Stroke Rehabilitation and The Positive Effects of Chiropractic on the Response to the Central Nervous System and Motor Training Tasks

 

A report on the scientific literature 


By

Mark Studin DC, FASBE (C), DAAPM, DAAMLP

 

Whithall, McCombe Waller, Silver, and Macko (2000) reported, "Stroke is the third leading cause of death in the United States and the leading cause of adult disability. Annually, approximately 750,000 Americans suffer a stroke. Although incidence rates have remained constant over the last 3 decades, mortality has declined, leaving an increasing number of patients requiring rehabilitation. Approximately two thirds of stroke survivors have residual neurological deficits that persistently impair function. Specifically, dysfunction from upper extremity (UE) hemiparesis [weakness on one side of the body] impairs performance of many daily activities such as dressing, bathing, self-care, and writing, thus reducing functional independence. In fact, only 5% of adults regain full arm function after stroke, and 20% regain no functional use. Hence, alternative strategies are needed to reduce the long-term disability and functional impairment from UE hemiparesis [weakness on one side of the body]" (p. 2390).

According to Kleim and Jones (2008), neuroscientists (specialists who study how the brain and nervous systems work) are often asked about specific therapies that should be included in clinical treatment programs. They go on to report that the data points to brain cells possessing the ability to alter their structure and function in response to a variety of internal and external pressures and is called "neural plasticity." They go on to say that, "Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage" (Kleim & Jones, 2008, p. S225). When you any type of brain damage, the goal is to limit additional damage and help restore as much function as possible.

Whithall et al. (2000) reported that, " Traditionally, methods of stroke rehabilitation have been focused on the first 3 months after stroke and consist largely of passive (nonspecific) movement approaches or compensatory training of the nonparetic [non affected] arm.

This time window is consistent with natural history studies of stroke recovery that show a plateau after 3 months. Recently, both the paradigms for rehabilitation interventions and the time frame for possible UE motor recovery have been challenged. Experiments demonstrate that functional gains and possible neural plasticity can occur, via active practice, long after spontaneous recovery would be expected to end. For example, monkey models of chronic stroke demonstrate functional recovery as well as cortical reorganization after being forced to use their paretic limb. On the basis of this 'forced-use' paradigm, Taub, Wolf, and colleagues constrained the nonparetic [non affected] arm of patients with chronic stroke and forced the use of the paretic arm in task-specific activities in an intensive 2-week protocol" (p. 2390).

The goal of rehabilitation is to create new pathways for the brain to express itself in the form of movement and function to enable the stroke victim to regain as much function as possible. This allows the individual to live as normal a life as he/she can without care and support from aides, devices and specialists, rendering a level of physical and resultant emotional independence.

Taylor and Murphy reported in 2010 that when motor activity is followed by a chiropractic spinal manipulation/adjustment, it altered the way in which the central nervous system responded to motor training tasks. In both the patient with and without recurring neck pain, it positively affected the process of use-dependant neural plastic changes. The research went on to report that spinal manipulation/adjusting alone leads to improved function. However, spinal manipulation/adjusting in combination with motor training tasks "...not only results in altered sensorimotor integration but also alters the way the CNS responds to a functional task..." (Taylor & Murphy, 2010, p. 268). Taylor goes on to report, "The results of this study suggests that this is possible, as an improved ability to filter somatosensory information in sensorimotor integration circuits was observed after the same 20-minute motor training task, when this was preceded with spinal manipulation of the subjects' dysfunctional cervical joints. This finding was similar to what has been previously observed after spinal manipulation alone and indicates that spinal manipulation improves gating or filtering of sensory information, an ability the CNS retains even after the motor training intervention" (Taylor & Murphy, 2010, p. 269). While no one suggests that manipulation/adjusting should replace motor training or skill acquisition, the results indicate that manipulation should significantly improve the outcomes of rehabilitation with stroke victims.

References:

1. Whithall, J., McCombe Waller, S., Silver, K. H. C., & Macko, R. F. (2000). Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke, 31 (10), 2390-2395.

2. Kleim, J. A., & Jones, T. A. (2008) Principles of experience-dependant neural plasticity: Implications for rehabilitation after brain damage, Journal of Speech, Language, and Hearing Research, 51(Suppl. Neuroplasticity),S225-S239.

3. Haavik Taylor, H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics, 33(4), 261-272.

 

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Published in Stroke

  

  

Arthritis Prevention and Chiropractic  

Chiropractic prevents arthritis in accident victims, the elderly and the sedentary

A report on the scientific literature 


By Mark Studin DC, FASBE(C), DAAPM, DAAMLP
 

According to the Arthritis Foundation (2007), "Forty-six million [46,000,000] Americans are currently living with arthritis, the nation's leading cause of disability, and we are all paying a high price for it. The Centers for Disease Control and Prevention (CDC) announced that the annual cost of arthritis to the United States economy was $128 billion in 2003 and increased by $20 billion between 1997 and 2003.

CDC attributes the dramatic increase to the aging of the population, predominantly baby boomers, and increased prevalence of arthritis. CDC also estimates an additional 8 million new cases of arthritis will be diagnosed in the next decade" (
http://www.arthritis.org/cost-arthritis.php
).

Arthritis, A.D.A.M., Inc. (2010, February 5), "...is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis...

Causes, incidence, and risk factors

Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

You may have joint inflammation for a variety of reasons, including:

- An autoimmune disease (the body attacks itself because the body immune system believes a body part is foreign)
- Broken bone
- General wear and tear
- Infection (usually cause by bacteria or viruses)... 

With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:

- Being overweight
- Previously injuring the affected joint
- Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223). With hypomobility (less mobility or movement), adhesions occur in a joint (the region where 2 bones connect).

According to A.D.A.M., Inc. (2010, March 30), "Adhesions are bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together. As the body moves, tissues or organs inside are normally able to shift around each other. This is because these tissues have slippery surfaces.

Causes, incidence, and risk factors

Inflammation (swelling), surgery, or injury can cause adhesions to form almost anywhere in the body...Once they form, adhesions can become larger or tighter over time. Symptoms or other problems may occur if the adhesions cause an organ or body part to twist, pull out of position, or be unable to move as well.

Adhesions may form around joints such as the shoulder...or ankles, or in ligaments and tendons. This problem may happen:

- After surgery or trauma
- With certain types of arthritis
- With overuse of a joint or tendon

Symptoms

Adhesions in joints, tendons, or ligaments make it harder to move the joint and may cause pain...Adhesions in the pelvis may cause chronic or long-term pelvic pain.

Signs and tests

Most of the time, the adhesions cannot be seen using x-rays or imaging tests" (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462).

Over time, with a sedentary lifestyle as seen in many portions of the population and increasingly with the elderly, joints become hypomobile. Hypomobility is also seen in trauma-related cases and repetitive use injuries, such as reading while looking down for extended periods, carrying heavy items, holding the phone between one's shoulder and ear, prolonged use of hands, wrists, back and neck, excessive use of computers, etc. As time progresses, internal scar tissue or adhesions continue to develop and further increases the loss of mobility.

Cramer, Henderson, Little, Daley and Grieve (2010), cite previous studies that have shown that adhesions have been found in numerous hypomobile (loss of normal movement) joints and that spinal adjusting separates the articular surfaces of the joint. The researchers inquired as to whether connective tissue adhesion developed in lumbar articular joints as a consequence to intervertebral hypomobility and utilized animal studies.  They concluded that "...hypomobility results in time-dependent [adhesions]..." (Cramer et al., 2010, p. 508). In other words, internal scar tissue (arthritis) developed within the joints over time.

Cramer et al. (2010) sited previous studies that found the spinal adjustment separates the joints which could break up intra-articular adhesions. In other words, in their animal studies, spinal adjustments/manipulation increased the "Z gap" or spacing between the joints/bones and the mobility of the joints. If this applied in humans, the adjustments would then prevent further development of adhesions and degeneration and osteophytes, which is how the arthritic process progresses.

While arthritis affects approximately 1 in 7 Americans, the prevention of and/or correction of arthritis would relieve a great strain on our economy. While not all arthritis is a result of hypomobility, much of it is. If every person was under chiropractic care, we could not only positively affect the lives of every American, we could potentially rescue the economy of the United States and every other country and insurer in the world that assumes risk for an aging and hypomobile society.
 

 

References:

1. Arthritis Foundation. (2007, January 17). Cost of arthritis increases to $128 billion annually. Retrieved from http://www.arthritis.org/cost-arthritis.php

2. A.D.A.M., Inc. (2010, February 5). Arthritis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223

3. A.D.A.M., Inc. (2010, March 30). Adhesion. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002462

4. Cramer, G. D., Henderson, C. N. R., Little, J. W., Daley, C., & Grieve, T. J. (2010). Zygapophyseal joint adhesions after induced hypomobility. Journal of Manipulative and Physiological Therapeutics, 33(7), 508-518.

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Published in Arthritis

Brain Function (Sensorimotor Cortex) Increases with Chiropractic Care

A report on the scientific literature 



by

Mark Studin DC, FASBE(C), DAAPM, DAAMLP
 

Chiropractic care improves brain function and the body's motor or movement ability
 

Research findings that redefine care for every rehabilitation patient for all motor disorders

 

According to the Sensory Processing Disorder Foundation (2011), "Sensory processing (sometimes called 'sensory integration' or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or 'sensory integration'" ( http://spdfoundation.net/about-sensory-processing-disorder.html ).

According to Wikipedia (2011), "A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups" (http://en.wikipedia.org/wiki/Motor_skill).

According to LearningRX (2010), "Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)" (http://www.learningrx.com/sensory-motor-integration-faq.htm).

The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.

In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn't a transient finding. The authors further offered that the practical applications suggesting that:

1. this alters the way the central nervous system responds to motor training

2. a chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level

3. this explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation

4. this explains the mechanism of overuse injuries and chronic pain conditions

The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:

1. muscular dystrophy

2. Duchenne muscular dystrophy

3. myasthenia gravis

4. Parkinson's disease

5. fibromyalgia

6. multiple sclerosis

7. Huntington's disease

8. stroke victims

9. all other neuro-muscular diseases

On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body's ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.

The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.

Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body's ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level. 

Through chiropractic care, the patient can have the ability to function at a higher level and live a "more normal life" with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.

 
 

References:

1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html

2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill

3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm

4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics, 33(4), 261-272.

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Published in Brain Function

Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation

Surgery vs. Chiropractic Care

 

A report on the scientific literature 


by

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

60% of Surgical Candidates Avoid Surgery with Chiropractic

 

According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).

Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).

A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
 
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
 
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients" (
http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).

It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.

This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.

Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.

While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.

References:

1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516

2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms

3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic

4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584

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Published in Leg-Feet Problems

Older American Utilization of Chiropractic Care

*Persons 65 Years and Older

A report on the scientific literature 


by

Mark Studin DC, FASBE(C), DAAPM, DAAMLP
 

5,372,280 Americans over 65 years old utilize chiropractic
 

According to the US Census Bureau (n.d.), the population in 2008 of persons over the age of 65 was 36,800,000. This represents a significant percentage of the total population and with the "baby-boomers" aging, the number is increasing yearly. As we get older, our bodies start to "break down" and experience signs of "wear and tear" along with other problems. The signs of "wear and tear" are called degenerative joint disease, spondylosis or arthritis as they all mean the same thing. In addition, we get accentuated curves in our spines either from side to side or forward and are both a form of scoliosis and are both unsightly and cause many other problems.

Many of these maladies can either be prevented or mitigated with regular exercise and/or chiropractic care throughout our lives to re-align the spine so that it stays straight. However, once we get older, many of these maladies have a side effect of pain and/or loss of function. In response to this, many older Americans seek solutions to improve function and reduce pain.

One solution that many Americans take is chiropractic care because it is a safe and effective means toward accomplishing the goals of getting well. As far back as 1993, according to Mange, Angus, Papadopoulos, and Swan, chiropractic was deemed safe and effective. This continues to 2010 where the safety of chiropractic was questioned regarding risks of stroke have been also been proven statistically rare with chiropractic care; therefore certifying chiropractic safe 

Weigel et al. (2010) reported that from 1993-2007 there were 14.6% Americans using chiropractic based on respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD) and their Medicare claims. Based upon the 2008 census report, that would be 5,372, 800 older American using chiropractic. In addition to the Medicare report, there are also countless others under chiropractic care who choose not to go through the Medicare system. The conclusion is a simple metric; older Americans are choosing a drugless solution to their problems and utilizing chiropractic care.

 

REFERENCES

1. U.S. Census Bureau. (n.d). Table 34. Persons 65 years old and over-characteristics by sex: 1990-2008, Current Population Reports, Retrieved from http://www.census.gov/compendia/statab/2010/tables/10s0034.pdf

2. Mange, P., Angus, D. E., Papadopoulos, C., & Swan, W. R. (1993). A study to examine the effectiveness and cost-effectiveness of chiropractic  management of low-back pain. The Manga Report, Retrieved from http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml

3. Weigel, P., Hockenberry, J. M., Bentler, S. E., Obrizan, M., Kaskie, B., Jones, M. P., Ohsfeldt, R., Rosenthal, G. E.,  Wallace, R. B., & Wolinsky, F. D. (2010). A longitudinal study of chiropractic use among older adults in the United States. Chiropractic & Osteopathy, 18(34) Retrieved from http://www.chiroandosteo.com/content/18/1/34

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Children/Pediatric Utilization of Chiropractic Care

A report on the scientific literature 


 

by

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

83% of children under 3 years old were referred by their medical practitioners

 

 

Children have been under chiropractic care for almost 100 years according to my 30 years of rendering chiropractic care to children and the 2 generations of my instructors and mentors that taught me how to care for children. While there is a growing body of evidence of the efficacy of chiropractic care and childhood maladies, the amount of children under care and being referred to chiropractors by pediatricians and other medical doctors is growing.

In December, 2008, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, released findings on Americans and the use of complementary and alternative medicine (CAM). "The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under" (National Center for Complementary and Alternative Medicine, 2008, http://nccam.nih.gov/news/camstats/ 2007/camsurvey_fs1.htm). They found that 11.8% of children in the United States have undergone CAM therapies, indicating that children aren’t obtaining the desired outcomes and their parents are looking for solutions.

CAM is a term applied to any healing discipline that does not fall into the category of traditional medicine or any health care that traditional medicine must govern over, such as nursing or physical therapy, rendering those as secondary health care providers and not allowing them to care for patients unless under the supervision of a medical doctor. Chiropractic is considered part of CAM simply because doctors of chiropractic are not medical doctors or secondary providers requiring supervision by a medical doctor.

Miller reported in 2010 on 2,645 children that were treated in the outpatient clinic of the Anglo-European College of Chiropractic from 2006-2010 for various maladies. Of these children, 87% were under the age of 5 and 13% were between 5 and 13. 34% were seen for musculoskeletal problems such as neck pain and postural issues, 30% were treated for infant colic/excessive crying, 16% for feeding disorders and the balance for various other issues. Every child had been seen by at least one medical practitioner and some by many medical providers. Of the 2,645 children referred to the chiroprctic clinic, 83% were referred by thier medical physicians.

According to Jandial, Myers, Wise, and Foster in 2009, 21% of all medical practitioners, including pediatricians, had no confidence in treating musculoskeletal issues and only 53% had "some" confidence in treating musculoskeletal issues in children. Considering the "self-rated" format of this study, there are no interpretation issues of the results. Miller (2010) also reported in the study that 83% of the children under 3 years of age were referred by medical practitioners, underscoring the need for this type of care and the efficacy of the care for children. In a limited study, Alcantara and Davis (2010) reported improvement with chiropractic treatment in children with attention deficit hyperactivity disorder (ADHD) as well as various other limited and case studies. While significantly more research is required for children and chiropractic care, the growing body of recognition by the medical and chiropractic communities and the public gives evidence to the results of chiropractic care in the pediatric population.

 

REFERENCES

1. National Center for Complementary and Alternative Medicine. (2008, December). The use of complementary and alternative medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

2. Miller, J. (2010). Demographic survey of pediatric patients presenting to a chiropractic teaching clinic, Chiropractic & Osteopathy,18(33), Retrieved from http://www.chiroandosteo.com/content/pdf/1746-1340-18-33.pdf

3. Jandial, S., Myers, A., Wise, E., & Foster, H. E. (2009). Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. Journal of Pediatrics, 154(2), 267-271.

4. Alcantara, J., & Davis, J. (2010). The chiropractic care of children with attention-deficit/hyperactivity disorder: A retrospective case series. Explore, 6(3), 173-182.

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Dizziness in Older Adults and Chiropractic Care

A report on the scientific literature 


by

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

83% of dizziness sufferers showed improvement or eradication under chiropractic care

 

According to Maarsingh , Dros, Schellevis, van Weert, Bindels, and van der Horst in BMC Family Practice (2010), dizziness in older patients is a very common occurrence as reported by family medical practitioners. They reported that an 8.3% one-year prevalence of dizziness was reported in patients over the age of 65, with females having a higher incidence. It was also reported that the number could be higher as this is a symptom reported by the patient.

According to Web MD in 2009, "Dizzinessis a word that is often used to describe two different feelings. It is important to know exactly what you mean when you say 'I feel dizzy' because it can help you and your doctor narrow down the list of possible problems.

Lightheadedness is a feeling that you are about to faint or 'pass out.' Although you may feel dizzy, you do not feel as though you or your surroundings are moving. Lightheadedness often goes away or improves when you lie down. If lightheadedness gets worse, it can lead to a feeling of almost fainting or a fainting spell (syncope). You may sometimes feel nauseated or vomit when you are lightheaded.

Vertigo is a feeling that you or your surroundings are moving when there is no actual movement. You may feel as though you are spinning, whirling, falling, or tilting. When you have severe vertigo, you may feel very nauseated or vomit. You may have trouble walking or standing, and you may lose your balance and fall.

Although dizziness can occur in people of any age, it is more common among older adults. A fear of dizziness can cause older adults to limit their physical and social activities. Dizziness can also lead to falls and other injuries" (http://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview).

As reported by Hampton (2005), dizziness has become such a prevalent problem that in spite of rising health care costs, in 2003, Medicare introduced that routine screenings to new beneficiaries for hearing loss, balance disorders and dizziness would be covered. The reason is that the government is looking long-term to save money; something that rarely happens, but in this case is the best solution.

According to Lynn, Schuster, and Kabcenell (2000), Medicare creates "RUG," a classification of patients in nursing facilities grouped by disability and other care needs, for the purpose of determining coverage and rates in the Medicare system. Dizziness is one of the criteria in determining the reimbursement rates for skilled nursing facilities. The costs for a skilled nursing home depending upon the RUG score ranges from $424.97 to $155.66 per day and the variable is the documented impairment of the resident and the amount of care needed to support that population of residents. From a financial perspective, the Federal Governmental and Medicare have a very high stake in ensuring that hearing and dizziness is cared for and corrected at as early an age as possible to save the system significant money.

In 2009, Hawk and Cambron studied the relationship between chiropractic care and dizziness over an 8 week course of manipulative care (chiropractic spinal adjustments). The patients having a "dizziness handicap inventory" baseline score indicating significant dizziness reported an 83% improvement or eradication of the dizziness as a direct result of chiropractic care. Hawk and Cambron reported that this was a pilot study and more research is needed, but their findings could encourage others to find solutions to a growing problem among older adults in American and could positively impact both the lives of Americans and the financial burden of our economy.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with dizziness. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.

  


References

1. Maarsingh, O. R., Dros, J., Schellevis, F. G., van Weert, H. C., Bindels, P. J., & van der Horst, H. E. (2010). Dizziness reported by elderly patients in family practice: Prevalence, incidence, and clinical characteristics. BMC Family Practice, 11(2), Retrieved from http://www.biomedcentral.com/1471-2296/11/2
2. WebMD (2009). Dizziness: Lightheadedness and vertigo-topic overview. Retrieved from http://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview

3. Hampton, D. (2005). New medicare benefit includes screening for hearing loss and dizziness. Hearing Review, Retrieved from http://www.hearingreview.com/issues/articles/2005-03_07.asp
4. Lynn, J., Schuster, J. L., & Kabcenell, A. (2000). 9.1.2 Skilled nursing facilities. In Improving care for the end of life: A sourcebook for healthcare managers and clinicians. Retrieved from http://www.mywhatever.com/cifwriter/content/66/4332.html
5.  Hawk, C., & Cambron, J. (2009). Chiropractic care for older adults: Effects on balance, dizziness, and chronic pain. Journal of Manipulative and Physiological Therapeutics, 32 (6), 431-437.

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Tennis (Golf) Elbow and Chiropractic Care

A report on the scientific literature 


By

Mark Studin DC, FASBE (C), DAAPM, DAAMLP


"Tennis elbow [or lateral epicondylitis] is a painful condition that happens when tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=symptoms). Tennis elbow is also called "golfer's elbow" and according to Owens, Wolf, and Murphy (2009), "...has been demonstrated to occur in up to 50% of tennis players. However, this condition is not limited to tennis players and has been reported to be the result of overuse from many activities. Lateral epicondylitis is extremely common in today's active society" (http://emedicine.medscape.com/article/1231903-overview).

Owens, Wolf, and Murphy (2009) go on to explain, "Any activity involving wrist extension [upward bending] and/or supination [twisting] can be associated with overuse of the muscles originating at the lateral epicondyle [outer elbow]. Tennis has been the activity most commonly associated with the disorder. The risk of overuse injury is increased 2-3 times in players with more than 2 hours of play per week and 2-4 times in players older than 40 years. Several risk factors have been identified, including improper technique, size of racquet handle, and racquet weight [and the same holds true for any sport or activity]. For work-related lateral epicondylitis, a systematic review identified 3 risk factors: handling tools heavier than 1 kg, handling loads heavier than 20 kg at least 10 times per day, and repetitive movements for more than 2 hours per day...Patients present complaining of lateral elbow and forearm pain exacerbated by use. The typical patient is a man or woman aged 35-55 years who either is a recreational athlete or one who engages in rigorous daily activities" (http://emedicine.medscape.com/article/1231903-overview).

In tennis, the USTA (United States Tennis Association), and in golf, the PGA (Professional Golf Association), along with almost every professional sports team in the United States and internationally, now employ chiropractors as part of their medical staff. They recognize the competitive edge that it gives their players in both avoiding and treating injuries. Professional sports are a big business and the owners want to protect their investments, the players. On a daily basis, as highlighted above, many of us are exposed to the negative effects of lateral epicondylitis.

According to
Fernández-Carnero, Fernández-de-las-Peñas, & Cleland (2008),  the application of a cervical spine thrust manipulation (chiropractic adjustment) produced an immediate bilateral increase in pain pressure thresholds, or less pain at the elbow in patients with lateral epicondylitis and an increased pain free grip on the affected or painful side. The implication in sports and everyday life is that lateral epicondylitis, tennis elbow, golf elbow, packaging elbow or any other name attached to the activity causing this problem, has been clinically proven in randomized clinical trials to have positive outcomes with chiropractic care.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with lateral epicondylitis. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.




References
1. Mayo Clinic Staff. (2010, Obtober 21). Tennis elbow, symptoms. MayoClinic.com. Retrieved from http://www.mayoclinic.com/health/tennis-elbow/DS00469/DSECTION=symptoms
2. Owens, B. D., Wolf, J. M., & Murphy, K. P. (2009, November 3). Lateral epicondylitis. emedecine from WebMD. http://emedicine.medscape.com/article/1231903-overview
3. Fernández-Carnero, J., Fernández-de-las-Peñas, C., & Cleland, J. A. (2008). Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal of Manipulative and Physiological Therapeutics, 31(9), 675-681.

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Stroke Risks While Under Chiropractic Care

Debunking the Myth that Chiropractic Causes Stroke

A report on the scientific literature 



By
Gerard Clum DC, Past President, Life Chiropractic College West

Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

According to the American Heart Association (2010), a stroke "...is a disease that affects the arteries leading to and within the brain. It is the No. 3 cause of death in the United States, behind diseases of the heart and cancer. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die...Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke)...The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can't reach the region that controls a particular body function, a stroke will ensue, then that part of the body won't work as it should" (http://www.strokeassociation.org/STROKEORG/AboutStroke/About-stroke_UCM_308529_SubHomePage.jsp).   


The AHA (2010) also posts signs and symptoms of an impending stroke. These include numbness or weakness of one side of the face, sudden confusion, difficulty speaking or understanding, problems seeing out of one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, and severe and sudden headaches with no known cause.

The blood supply to the brain is provided through the vertebral arteries and the carotid arteries. Problems in any of these arteries can result in the development of a thrombus (clot) or an embolism. If the thrombus is large enough it can occlude the normal blood flow. If an embolism occurs, it can move through the circulation into the brain and occlude blood flow. Either way, a stroke can be the result of these situations. One of the unique characteristics of strokes of this nature is that they can involve neck pain and headache.

Many patients will seek chiropractor care for neck pain and headaches. In the great majority of cases, the pain involved is not related to a stroke. However, on occasion, it may be. When the pain is related to a stroke, some of these patients developed a full range of stroke symptoms. Over the years, reports in the popular press and the scientific literature have suggested or stated outright that in patients who experience a stroke following chiropractic care, the stroke was caused by the chiropractor! We now know that this is very unlikely to be the case. What is far more likely is that the patient developed a thrombus or embolism in their vertebral arteries, producing neck pain and headache. This person sought health care for the pain. Whether they saw a chiropractor or their medical provider, they would progress on to a stroke at virtually the same rate. While the argument that the chiropractor caused the problem is convenient, the science indicates that it is in all likelihood a mistake to draw such a conclusion.

In 2008, Cassidy, Boyle, Côté, He, Hogg-Johnson, Silver, and Bondy  studied the occurrence of this problem in the province of Ontario over a nine year period with a database representing almost 110 million person-years (12.2 million people, studied over 9 years equals 110 million person-years). The purpose of this study was to investigate if an association between chiropractic care and vertebral basilar artery stroke exceeded the association between medical primary care providers and vertebral basilar artery stroke. The premise was that if there was a greater association between chiropractic care and this stroke then one could logically say there was a cause and effect relationship between chiropractic care and this problem. There was no greater likelihood of a patient experiencing a stroke following a visit to his/her chiropractor than there was after a visit to his/her primary care physician. The results were conclusive; there was no greater association between manipulation (chiropractic adjustments) and ischemic stroke or TIA's (transient ischemic attacks).

The research did conclude that overall, 4% of stroke victims had visited a chiropractor within 30 days of their strokes, while 53% of the stroke cases had visited their medical primary care providers within the same time frame. The authors offer the perspective that because neck pain is associated with some stroke, patients visit their doctors prior to the development of a full-blown stroke scenario. Cassidy et al. (2008) noted, "Because the association between chiropractic visits and [vertebral basilar artery] stroke is not greater than the association between PCP [medical primary care providers] visits and [vertebral basilar] stroke, there is no excess risk of [vertebral basilar] stroke from chiropractic care" (p. S180). In fact, the incident of chiropractic vs. medical care was substantially lower in certain situations based upon the data.

In 2010, Murphy considered the argument that a chiropractic manipulation could cause stroke and concluded, "...if this is a possibility, it would have to be considered so rare that a case-control and case crossover study covering over 109,000,000 person-years failed to detect it" (h
ttp://www.chiroandosteo.com/content/18/1/22). He also reports that "... in 20% of cases of [vertebral artery dissection and stroke] the individual does not have neck pain or headache and in a very small percentage of vertebral artery dissections can occur in a person who has no symptoms of any kind. Thus, in cases in which an asymptomatic individual experiences [vertebral artery dissection and stroke] after [chiropractic manipulation] it is not clear whether manipulation was a cause or contributing factor to the dissection or whether the patient had an asymptomatic arterial dissection prior to the chiropractic visit" (Murphy, 2010, http://www.chiroandosteo.com/content/18/1/22). He concluded his report with the following, "...current evidence indicates that [vertebral artery dissection and stroke] is not a 'complication to [chiropractic manipulation]' per se. That is, the weight of the evidence suggests that [chiropractic manipulation] is not a cause of [vertebral artery dissection and stroke]..." (Murphy, 2010, http://www.chiroandosteo.com/content/18/1/22).

The real issue is not whether chiropractic or medical primary care causes stroke, as the research conclusively refutes this, but rather it is an issue of public awareness and perception. The argument must shift to the real issue of protecting the public and making people aware of the importance of recognizing risk factors and of gettiing immediate care to avoid long term disability or death.

Murphy (2010) offers the following advice, "...engage in a public health campaign to educate the public about the warning signs and symptoms of this uncommon but potentially devastating disorder...
public education materials regarding stroke in general are available from organizations such as the American Stroke Association (http://www.strokeassociation.org/presenter.jhtml?identifier=3030387 accessed 1 April 2010) the National Stroke Association (http://www.stroke.org/site/PageServer?pagename=HOME accessed 1 April 2010) the British Stroke Association (http://www.stroke.org.uk/information/index.html accessed 22 May 2010), the Heart and Stroke Association of Canada (http:/ / www.heartandstroke.com/ site/ c.ikIQLcMWJtE/ b.2796497/ k.BF8B/ Home.htm?src=home accessed 22 May 2010) and the National Stroke Foundation - Australia (http://www.strokefoundation.com.au/ accessed 22 May 2010)..." (http://www.chiroandosteo.com/content/18/1/22).




References:
1. American Heart Association, Inc. (2010). About stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/AboutStroke/About-stroke_UCM_308529_SubHomePage.jsp
2. American Heart Association, Inc. (2010). Warning signs. Retrieved from http://www.strokeassociation.org/STROKEORG/WarningSigns/Warning-Signs_UCM_308528_SubHomePage.jsp
3. American Heart Association, Inc. (2010). Ischemic (clots). Retrieved fromhttp://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Clots_UCM_310939_Article.jsp
4. Cassidy, J. D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F. L., & Bondy, S. J. (2008). Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine, 33(45), S176-S183.
5. Murphy, D. R. (2010). Current understanding of the relationship between cervical manipulation and stroke: What does it mean for the chiropractic profession? Chiorpractic & Osteopathy, 18(22),
http://www.chiroandosteo.com/content/18/1/22

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Published in Stroke

Back and Leg Pain (Lumbar Radiculopathy)  as a Result of Disc Herniation and the Long Term Effect of Chiropractic Care


90% of all low back-lumbar disc herniation patients got better with chiropractic care

A report on the scientific literature 



By

Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

The term "herniated disc" has been called many things from a slipped disc to a bulging disc. For a doctor who specializes in disc problems, the term is critical because it tells him/her how to create a prognosis and subsequent treatment plan for a patient. To clarify the disc issue, a herniated disc is where a disc tears and the internal material of the disc, called the nucleus pulposis, extends through that tear. It is always results from trauma or an accident. A bulging disc is a degenerative "wear and tear" phenomenon where the internal material or nucleus pulposis does not extend through the disc because there has been no tear, but the walls of the disc have been thinned from degeneration and the internal disc material creates pressure with thinned external walls. The disc itself "spreads out" or bulges.

There are various forms and degrees of disc issues, but the biggest concern of the specialist is whether nerves are being affected that can cause significant pain or other problems. The problem exists when the disc, as a result of a herniation or bulge, is touching or compressing those neurological elements, which is comprised of either the spinal cord, the nerve root (a nerve the extends from the spinal cord) or the covering of the nerves, called the thecal sac.

With regard to the structure that we have just discussed, the doctor must wonder what the herniation of the neurological element has caused. In this scenario, there are 2 possible problems, the spinal cord and nerve root. If the disc has compromised the spinal cord, it is called a myelopathy (my-e-lo-pathy). You have a compression of the spinal cord and problems with your arms or legs. An immediate visit to the neurosurgeon is warranted for a surgical consultation. The second problem is when the disc is effecting the spinal nerve root, called a radiculopathy. It is a very common problem. A doctor of chiropractic experienced in treating radiculopathy has to determine if there is enough room between the disc and the nerve in order to determine if a surgical consultation is warranted or if he/she can safely treat you. This is done by a thorough clinical examination and in many cases, an MRI is required to make a final diagnosis. Most patients do not need a surgical consultation and can be safely treated by an experienced chiropractor.

While herniations can occur anywhere, it was reported by
Jordan, Konstanttinou, & O'Dowd (2009)  that 95% occur in the lower back.  "The highest prevalence is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years" (http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence).

It was reported by Aspegren et al. (2009) that 80% of the chiropractic patients studied with both neck and low back (cervical and lumbar) disc herniations had a good clinical outcome with post-care visual analog scores under 2 [0 to 10 with 0 being no pain and 10 being the worst pain imaginable] and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. A study by Murphy, Hurwitz, and McGovern (2009) focused only on low back (lumbar) disc herniations and concluded that, "Nearly 90% of patients reported their outcome to be either 'excellent' or 'good'...clinically meaningful improvement in pain intensity was seen in 74% of patients (p. 729)." The researchers also concluded that the improvements from chiropractic care was maintained for 14 1/2 months, the length of the study, indicating this isn't a temporary, but a long-term solution. It was reported by BenEliyahu (1996) that 78% percent of the low back-lumbar disc herniation patients were able to return to work in their pre-disability occupations, which is the result of the 90% of all low back-lumbar disc herniation patients getting better with chiropractic care as discussed above.

These are the reasons that chiropractic has been, and needs to be, considered for the primary care for low back-lumbar disc herniations with resultant pain in the back or legs.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for herniated discs and low back or leg pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.




References:

1. Jordan, J., Konstanttinou, K., & O'Dowd, J. (2009, March 26). Herniated lumbar disc. Clinical Evidence. Retrieved from http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence
2. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal Manipulative Physiological Therapy 32(9), 765-771.
3. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal Manipulative Physiological Therapy, (32)9, 723-733.

4. BenEliyahu, D. J. (1996). Magnetic resonance imaging and clinical follow-up: Study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal Manipulative Physiological Therapy, 19(9), 597-606.

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Published in Leg-Feet Problems

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