during rear-impact scenarios are complex and not entirely understood (e.g., Luan et al 2000).

               Pioneering work by Severy (1955) showed that rear-end collisions cause a sequential acceleration of the vehicle, the occupants trunk and shoulders, and the occupants head. As the vehicle is impacted (e.g., in an automobile rear-end collision), it accelerated first, reaching a peak acceleration of almost 5 g, that is, five times the acceleration of gravity. The vehicle occupant’s shoulders reach their peak acceleration of about 7 g 100 ms later. Finally, the occupant’s head reaches its peak acceleration of greater than 12 g at 250 ms after initial impact. This sequential progression of peak acceleration is evidence of both momentum and energy transfers.

               Response of the cervical spine depends on impact awareness, muscle involvement, and direction of impact (Kumar et al. 2005). In an unaware vehicle occupant, muscles are recruited late during the whiplash episode. Muscle recruitment and tension development may not happen until 200 to 250 ms after impact. Given that much of the critical cervical motion occurs during the first 200 ms, muscle involvement may only play a role in the late stages of whiplash. Injury may have already happened before the muscles become involved (Bogduk and Yoganandan 2001).

               On a positive note, epidemiological evidence suggests that many victims of rear-end collision do not sustain injuries, and most of those who are injured show no long-lasting effects. In one study, 18% of patients had injury-related symptoms 2 years post injury--82% were asymptomatic (Radanov et al. 1995).

               In addition to impact awareness, muscle involvement, and direction of impact, many other factors determine injury risk in rear-end impacts: vehicle mass, velocity, and ability to withstand crashes; road conditions; use of restraint systems; and the passenger’s or driver’s body and head position at impact, neck rotation, gender, history of neck injury, and age.

Special Diagnostic Considerations

Special Diagnostic Considerations

Disc Pain Distribution

               Theannulus fibrosis has nociceptive nerve endings in it, and therefore an annular tear can cause pain referral of purely discogenic origin into the low back, buttock, and sacroiliac region, and lower extremity even in the absence of neural compression.

Facet Joint Pain Distribution

               The zygapophysial joints are well innervated, and facet naturopathy can cause lowback pain and referred pain into the buttocks and lower extremities. Classic facet syndrome pain is in the hip and buttock, with cramping leg pain primarily above the knee, low back stiffness (especially in the morning with inactivity), and the absence of paresthesia. Classic signs are local paravertebral tenderness, hyperextension back pain, and no neurologic or root tension signs with hip, buttock, or back pain on straight leg raising.

Differentiating Disc from Facet Pain Distribution

               Differential diagnosis of lower-extremity pain of disc versus facet includes the facet that facet pain rarely extends beyond the calf, usually only into the thigh, and not into the foot. Radicular disc pain is potentially worse than back pain. In facet pain, the back pain is worse than the leg pain. Radicular pain is usually accompanied by neurologic signs in disc legions but not in facet problems.

Elevated Cerebrospinal Fluid Proteins

               The protein concentration in the cerebrospinal fluid (CSF) is often increased in patients with sciatica, probably because of plasma proteins leaking through the blood-nerve root barrier into the cerebrospinal fluid. Significantly higher values of the CSF/ serum albumin ratio and the CSF/ serum immunoglobulin G ratio were found in patients with positive SLR test results and paresis compared with patients with no clinical findings. Elevated CSF proteins seem to be an important indicator of the functional status of the nerve root and a measure of the degree of seriousness of sciatica.

               Nerve root injury, as suggested by a positive straight leg raising test, appears to be neurochemically linked to altered CSF vocative intestinal peptide levels in patients with radicular pain symptoms caused by disc herniation and lumbar stenosis.

Differentiating Recurrent Disc Herniation from Scar Formation

               Gradually increasing symptoms beginning a year or more after discectomy are considered more likely caused by scar formation, whereas a more abrupt onset at any interval after surgery is more likely cause by a recurrent herniated disc.

               Symptoms and signs that best distinguish between recurrent herniation and fibrosis are pain on coughing, a severly reduced walking capacity, and a SLR test positive at less than 30 degrees; the presence of two or more of these parameters was found in 16 of 22 patients with recurrent herniation, compared with 5 of 18 patients with fibrosis.

Pathologic Change in Sciatica Foramen as Cause of Sciatica

               Longstanding sciatica symptoms and signs should include pathologic changed in the sacral foramen by benign and malignant neoplasms as well as infection. CT scanning should include the sciatic foramen in longstanding, undiagnosed sciatica.

Dorsal Root Ganglion Compression Symptoms

               Dorsal room ganglion compression can result in myalgia and tendonitis symptoms into the lower extremities, as well as intermittent claudicating, sciatica, and groin pain.

Clinical Instability Defined

               White and Panjabi states that a narrowed disc space without spondylosis is a sign of instability. Clinical instability is defined as the loss of the spine’s ability, under physiologic loads, to maintain normal relationships between vertebrae so that no damage and no subsequent limitation to the spinal cord or nerve roots occurs and no incapacitating deformity or pain develops from structural change.

Differentiating Contained from Noncontained Disc

               When a disc lesion is present, a differential diagnosis between protrusion and prolapse is necessary. The sudden onset of leg pain and absence of low back pain indicates protrusion.

Sciatic Scoliosis Defines Disc Lesion Type

               Relief of pain on lateral flexion may indicate whether the disc protrusion is lateral or medical to the nerve root.

Cervical Disc as Cause of Myofascitis and Leg Pain

               Cervical disc herniations have been reported to cause Myofascial pain and altered deep reflexes in the lower extremities; the Myofascial pain caused by this irritation ceased once the mechanical cervical disc rubbing of the cord was surgically relieved.

Leg Length Effect on Low Back Pain

               Leg length inequality alters gait efficiency and predisposes to low back pain and hip arthrosis.

What Is the Best Lifting Posture?

Back Muscle Forces in Flexion Similar to Upright Posture

               Compression forces and moments exerted by the back muscles in full flexion are not significantly different from those produced in the upright posture.