Headaches & Migraine: Chiropractic vs. Medication

Effectiveness & Safety

 

In randomized clinical trials, chiropractic was 57% more effective in the reduction of headaches and migraines than drug therapy

A report on the scientific literature 


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

It was reported in October of 2010 by Wrong Diagnosis that approximately 1 in 6,16.54% or 45 million Americans get headaches yearly, with many people suffering daily. While the statistical numbers vary based upon your source of information, it can be agreed upon that headaches are very common and shared among Americans at an epidemic rate. Taking into account that a single pill for many Americans to treat a headache can cost as much as $43, according to Consumer Reports Health Best Buy Drugs, the overall cost to our economy totals billions of dollars and we need to focus not on the treatment of the effects, but the root of the cause.

When you suffer from headaches, it affects every facet of your life and you search for immediate answers. Most often it is a medication, either over-the-counter or prescription as evidenced by the amount of money spent as previously reported. One of the first medications recognized for the potential treatment of headaches is amatriptyline, commonly known by brand names such as Elavil, Endep or Amitrol as reported by Robert on About.com in 2006. It is also used as an antidepressant. This medication has made up a large part of the billion dollar industry along with over-the counter-medications. Although in many instances, this drug is indicated, the question that arises is what are the risks of taking this widely used medication?

The potential side effects of this medication targeted for headache sufferers, according to drugs.com (n.d.), are: blurred vision, change in sexual desire or ability, constipation, diarrhea, dizziness, drowsiness; dry mouth, headache, loss of appetite, nausea, tiredness, trouble sleeping, and weakness. Severe allergic reactions can be: rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue, chest pain, confusion, dark urine, delusions, difficulty speaking or swallowing, fainting, fast or irregular heartbeat, fever, chills, or sore throat; hallucinations, new or worsening agitation, anxiety, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still, numbness or tingling in an arm or leg, one-sided weakness, seizures, severe or persistent dizziness or headache, severe or persistent trouble sleeping, slurred speech, suicidal thoughts or actions, tremor, trouble urinating, uncontrolled muscle movements (such as in the face, tongue, arms or legs), unusual bleeding or bruising, unusual or severe mental or mood changes, vision problems, and yellowing of the skin or eyes. Over the counter remedies of NSAID's or aspirin have a long list of their own of side effects.

The safety of chiropractic, in spite of rhetoric from naysayers, has been documented in clinical trials by Miller and Benfield (2008), who reported on children younger under 3 years old, "the youngest and most vulnerable population..." (p. 420). There was one reaction reports for every 749 adjustments which was typically crying. None were reported to have any serious side effects.

In adults, clinically, the majority of any side effects are soreness that is transient. This is based upon this author's 30 years of clinical experience and teaching doctors of chiropractic who are trained in creating an accurate diagnosis, prognosis and treatment plan. To say that more serious side effects cannot happen is irresponsible. However, they are rare, non-life threatening and usually transient in nature, no different than infants. To ensure the best outcomes, like with any professional, you have to verify the doctor's credentials and experience, which is best accomplished by securing a copy of the doctor's curriculum vitae (his/her academic and professional credentials).

Nelson et. al. (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, 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.

Bryans, et. al. (2011) confirmed Nelson's findings and reported that spinal manipulation (adjusting) is recommended for patients with episodic or chronic migraines with or without aura and patients with cervicogenic headaches. This follow-up study is not a comparison or comment on the use of drugs. It simply demonstrates that chiropractic is a viable solution for many and can save the government and private industry billions in expenditures both in health care coverage, loss of productivity and avoidance of absenteeism in industry creating a new level of cost as sequella to headaches.

Medications and other forms of invasive care are often necessary and it is critical for a trained doctor to perform an accurate history and physical and when indicated, advanced diagnostic testing (CAT scans, MRI's, etc.) to ensure there aren't more serious underlying complications. However, based upon the results of the research provided by Nelson et al. (1998) and Bryans et. al. (2011), it should be chiropractic first, drugs second and surgery last to render better outcomes with less potential side effects and a quicker return to productivity.

 

References:

1. Wrong Diagnosis. (2010, October 6). Prevalence statistics for types of headaches and migraine conditions. Health Grades Inc. Retrieved from http://www.wrongdiagnosis.com/h/headache_and_migraine_conditions/prevalence-types.htm

 

2. Consumer Reports Health Best Buy Drugs. (n.d.). Treating migraine headaches: The triptans, Comparing effectiveness, safety, and price. Health.org. Retrieved from http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf

 

3. Robert, T. (2006, May 26). Amitriptyline: Headache and migraine drug profiles. About.com. Retrieved from http://headaches.about.com/od/medicationprofiles/a/amitriptyline.htm

 

4. Drugs.com. (n.d.). Amitriptyline side effects. Retrieved from http://www.drugs.com/sfx/amitriptyline-side-effects.html

 

5. 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.

6. 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.

7. Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R.,... White, E. (2011). Evidenced-based guidelines for the treatment of adults with headache. Journal of Manipulative & Physiological Therapeutics, 34(5), 274-289.

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Published in Headaches-Migraines

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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Published in Low Back Problems

Headaches and Chiropractic Care

A report on the scientific literature 


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

It was reported in October of 2010 by Wrong Diagnosis that approximately 1 in 6,16.54% or 45 million Americans get headaches yearly, with many people suffering daily. While the statistical numbers vary based upon your source of information, it can be agreed upon that headaches are very common and shared among Americans at an epidemic rate. Taking into account that a single pill for many Americans to treat a headache can cost as much as $43, according to Consumer Reports Health Best Buy Drugs, the overall cost to our economy totals billions of dollars and we need to focus not on the treatment of the effects, but the root of the cause.

While there are many types of headaches, including common headaches, migraine headaches, cluster headaches, and tension headaches, the one thing to keep in mind is that there is no such thing as a "normal headache." You are not supposed to get headaches as pain is an indicator of a problem and your body’s mechanism of letting you know something is wrong and you need to go fix it.

One of the most common and less understood headaches is the "cervicogenic headache." This is a syndrome characterized by chronic pain around the head that is associated with either the bony structures of the head or the muscles of the neck. This has also been associated with migraine headaches. In a study by Biondi (2005), 64% of migraine sufferers reported associated neck pain/stiffness with their migraine attacks. 31% experienced neck symptoms before the headache, 93% during the headache phase and 31% during the recovery phase. Therefore, cervicogenic headaches are also a component of the migraine headaches and can be treated. One of the hallmarks of determining if there is a cervicogenic component of any headache is to change the position of your head and if you increase, activate or alter the pain pattern, there is a component.

According to Haas, Spegman, Peterson, Aickin, and Vavrek (2010), spinal manipulative care (chiropractic adjustments) resulted in a reduction in pain from cervicogenic headaches of up to 50% for the group that received adjustments for up to 24 weeks, the length of the study. The researchers also noted a decrease in over the counter medication during the 24 weeks of the study. Haas, Schneider, and Vavrek also reported in 2010 that at 12 weeks, 85% showed improvement with varying degrees of improvement ranging from a small improviement all the way up  to 100% with similar findings at 24 weeks.

Chiropractic has been proven to reduce, and in many instances totally eradicate, headaches. The financial cost to headache sufferers for drugs is staggering. Costs for chronic headaches can also include loss of paychecks when sufferers are unable to work, disability costs to insurers and loss of production of workers to industry when their employees cannot perform their jobs on a daily, weekly or monthly basis. Research has concluded that chiropractic has a drugless solution that works.

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



References:

Wrong Diagnosis. (2010, October 6). Prevalence Statistics for Types of Headaches. Retrieved from: http://www.wrongdiagnosis.com/h/headache/prevalence-types.htm

Consumer Reports Health Best Buy Drugs. (n.d.). Treating Migraine Headaches: The Triptans, Comparing Effectiveness, Safety, and Price. Retrieved from: http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf

Biondi, D. M. (2005). Cervicogenic Headaches: A Review of Diagnostic and Treatment Strategies. Journal of the American Osteopathic Association, 105(4), 16-22.

Haas, M., Spegman, A., Peterson, D., Aickin, M., & Vavrek, D. (2010). Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: A pilot randomized controlled trial. The Spine Journal, 10(2),117-128.

Haas, M., Schneider, M., & Vavrek, D. (2010). Illustrating risk difference and number needed to treat from a randomized controlled trial of spinal manipulation for cervicogenic headache. Chiropractic & Osteopathy, 18(9), Retrieved from http://www.chiroandosteo.com/content/18/1/9

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Published in Headaches-Migraines

Effectiveness of Chiropractic Care

Certified for:

1. Low Back Pain: Chronic, severe, moderate & non-specific

2. Neck Pain: Severe and moderate

3. Migraine Headaches

4. Headaches: Cervicogenic

5. Dizziness: Cervicogenic

6. Hip Pain: From Arthritis

A report on the scientific literature 



By

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

 

In order to understand the vast importance of this study, it is critical to understand the context of the work. These conclusions were based on randomized clinical trials and evidenced based results. The studies which the conclusions were based upon come from the input of hundreds of sources.

Randomized Clinical Trials

According to the National Cancer Institute (2004), "Randomization is a process that assigns research participants by chance, rather than by choice, to either the investigational group or the control group of all phase III (and some phase II) clinical trials...Each study participant has a fair and equal chance of receiving either the new intervention being studied (by being placed in the investigational group), or of receiving the existing or 'control' intervention (by being placed in the control group)" (http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).

"The goal of randomization is to produce comparable groups in terms of general participant characteristics, such as age or gender, and other key factors that affect the probable course the disease would take. In this way, the two groups are as similar as possible at the start of the study. At the end of the study, if one group has a better outcome than the other, the investigators will be able to conclude with some confidence that one intervention is better than the other. A randomized, controlled trial is considered the most reliable and impartial method of determining what medical interventions work the best" (National Cancer Institute, 2004, http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).

Evidenced Based Healthcare/Practice

According to Schardt and Mayer (2010), "[Evidenced based practice] is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology" (http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).

"The evidence, by itself, does not make a decision for you, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature" (Schardt & Mayer, 2010, http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).

Conclusion

In a 2010 study by Bronfort, Haas, Evans, Leininger and Triano, the researchers both randomized clinical trials and studied evidenced based practice results utilizing guidelines found in scientific literature. In each case, they compared the results of manipulation (chiropractic spinal adjustments or extremity adjusting) to "sham" treatment and concluded that manipulation was effective for:

1. Low back pain, soreness or tension

2. Neck pain

3. Hip pain from arthritis

4. Migraine

5. Headache localized in the neck or back of the head

6. Dizziness emanating from the neck

The following entities were included in the above study to help conclude the results of this research: The American College of Physicians/American Pain Society, The Journal of the AMA, the World Health Organization, Journal of Manipulative Physiological Therapeutics, New Zealand Journal of Medicine and many others. Some clarified what was not yet conclusive while others certified chiropractic as a viable choice for care. The arguments as to whether chiropractic works or not has been long silenced. The only question that now arises is when will the more scientific literature be published?

Asthma is one area is that is lacking in research. As the author of this article and a chiropractic practitioner for 30 years, there has not been one asthma patient that didn’t respond to chiropractic care ranging from the acute to the chronic patient where most discarded their drugs and inhalers (as a result of the advice of their medical practitioners) because they didn’t need them anymore. During most of my career, there was no literature, it just worked. Today, we do not have to go simply on faith as there is much literature in the scientific community confirming the benefits of chiropractic.

This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for many problems and returning to a normal life. 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 Cancer Institute. (2004, August 3).What is randomization? Retrieved from http://www.cancer.gov/clinicaltrials/learning/what-is-randomization
2.
Schardt, C., & Mayer , J.
(2010, July). What is evidence-based practice. Retrieved from http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm
3. Bronfort, G., Haas M., Evans R., Leininger, B., &Triano, J. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic and Osteopathy, 18(3). Retrieved from http://www.chiroandosteo.com/content/18/1/3

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Published in Neck Problems

Acute (Severe) Low Back Pain, Early Intervention
and Chiropractic

87% of chiropractic patients showed improvement

A report on the scientific literature 


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

William J. Owens DC, DAAMLP
 

One of the most common areas of the body to be hurt while working, playing sports, cleaning out the garage or any other household or life chore is the lower back. The American Chiropractic Association has reported that 31 million Americans experience low back pain at any given time. This represents a significant health concern, especially if many of the conditions contributing to low back pain go untreated.

The cause of the pain can be injuries as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with lower back pain, either from an injury while working or simply waking up with it. Finding a doctor that can determine what exactly is wrong (creating an accurate diagnosis) and prescribing the right treatment is the most important aspect of getting well. In fact, one of the most dangerous phrases one can utter is, "Maybe the pain will go away," and is often adopted by too many sufferers.

According to a 2008 study by Globe, Morris, Whalen,
Farabaugh, and Hawk on low back pain disorders reported, "Most acute pain, typically the result of injury (micro- or macrotrauma), responds to a short course of conservative treatment [chiropractic care]. If effectively treated at this stage, patients often recover with full resolution of pain...Delayed or inadequate early clinical management may result in increased risk of chronicity and disability" (p. 654).

A 2005 study by DeVocht, Pickar, & Wilder concluded through objective electrodiagnostic studies (neurological testing) that 87% of chiropractic patients exhibited decreased muscle spasms. This study validates the reasoning behind the later study that people with severe muscle spasms in the low back respond well to chiropractic care and prevents future problems and disabilities. It also dictates that care should not be delayed or ignored due to risk of complications.

Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment. Chiropractic and lower back pain has been one of the most commonly researched topics to date. There is a large volume of research showing that the chiropractic adjustment is effective for treating lower back pain.


These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with 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. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Globe, G. A., Morris, C. E., Whalen W. M., Farabaugh, R. J., & Hawk C. (2008). Chiropractic management of low back disorders: Report from a consensus process.
Journal of Manipulative and Physiologic Therapeutics, 31(9), 651-658.
3. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.

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Published in Low Back Problems

  Children and Chiropractic:

A Study in Adverse Effects


Chiropractic adjustments were found safe for young children and adolescents

A report on the scientific literature 



By

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

For over 100 years, parents have been taking their children for chiropractic care for various reasons. Clinically, chiropractic has been effectively treating numerous childhood ailments, from asthma to scoliosis to attention deficit disorder to sports-related injuries as well as other symptoms, conditions and diagnoses. This article is not about the efficacy of chiropractic caring for those types of disorders. It is limited to a single topic the safety of the chiropractic adjustment for children.

Having cared for children for 30 years in clinical practice for various diagnoses and wellness care, the safety of the adjustment has been the most asked about by parents. When asked if it was safe, my answer has always been based on my personal clinical experience, which resulted in me answering, "Yes." As with medicine and any other healing discipline, the results have to be verified with science over time to prove that assertion to be true.

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.


In clinical practice, having successfully cared for children with scoliosis, attention deficit disorders, hearing loss, bedwetting, ear infections, eczema, headaches, cerebral palsy, whiplash, low back pain, neck pain and many other conditions, I cannot recall one instance of a child having an adverse reaction. It is also of importance to note that approximately 100% of the patients had visited their pediatrician or other medical subspecialists prior to seeking chiropractic care as their "last alternative" to get help. These weren’t patients who needed convincing on a philosophy or religious beliefs. They were desperate for help. This is not an indictment against medicine and pediatrics. It is an endorsement for having the right care available when the correct diagnosis is rendered. Often chiropractic should be the first choice and not the last, after expensive and sometimes dangerous testing and treatment is performed.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for parents seeking safe care for their children. 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.  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.

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Decreased Muscle Spasms and Chiropractic Care

A report on the scientific literature 


By

William J. Owens DC, DAAMLP

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

 

There have been many discussions regarding the effects of the short and long term benefits of a chiropractic adjustment. The ultimate focus is a change in the biomechanics and therefore, the physiology surrounding the affected area of the spine. Although there is a significant amount of evidence showing the effects of spinal adjusting on the central nervous system, this study concentrated on the effects on the peripheral nervous system (outside of the brain and spinal cord) and paraspinal musculature, specifically of the effects of spinal adjusting on the paraspinal musculature in the mid-lower back (thoracic and lumbar spines).

The authors stated, "Many chiropractors palpate for tight muscle bundles in the paraspinal musculature as one indication of where to adjust. It seems reasonable to expect resting muscle activity, which can be monitored by an electromyogram (nerve test to determine muscle firing, and resultant spasm) to be abnormally high in the region of a tight muscle bundle" (DeVocht, Pickar, & Wilder, 2005, pp. 465-466). They went on to state, "In this descriptive study, we have further explored the phenomenon of reduced electromyogram (muscle firing and resultant spasms) activity after [spinal adjusting] to better understand the immediate effects of [spinal adjusting]" (DeVocht et al., 2005, p. 466).

The results of the study showed, "With electromyogram recordings obtained from 2 paraspinal muscle sites on each participant (except for one), 27 of the 31 pre-treatment resting electromyogram levels decreased after treatment. During the 5 to 10 minutes of the treatment protocol, distinct changes (both increases and decreases) in the level of muscle activity were often observed" (DeVocht et al., 2005, p. 470). Ultimately the study revealed, "… the reduction of resting electromyogram activity after [spinal adjusting that we observed in the greater majority of cases is consistent with and supportive of the commonly held perception that tight muscle bundles are associated with low back pain and that they can be alleviated by [a chiropractic spinal adjustment]" (DeVocht et al., 2005, p. 470).



Reference:

1.  DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.

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Published in the 9-9-2010 Dynamic Chiropractic Journal
 

Work Injuries, Workers Compensation and Chiropractic:

A solution to lowering health care costs in America

 

A report on the scientific literature 


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

 
The cost of healthcare has been such a burden on the economy that it now accounts for 16.2% of the national gross domestic product (GDP) in 20081. Congress, along with President Obama, has recently enacted a health care reform bill that addresses many issues in the health care reform arena that will ensure every American has health care coverage. Leaving politics aside, there is a potential that the percentage of health care costs in the GDP will rise.
 
With mushrooming annual budgets that include multi-billion dollar shortfalls, most individual states are now pressured to cut costs and prevent unnecessary spending. One of the largest areas of expenditure in every state’s budget is health care through workers compensation and Medicaid. If those governments put politics aside and look at the hard numbers, they will see chiropractic as a solution. It appears that chiropractic care has continued to be a political football and has been seen as a scapegoat to many of our states’ health care financial problems.
 
One political argument in California during the quest to remove chiropractic from the workers compensation system was that chiropractors pander to lawyers who want higher fees to win their cases. This detractor, an MD with a long anti-chiropractic history should realize, as should the California legislature, that there will always be a certain number of unscrupulous people in any system and that number is equal among medical doctors and chiropractors alike. The problem is that this should not be a political argument. It should be guided by the statistics alone and the metrics of health care outcomes and the financial savings should be solely judged.
 
As to the health care metric, that argument is long over, as chiropractic has been proven effective and a topic long laid to rest. The cost metric has to go beyond the simple office visit to the orthopedist or medical back care provider. The real costs accrue cover the medical office visits and the drugs which are often used over a lifetime and consequently, one must often deal with the addiction to the narcotics. The metric covers durable medical equipment, physical therapy and all of the associated ancillary requirements followed by the surgeries and high cost of hospital stays. Then we need to account for the lifetime of disabilities that could have been avoided. Every one of those costs needs to be accounted for.
 
With that being said, there are many times medical intervention and all of its wonderful tools are needed because no one doctor can care for every ailment. However, the progression of treatment should be drugless first, drug administration used second and surgery as a last resort. In states like California, the less expensive, largest, most effective drugless option is no longer available to its residents. In other states like New York, the reimbursement is so low that chiropractors are emigrating from the state in alarming numbers, leaving a void for injured people to seek appropriate care and lower the cost of health care reducing the financial burden to the NYS workers compensation system.
 
An obvious pragmatic strategy would be utilizing services for injured workers that have been proven to be more effective at lower costs. Past history would suggest that if such a method was identified, tax credits or other incentives could be offered to ensure workers received this care, thereby reducing costs to the system and creating a more competitive business environment.
 
Chiropractic care has been shown repeatedly in government and private studies conducted around the world to be more effective at helping injured workers return to work faster at significantly lower costs. (See Table 1.)
 
TABLE 1
Samples of research showing the effectiveness and reduced costs of chiropractic care for spinal-related injuries and conditions.

 

REFERENCE
FINDINGS
UtahWorkers  Compensation Board
Study2
 
Total treatment costs for back-related injuries averaged $775.30 per case when treated by a chiropractor; $1,665.43 when injured workers
received standard medical treatment.
 
North Carolina Workers Compensation Patients3  
Average medical care cost for lumbosacral sprain was $3,425, but only $634 when treated with chiropractic.
 
           
Ministry of Health,
OntarioCanada4
 
“Inured workers…diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."
 
The American Journal
of Managed Care5
 
The cost of healthcare for back and neck pain was substantially lower for chiropractic patients than medical care ($539 versus $774).
 
Medical Care Journal6  

  1. The mean total payments were lower for chiropractic care ($518) versus medical care ($1020).
  2. Favorable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gate keeper strategies adopted by employers and third-party payers to control health care spending.
Universityof Ottawa7  

  1. Chiropractic treatment was significantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Significantly fewer patients needed to return for further treatments at the end of the first and second years in those who received chiropractic care (17% compared with 24%).
  2. Highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors.
OaklandUniversityStudy8 Health insurance claims for 395,641 chiropractic and medical care patients concluded patients who receive chiropractic care, solely or in conjunction with medical care, experienced significantly lower health care costs compared with those who received only medical care. Total insurance payments were 30% higher for those who elected medical care only.
MedicalCollege
of Virginia9
By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.
FloridaWorkers Compensation Board10  
Of 10,652 back-related injuries on the job, individuals who received chiropractic care compared with standard medical care experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.
 
Australian Workers Compensation Study11  
Individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors.
 
VU Medical Center Extramural Medicine12  
Total costs of manual therapy (447 Euro) were around one third of the costs of physiotherapy (1297 Euro) and general practitioner care (1379 Euro) for neck pain.
 
Journal of Manipulative Physiological Therapy13  
For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.
 
 
 
 
As a result of these studies and many more nationally and globally, governments, both federal and state, should be offering tax incentives for our brightest young minds entering the health care educational arena to become chiropractors and urging every injured citizen of the United States to be under chiropractic care because it works and saves the system money. The hard part is getting the legislators to see through the special interests to the facts. Fair and equitable access and reimbursement to chiropractors serves the needs of the millions of chiropractic patients nationally as well as affording fiscal savings for the government.  It is also in the best interest of all to keep the existing chiropractors and encourage new chiropractic practices in the business place.
 
It’s not the chiropractors who want to be treated different; it’s the people who are being denied the care they need and the government who is epitomizing the adage of being “penny wise and billions of dollars foolish.” These studies and more indicate that chiropractic saves every system in the world money by having a prominent place and if governments put rhetoric aside and opened their eyes, they would fight to lower the GDP by offering incentives to any injured person who sought chiropractic care.
 
References
 

  1. The Henry J. Kaiser Family Foundation. U.S. Health Care Costs. Retrieved fromhttp://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358
  2. Jarvis, K. B., Phillips, R. B., Morris, E. K. (1991, August). Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, 33(8), 847-852.
  3. Devitt, M. (2004, November 18) Work comp study: chiropractic less expensive, more effective than medical care.Dynamic Chiropractic,22(24). Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?t=9&id=46515
  4. Meade, T. W., Dyer, S., Browne, W., Townsend, J., & Frank, A. O. (1990, June 2). Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment.British Medical Journal, 300(6737),1431-1437.  
  5. Mosley, C. D., Cohen, I. G., & Arnold, R. M. (1996, March).Cost-effectiveness of chiropractic care in a managed care setting.The American Journal of Managed Care, 2, 280-282.
  6. Stano, M. & Smith, M. (1996, March). Chiropractic and medical costs of low back pain. Medical Care, 34(3), 191-204. 
  7. Manga, P., Angus, D. E., Papadopoulos, C. & Swan, W.R. (1993, August). The effectiveness and cost effectiveness of chiropractic management of low-back pain. Retrieved from http://www.zehrchiropractic.com/zehrchiropractic/Portals/ 0/Manga_report_summary%5B1%5D.pdf
  8. Stano, M. Stano/Medstat Research. Retrieved from http://www.dcdoctor.com/ pages/rightpages_allaboutchiro/research/research_costeffectiveness.html
  9. Dean, D. H., Schmidt, R. M. (1992, January 13). A comparison of the costs of chiropractors versus alternative medical practitioners.Retrieved from http://www.dcdoctor.com/pages/rightpages_allaboutchiro/research/research_ costeffectiveness.html
  10.  Wolk, S. (1988). An analysis of florida workers’ compensation medical claims for back related injuries. Retrieved from http://www.dcdoctor.com/pages/ rightpages_allaboutchiro/research/research_costeffectiveness.html
  11. Ebrall, P.S. (1992). Mechanical low-back pain: a comparison of medical and chiropractic management within the victorian work care scheme.Chiropractic Journal of Australia 22, 47-53.
  12. Korthals-de Bos I. B. C., Hoving J. L., van Tulder, M. W., Rutten-van Molken M. P. M. H., Adèr, H.J., de Vet, H. C. W., Koes, B. W., Vondeling, H., & Bouter L. M. (2003, April 26). Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.British Medical Journal, 326(7395), 911.
  13. Nelson, C.F., Metz, R.D. & LaBrot, T. (2005, October). Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain.Journal of Manipulative Physiological Therapeutics,28(8), 564-569.
 
 

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Published in Work Injuries

Prediction of Outcomes with Chiropractic Care and Cervical Pain

A report on the scientific literature 



By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP

updated 12-4-2013

 

Pain located in the neck is a very common condition. Neck pain can come from a number of activities, disorders and diseases in the neck, such as degenerative disc disease, neck strain, whiplash, a herniated disc, or a pinched nerve. It can also come from overuse, sports injuries, and everyday home and work related activities. Usually, there is an underlying instability or problem in the neck that is a precursor to the pain. Neck pain is also referred to as cervical pain.

"Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, swishing sounds in the head, dizziness or lightheadedness, and gland swelling" (MedicineNet.com, 2008, http://www.medicinenet. com/neck_pain/article.htm).

"There are seven vertebrae that are the bony building blocks of the spine in the neck (the cervical vertebrae) that surround the spinal cord and canal. Between these vertebrae are discs, and nearby pass the nerves of the neck" (MedicineNet.com, 2008, http://www.medicinenet.com/neck_pain/article.htm).

"Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury" (American Chiropractic Association, n.d., http://www.acatoday.or/ content_css.cfm?CID=2430).

"The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear" (American Chiropractic Association, n.d., http://www.acatoday. or/content_css.cfm?CID=2430).
 

Further detailed explanations of some of the causes of neck pain are:

"Injury and Accidents:
A sudden forced movement of the head or neck in any direction and the resulting "rebound" in the opposite direction is known as whiplash. The sudden "whipping" motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash"
(American Chiropractic Association, n.d., http://www.acatoday.or/ content_css.cfm?CID=2430).

"Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

- Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.

- Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.

- Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Herniated discs are NOT an effect of growing older and are a direct effect of trauma, but can also cause similar reduction in elasticity and height of the intervertebral disc, but have the potential to cause more serious problems. 

"Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms" (American Chiropractic Association, n.d., http://www.acatoday. or/content_css.cfm?CID=2430).

When considering solutions for neck pain, you must look at what will help you and how long it will take to get better. Like with any malady, the progression of treatment should be drugless first, involve drugs second and have surgery as a final option. A significant factor must be the scientific evidence that predicts the outcome of any treatment. A cancer patient or a heart disease patient, prior to undergoing chemotherapy or open heart surgery, will ask the doctor what the percentage of success is for the treatment. The same question should be asked of every doctor for every treatment and chiropractic is no different.

In 2008, Thiel and Bolton studied 19,722 patients that were treated for a variety of symptoms, most of which were pain or stiffness in the neck, shoulder or arm region. The purpose of the study was to determine the outcome of chiropractic care in patients with nonspecific musculoskeletal disorders, including mechanical neck disorders. The results revealed that 71.6% of females and 67.9 % of males had immediate improvement. This shouldn’t be confused with the overall satisfaction rate of 94% of patients treated with acute neck pain as reported by Haneline (2006), asThiel and Bolton (2008) examined immediate improvement, not improvement over time as Haneline did.

Since statistics can be manipulated in many different ways, let’s examine those patients who experienced immediate worsening. The Thiel and Bolton (2008) study revealed that 95.2% of females and 96.2% of males reported no immediate worsening, rendering an overwhelming predictor of a successful outcome. Predictable outcomes are critical in guiding both the public and the doctor in realizing a successful treatment plan.

These studies, along with many others, conclude that a drug-free approach of chiropractic care is one of the best solutions to treat neck 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. MedicineNet.com. (2008, January). Neck pain. Retrieved from http://www.medicinenet.com/neck_pain/article.htm
2.  American Chiropractic Association. (n.d.). Chiropractic and neck pain: Conservative care of cervical pain, injury. Retrieved from http://www.acatoday.org/content_css.cfm?CID=2430
3.  Thiel, H. W., & Bolton, J. E. (2008). Predictors for immediate and global responses to chiropractic manipulation of the cervical spine. Journal of Manipulative and Physicological Therapeutics, 31(3), 172-183.

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Published in Neck Problems

Balance and Movement and The Effect

of Chiropractic Care

 

Utilization with the Elderly, Cerebral Palsy, the Athlete

and the General Population

 

Chiropractic care reverses maladaptations in sensorimotor integration
and improves motor control

A report on the scientific literature 



By

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

William J. Owens DC, DAAMLP

 

Sensorimotor is defined as our ability to feel and move. With infants, Piaget, the renowned researcher, categorized the first 2 years of an infant’s life as the sensorimotor stage. "During this period, infants are busy discovering relationships between their bodies and the environment. Researchers have discovered that infants have relatively well developed sensory abilities. The child relies on seeing, touching, sucking, feeling, and using their senses to learn things about themselves and the environment. Piaget calls this the sensorimotor stage because the early manifestations of intelligence appear from sensory perceptions and motor activities" (Anderson, n.d., http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html).

As we develop and our nervous systems have acquainted us to our surroundings, we need the neurological "hookups" to remain intact to function optimally and pain free. In addition, our sensory and motor systems need to work in tandem in order for us to function normally.

To further break it down, our sensory system is part of the nervous system that consists of receptors that receive stimuli from both our internal and external environments. These receptors, such as the ones located in our fingertips, sense external stimuli, such as hot or cold, or what we feel. An internal receptor may be found in the tendons (connect your muscles to your bones) and lets you know what your joints are doing, such as are my fingers sensing if they are relaxed or in a fist. The sensory system is also controlled by the brain that processes what we feel.

Pain is part of the sensory nervous system and to the surprise of many, pain is an important component to protecting yourself. Without pain, you could get seriously hurt, such as by keeping your finger on a hot stove too long or touching a sharp object too heavily and cutting your hand. Internally, pain is a warning sign that an organ or system is "sick" and alerts you to seek medical care.

All pain receptors are free nerve endings, meaning they only bring information to your brain and function as the "pain receptors." There are three types of pain receptors; mechanical, thermal and chemical. They are found in skin and on internal surfaces such as the coverings of the bone and joint surfaces. "Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas is experienced. Pain receptors do not adapt to stimulus. In some conditions, excitation of pain fibres becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia [commonly known as, "WOW, that hurts a lot!"]" (Global Oneness, n.d., http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137).

Your motor system is what allows you to move, maintain your posture and control your muscles. The motor system is controlled through nerves similar to the sensory system and like the sensory system, has a controlling element in the brain.

Functional tasks are defined as those things we do in our lives. Answering a telephone, putting a key in a door lock or picking up a fork to eat are all examples of functions. These functions, just like Piaget described in infants, are how we have a relationship with our body and the environment and require an integrated motor and sensory nervous system. Every functional task that we do involves both the motor and sensory components of our nervous system and while performing these tasks, we are protected by our ability to perceive pain.

Due to the development and integrategration of the world around us necessary to complete every task in our lives, as we get older, postural disturbances can arise and negatively affect how we integrate the sensorimotor information we are receiving both internally and externally and lead to significant balance disorders. Lord and Ward (1994) reported that, "All of the sensory, motor and balance system measures showed significant age-associated differences" (http://ageing.oxfordjournals.org/cgi/content/abstract/23/6/452). This means that as one gets older, his/her sensorimotor system often fails to integrate the internal and external environment as it once could.

A research study by Taylor and Murphy (2008) concluded that chiropractic care reverses maladaptations in sensorimotor integration and improving motor control. The study suggests that spinal dysfunction may lead to muscle specific alterations of the brain’s ability to process motor control. The "real-life" implications of this finding affect every facet of our lives and every person. Whether it be an older person who is starting to exhibit balance disorders, or a cerebral palsy victim who struggles on a daily basis with the simple tasks of life or a world class athlete looking to increase his/her fine motor skills just 1/10 of 1%, the results of chiropractic care can be dramatic.

From the clinical observation of Dr. Mark Studin, a co-author of this article and a practicing chiropractor for 30 years, "This now gives scientific evidence and validation to what patients have been sharing after receiving chiropractic care. The most common comment from patients post care is, 'I perceive my surroundings more acutely and feel straighter.'" Dr. Studin continues, "Although I have heard this from every age group, my first patient was a cerebral palsy patient who stated that without getting adjusted he could barely function. With care, he walked to and from the office, a distance of 3 miles."

These studies, along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions to increase integration between the motor and sensory systems of your body. 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.  Anderson, M. (n.d.). Sensorimotor stage. Jean Piaget's Theory of Development. Retrieved from http://facultyweb.cortland.edu/andersmd/PIAGET/sms.html
2. 
Global Oneness. (n.d.). Pain - Physiology. Retrieved from http://www.experiencefestival.com/a/Pain_-_Physiology/id/597137
3.  Lord, S. R. & Ward, J. A. (1994). Age-associated differences in sensori-motor function and balance in community dwelling women. Age and Ageing. Retrieved from http://ageing.oxfordjournals.org/cgi/content/ abstract/23/6/452
4.  Taylor, H. H. & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation. Journal of Manipulative and Physiological Therapeutics, 31(2), 115-126.

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Published in Balance

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