Disc Herniations and Low Back Pain Post Chiropractic Care

88% of patients reported continued improvement at 1 year post-care

A report on the scientific literature 


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

Robert Reiss DC

According to Hoy et. al. (2014), "Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP [low back pain] ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs)...LBP causes more global disability than any other condition" (p. 968). Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) wrote that, "Back pain is the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388).

There are many treatment options available that fall into one of two categories, surgical or conservative care.  Spinal manipulation/adjustments are one of the most widely used conservative treatment options with doctors of chiropractic performing the majority of them.  There have been various studies comparing the effectiveness of spinal manipulative therapy (SMT) on low back pain (LBP) patients with disc herniations to other therapies, all of which have been inconclusive. 

But now, a 2013 study by Leemann, Peterson, Schmid, Anklin, and Humphreys concluded that, “a large percentage of acute and importantly chronic lumbar disc herniation patients treated with high-velocity, low-amplitude side posture SMT reported clinically relevant “improvement” with no serious adverse events” (p. 162). The study’s purpose was to evaluate patients with low back pain and leg pain that was the result of a herniated lumbar disc which had been confirmed by magnetic resonance imaging.  The patients were treated with high-velocity, low-amplitude spinal manipulations by chiropractors.  The patients’ outcomes of self-reported global impression of change and pain levels were collected at various time points up to 1 year.

The results showed significant improvement for all outcomes at all of the time points.  “Patients responding ‘better’ or ‘much better’ were categorized as ‘improved,’ and all other patients as ‘not improved.’ ‘Improved’ was the primary outcome measure. ‘Slightly improved’ was not considered clinically relevant improvement” (Leemann et al., 2013, p. 158).  At 1 year, 88.0% were much better or better. According to the authors, “The results in this current study are encouraging when considering that it is chronic LBP patients who are a large economic burden with greater use of prescription medications and increased use of other health care resources” (Leemann et al., 2013, p. 161).

To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiropracticDirectory.com and search your state.

References:

1. Hoy, D., March L., Brooks, P., Blyth, F., Woolf, A., Bain, C.,…Buchbinder, R. (2014). Extended Report, The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73, 968–974.

2. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E. (2006). Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.

3. 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 subacute low back pain. .Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.

4. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4), 387-402.

5. Leemann, S., Peterson, C. K., Schmid, C.,  Anklin, B., & Humphreys, B. K. (2013).  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.

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Published in Research

Chiropractic: Safer Pregnancy and Birthing

A recent article in the Jamaica Observer in the May 25 issue titled “Safer pregnancy, birthing through chiropractic care,” highlighted a increase in the number of pregnant women who are looking for a safer, more natural and easier birthing process.  The article goes on to describe what happens to the woman’s body structurally and hormonally throughout the pregnancy.

These changes include increases in weight, which shift her center of gravity outward and forward.  When this is added to the laxity of ligaments, due to the release of relaxin and elastin, needed for the birthing process it tends to destabilize posture and realign the carriage of weight and forces throughout the joints of the body.  This can lead to misalignment in the spine and pelvis or subluxations causing low back pain. 

The author goes on to explain how a condition called intrauterine constraint can be effected by spinal and pelvic misalignment.  The mother’s pelvic anatomy and the relationship between its biomechanics and the baby's positioning can be affected adversely.  If the pelvis is supported symmetrically it allows the baby optimal room for movement and the opportunity to develop free of constraint. 

On the other hand if the pelvis is out of alignment it can create an uneven pulling effect on the uterine ligaments limiting the space available for the baby to develop.  This can lead to development problems in the baby's musculoskeletal system.  Fetal positioning is important for delivery without outside intervention.  The optimal positioning is rear-facing, head down.  When the baby presents breech or posterior, it often is the result of an imbalance in the mother's pelvis. 

If the mother's biomechanics are not working properly then obstetric interventions are more likely to be recommended and implemented.  The problem is that each and every intervention has significant side effects for both mother and baby.  Fortunately, today more and more parents are becoming aware of the detrimental effects of these interventions and are choosing safer alternatives including chiropractic to address both the needs of the mother and the newborn.

For more news articles or chiropractic research please click on the research link on the Uschirodirectory.com website.

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Frozen Shoulder Syndrome Improves With Chiropractic Care



98% of patients studied with Frozen Shoulder Syndrome (Adhesive Capsulitis) responded positively

 

A report on the scientific literature 


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



Frozen shoulder syndrome (FSS)  is a common condition presenting to a variety of health care practitioners including chiropractors, osteopaths, medical doctors, and physical therapists. Also referred to as adhesive capsulitis, FSS remains one of the most poorly understood shoulder conditions, with its cause most of the time, unknown. Recently, a consensus definition of FSS was reached by the American Shoulder and Elbow Surgeons to be a condition characterized by functional restriction of both active (while moving) and passive (while still) shoulder motion for which  x-rays of the shoulder are usually negative. It occurs usually between 40 and 60 years of age, is 3 to 7 times more prevalent in women than men and it is characterized by sudden onset, night pain along with a painful restriction of numerous motions of the shoulder. Common  traditional medical treatments include nonsteroidal anti-inflammatory drugs, steroid injection, and shoulder surgery. 

The purpose of this study was to describe the treatment and outcomes of a series of patients presenting with frozen shoulder syndrome who received a chiropractic approach (OTZ Tension Adjustment) which was mostly neck and midback adjustments.

The files of 50 consecutive patients who presented to a private chiropractic practice with frozen shoulder syndrome were reviewed. Two primary outcomes were extracted from the files for initial examination and at final evaluation: (1) the 11-point numeric pain rating scale and (2) the percentage change in shoulder abduction (ability to raise their arm from their side as far as they could go). Each patient received a series of chiropractic manipulative procedures that focused on the cervical (neck) and thoracic (mid back) spine.
 
Of the case files reviewed, 20 were male and 30 were female; and all were between the ages of 40 and 70 years. The average number of days under care was 28 days (range, 11 to 51 days). The median change in Numeric Pain Rating Scale score was −7 (range, 0 to −10). Of the 50 cases, 16 resolved completely (100% improvement), 25 showed 75% to 90% improvement, 8 showed 50% to 75% improvement, and 1 showed 0% to 50% improvement.

Conclusion: 98% of patients treated with frozen shoulder syndrome were reported to have improved with chiropractic care.

Reference:

Murphy F., Hal, M., D'Amico L., Jensen A., (2012) Chiropractic management of frozen should syndrome using a novel technique: a retrospective case series of 50 patients, Journal of Chiropractic Medicine 11, 267-272




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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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Published in Low Back Problems

Chiropractic Scores Highest Among Professional Students in

Understanding Musculoskeletal Conditions 

A report on the scientific literature 


William J. Owens Jr DC DAAMLP

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

 

According to Wikipedia: The musculoskeletal system (also known as the locomotor system) is an organ system that gives animals (including humans) the ability to move using the muscular and skeletal systems. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together. The musculoskeletal system's primary functions include supporting the body, allowing motion, and protecting vital organs. The skeletal portion of the system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system. 

Musculoskeletal conditions range from neck, mid and low back pain to certain type of headaches and arm and leg pain. Most sports injuries are musculoskeletal in nature as well and most degenerative conditions (arthritis) that prevents the use of an limb over time. If it has to do with moving, lifting, sitting or carrying, it is usually a musculoskeletal condition responsible for the inability to perform that action, or have pain with completing the task related to movement. 

In a recent article written by Humphreys, Sulkowski, McIntyre, Kasiban, and Patrick (2007), they stated, “In the United States, approximately 10% to 25% of all visits to primary care medical doctors are for MSK [musculoskeletal] complaints, making it one of the most common reasons for consulting a physician...Specifically, it has been estimated that less than 5% of the undergraduate and graduate medical curriculum in the United States and 2.26% in Canadian medical schools is devoted to MSK medicine” (p. 44). 

Musculoskeletal complaints have a major impact on the healthcare system and although many patients believe that traditional providers are highly trained, recent publications relating to basic competency have shown otherwise.  For example, the authors cited another study stating, “A study by Childs et al on the physical therapists’ knowledge in managing MSK conditions found that only 21% of students working on their master’s degree in physical therapy and 25% of students working on their doctorate degree in physical therapy achieved a passing mark on the BCE [Basic Competency Evaluation]” (Humphreys et al., 2007, p. 45).  

The authors reported, “The objective of this study was to examine the cognitive (knowledge) competency of final-year chiropractic students in MSK [musculoskeletal] medicine" (Humphreys et al., 2007, p. 45).  "The typical chiropractic curriculum consists of 4800 hours of education composed of courses in the biological sciences (ie, anatomy, embryology, histology, microbiology, pathology, laboratory diagnosis, biochemistry, nutrition, and psychology), chiropractic sciences, and clinical sciences (ie, clinical diagnosis, neurodiagnosis, orthorheumatology, radiology, and psychology).  As the diagnosis, treatment, and management of MSK disorders are the primary focus of the undergraduate curriculum as well as future clinical practice, it seems logical that chiropractic graduates should possess competence in basic MSK medicine” (Humphreys et al., 2007, p. 45). 

The following results were published in this paper for the Basic Competency Examination and various professions that are in the front line of the diagnosis and treatment of musculoskeletal conditions.  In Table 2 on page 47, the following results were shown when the passing score was established at 73% or greater: 

Recent medical graduates (18%), medical students, residents, and staff physicians (20.7%), osteopathic students (29.6%) physical therapy  (MSc level, 21%), physical therapy (doctorate level, 26%), chiropractic students (51.5%). 

In Table 2 on page 47, the following results were show when the passing score was established at 70% or greater.  

Recent medical graduates (22%), medical students, residents, and staff physicians (NA), osteopathic students (33%) physical therapy  (MSc level, NA), physical therapy (doctorate level, NA), chiropractic students (64.7%). 

Although many professions offer significant training in musculoskeletal conditions, chiropractors, based upon their training and outcomes in comparative studies are shown to be highly competent in caring for musculoskeletal conditions. It is therefore in the public's best interest to consider chiropractic as a "first-line" treatment option or the primary care for "all things musculoskeletal." 

Reference: 

1. Human Musculoskeletal System, Retrieved from: http://en.wikipedia.org/wiki/Musculoskeletal_system

2. Humphreys, B. K., Sulkowski, A., McIntyre, K., Kasiban, M., & Patrick, A. N. (2007). An examination of musculoskeletal cognitive competency in chiropractic interns. Journal of Manipulative and Physiological Therapeutics, 30(1), 44-49.

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Urinary Incontinence May Improve

With Chiropractic Care

A 6 year  "Case Report" study of 21 Cases

A report on the scientific literature 



81% of chiropractic case showed improvement

 

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

 

Urinary incontinence (UI), according to Cuthbert and Rosner (2012) "occurs when there is leakage of urine that is involuntarily, most commonly in older patients. Incontinence affects 4 of 10 women and 1 of 10 men during their lifetime, and about 17% of children younger than 15 years. A large postpartum study of the prevalence of UI found that 45% of women experienced UI at 7 years postpartum. Thirty-one percent who were initially continent in the postpartum period became incontinent in the future" (pg 50.)

According to Holroyd-Leduc et. al (2010) "Urinary incontinence (involuntary leakage of urine) is of high priority to older women. In a survey of 2,500 women aged 55–95, 64% reported that urinary incontinence was of great concern to them but only 25% perceived that it was being adequately addressed by their healthcare providers. The prevalence rate of urinary incontinence is up to 55% among older women.. Urinary incontinence is associated with poor quality of life, poor self-rated health, social isolation, depressive symptoms, decline in instrumental activities of daily living and out-of-pocket expenses. The majority of older women with urinary incontinence remain under-treated" (pg 228.)

 

Cuthbert and Rosner addresses co-morbidities (other problems) of pelvic pain and imbalances and Holroyd-Leduc et. al cites sensory involvement in addition; both conditions that have historically responded well under chiropractic care.

Cuthbert and Rosner reported in a study of 21 patients, that were followed for 6 years that in 48% of the case, the UI symptoms resolved totally, another 33% considerably improved and a further 19% slightly improved. That equates to 81% of the case studies showing improvement with urinary incontinence. Comparatively, Holroyd-Leduc et. al reported that 50% improved with pharmacological trials.  

Based upon the prevalence of urinary incontinence in our population and the conclusion that the vast majority of the population is being undertreated, the public must take an honest look at treatment choices.

Chiropractic, based upon the results shouldn't be considered an alternative choice, but the first line of care with no side effects to consider from medications.  

 

References: 

Scott, C., Rosner A., (2012) Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report, Journal of Chiropractic Medicine, 11 (1) pp 49-57

Holyrod-Leduc J., Straus. S, Thorpe K., Davis D., Schmaltz H., Tannenbaum C, (2010)  Translation of evidence into a self-management tool for use by women with urinary incontinence, Oxford Journals, 40 (2) pp 227-233

 

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Children with Tremors and Conversion Disorder

A Possible Chiropractic Solution

 

Reporting a Limited Case Study

 

A report on the scientific literature 


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

 

Chiropractors and chiropractic has been treating children safely for over 110 years for a host of maladies. 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 chiropractic clinic, 83% were referred by their medical physicians.

 

Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results. 

The pediatric related conditions that were reported to be cared for by chiropractors were the following:

  1. Musculoskeletal
    1. Joint pain
    2. Walking/crawling
    3. Neck pain
    4. Mid back pain
    5. Low back pain
  2. Neurological
    1. Headaches
    2. Autism
    3. Balance
    4. Cerebral Palsy
    5. Movement Disorders
    6. ADD/ADHD
    7. Behavioral
    8. Crying/Irritability/Sleep
    9. Developmental
    10. Growing
    11. Cognitive
  3. Gastrointestinal
    1. Colic
    2. Constipation
    3. Digestive
    4. Eating
    5. Drinking
    6. Reflux
    7. Hiatus hernia
    8. Bowel problems
  4. Genitourinary
    1. Menstrual cramps
    2. Bed wetting
  5. Immune
    1. Allergies
    2. Asthma
    3. Food intolerance
    4. Respiratory
    5. Eczema
    6. Skin rashes
  6. Infections
    1. Ear infections
    2. Ear-nose-throat problems
    3. Common cold
    4. Flu

 

Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
 
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.

 

Conversion Disorder according to Heruti, Levy, Adunski and Ohry (2002) has been previously labeled Hysterical Neurosis, Somatisized Disorder, Anxiety Hysteria and Hysterical Personality. Today's proper accepted nomenclature has been the simple use of  Hysterical Neurosis, where Conversion Disorder is lumped together with Dissociative Disorder. This disorder, according to the authors is "disability to a psychological mechanism in people with physical impairment secondary to trauma without evidence of organic etiology (deviation or disruption from any internal organ, part or system)" Page 327.

 

Alcantara and Adamek (2012) reported "that an 11 year old girl with presented with complaints of uncontrollable tremors of both arms and right leg. Conversion Disorder was diagnosed following  negative examination findings of an organic etiology. Prior to institutionalization, her parents requested a second opinion from a clinical psychologist who referred her to a chiropractor. Care was provided using spinal manipulation to sites of spinal and cranial dysfunctions. With subsequent visits the patient's tremors improved. Following 12 chiropractic visits the patient's symptoms resolved. Long-term follow-up revealed continued resolution of the symptoms of tremors." (page 89)

 

Although this is one case as reported in a limited case study, it adds to the growing body of the results chiropractic care. It also adds to the growing list of conditions chiropractors care for. Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in both the pediatric and adult population with minimal to no side effects.

 

References:

 

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.Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380

4. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.

5.Heruti R., Levy, A., Adunski A. and Ohry A., (2002) Conversion Motor Paralysis: Overview and Rehabilitation Model, Spinal Cord, 40, 327-334

6. Alcantra J., Adamek R., (2012) The chiropractic care of a child with extremity tremors concomitant with a medical diagnosis of conversion disorder,  Complementary Therapies in Clinical Practice, 18, 89-93

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Children and Chiropractic Care:

Birth to 18 Years

Conditions cared for and side effects

2012 Report

A report on the scientific literature 


By

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

 

Chiropractic has been successfully caring for children for various conditions for over a century. The main issues are what conditions are cared for by chiropractors, what is the reported success rate and what is the incidence of side effects. Over time, research has started to catch up on what individual chiropractors have been realizing in their private practices and this article will outline the current state of the literature. 

Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results. 

The pediatric related conditions that were reported to be cared for by chiropractors were the following:

  1. Musculoskeletal
    1. Joint pain
    2. Walking/crawling
    3. Neck pain
    4. Mid back pain
    5. Low back pain
  2. Neurological
    1. Headaches
    2. Autism
    3. Balance
    4. Cerebral Palsy
    5. Movement Disorders
    6. ADD/ADHD
    7. Behavioral
    8. Crying/Irritability/Sleep
    9. Developmental
    10. Growing
    11. Cognitive
  3. Gastrointestinal
    1. Colic
    2. Constipation
    3. Digestive
    4. Eating
    5. Drinking
    6. Reflux
    7. Hiatus hernia
    8. Bowel problems
  4. Genitourinary
    1. Menstrual cramps
    2. Bed wetting
  5. Immune
    1. Allergies
    2. Asthma
    3. Food intolerance
    4. Respiratory
    5. Eczema
    6. Skin rashes
  6. Infections
    1. Ear infections
    2. Ear-nose-throat problems
    3. Common cold
    4. Flu

 

Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
 
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
 

Marchand (2012) also reported the negative side effects of chiropractic care in children to be less then 1% (0.23%,) which is consistent with what Miller and Benfield reported 4 years prior in an independent study. However, Marchand went further to categorize the negative side effects into mild, moderate and severe. In a 1 year study of 237,857 pediatric patients, there was a reported 534 mild side effects (0.2%) and 23 (0.009%) had moderate side effects with 0 (zero) reporting any severe side effects. 

To render perspective on the safety of chiropractic care and children Le, Nguyen, Law and Hodding (2006) reported  "The incidence of adverse drug reactions among hospitalized children in the United States has not been well studied. Because clinical trials involving neonates, infants, children, and adolescents are limited, the safety and tolerability of many pharmacologic agents are not well established. Often the pharmacologic actions of drugs in neonates, infants, and children are not similar to those identified for adults; therefore, information obtained from research with adults cannot be applied directly. On the basis of a meta-analysis of 17 prospective studies conducted in the United States and Europe, the incidence of adverse drug reactions among hospitalized children was 9.5%, with severe reactions accounting for 12% of the total (pg. 557.) 

The above study indicates that side effects need more researched  in many sects of health care, but comparatively speaking, chiropractic is a much safer choice than most alternative options. 

Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in the pediatric population with minimal to no side effects.

 

References:

  1. Marchand, Aurelie (2012) Chiropractic Care of Children From Birth to Adolescence and Classification of reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors, Journal of Manipulative and Physiological Therapeutics, 35 (5) 372-380
  2. Miller, J. E., & Benfield, K. (2008). Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31(6), 419-423.
  3. Studin M. (2010, September). Chiropractic and Children; A Study in Adverse Effects, US Chiropractic Directory. Retrieved from  http://uschirodirectory.com/index.php?option=com_flexicontent&view=items&id=261
  4. Le, J., Nguyen, T., Law, A., Hodding, J. (2006) Adverse Drug reactions Among Children Over a 10-Year Period, Pediatrics, 118 (2) 555-562

 

 

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Scoliosis and Chiropractic Care

 

The average reduction of thoraco-lumbar scoliosis was 17.2° and was maintained for 24 months.

Function improved 70% and pain was reduced by 60%.

A report on the scientific literature 


 

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

 

 

According to the Mayo Clinic (2009), " Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe cases of scoliosis" (http://www.mayoclinic.com/health/scoliosis/DS00194). They go on to say that signs and symptoms of scoliosis may include, uneven shoulders, "Signs and symptoms of scoliosis may include: uneven shoulders, one shoulder blade that appears more prominent than the other, uneven waist, [and] one hip higher than the other" (Mayo Clinic Staff, 2009, http://www.mayoclinic.com/health/scoliosis/ DS00194/ DSECTION=symptoms).

 

"If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing. Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves can develop without the parent or child knowing it because they appear gradually and usually don't cause pain" (Mayo Clinic Staff, 2009, http://www.mayoclinic.com/health/ scoliosis/DS00194/ DSECTION=symptoms).

 

According to Lou et al. in 2010, three-dimensional lateral curvatures of the spine affect 2-3% of the adolescent population. According to ACT Youth who utilizes the 2000 US Census Bureau statistics, the number of adolescents in the United States is 41,747, 962. Averaging 2.5% of all adolescents having scoliosis equates to 1,043, 699 children facing issues as result of scoliosis. Lou et al. (2010) continue, "Brace (orthotic) treatment is recommended for growing children with curves of 25–45° Cobb angle. Surgery is the final treatment option for curves greater than 45° and its goals are to obtain safe correction, to produce a solid spinal fusion of the curve region, and to bring the spine and body into a more balanced position (p. 292). However, they conclude, " Although brace treatment for scoliosis has been used for more than fifty years, its effectiveness is still debatable... Most studies used the amount of curve progression (as measured by the Cobb angle) to determine the effectiveness of brace treatment. Some defined success as 5° or less curve progression" (Lou et al., 2010, p. 292).

 

While allopathic medicine is still entrenched in the debatable practice of bracing and eventually surgery with the eventual progression of scoliosis, there are proven solutions. Morningstar concluded in 2011 that as a result of chiropractic spinal adjusting and chiropractic spinal manipulation, a thoracolumbar curvature (scoliosis) averaged a 17.2° reduction that was maintained for 24 months, the length of the study. Across all spinal groups, an average of 10° reduction was realized that persisted for 24 months, again the length of the study. Morningstar also concluded that pain scales reduced by 60% at 24 months and function improved by 70% while respiratory capacity increased 7%. Although this was a limited study with 28 patients, it is the first scientific conclusion that documents and reflects the results of what chiropractors have been realizing in their offices for over a 100 years.

 

The real issue is that if adolescents have their curvatures reduced by 10°-17.2°, then bracing and surgery are not an option because they will not be indicated. As bracing has been deemed "highly questionable" in the literature and now the literature reflects chiropractic as a highly effective modality, the standard of care across professions should be chiropractic care for scoliosis as first line treatment and should be standardized in every discipline.

 

 

 

REFERENCES

1. Retrieved from http://www.mayoclinic.com/health/scoliosis/DS00194

2. Retrieved from http://www.mayoclinic.com/health/scoliosis/DS00194/DSECTION=symptoms

3. Lou, E., Hill, D., Hedden, D., Mahood, J., Moreau, M., Raso, J., (2010). An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis. Medical Engineering and Physics, 33(3), 290-294.

4. Retrieved from http://www.actforyouth.net/health_sexuality/demographics/

5. Morningstar, M. (2011). Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: A 24-month retrospective analysis. Journal of Chiropractic Medicine, 10(3), 179-184.

 

 

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Published in Scoliosis-Curvatures

Headaches and Migraines:

Chiropractic Saves Federal and Private Insurers $13,680,000,000

and Resolves Many Issues Facing Emergency Rooms Today

A report on the scientific literature 


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

Published in Dynamic Chiropractic, Volume 29, Issue 22

It was reported by Doheny in 2006 that migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism. Doheny goes on to report that according to Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, "The programs are so few and far between because many companies ‘don't perceive it as a priority’" (p. 10).

Much of the public perceive headaches and migraines as normal occurrences. For example, a patient will enter a doctor's office and report they get normal headaches, not realizing that pain is never a normal occurrence. Symons, Shinde and Gilles (2008) highlighted a statement from http://www.iasp-pain.org saying that pain is "'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'" (p. 277). As a result of the public not taking many types of headaches as potential serious problems, they let the condition linger and that can lead to negative sequella.

According to Munakata, Hazard, Serrano, Klingman, Rupnow, Tierce, Reed and Lipton (2009) "...neuroimaging studies have provided compelling evidence that suggests progressive brain changes in persons with migraines...migraine frequency is associated with posterior circulation infarcts and diffuse white-matter lesions...Welch et al. showed that impairments in iron homeostasis in periaqueductal grey areas that were associated with migraine duration and chronic daily headache" (Munakata et al., 2009, p. 499).

Munakata et al. also reported that the economic impact of migraines in both direct healthcare costs and indirect costs of absenteeism is a huge economic burden. The direct cost of migraines ranges from $127 to $7,089 per and the indirect cost due to absenteeism ranges from $709 to $4,453 per victim, making migraines an economic burden to the individual, the insurer, the employer with absenteeism and increased benefits paid and local, state and federal entities who will experience a lowered tax base from lost wages. It was also reported that between 2005 and 2006 there were 1,729,555 physician office visits, 186,603 advanced imaging procedures, 59,589 other diagnostic procedures, and 22,168 hospital days with a primary diagnosis of migraine or headache; all of which are paid by private or public insurers or out of the pockets of individuals. In short, the costs are staggering and a burden to the economy.

Friedman, Feldon, Holloway and Fisher (2009) reported that acute headaches account for 5% of emergency department (ED) visits in hospitals. In addition, they also reported that "…the ED environment that may also contribute to unsatisfactory treatment response include limited physician contact time that may preclude a detailed history, overuse of ED by patients with substance abuse problems, the need for rapid triage, the competing distraction of patients with life-threatening conditions, and directives (or lack thereof) for care dictated by the referring physician…Thus, the treatment of migraine patients in the ED appears to be suboptimal and the high rate of recurrent headache may be attributed to underutilization of relatively ‘migraine specific’ treatment" (Friedman et al., 2009, p. 1164).

Nelson, Suter, Casha, du Plessis and Hurlbert (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care and for amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy. In addition, it was reported that, with the drug group, "...58% experienced medication side effects important enough to report them. In the amatriptyline group, 10% of the subjects had to withdraw from the study because of intolerable side effects. Side effects in the SMT (Spinal Manipulative Therapy) group were much more benign, infrequent, mild and transitory. None required withdrawal from the study (Nelson et al., 1998, p. 511). Although this study was conducted 13 years ago, a more current study by Chaibi, Tuchin and Russell (2011) reported that that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine, supporting the previous findings. Although more research is desperately needed, the above conclusions give the public clear directions with migraines and headaches.

Using the 57% increased effectiveness that chiropractic has over drug therapy (leaving out the overlap that chiropractic could help without drugs) and the $24,000,000,000 ($24 billion) Americans pay for headaches and migraines, the savings would result in $13,680,000,000. back in the insurers, the public's and the government's pockets. In addition, if chiropractic reduced the necessity for emergency room visits by 57%, then the ED doctors could focus on what their primary purpose is, to save lives in urgent scenarios.

Chiropractic offers solutions to the federal government, local government, public and private insurance companies, eases the burden on emergency rooms and prevents unnecessary side effects of drugs that are not clinically indicated, with a more viable and proven drugless solution. Although much more research is desperately needed to explore the benefits of chiropractic with migraines and headaches, the research that is available clearly reports that chiropractic offers immediate solutions. These solutions will add to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year and productivity avoiding absenteeism. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.

References:

1. Doheny, K. (2006). Recognizing the financial pain of migraines. Workforce Management, 85(16), 10-12.

2. Symons, F. J., Shinde, S. K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(Pt 4), 275-286.

3. Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F. T., Tierce, J., Reed, M., & Lipton, R. (2009). Economic burden of transformed migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 49(4), 498-508.

4. Friedman, D., Feldon, S., Holloway, R., & Fisher, S. (2009). Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department. Headache, 49(8),1163-1173.

5. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.

6. Chaibi, A., Tuchin, P. J., & Russell, M.B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain, 12(2), 127-133.

 

 

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Published in Headaches-Migraines

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