Low Back Problems

Low Back Problems (30)

US Chiropractic Directory Presents:

Low Back Problems


Low back problems are one of the most prevalent issues that people worldwide suffer. Low back pain has been called lumbago, sciatica and a host of other names, however to the public, it is literally a "pain in the butt." Chiropractic has been safely and effectively helping patents with pain in the back for over 100 years and The US Chiropractic Directory has create a forum of information involving the entire healthcare and scientific community to bring the public evidenced and researched based answers on how and why chiropractic works to help those with low back pain/problems.

 

Chiropractic vs. Oral Steroids vs. Muscle Relaxants: Outcomes for Low Back Pain and Sciatica

 

A report on the scientific literature 


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

 

Reference: Studin M. (2015) Chiropractic vs. Oral Steroids vs. Muscle Relaxants: Outcomes for Low Back Pain and Sciatica,The American Chiropractor, 37(7) 42-47

 

Choices. Every health care practitioner is caring for his/her patients having multiple treatment options and often those choices are influenced by pieces of information. That information can be what was learned in formal training, colleagues sharing anecdotal experience, patients giving direct feedback or well-scripted “representatives” of the pharmaceutical industry who only have one agenda…sales.As a result of doctors managing their patients’ conditions, there are two major parameters that are utilized, best medical practice, also known as “experience,” and evidence-based practice or that which has only been concluded in the medical literature. Both have a strong place in a healthcare delivery system with the best possible outcomes as the ultimate goals.

 

“A best practiceis a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. In addition, a "best" practice can evolve to become better as improvements are discovered. (“Best Practice,” http://en.wikipedia.org/ wiki/Best practice).”

 

“Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that has been gaining ground following its formal introduction in 1992. It started inmedicineasevidence-based medicine (EBM) and spread to other fields such as dentistry, nursing, psychology, education, library and information science…” (“Evidence-Based Practice,” http://en.wikipedia.org/wiki/Evidence-based_practice) and other fields. Its basic principles are that all practical decisions made should 1) be based on research studies and 2) that these research studies are selected and interpreted according to some specific norms characteristic for EBP. Typically such norms disregardtheoretical studiesandqualitative studiesand considerquantitative studiesaccording to a narrow set of criteria of what counts asevidence.

 

 

“’Evidence-based behavioral practice’(EBBP) entails making decisions about how to promote health or provide care by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected. This is done in a manner that is compatible with the environmental and organizational context. Evidence is comprised of research findings derived from the systematic collection of data through observation and experiment and the formulation of questions and testing of hypotheses" (“Evidence-Based Practice, http://en.wikipedia.org/wiki/Evidence-based_practice).

 

This highly-debated topic of best practice vs. evidence-based practice has valid issues on each side, but putting together the two concepts as a hybrid would allow them to thrive in any healthcare delivery system as all options would be considered. This would allow advances in healthcare to save more lives, increased quality of life and at the same time, enough safeguards to prevent abuse of those with one-sided agendas to profit. It would also take the blinders off those who have dogmatic prejudice against that which has been verified to be successful in both the best practice and evidenced-based models (experience and literature).   

For years, too many non-chiropractic practitioners have ignored the “best practice” model or the results reported by both the patients and the practicing chiropractors with treatments regarding low back and leg pain (often associated with herniated discs). These non-chiropractic practitioners refuse to consider chiropractic as a first referral option. The main reason cited over the past few decades as this author’s personal experience has been that there is no literature that proves these claims in spite of patients corroborating their positive experiences with the chiropractors’ claims. As a result of ignorance, blinders and possibly a deep rooted prejudice, too many patients have been and are currently being treated with poor alternatives based upon outcomes that are now being clearly reported. Treatment with both oral steroids and muscle relaxers are two often used, but inferior choices and now the literature verifies why chiropractic is the best possible first-line of referral for diagnosis that are the subject for this paper.

 

ORAL STEROIDS

Goldberg et al. (2015) reported: Despite conflicting evidence, [epidural steroid injections] are frequently offered under the assumption that radicular symptoms are caused by inflammation of the affected lumbar nerve root.Epidural steroid injections are invasive, generally require a pre-procedure magnetic resonance imaging (MRI) study, and expose patients to fluoroscopic radiation. In addition, the US Food and Drug Administration recently warned of rare but serious neurologic sequella from [epidural steroid injections].Oral administration of steroid medication may provide similar anti-inflammatory activity, does not require an MRI or radiation exposure, can be delivered quickly by primary care physicians, carries less risk, and would be much less expensive than an [epidural steroid injection]. Oral steroids are used by many community physicians, have been included in some clinical guidelines,and are noted as a treatment option by some authors.However, no appropriately powered clinical trials of oral steroids for radiculopathy have been conducted to date. To address this issue, we performed a parallel-group, double-blind randomized clinical trial of a 15-day tapering course of oral prednisone vs placebo for patients with an acute lumbar radiculopathy associated with a herniated lumbar disk... (p. 1916).

 

Results showed that “participants in both blinded treatment groups showed an improvement in symptoms over the initial 6 weeks, with more gradual reductions until the 24-week visit, after which changes were more variable. Baseline ODI [Oswestry Disability Index] scores were 51.2 and 51.1 in the prednisone and placebo groups, respectively; corresponding ODI scores at 3 weeks were 32.2 and 37.5” (Goldberg, 2015, p. 1919-1920). This indicates that both at 3 and 6 weeks there was no difference in the placebo vs. oral steroid groups. Among patients with acute radiculopathy due to a herniated lumbar disk, a short course of oral steroids, compared with placebo, resulted in modest improvement in function and no significant improvement in pain” (Goldberg, 2015, p.1922).

 

MUSCLE RELAXANTS

 

Hoiriis et al. (2004) reported, “Reviews of low back pain studies often fail to distinguish between manipulative interventions. Manipulation and spinal manipulative therapy (SMT) are vague terms describing procedures used by chiropractors, physiotherapists, massage therapists, and osteopaths. These maneuvers may decrease ligamentous adhesions and myospastn, increase disk nutrition, or alter the function of the nervous system. The manipulative procedures used in this study, referred to as chiropractic adjustments, involve specific application of force thought to restore mechanical and neurological function to the spine…This study was a randomized clinical trial (RCT) in which subjects and assessors were blinded to the interventions, chiropractic providers were blinded to medical/sham assignment and an independent consultant provided the statistical analysis. Visit lengths and provider-subject interactions were monitored to preserve patient blinding” (p. 389).

 

At the 2 week period, the study revealed that the chiropractic group had statistically slightly better outcomes, but statistically insignificant, than the muscle relaxants and at the 4 week period had a significantly reduced visual analog pain scale of 24% from the muscle relaxant group and 23% from the placebo group. Although the authors reported this as statistically insignificant, I don’t, and one cannot lose sight of the fact that chiropractic outperformed muscle relaxant therapy with the absence of any possibility of side effects from medications, making the utilization of the drugs clinically unnecessary based upon the outcomes of a safer and statistically better alternative.  

 

CHIROPRACTIC TREATMENT

 

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. 

 

The 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 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. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.

 

Although the previous report concluded that a chiropractic spinal adjustment is an effective treatment modality for a herniated disc, a more recent study by Leemann et al. (2014), further clarifies the improvement with chiropractic care. This study considered both herniated discs and radiculopathy or pain radiating down into the leg as a baseline for analysis. The study also considered acute and chronic lumbar herniated disc pain patients.

 

In this study, the acute onset patient (the pain just started) reported 80% improvement at 2 weeks, 85% improvement at 1 month, and a 95% improvement at 3 months. The study went on to conclude that the patient stabilized at both the six month and one year marks following the onset of the original pain. Although one might argue that the patient would have gotten better with no treatment, it was reported that after two weeks of no treatment, only 36% of the patients felt better and at 12 weeks, up to 73% felt better. This study clearly indicates that chiropractic is a far superior solution to doing nothing and at the same time helps the patient return to his/her normal life without pain, drugs or surgery.

 

Chiropractic Care and Herniated Discs with Leg Pain

 

2 Week Improvement

1 Month Improvement

3 Month Improvement

80.6%

84.6%

94.5%

 

The caveat is that there are patients who could need drugs or surgery and an accurate diagnosis is paramount. It is incumbent upon the doctor of chiropractic to be fully trained in both the diagnostic and treatment facets of care. It is also important that the chiropractor be well-versed in MRI protocols and interpretation as well as disc pathology in order to be able to triage the patient accordingly based upon the clinical presentation inclusive of the MRI results.

 

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

 

CONCLUSION

 

Contemporary research is clearly defining the most effective and safest treatment options for low back pain sufferers with associated leg pain (sciatica). In too many offices today, chiropractic treatment is not being considered the first option for care and the responsibility to change that habit falls to the chiropractic profession. Our profession is no different than the pharmaceutical companies who have an “army” of drug representatives. Pharmaceutical sales representative (formerly detailmen) are sales people employed bypharmaceutical companiesto persuade doctors to prescribe their drugs to patients. Drug companies in theUnited Statesspend ~$5 billion annually sending representatives to doctors,to provide product information, answer questions on product use, and deliver product samples. Companies maintain this provides an educational service by keeping doctors updated on the latest changes in medical science. Critics point to a systematic use of gifts and personal information to befriend doctors to influence their drug prescriptions.”  (http://en.wikipedia.org/ wiki/Pharmaceutical_sales_representative)

 

What makes the chiropractic profession different from the “real world” of business? The answer is absolutely nothing and it is incumbent upon every entity of the profession from individual practitioners to organizations to start educating the public and every referral source because we now have the evidence. Oral steroids offer no relief and modest return to function. Muscle relaxants offer some help, but render worse results than chiropractic care with clearly defined side effects that can be avoided. It has been clearly concluded that chiropractic care is an extremely safe environment regarding side effects. That is verifiable with close to 7 million subjects studied. By considering chiropractic as the first-line for referral, the scientific evidence verifies solutions to low back pain and leg pain inclusive of herniated discs. The results indicate that at 2 weeks, 80.6% and at 3 months 94.5% of those with herniated dics show significant improvement with chiropractic care.

 

References:

1. Best Practice. (2015). Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Best_practice

2. Evidence-Based Practice. (2015). Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Evidence-based_practice

3. Goldberg, H., Firtch, W., Tyburski, M., Pressman, A., Ackerson, L., Hamilton, L.,…Avins, A. L. (2015). Oral steroids for acute radiculopathy due to a herniated lumbar disk: A randomized clinical trial. Journal of the American Medical Association (JAMA), 313(19), 1915-1923.

4. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for sub-acute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.

5. 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.

6. Leeman S., Peterson C., Schmid C., Anklin B., Humphrys K. (2014) Outcomes of Acute and Chronic Patients with Magnetic Resonance Imaging Confirmed Symptomatic Lumbar Disc Herniations Receiving High Velocity, Low Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One Year Follow Up, .Journal of Manipulative and Physiological Therapeutics, 37(3), 155-163.

7. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

8. Pharmaceutical Sales Representative. (2015). Wikipedia. Retrieved from http://en.wikipedia.org/wiki/ Pharmaceutical_sales_representative

 

Dr. Mark Studin is an Adjunct Associate Professor of Chiropractic at the University Of Bridgeport College Of Chiropractic, an Adjunct Professor, Division of Clinical Sciences at Texas Chiropractic College and a clinical presenter for the State of New York at Buffalo, School of Medicine and Biomedical Sciences for post-doctoral education, teaching MRI spine interpretation and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the legal community (www.DoctorsPIProgram.com), teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally and studies trends in healthcare on a national scale (www.TeachDoctors.com). He can be reached at or at 631-786-4253 or DrMark@AcademyOfChiropractic.com 

 

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Friday, 26 June 2015 17:57

Pregnancy, Low Back Pain and Chiropractic

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Pregnancy, Low Back Pain and Chiropractic

 

A report on the scientific literature 


 

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

 

It has been this authors personal experience that pregnant woman experiencing low back pain secondary to her pregnancy has been told to “wait and see” over time, with the hope that the back pain would go away. This is predominantly because the “drug option” is off the table with complications to the fetus and most doctors are not willing to take the chance to relieve mechanical (no tumors, fractures or infection) low back pain.  My patients reported to me that their obstetricians told them their pain was a result of altered biomechanics and hormonal changes affecting the muscles and ligament of their spine. Current research has now verified through scientific evidence what practicing chiropractors and their patients have been claiming for decades, that chiropractic work to help relieve pain for pregnant woman with a safe, conservative treatment for both mother and the fetus. As a result of the effectiveness and safety, it now demands that chiropractic be the first referral option for pregnant woman experiencing low back pain.

 

 

According to Petersen, Muhlemann and Humphreys (2014) “Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8]. Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain, posterior pelvic pain, or a combination of these two, with posterior pelvic pain reported to be the most common presentation and the location most specific for pregnant patients. Although the etiology of low back pain associated with pregnancy is not definitively known, the predominate theories include biomechanical changes due to the enlarging uterus resulting in an increasing lumbar lordosis and the influence of the hormone relaxin on stabilizing ligaments leading to hypermobility of joints.” [pg. 2]

 

Petersen went on to report “The results of this current study which showed that a high proportion of pregnant patients with LBP undergoing chiropractic treatment reported clinically relevant improvementsupport those published in a recent cohort study as well as the recent randomized clinical trial (RCT) looking at chiropractic treatment for pregnant patients with low back or pelvic pain.” [pg. 5] Meaning, that chiropractic works for low back pain in pregnant woman and it has been proven in many scientific studies. The result showed that at various times during the pregnancy, upwards of 90% of pregnant woman reported positive results. The specific results reported:

 

52% improved at 1 week

70% improved at 1 month

85% improved at 3 months

90% improved at 6 months

 

All of these were with chiropractic care only and no drugs or any other type of intervention beyond patient education by the chiropractor.

 

 

Mullen ET. Al reported that when interviewing midwives, that 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience.  The most revealing statistic is one of safety. 100% of midwives question answered that chiropractic was safe for their pregnant patients.

 

 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

 

References:

  1. Petersen C., Muhlemann D., Humphreys B. (2014) Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up, Chiropractic & Manual Therapies 22:15, 1-7
  2. Mullin, L., Alcantara J., Barton D., Dever L. (2011) Attitudes and Views on Chiropractic: A Survey of United States Midwives, Complementary Therapies in Clinical Practice 17 (2011) 135-140
  3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

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Tuesday, 23 June 2015 19:30

Pregnancy and Chiropractic: Care and Safety

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Pregnancy and Chiropractic: Care and Safety

“A Report on Midwives & Chiropractic”

 

A report on the scientific literature 


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

 

 

Being a chiropractor for 34 years, I have treated hundreds of pregnant patients in my career for a host of “pregnancy related spinal conditions.” The impetus for conservative chiropractic care was in part because the pregnant patient could not utilize drugs as a result of contraindications with pregnancy and also in part because of the positive experiences both patients, midwives and obstetricians have observed through the years. It has been my persona observation that chiropractic is a safe alternative for pregnant patients and should always be the first option for anyone (pregnant or not) before the utilization of drugs, making them needless if a non-drug approach delivers positive outcomes. 

 

According to Mullen, Alcantara, Barton and Dever (2011) “Chiropractors and midwives, with their conservative approach to patient care grounded in a holistic and vitalistic philosophy, share many common ideals in the care of patients. In the age of evidence based practice with an emphasis on an integrative approach to patient care, chiropractors and midwives have a unique opportunity to develop partnerships in this regard.” They found “that 57% of their nurse-midwife responders recommended chiropractic to their pregnant patients to address pregnancy-related neuromusculoskeletal (NMS) complaints, sciatica and fetal malposition. In a survey of both lay-midwives and nurse-midwives on their use of CAM (complementary and alternative medicine)  therapies, found chiropractic was the most popular CAM therapy to address musculoskeletal back pain. There are also indicators that chiropractors advocate for a strong working relationship with midwivesparticularly in addressing fetal malposition during pregnancy.” Pg. 135

 

Mullen Et. Al went on to report that 98.9% of midwives were aware that chiropractors worked with “birthing professionals” and 92.5% were knowledgeable about chiropractic’s role in prenatal care. 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience.  The most revealing statistic is one of safety as 100% of midwives questioned answered that chiropractic was safe for their pregnant patients. 

 

We are now starting to get answers from disparate sects of healthcare that verify what was once considered “miracles” with maladies such as fetal repositioning during pregnancy. These research findings verify that the chiropractic adjustment does not deliver miracles, it only helps the body work better and we now know why. 

 

We also know that chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 

 

References:

 

 

  1. Mullin, L., Alcantara J., Barton D., Dever L. (2011) Attitudes and Views on Chiropractic: A Survey of United States Midwives, Complementary Therapies in Clinical Practice 17 (2011) 135-140
  2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

 

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Acute and Chronic Herniated Discs Have Significantly Favorable Outcomes With Chiropractic Care

 

95% Reported Improvement 

 

A report on the scientific literature 


 

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

 

Approximately 70% of the population will have back pain at some point in time in their life according to Lehman ET. Al. (2014). The pain ranges from mild to either moderate or severe and can often be debilitating and associated with or without leg pain if it’s originating from your lower back. Treatment for this common problem is usually broken up into two categories, surgical versus conservative care however, I am going to break it into three categories: surgical, medication and conservative care. This article is going to focus on the continual growing body of evidence of treatment of herniated discs via conservative care and specifically with a chiropractic spinal adjustment.

 

It was reported by McMorland, Suter, Casha,du Plessis, andHurlbertin 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. 

 

The 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 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. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.

 

Although the previous report concluded that a chiropractic spinal adjustment is an effective treatment modality for herniated disc a more recent study (Lehman ET. Al. (2014), further clarifies the improvement with chiropractic care. This study considered both herniated discs and radiculopathy or pain radiating down into the leg as a baseline for analysis. The study also considered acute and chronic lumbar herniated disc pain patients.

 

In this study the acute onset patient (the pain just started) reported 80% improvement at 2 weeks, 85% improvement at 1 month, and a 95% improvement at 3 months. The study went on to conclude that the patient stabilized at both the six month and one year mark after the onset of the original complaint. Although one might argue that the patient would have gotten better with no treatment it was reported that after two weeks of no treatment only 36% of the patients felt better and at 12 weeks up to 73% felt better. This study clearly indicates that chiropractic is a far superior solution to doing nothing and at the same time helps the patient return to their normal life without pain, drugs or surgery.

 

             Chiropractic Care and Herniated Discs with Leg Pain

2 Week Improvement

1 Month Improvement

3 Month Improvement

80.6%

84.6%

94.5%

 

 

The caveat is that there are patients who could need drugs or surgery and an accurate diagnosis is paramount and it is incumbent upon the doctor of chiropractic to be fully trained in both the diagnostic and treatment facets of care. It is also important that the chiropractor is well-versed in MRI protocols and interpretation as well as disc pathology to be able to triage the patient accordingly based upon the clinical presentation inclusive of the MRI results.

 

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon et al. (2014) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM (spinal manipulation) induces injury into normal healthy tissues has been identified.(Whedon et al.,2014, p. 5) 

 

References:

 

  1. Leeman S., Peterson C., Schmid C., Anklin B., Humphryes B., (2014) Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow Up, Journal of Manipulative and Physiological Therapeutics, 37 (3) 155-163
  2. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiscectomy for sciatica? A prospective randomized clinical study.Journal of Manipulative and Physiological Therapeutics, 33
  3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69.Spine, [Epub ahead of print]1-33.

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The Journal of the American Medical Association Suggest a Link between Pregnant Woman – Back Pain – Tylenol Use & ADHD: Chiropractic Offers a Solution

 

A report on the scientific literature 


 

By Travis McKay DC,

William J Owens Jr DC DAAMLP CPC

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

 

Liew, Ritz, Rebordosa, Lee and Olsen (2014) reported that pregnant women, at some point during their pregnancies, may experience musculoskeletal pain, particularly in the lower back, pelvis and hips.  Since the symptoms are related to biomechanical changes associated with pregnancy, it is important to be able to offer relief while limiting potentially harmful side effects.   One of the most common ways to treat musculoskeletal pain in general and during pregnancy, in particular, is through over-the-counter (OTC) medications.  Most doctors and family members will recommend acetaminophen, more commonly known and marketed as Tylenol, as a pain reliever and as a safe choice for both mothers and their babies. However, Liew et al. (2014) reported, “Acetaminophen (paracetamol) is the most commonly used medication for pain and fever during pregnancy in many countries. Research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development” (p. 313).   

According to Liew et al. (2014):

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders worldwide, characterized by inattention, hyperactivity, increased impulsivity, and motivational/emotional dysregulation. Hyperkinetic disorder (HKD; International Statistical Classification of Diseases, 10th Revision) is a particularly severe form of ADHD (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]). The etiology of HKD/ADHD is not well understood but both environmental and genetic factors are believed to contribute. (p. 313) 

The study reported that children whose mothers used acetaminophen during pregnancy were at higher risk for a diagnosis of hyperkinetic disorder, use of attention deficit hyperactivity disorder (ADHD) medications, and/or having ADHD like behaviors by age 7.  The study found that these outcomes were seen more in the mothers who used acetaminophen during more than one trimester of their pregnancies and that the more acetaminophen that was taken, the greater the likelihood that one of the previously mentioned conditions would be seen in their children.  The authors reported, “We observed an increased risk for ADHD-like behaviors in children at age 7 years with maternal acetaminophen use during pregnancy…as well as use in more than 1 pregnancy trimester, especially in later pregnancy, and a stepwise increase in risks with increasing frequency of use throughout pregnancy” (Liew et al., 2014, p. 318).

What does this mean for pregnant women?  If additional studies confirm the association between acetaminophen and hyperkinetic disorder and ADHD, what options are available for pregnant women who are suffering from spinal pain during pregnancy?  The answer lies in understanding other forms of pain management and non-medication based therapies which are already available to pregnant women.    According to Coronado et al. (2012), “The mechanism of SMT [spinal manipulation therapy] remains elusive, but SMT appears to modulate pain through both central [brain and spinal cord] and peripheral pathways [down the arms and legs]. Studies have investigated the effect of SMT using variable experimental pain modalities including chemical, electrical, mechanical, and thermal stimuli. SMT demonstrated a favorable effect over other interventions on pressure pain thresholds (PPT)” (p. 763).  This means that the chiropractic adjustment has a very specific influence on the body’s perception and management of pain. 

Since the most common reason for pregnancy-related spine and pelvic pain during pregnancy has to do with altered mechanics, a non-drug approach to reducing pain and increasing function should be considered as a first-line alternative to eliminate the possible connection between acetaminophen and ADHD. Chiropractic care offers a neuromuscular and spinal biomechanical approach that focuses on the underlying causes of a patient’s spinal-related pain.   

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration, particularly as a first line treatment. Whedon, Mackenzie, Phillips, and Lurie (2015) based a study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury in normal healthy tissues has been identified” (Whedon et al., 2015, p. 265).

Chiropractic should be considered as a first-line, safe choice for pregnant woman with back pain to avoid any potential side effects from all medications, when clinically indicated.

References:

1. Liew, Z., Ritz, B., Rebordosa, C., Lee, P. C., & Olsen, J. (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics, 168(4), 313-320.

2. Coronado, R. A., Gay, C. W., Bialosky, J. E., Carnaby, G. D., Bishop, M. D., & George, S. Z. (2012). Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis. Journal of Electromyography and Kinesiology22(5), 752-767.

3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

           

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Patient Outcomes Proves More Effective with Chiropractic Combined with Standard Medical Care Than Standard Medical Care Alone in the Military

 

A report on the scientific literature 


BY: D. Scott Ferguson

DC, William J. Owens DC, DAAMLP

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

 

Many people suffer from lower back pain at some point in their lives.  Most will seek the advice of a healthcare professional. However, many times this care is fragmented and not based on current evidence and can result in poorer outcomes. When considering outcomes, all doctors must consider creating a diagnosis, prognosis and then conclude a treatment plan. It is that treatment plan, which then determines the outcome after an accurate diagnosis. Many times, low back pain patients seek solely standard medical care and bypass a more effective chiropractic solution. This type of self-referral and physician triage has also been prevalent in the military and asks the question based upon outcome studies, is that in the best interest of both the military and the general public?  

 

In a recent paper by Goertz et al. (2013), the objective was, “To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (chiropractic adjustments) for the treatment of low back pain  among 18 to 35-year-old active-duty military personnel” (p. 627).  The authors stated, “Lifetime prevalence of low back pain has been estimated to be as high as 84%, with a median cost per quality-adjusted life year of $13,015” (p. 627).  The fact that lower back pain is a major source of disability and abuse of pain medication makes providing the best care possible a priority based upon outcome studies.  In this paper, it was reported that, “The majority of systematic reviews find that chiropractic manipulative therapy (adjustments) seems to reduce pain and disability at least moderately for many patients with low back pain” (p. 627).  Therefore, the questions are, “Should chiropractic care be part of your treatment plan and should it be included with standard medical treatment for lower back pain?” 

 

 

In the Goertz et al. (2013) study, the patients were allowed to seek standard medical care in an unrestricted fashion which meant they could go to their medical doctors as they normally would for lower back pain.  “Standard care included any or all of the following: a focused history and physical examination, diagnostic imaging as indicated, education about self-management including maintaining activity levels as tolerated, pharmacological (drug) management with the use of analgesics and anti-inflammatory agents, and physical therapy and modalities such as heat/ice and referral to a pain clinic” (p. 628).  On the chiropractic side, the authors stated “Treatments consisted of HVLA [high velocity low amplitude a.k.a. chiropractic adjustment] manipulation as the primary approach in all cases, with ancillary treatments at the doctor’s discretion, including brief massage, the use of ice or heat in the lumbar area, stretching exercises, McKenzie exercises, advice on activities of daily living, postural/ergonomic advice; and mobilization” (p. 628).  This is important since chiropractors view the spine as an entire system and the approach to patients is different as well as the therapeutic intervention.

 

 

In conclusion, the authors reported, “The results of our pragmatic pilot study indicate a statistically and clinically significant benefit to those receiving chiropractic manipulative therapy (adjustments) in addition to standard medical care” (p. 631).  Finally, they report, “The results of this trial suggest that chiropractic, in conjunction with standard medical care, offers a significant advantage for decreasing pain and improving physical functioning compared with only standard medical care, for active-duty men and women between 18 and 35 years of age with acute low back pain when delivered in a pragmatic treatment setting” (p. 633).

 

This study concurs with a previous study by Liliedahl et al. (2010) who studied 85,402 patients and adds to the growing body of evidence in diverse forums that chiropractic for mechanical back pain is more effective and cost-effective than standard medical care. Evidence such as this helps to dispel the partial truths and overcome the prejudices to help the public make informed choices.

 

References:

1. Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J.,…Meeker, W. C. (2013). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Spine, 38(8), 627-634.

2. Liliedahl, R. L., Finch, M. D., Axene, D. V., & Goertz C. M. (2010). Cost of care for common back pain conditions initiated with chiropractic doctor vs. medical doctor/doctor of osteopathy as first physician: Experience of one Tennessee-based general health insurer. Journal of Manipulative and Physiological Therapeutics, 33(9), 640-643.

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Harvard Report Points to Chiropractic Care for Pain Relief

& The Safety of the Chiropractic Adjustment

By

Noah Herbert, D.C., CCSP®

William J. Owens DC, DAAMLP

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

A recent article released by Harvard Health Publications at Harvard Medical School points to chiropractic care as a form of pain relief. There are currently many Americans that seek out chiropractors, but many people don’t realize the wide variety of treatments that a chiropractor can provide for pain relief. The article states “while the mainstay of chiropractic is spinal manipulation, chiropractic care now includes a wide variety of other treatments, including manual or manipulative therapies, postural and exercise education, ergonomic training (how to walk, sit, and stand to limit back strain), nutritional consultation, and even ultrasound and laser therapies. In addition, chiropractors today often work in conjunction with primary care doctors, pain experts, and surgeons to treat patients with pain.”

While this is nothing new for the chiropractic community, it may serve to further educate the public as to the many tools a chiropractor possesses to help patients. While the majority of research on chiropractic has focused on spinal manipulation, or adjustment of the spine, for pain relief, there have been studies done on the effectiveness of chiropractic for treating musculoskeletal pain, headaches, asthma, carpal tunnel syndrome and fibromyalgia (Harvard Health Publications). The author goes on to state “a recent review concluded that chiropractic spinal manipulation may be helpful for back pain, migraine, neck pain and whiplash.” It should be pointed out there have been reports of serious complications, including stroke, but this has been shown to be extremely rare and some studies suggest this may not be directly caused by the treatment provided by the chiropractor (Harvard Health Publications).

Spinal manipulation, or adjustment of the spine, is a term used to describe providing a high velocity, low amplitude thrust to the vertebra. Chiropractors use this technique to correct the body’s spinal alignment to relieve pain and improve function and to allow the body to heal itself. Treatment usually takes between 10 to 20 minutes and most patients are scheduled 2-3 times per week initially. Patients generally see improvement of their symptoms in the first two to three weeks (Harvard Health Publications).

Harvard Medical School is now saying what chiropractors have been saying for over 100 years and although their article was based on pain, it does add more evidence to the false rhetoric of chiropractic patients having a greater risk of stroke. In the future, reports from Harvard and other medical academic institutions will embrace the growing body of scientific evidence of the varied maladies that respond to chiropractic care.

 

References:

  1. Harvard Health Publications. (2015). Chiropractic Care for Pain Relief. Retrieved from http://www.health.harvard.edu/pain/chiropractic-care-for-pain-relief

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Back Pain:

Chiropractic vs. Medical Doctors

Who Get Better Results and Who is More Cost Effective?

 

Chiropractic Proves 300% more effective

Chiropractic Proves 50% More Cost Effective

A report on the scientific literature 


 

BY: Donald Capoferri DC, DAAMLP

William J. Owens DC, DAAMLP

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

 

In 2010 a study of back pain patients insured by Blue Cross Blue Shield of Tennessee revealed patients receive nearly 3x better results at almost half the cost when consulting a chiropractor instead of a traditional medical doctor.

 

Statistics show that back pain, and more specifically lower back pain will affect 70-80% of all Americans.  Back pain is one of the top 10 most costly conditions treated in the United States.  Costs directly associated with examination and treatment are in excess $50 billion dollars per year.  Indirect cost of back pain include lost work day, reduced employee productivity and disability are $47 billion dollars.  That makes the total economic impact of lower back pain in excess of $97 billion dollars per year.

 

The study was conducted on 85,402 patients, all insured with Blue Cross Blue Shield of Tennessee.  This insurer was chosen because it provided equal access to both traditional medical and chiropractic care. The population of patients were diagnosed with the following conditions: Spinal disc disorders, Lower back pain, muscle spasms, joint mobility restrictions, Sacroiliac joint sprain/strain and lumbar spine sprain/strain.  The results of the study revealed those patients who initiated care with a chiropractor had a 61% “very satisfied response” when surveyed.  Those patient who initiated care with a medical doctor had a 27% “very satisfied response.” The patients who initiated care with a chiropractor incurred 40% less cost than those choosing traditional medical care.

 

There is a growing body of evidence indicating that chiropractic care is more effective and less costly than medical care for back pain.  In contrast to this and many other studies indicating the efficacy of chiropractic care for back pain, only 7% of U.S. back pain sufferers consult a chiropractor.  Using the data from this study insurers nationally would realize billions of dollar of savings if the population of back pain patients initiated care with a chiropractor first. 

 

Insurance companies that restrict access to chiropractic care at this juncture with statistical evidence, are paying more for care and delaying necessary, effective care for no apparent reason other than politics or prejudice. If all restrictions for chiropractic access were removed carriers would save money and offer a significant public health benefit. The statistics speak for themselves.

 

Reference:

Liliedahl R., Finch M., Axene D., Geertz C., (2010) Cost of Care for Common Back Pain Conditions Initiated with Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician:  Experience of One Tennessee-Based General Health Insure, Journal of Manipulative and Physiological Therapeutics 33 (9) pgs. 640-643

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Chiropractic Care Reduces the Odds
of Low Back Surgery

42.7 Percent of Workers Who Consulted a Surgeon First - Had Surgery
vs.
1.5% Who Consulted a Chiropractor First - Had Surgery

A report on the scientific literature 


By Mark Studin, DC, FASBE(C), DAAPM, DAAMLP
 Michael Schonfeld, DC, DABCO


Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury. It was reported by Keeney et. al. in May 2013 that the chances of the patient undergoing lumbar spinal surgery vary dramatically changes depending upon what specialist they saw first.

Trauma, aging, improper body mechanics, and normal wear and tear can all injure your spine. Damage to any part of your back or pressure on the nerves in your spine can cause back pain and other symptoms. If you have ongoing back pain, maybe you've wondered — could back surgery help?

The rate of spinal fusion surgery has risen six fold in the United States over the past 20 years, according to federal figures, and the expensive procedure has become even more common than hip replacement. The rate of spinal fusions in the United States is about 150 per 100,000 people, according to federal data. In Australia, it is about one-third of that; in Sweden, it is about 40 per 100,000; and in Britain it is lower still.

Even by American health-care standards, the rise of spinal fusions has been remarkable. According to federal figures, the number of spinal fusions in the United States rose from 56,000 in 1994 to 465,000 in 2011.

Using Disability Risk studies by Keeney et. al., they examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation and temporary total disability claims for back injuries. In the sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. They concluded that there was a very strong association between surgery and first provider seen.

If back surgery is something you must seriously consider, consider this:

Back surgery is needed in only a small percentage of cases. Most back problems can be taken care of with nonsurgical treatments.

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.

The 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 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. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.

Choosing a conservative approach for your back injury requires choosing a conservative practitioner of healthcare that has been certified to equate to successful outcomes without surgery. Chiropractors are trained in a drugless/non-surgical approach to treating you and your back. 

The bottom line is this: see a chiropractor first and the research supports that decision.

42.7 Percent of Workers Consulted a Surgeon First - Had Surgery
vs.
1.5% Who Consulted a Chiropractor First - Had Surgery



References:

     1.      Mayo Clinic staff. Retrieved from http://www.mayoclinic.com/health/back-surgery/HQ00305

     2.      Whorksy, P. and Keating, D. of the Associated Press. Retrieved from
               http://union-bulletin.com/news/2013/oct/28/spinal-surgery-raises-questions-excess/


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





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Monday, 25 October 2010 13:31

Chronic Low Back Pain: Chiropractic vs. Medicine

Written by

Chronic Low Back Pain:

Chiropractic vs. Medicine

Research Results: Chiropractic is 457% more effective

A report on the scientific literature 


 

By

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

 

As reported in 2003 by the National Institute of Neurological Disorders and Stroke, "If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common" (http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm)

They went on to report many of the causes of low back pain. " As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae"
(National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).

"Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results"
(National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).

"Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury"
(National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).

Chronic low back pain is where the symptoms have persisted for longer than 3 months, as reported by Bogduk in 2004, although recent studies have classified chronic low back pain as pain persisting for only 4 weeks. The duration is important from a diagnosis and prognosis perspective, where it is critical for the doctor to develop an accurate plan of care. The most important component is not the label, but a complete history being performed, including examination and subsequent testing, when indicated, to develop the right treatment plan.

Wilkey, Gregory, Byfield, & McCarthy reported in 2008 that the proportion of the population that suffers from persistent or chronic low back pain is between 8% and 33%. 13% accounts for those whose pain never goes away and the remainder fluctuate in and out of pain. They also reported that the low back pain was generally recurring, indicating that doing nothing is a poor choice.

While there are a limitless number of treatments, the National Institute of Health in the United States and the National Health Service in the United Kingdom have listed accepted treatment modalities for this very prevalent condition. While there are choices for the public, the question is what is the best treatment choice for each individual back pain sufferer? The answer has to be based on real evidence and outcome based studies offer the answer.

As mentioned ealier,
Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic groupsubjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain. To say that the medical approach doesn't have a place in healthcare would be inaccurate and irresponsible, but based upon evidenced based outcome studies, research concludes that for chronic low back pain, the path is chiropractic first and drugs 457% second. Chiropractic doctors are trained to determine the cause of the injury and are expert at formulating an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment.

These studies along with many others conclude that a drug-free approach of chiropractic care is the best solutions for patients with chronic low back 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. National Institute of Neurological Disorders and Stroke. (2003, July). Low Back Pain Fact Sheet. Retrieved from http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

2. Bogduk, N. (2004). Management of chronic low back pain. The Medical Journal of Australia, 180(2), 79-83.Retrieved from http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html

 

3. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.

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