Category: Other Articles

:dropcap_open:I:dropcap_close: talk to a lot of chiropractors from all across the country. My business (Matlin Mfg. Inc.) brings me into contact with doctors from a very wide range of backgrounds and techniques. The number of techniques and therapeutic modalities used by chiropractors is extremely varied.  But almost without exception, the vast majority of chiropractors still center much of their treatment for spinal pain around the use of spinal manipulation. Manual manipulation of the spine is most often rendered in the form of High Velocity/Low Amplitude (HVLA) adjustments. So in spite of all the differences we might observe between chiropractors of differing backgrounds, there remains this one thing which the vast majority of us seem to have in common.

 

I’ve also noticed one more thing chiropractors tend to have in common. As a group, chiropractors tend to not be lacking at all in confidence as to the value of their adjustments. By far, most chiropractors tend to strongly ‘believe” in the value of the adjustment. And most of the time, that’s probably a good thing. This month’s covered article supports the value of your adjustments compared to medications and home exercise. But beyond the author’s published conclusions, I think you might find this paper thought provoking in terms of where the profession (and your practice) may be headed in the future.

 

The Facts:

Take Home: 

Chiropractic care (SMT) proved most effective than medication both in terms of pain and in most of the secondary outcomes.  Home exercise with advice (HE) was a very close second and actually produced “similar short- and long-term outcomes.”   In fact, the HE group actually showed the most improvement in terms of spinal motion. Patients in the medication group fared the worst and a number of patients in the M group reported using higher levels of pain medication by the end of the study  

 

Many chiropractors utilize both manipulation and exercise. The authors make note of the limited difference in outcomes for the HE group and took pains to point out that ” the potential for cost savings over both SMT and medication interventions, is noteworthy.” 

 

Obviously it’s neat to have evidence supporting the chiropractic adjustment over NSAIDS, pain meds and muscle relaxers. But readers should take note. This paper also highlights the comparable outcomes and significant cost savings of active care/home care programs. Doctors who fail to provide exercise plans for acute/subacute spinal pain may well find their care plans in the cross hairs as plan administrators look continually to cut costs.

 

The study also made me consider that all too often pain relief may be the only thing many third parties are paying attention to. Unfortunately, that’s also the case with many chiropractors who simply adjust until patients feel better and then rinse and repeat whenever another exacerbation occurs. If all we do is relieve pain, then we can hardly blame interested third parties for seeking out the cheapest method available. I submit that if the profession hopes to survive and prosper, we are increasingly going to be challenged to show exactly how we produce improved clinical outcomes above and beyond the resolution of pain.

 

Special thanks to our Chiropractic Sciences Contributor Roger Coleman DC for this interesting article.

 

Reference:

Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1 Pt 1):1-10.

 

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/22213489

 
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.

:dropcap_open:I:dropcap_close:n 2011, Spine published an article that bears reading by every chiropractor. The study, entitled “The Pros and Cons of Evidence-Based Medicine” (Croft et al.), takes a look at the continuing debate within the medical profession as to the proper role of “evidence-based medicine.” The authors’ comments should be food for thought for chiropractors interested in keeping their practices on sound scientific footing. As you will see, the value of EBM is a subject that may be viewed quite differently by “researchers, clinicians, and policy makers.”

 

The Facts:

• Evidence-based medicine is the idea that current scientific evidence can be combined with the clinician’s expertise, as well as the patient’s preferences and expectations, to obtain the best outcomes.

• The “evidence” usually comes in the form of original research and systematic reviews of current scientific literature on a given subject. 

• Some argue that evidence could also mean observations and the clinical experience of the practitioner, even if there isn’t published data to back up those observations. In that case, the term “evidence-based” may more rightfully be called “experience-based” medicine.

• Often the “evidence” eventually ends up in published clinical guidelines. The authors note that “much of the evidence in any clinical guideline is likely to come from expert opinion.”

• Guidelines often combine expert consensus, scientific research, clinical practice, observation, and clinical judgment to produce their recommendations.

• Unfortunately, there is a significant risk of bias among “experts” and the term “evidence-based medicine” may not be entirely appropriate.

• The authors note that EBM can help make clinical practice more transparent, reduce random variables in treatment protocols across the professions, and even help reduce or eliminate harmful/ineffective treatment methods.

• They also state that EBM has been accused of refusing to give credence to valid information unless it is derived from randomized controlled trials. This can be very limiting because the ability to assess treatment using the rigid structures of clinical trials can often be confounded for “practical or ethical” reasons. For this reason, many common forms of treatment currently are accepted as standard practice even though there is little or no evidence in the form of clinical trials. 

• In reality, the daily decisions that doctors and patients must make are much more complex than the structured design of clinical trials. 

• Furthermore, too many sources of information or too many highly detailed clinical guidelines may result in practitioners choosing to simply ignore all or part of the recommended care for a given condition.

Of particular relevance to chiropractors is this comment made by the authors: “In the field of low back pain, EBM rarely provides the basis for action in a primary care consultation.” For example, most clinical trials evaluate only a single-treatment intervention. In real life, though, chiropractors often use multiple interventions (adjustments, ice, muscle stimulation, etc.) simultaneously. The use of multiple interventions may result in improved outcomes regardless of whether or not the treatment methods have ever been studied together in concert. Limiting our treatment only to those methods that have been thoroughly researched may easily hamstring our best efforts to treat patients.

 

As the chiropractic profession continues to move toward evidence-based practice guidelines, it’s also good to remember the ever-present potential for bias. Research by chiropractors, for example, might tend to be biased in favor of spinal manipulation as a treatment while other studies by MDs or PTs might easily be less favorable. It’s also worth remembering that treatment guidelines are to “skew toward select areas where evidence has been gathered, and away from interventions for which research is lacking, regardless of efficacy.” In the same vein, it should also be understood that the constant demand for more evidence before particular treatment methods are allowed is likely to retard progress and stifle creativity.

 

Finally, clinical practice guidelines are increasingly being used as far more than recommendations for treatment. Insurers frequently cite lack of evidence as justification for denial of payment. Failure to follow published treatment guidelines may too easily become the basis for a lawsuit. It’s worth remembering that a lack of good data on a particular therapy or treatment tells us absolutely nothing as to the efficacy, or lack thereof, of the method (a fact many insurers conveniently seem to overlook). 

 

Take Home: 

Taken too far, overreliance on EBM can serve to stifle professional judgment and negate the value of hard won experience. So what to do? Should we just ignore all the “evidence” and proceed to randomly do whatever we like in our clinics? Not at all, but neither should we proceed as if we’re totally blinded by the presence (or lack) of evidence. The debate about the value of EBM will likely continue. Established standards of professionalism demand we stay current as to the best available evidence. However, being the doctor has always required practitioners to think, evaluate, and temper that knowledge with professional experience and judgment. Special thanks to our chiropractic sciences contributor Roger Coleman, DC for this thought-provoking article. 

 

Reference: 

Croft P, Malmivaara A, van Tulder M. The pros and cons of evidence-based medicine. Spine. 2011;36:1121-5.

 

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/21629165

 
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.

:dropcap_open:I:dropcap_close:t’s common for patients to come to our office with complaints related to ‘working out’ or ‘over-training’ and not enough rest and recovery in between workout sessions. I see clients involved with athletic pursuits like cross fit, yoga, martial arts, running 5 K’s, swimming, biking, and/or other sports. We have such extremes in the population, those who sit way too much and wind up getting dehydrated and inhibited glutes from excessive and prolonged sitting (they never get physical activity), and those who are exercise ‘junkies.’ I think it’s important as part of the patient history for doctors to question clients about there past and current exercise routines and programs. My hope is that you are able to provide knowledge and have the ability to write exercise programs for home, or at-the-gym sessions for patients in a way that allows for recovery and (high) performance.

 

I like using the following ‘exercise template’ when educating patients on what a long-term exercise program includes:

After talking with patients and hearing what they do or don’t do physically, my suggestions begin first with ‘remove the negatives’. I discuss proper posture, breathing, hydration, diet, supplements, attitude, and sleep. I want to make sure patients are doing the right thing and not the wrong (negative) thing in each of these categories. In addition some patients need to “add in” cardio, strength, or flexibility training depending on there goals. The ‘fatty-bomba-lattes’ who do absolutely no physical activity need to start a walking program; the long distance runner, swimmer or cyclist might need a flexibility program; the Country Western dancer’s and the ‘dance-with-the stars’ people might need some strength training; the yoga dominant person might need some free weight training; the weight lifter might need some cardio and flexibility added on. Depending on the patient’s goals (fat loss, finish a marathon, flexibility, etc), I often find the program they designed isn’t “enough” on its own.

 

Physique-related goals are popular these days. Women want to lose pant sizes and men want to look good without a shirt on. No matter the goal, I still like the functional approach – start with teaching patients how to use the foam roll to inhibit overactive muscles, then teach a little stretching to those same overactive muscles, then do a little bodyweight or band exercises to the underactive muscles, then teach the “conventional” weight lifting approaches, then do some cardio. For fat loss, it isn’t really necessary for someone to have to add steady state cardio. An improved nutritional plan and consistent 20-30 minute workout with bodyweight exercises, bands, balls, free-weights or kettlebells produces incredible results.

 

Mobility and stability: Our typical patient who has a ‘ginger’ or ‘sensitive’ low back, usually needs some mobility and some stability work. The starting point to enhanced stability training begins with improvements in mobility. The stability work gives clients joint protection, helps get them stronger, and this reinforces the new mobility and the new mobility makes improved stabilization possible. This sort of dual reinforcement (mobility and stability training) is powerful—it can motivate people to permanently adopt a healthier workout lifestyle.

Whether your patient is into yoga, power training, competitive sports, martial arts, or other athletic pursuits, I am seeing more and more clients that seem to short change their rest and recovery. I also see clients who are repetitively lifting weights using bench press and biceps curls and this contributes to a forward head and forward shoulders posture.  At the end of the article I’ll give you an example workout of how I have made a corrective exercise/conditioning program work within one of my patient’s lifestyle who has been working heavy on the chest. This patient and I have created the long-term goals of improving posture. The routine is specifically designed with enough rest days to allow for the inclusion of other sports and activities. The program I wrote for the patient is especially upper body focused, but emphasizes the back side. Just keep in mind that if your patient’s “extracurricular activities” are particularly upper body inclusive you may wish to choose a lower body routine to work with. If they are cardio dominant, make sure they have a flexibility program.

:dropcap_open:Personally, I like shorter duration workouts aimed towards skill building, optimal movement patterns, and the control of maximum tension where needed in each rep.:quoteleft_close: 

An important thing to remember with both cardio and weight lifting training is that less is often more. I teach my clients to keep strict form and coordinated full body tension with each exercise—while not training to failure. In my opinion, practicing flexibility, strength training (I prefer about 6 reps and 2-3 sets), balance training, and cardio workouts can be done with high intensity and short rest periods between sets. Think of a marathon vs. a sprint—to run a marathon, the athlete will need to pace themselves. In a sprint, the athlete will basically go “all out” for a short period of time. Personally, I like shorter duration workouts aimed towards skill building, optimal movement patterns, and the control of maximum tension where needed in each rep.

 

I like to write exercise programs for patients that I ‘change up’ about every 6-10 weeks. It usually takes patients several weeks to adapt to this type of progressive exercise training. The weeks following the example below would have variations in the band, the ball, kettlebells and free-weights. This is a fairly typical example of my program training for a patient that needs back work to improve posture:

 

Monday: 5-8 minutes of foam roll, stick, or “knot out” especially to the hip flexors, lats, pecs and thoracic spine; 5 minutes of stretching to the hip flexors, lats, pecs and thoracic spine; 10-15 minutes of alternating Turkish-get-ups on the right and left side and doing 20 kettlebell swings.

 

Tuesday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of 30 – 60 second isometric plank holds, side bridges, birddog, glute bridges; 5-10 minutes of kettlebell swings. The swing technique for this workout is 15-20 reps range followed by 20-30 seconds of rest.

 

Wednesday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of isometric planks (prone, supine, side) and “stir the pot” position holds with forearms on the ball (ensuring scapula stability); 5-10 minutes of Y-T-W-L maneuvers. I have them finish with hands held overhead with band resistance doing squats – usually 2 sets of 8-10 reps is enough. Optional: cardio work.

 
:quoteright_open:Sunday: Rest/Recovery/Mobility. Be with loved ones.:quoteright_close:

Thursday: Rest/Mobility/Yoga practice. I usually suggest some resisted neck retraction work using the bands on this day.

 

Friday: 5-8 minutes of foam roll, stick, or “knot out”; 5 minutes of stretching; 5-10 minutes of 30 – 60 second isometric plank holds, side bridges, birddog, glute bridges; 5-10 minutes of kettlebell swings. The swing technique for this workout is 15-20 reps range followed by 20-30 seconds of rest.

 

Saturday: 5-8 minutes of foam roll or “knot out”; 5 minutes of stretching; 5-10 minutes of Y-T-W-L maneuvers. A 5-10 minute kettlebell challenge circuit workout or band work – usually includes 1 arm rows, 2 arm rows, supine pulls.

 

Sunday: Rest/Recovery/Mobility. Be with loved ones.

Dr. Jeffrey Tucker is the 2012 ACA Rehab Council Doctor of the Year. He is a certified instructor for the Functional Movement Screen (FMS) workshops, on the education committee for the Hygenic Corporation, and is a post-graduate instructor for the Diplomate program offered by the American Chiropractic Rehabilitation Board. Visit his website at www.DrJeffreyTucker.com

:dropcap_open:M:dropcap_close:ost of us who have been in practice for a while would probably prefer to think that our accumulated experience must be of some benefit to our patients. Personally, I prefer a bit of experience in some professions… airline pilots for example (I just feel better when I see a gray haired, “Captain Sully” type in the cockpit!). But as you’ll see, experience may not always be the best teacher when it comes to the practice of medicine. This month’s column recaps our review of a 2011 article which sought to determine how physician experience might impact patient outcomes within a hospital setting. And while we don’t have a comparable study that applies specifically to chiropractic, this study should provide food for thought, especially for those of us who have been in practice for a while. Thanks to our chiropractic sciences contributor Roger Coleman, DC (Othello, WA) for this interesting article. I hope you find it helpful.

 

The Study: Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice

 

The Facts:

Take Home: 

Years of practice time may not equate to better outcomes. Regardless of experience, everyone needs to adhere to best standards of practice.

:quoteright_open:…encouragement for providers, such as yourself, who are making the effort to stay up to date with the scientific literature.:quoteright_close: 

Reviewer’s Comments: 

I was surprised because I thought more experience would result in better outcomes. This may come as a wakeup call to keep providers on their toes and motivate them to stay up-to-date throughout their career.  This would also seem to be an encouragement for providers, such as yourself, who are making the effort to stay up-to-date with the scientific literature.

 

Reviewer:

Roger Coleman, DC

 

Reference:

Southern WN, Bellin EY, Arnsten JH. Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice. Am J Med. 2011 Sep;124(9):868-74.

 

Link to Abstract:

 

:dropcap_open:F:dropcap_close:unctional Medicine is patient-centered medical healing at its best. Instead of looking at and treating health problems as isolated diseases, it treats individuals who may have bodily symptoms, imbalances, and dysfunctions. 

 

As the following graphic of an iceberg shows, a named disease such as diabetes, cancer, or fibromyalgia might be visible above the surface, but according to Functional Medicine, the cause lies in the altered physiology below the surface. Usually, the cause of the disease and its symptoms is an underlying dysfunction or an imbalance of bodily systems.

 

Named diseases are just the tip of the iceberg. Below the surface, according to Functional Medicine, are the real causes of a patient’s health problems.

 

If health care treats just the tip of the iceberg, it rarely leads to long-term relief and vibrancy. Identifying and treating the underlying root cause or causes, as Functional Medicine does, has a much better chance to successfully resolve a patient’s health challenge.

 

Using scientific principles, advanced diagnostic testing, and treatments other than drugs or surgery, Functional Medicine restores balance in the body’s primary physiological processes. The goal is the patient’s lifelong optimal health. 

 

Today’s health care system is in trouble because it applies a medical management model that works well for acute health problems to chronic health problems, where it is much less successful.

 

If you have a heart attack, accident, or sudden lung infection such as pneumonia, you certainly want a quick-thinking doctor to use all the quick-acting resources of modern medicine, such as life-saving technology, surgery, and antibiotics. We are all grateful for such interventions.

 

However, jumping in with drugs, surgery, and other acute care treatments often does not succeed in helping those with chronic, debilitating ailments, such as diabetes, heart disease, or arthritis. Another approach is needed.

 

To battle chronic health conditions, Functional Medicine uses two scientifically grounded principles:

1. Add what’s lacking in the body to nudge its physiology back to a state of optimal functioning.
2. Remove anything that impedes the body from moving toward this optimal state of physiology.

Plainly put, your body naturally wants to be healthy. However, the body may be missing things needed to function at its best, or something might be standing in the way of its optimal functioning. Functional Medicine first identifies the factors responsible for the malfunctioning. Then it deals with those factors in a way appropriate to the patient’s particular situation.

 

Functional Medicine practitioners often use advanced laboratory testing to identify the root cause or causes of the patient’s health problem. Old-fashioned medical diagnosis helps too, in the form of listening carefully to the patient’s history of symptoms and asking questions about his or her activities and lifestyle.

 

For treatment, Functional Medicine practitioners use a combination of natural agents (supplements, herbs, nutraceuticals, and homeopathics), nutritional and lifestyle changes, spiritual/emotional counseling, and pharmaceuticals, if necessary to prod a patient’s physiology back to an optimal state. In addition, educating patients about their conditions empowers them to take charge of their own health, ultimately leading to greater success in treatment. 

 

In the dominant health care model today, medication is used to get rid of people’s symptoms. If the patient stops taking the medication, symptoms generally return. 

 

Functional Medicine approaches health problems differently. Instead of masking the problem, it aims at restoring the body’s natural functioning. Although Functional Medicine practitioners may prescribe pharmaceuticals, they use medications to gently nudge the patient’s physiology in a positive direction so the patient will no longer need them.

 

:dropcap_open:Another important saying by Osler is: “If you listen carefully to the patient, they will tell you the diagnosis.”:quoteleft_close: 

For example, conventional doctors would normally prescribe pharmaceuticals like Prilosec, Prevacid, or Aciphex to treat acid reflux or heartburn. When the patient stops taking such drugs, the heartburn symptoms come back. In contrast, a Functional Medicine practitioner might find that a patient’s acid reflux is caused by Helicobacter pylori bacteria. Eradicating the Helicobacter pylori might very well lead to the end of heartburn symptoms, permanently.

 

It’s also important to note that in Functional Medicine treatment for similar symptoms might vary tremendously for different patients, according to their medical histories and results of laboratory tests. Factors that can come into play in producing the same symptoms include toxic chemicals, pathogenic bacteria, parasites, chronic viral pathogens, emotional poisons like anger, greed or envy, and structural factors such as tumors or cysts. 

 

The Roots of Functional Medicine 

You may be surprised to learn that the concept of Functional Medicine isn’t new. It actually represents a return to the roots of modern scientific medicine, captured in this statement by Sir William Osler, one of the first professors at Johns Hopkins University School of Medicine and later its Physician-in-Chief: “The good physician treats the disease; the great physician treats the patient who has the disease.”

 

Another important saying by Osler is: “If you listen carefully to the patient, they will tell you the diagnosis.” This encapsulates the importance that Functional Medicine places on taking a thorough history from the patient.

 

When you consult a Functional Medicine practitioner, the first step is always your history. Practitioners are trained on how to unravel and make sense of a complicated story. Often clues in the story lead to the identification of key imbalances.

 

The next set of clues comes from a comprehensive physical examination, which includes many nearly forgotten examination procedures used by famous diagnosticians (both living and long gone), such as chapman reflex points, ankle brachial reflex, and nail inspection.

 

The final set of clues comes from advanced laboratory testing. Innovative, cutting-edge lab tests help the practitioner look deeply into a patient’s physiology to identify how it has been compromised and how physiological balance can be restored.

 

After diagnosis and treatment, a Functional Medicine patient can expect his or her symptoms to diminish in severity, along with a renewed sense of well-being and significant increase in health and vitality.

 

A Functional Medicine Sampler of Case Studies

CASE 1: Sinus Infections and Allergies

“Lions and tigers and bears, oh my!” Dorothy in The Wizard of Oz reminds us that the world is full of many dangers. It’s the same with the body. There are many things that can disconnect us from our inborn perfection and prevent us from functioning at our optimum, thus creating dis-ease.

D.D. Palmer had it right; three things that ruin our health are toxins, trauma, and thoughts (autosuggestion). 

 

D.D. and B.J. Palmer’s understanding of the subluxation is more profound than most chiropractors originally realized.

 

D.D. Palmer acknowledged that spinal adjusting was used in ancient healing systems. For example, in The Chiropractors Adjustor (p. 12):

 

 

However, before ancient Greece, there was a land that was ancient to the Greeks, and that land was Egypt. Palmer writes (ibid):

 

 

Chiropractic’s connection to ancient Greek and Egyptian healing practices was highlighted in Blessed by Illness by L.F.C. Mees, MD (Anthroposophic Press, 1983, p. 50). Mees reports that the Greeks believed “deformation” caused illness and was treated by “temple sleep, prayers, herbs, laying on of hands, baths, diet, lifestyle.”

 

The Egyptians (thousands of years earlier) also said “deformation” caused illness and was treated by “temple sleep, prayers, and herbs.”

 

We do not know precisely what these ancient people meant by deformation. However, we do know that a deformed object does not work as well as a properly formed object. This coincides nicely with chiropractic’s relationship between structure and function.

 

Dis-ease is a communication disorder and subluxations result from that dis-ease or communication disorder.

 

The subluxation is a metaphor for interference, blockage, deformation, distortion, or stagnation (of energies, too much or too little).  

 

B.J. Palmer reinforced this understanding when he said:

 

 

The subluxation is secondary, not primary. The primary problem is lack of or altered communication.

How do We Remove the Subluxation?
Different healing systems use different methods to remove blockages, interferences, and subluxations to reestablish communication:

Many other systems, both ancient and modern may also reestablish communication.

How else could an acupuncturist putting a single needle in the body relieve sciatica? How could a homeopath using a little sugar pellet in water do the same? How else could a qigong master release sciatica without touching the patient?

Let’s expand our understanding of chiropractic philosophy, build bridges with other vitalist healing systems, and resist merging with those that do not share our philosophy. Let us not emulate the narrow-mindedness of modern medicine holding fast to discredited mechanistic models of life.

• Connection
• Wholeness
• Healing
• Release
• Integration
• Restoration
• Renewal

:dropcap_open:G:dropcap_close:reetings and welcome to Science In Brief. This column is an extension of ScienceInBrief.com, our chiropractic literature review service. The Science In Brief project scans the scientific literature base, both past and current, for articles of interest to practicing chiropractors, and then distills each paper’s pertinent points into “plain English” format for busy practitioners. Reviews are delivered weekly to your in-box and there is absolutely no charge to subscribe. The American Chiropractor has graciously allowed us to publish a monthly column to help in our efforts to keep the profession abreast of the latest relevant research. The following is a review of a 2008 article that didn’t get a lot of attention at the time. Thanks to our chiropractic sciences contributor Roger Coleman, DC (Othello, Washington) for this interesting article. I hope you find it and future articles to be helpful.

 

Title: 

Spinal extension exercises prevent natural progression of kyphosis

 

The Facts:

Take Home:

Although this was only a pilot study, extension exercises appear to be helpful in the prevention of kyphosis progression. More study is needed.

 

Reviewer’s Comments: 

Most doctors of chiropractic utilize exercise in their treatment programs, although it is probable that many do not recommend exercises specifically for thoracic kyphosis. This paper should encourage doctors to look more closely at implementing appropriate programs of extension exercises for their patients with thoracic kyphosis.

 

Reviewer:  

Roger Coleman, DC

 

Reference:

Ball JM, Cagle P, Johnson BE, Lucasey C, Lukert BP. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int. 2009;20:481-9. Epub 2008 Jul 26.

 

Link to Abstract: 

 

The authors point out that more study is needed. Nevertheless, I think the paper has practical application. Patients with kyphosis present in chiropractic offices with great regularity, so the subject is relevant. Also, by chiropractic standards, this wasn’t a particularly small study. Furthermore, the design and conclusions seem fairly straightforward. Best of all, there’s minimal risk and cost associated with the treatment involved. Taken together, I’m very comfortable recommending extension exercise for my patients with kyphotic deformity. 

 

Finally, it’s noteworthy that the authors, who are all faculty members of the Department of Physical Therapy Education, University of Kansas, experienced the same problems with patient compliance that many of us see in practice. This study tells us that, although it can be frustratingly difficult to actually get patients to do their self-care programs, the results for those who do participate are definitely worthwhile.

 

 
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.

:dropcap_open:S:dropcap_close:tress is one of the largest understated health problems in our country.1 Every chiropractor understands the important role the autonomic nervous system (ANS) plays in stress, and which adjustments enhance sympathetic/parasympathetic balance, decrease nervous tension, and produce relaxation and calm. 

 

However, many may not be as familiar with the function of the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately related to the ANS and influences production of adrenal hormones that regulate stress adaptation. Chronic or excessive stress can overtax the ability of the HPA axis to respond adequately, which results in suboptimal adrenal function (adrenal fatigue). Unlike the relatively rare Addison disease,2 adrenal fatigue is a widespread problem that manifests as a unique circadian energy/fatigue pattern.3 By addressing adrenal fatigue in stressed patients, chiropractic can achieve deeper changes that increase patient well-being, vitality, and the ability to handle stress. In addition, adjustments hold better once the HPA axis and adrenal hormones are balanced. 

 

Begin by listening for the common signs and symptoms of adrenal fatigue:

If  these are present, there are three quick clinical tests to confirm suboptimal adrenal function: iris contraction, postural low blood pressure, and Sergent’s white line.4 

 

A positive test result can be followed with lab tests to establish baseline cortisol levels. My preference is the salivary hormone test, which patients can do during their regular daily routines. It measures salivary cortisol levels (more indicative of tissue levels than serum levels5) at four times during the day, usually at 8 a.m., noon, 4 p.m., and bedtime. Many labs can also measure salivary estrogen, progesterone, testosterone, and DHEAS. 

 

Much can be done to help chiropractic patients with adrenal fatigue, even when the severity is so great that they cannot hold down jobs or function well in daily life. The core of effective treatment is a combination of lifestyle and dietary modifications plus specific dietary supplements designed for adrenal fatigue. Spinal adjustments that release tension are helpful and about 25% of patients with adrenal fatigue have fixations at T-11 through L-2 motor units. Diathermy with the heads placed over the adrenals can also aid adrenal function.

 

Lifestyle recommendations include minimizing sources of stress, one or two brief rests during low-energy times of day (preferably lying down), sleeping in until 9 a.m. whenever possible, eating at regular intervals, and engaging in enjoyable, revitalizing activities. Dietary choices are important with emphasis on easily digestible protein, unrefined carbohydrates, and good quality fats or oils in every meal and snack, plus five to six servings of fresh vegetables daily. Frequent small meals help avoid getting too hungry and help keep blood sugar levels more normal. It is also important to eat by 10 a.m. and again before noon. Patients should avoid caffeine, alcohol, sugar and white flour. Ask your patients to read Adrenal Fatigue: The 21st Century Stress Syndrome and it will save you time by answering their questions and providing detailed lifestyle and dietary information to aid recovery.

 

The right dietary supplements are integral to full recovery in all but the mildest cases of adrenal fatigue. Chief among these are glandular extracts. In more than thirty years of professional experience, I have found that a combination of hormone-free, porcine extracts from the adrenals, hypothalamus, pituitary, and gonads works best. This provides the essential building blocks for repair and maintenance of the HPA axis, especially the adrenal glands. Herbs that balance the HPA axis function include ashwagandha,6 maca,7 Eleutherococcus senticosus,8 and licorice.9 They are especially beneficial when taken together, promoting a sense of balance and well-being during the day, and then calm and restful sleep when taken at bedtime. Specific nutrients are essential for normalizing and maintaining adrenal hormone cascade function, including relatively large quantities of niacin, vitamin B6, pantothenic acid, vitamin C, and magnesium, among others.10, 11, 12, 13 Vitamin C should be pH-balanced, to avoid aggravating the physiological acidity that occurs during adrenal fatigue, and sustained release for optimal clinical effect.

 

During a regular or briefly extended office visit, you can use this protocol to listen for signs and symptoms of adrenal fatigue, assess adrenal function, and start your patient down the road to recovery.

 

 
For more than thirty-five years, Dr. Wilson has dedicated himself to helping people regain their health and vitality, and to promoting a deeper understanding of the physiology underlying stress. His book, Adrenal Fatigue: The 21st Century Stress Syndrome, is used as a university textbook, and many of the clinical tools he developed to help stressed patients are available at icahealth.com, including his original Adrenal Fatigue Questionnaire.

:dropcap_open:M:dropcap_close:ost doctors I speak with have a difficult time determining how often a patient should be adjusted. It all seems to stem from our understanding, application, and patient explanation of “maintenance care” and “corrective care”—terminology we often use interchangeably.

 

What do these terms mean exactly? The vast majority of chiropractors across the globe schedule their patients (adults and children) for their monthly maintenance adjustment visit. We tell our patients that their monthly visit will help prevent and alleviate many problems that they will experience if they do not heed our warnings and accept our preventative-measure philosophy. 

 

Patients look forward to the end of their corrective care and the start of their maintenance care because it means to them that they have graduated; they have paid their dues. Their subluxations are corrected and are no more. Now life begins!

 

Patients are then seen on a monthly basis because it is good for them—that is our mantra. Most doctors are adamant about their patients following this protocol. And our CAs urge patients to follow their doctor’s advice on this matter. It makes total sense not only for the benefit of the patient, but also for the benefit of the doctor.

 

We all like to see our patients return and be happy to see us. There are also other benefits: Doctors can be certain of a steady income stream from “maintenance patients.” 

 

What about the benefit to the patient? A likely response is that your patients are getting great care, and you are preventing any future problems from presenting. But how certain are you that this is the case? Your monthly maintenance program may not be preventing or alleviating your patients’ future health problems.

 

Rather than solving or preventing the problem, most DCs place their patients on maintenance care that is simply maintaining the problem. Most of us tell our patients that our monthly maintenance program is of great benefit to them and that it will prevent specific issues from happening to them in the future. However, while the patients’ symptoms are gone, the problem is still very much present. Patients think their problem is resolved because they feel so much better, and as far as they are concerned, you have done a wonderful job. 

 

However, research by Tapio Vidman tells us that a subluxation, once formed, will initiate a degenerative pathological progression if it is allowed to remain for any longer than two weeks. This means that a monthly maintenance patient visit to our offices will ensure the patient will get worse over time. Their condition will slowly deteriorate and accelerate. 

 

Picture for a moment explaining the results of a patient’s progress exam to them and the fact that their films now seem to be much worse. The patient may confront you and ask why you have allowed their condition to worsen when they have paid you to keep them healthy. They may even ask for their money back as you have failed to provide them with a level of care that you promised. This can escalate into a huge problem, including State Board complaints and a possible lawsuit, not to mention the erosion of your reputation in the community. 

 

:dropcap_open:Money will not be an issue as long as they trust you and what you are saying makes sense.:quoteleft_close: 

In addition, most doctors do not see their patients on an appropriate schedule of care in order to be able to really correct their patients’ subluxations. Once formed, a subluxation becomes a habit; it is a neurological pattern that the body learns, adapts to, and copes with. Most often, subluxations start in children. 

The following excerpt is from a research paper I wrote on this subject:

 

“In the child, neuromuscular and functional adaptive reflex development represents a critical period of time when the young developing nervous system assimilates, differentiates, and adapts to external and internal stimuli. By means of these processes,the nervous system learns proprioceptive patterns and acquires future habits and reactions by responding to repetitive stimuli.

 

However, such a developing nervous system is not always able to distinguish between proper and improper stimuli; therefore, it responds to both. This is the conundrum – the response is neither “good” nor “bad,” but rather adaptive to the presenting stimulus. These adaptive responses are remembered and patterned, and thus the young nervous system is conditioned for future response.

 

This process of neurological “learning” or “programming” of the central nervous system with respect to locomotion, posture,proprioception, and body kinetics begins within a few short months after birth.”1

 

Unfortunately, many doctors see their patients on a schedule that they feel their patients will accept and can afford. This often translates into a patient being placed on monthly maintenance—and nothing more—once their symptoms are relieved. 

 

Rather than putting your patients on some nebulous and poorly understood maintenance program, I recommend you see your patients on “wellness” care: a maximum of every two weeks, especially for children. The correction of your patients’ subluxation patterning and habit is the most important thing. To me, there is no such thing as “maintenance.”

 

I suggest you tell your patients the truth. Tell them what you are doing and why. Money will not be an issue as long as they trust you and what you are saying makes sense. Now, get out there and be the doctor you were meant to be.

 

References:

1. Ressel, O, Rudy R, Vertebral Subluxation Correlated with Somatic, Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care, J. Vertebral Subluxation Res. October 18, 2004

Dr. Ogi is a Practice Coach and teaches the Practice Evolution Program. He is an international lecturer, a pediatric and x-ray specialist, researcher and clinician. It was Dr. Ogi and Dr. Larry Webster who started the whole pediatric awareness and movement on the planet – when it comes to kids, he has no equal. He can be reached at [email protected] or www.practiceevolution.com

A cancer diagnosis is terrifying. 

 

The questions, the fear, and the concept of facing mortality are enough to paralyze even the strongest individual.

 

In the not so distant past, the standard was surgery, chemotherapy, or radiation, or some combination of the three, and that was it.

 

Then the patient played the waiting game to see what, if anything, worked.

 

People didn’t realize that the end of a course of chemotherapy was not the end of the healing process. They would deal with the lasting effects of chemotherapy long after their hair returned and the nausea ended.

 

One lasting effect for some patients is post-chemotherapy peripheral neuropathy.

 

Fortunately for the community, cancer patients are quickly learning that the right combination of physical therapy, nutrition, and often the correct forms of nerve stimulation in the hands of a skilled therapist can help alleviate the symptoms of post-chemotherapy peripheral neuropathy.   

 

The post-chemotherapy peripheral neuropathy patient is becoming an enlightened consumer of this specialty practice that goes beyond traditional medications and standard medical treatments.

 

A new, progressive approach to treating peripheral neuropathy symptoms gives specialty-trained DCs an ever-expanding patient population to serve. Treating patients who have already been through an experience that most people fear can be incredibly rewarding. 

 

To get these patients in your office though, you need to show them exactly how your training, expertise, and specialty care can improve quality of life. It’s not just about marketing traditional care that people associate with post-op issues or sports injuries. It’s about educating potential post-chemotherapy peripheral neuropathy patients on a multi-pronged approach to their medical issues:

 

Chances are that a therapist specializing in neuropathy has never treated your potential post-chemotherapy peripheral neuropathy patients. They may think they know what a specialty DC does, but they may not understand everything that your unique services can do to manage their condition. 

 

Traditionally, your therapy is associated with the treatment of injuries and illnesses affecting the bones, muscles, ligaments, tendons, and joints. In educating post-chemotherapy peripheral neuropathy patients, recognize that they may deal with gait problems, muscular weakness, or even issues caused by radiation. Your usual techniques cannot always address the stress of dealing with any of these conditions.

 

Great therapy can help the post-chemotherapy neuropathy patient deal with the symptoms and pain associated with both their cancer and their course of treatment. Often, by carefully addressing pain in the correct way, as well as related tissues, we may actually stimulate a healthier nervous system, which is a basic building block for regaining pre-cancer health and alleviating nerve pain.

 

Chemotherapy and other cancer medications can wreck a patient’s digestive system. In the process of killing cancer cells, it can also damage healthy cells, which brings on the side effects of chemotherapy. This not only affects the ability to eat, but also prevents the body from getting the nutrients it needs.

 

Learn enough about good nutrition, but beyond that, knowing the basics of the biochemistry of nerve metabolism allows you to talk professionally to your post-chemotherapy peripheral neuropathy patients and their physicians about their nutrition issues. They may be dealing with any number of symptoms ranging from nausea and loss of appetite to dry mouth and changes in their senses of taste and smell. Offering nutrition information and dietary planning in your practice’s services is another way to serve this patient population. Good nutrition will boost the immune system and let it do its job fighting off illnesses brought on by chemotherapy.

 

Potential post-chemotherapy peripheral neuropathy patients may not realize that you can help with this is an area of their recovery. So if you trained in this specialty, make sure to include nutrition information in your patient education materials. Post-chemotherapy peripheral neuropathy patients need to make sure they’re getting nutrients to prevent or reverse nutritional deficiencies, lessen the side effects of treatment, and improve quality of life. Without appropriate, simultaneous nutrition, other treatment protocols have no chance to succeed. Just be sure you are trained and working within the scope of your license.

 

Once a course of treatment has been designed and a nutrition plan established, the final piece in the overall treatment of the post-chemotherapy peripheral neuropathy patient treatment plan is modality selection and combination.

 

There are several neuropathy treatment devices and therapies being advocated to help peripheral neuropathy patients. Misapplication is dangerous. Learning the correct applications for both clinic and home care for each unique patient is the best course of action.

 

:dropcap_open:When specialty trained and properly equipped can offer them hope for a more normal life without debilitating pain.:quoteleft_close: 

Some patients may have adopted an attitude of “I went through chemotherapy and my cancer is gone. I shouldn’t complain about nerve pain, tingling, and numbness. I should just be thankful to be alive.”

 

What they need to know is that they don’t always have to live with sleeplessness, pain, and balance and walking issues secondary to their treatment. Those who are specialty trained and properly equipped can offer them hope for a more normal life without debilitating pain. 

 

Yes, they survived cancer, but many can beat post-chemotherapy peripheral neuropathy too. 

 

Precise combinations of therapy, nutrition, and often forms of LLLT and LED with combined neurostimulation are showing great promise in helping post-chemotherapy peripheral neuropathy patients return to a pain-free life without the debilitating effects of neuropathy.

 

Serving this courageous patient population can be incredibly rewarding. However, this subspecialty takes some study and time to learn—you can’t learn it in a weekend.

 

When you are ready, let them know you’re there to help them. Just be sure you are the real deal. If not, let them seek appropriate care elsewhere.