Chiropractic Can Prevent Absenteeism in the Workplace from Chronic Pain

 

  • A Potential Savings of $140 - $159,000,000,000 (billion) in Unnecessary Health Care Expenditure to Federal and Private Insurers
  • A Potential Savings of $52 - $58,000,000,000 (billion) from Absenteeism and Lowered Productivity to the United States Economy

 

 

A report on the scientific literature 


 

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

 

According to Cady (2014) over 100 million Americans experience chronic pain with common painful conditions including back pain, neck pain, headaches/migraines, and arthritis, in addition to other painful conditions such as diabetic peripheral neuropathy, etc...In a large study in 2010, 30.7% of over 27,000 U.S. respondents reported an experience of chronic, recurrent pain of at least a 6-month duration. Half of the respondents with chronic pain noted daily symptoms, with 32% characterizing their pain as severe (≥7 on a scale ranging from 0 to 10). Chronic pain has a broad impact on emotional well-being and health-related quality of life, sleep quality, and social/recreational function.

Peterson ET. AL. (2012) reported, “The … prevalence of low back pain is stated to be between 15% and 30%, the 1-year period prevalence between 15% and 45%, and a life-time prevalence of 50% to 80%” (pg. 525).  Apkarian Et. Al. (2004) reported that “Ten percent of adults suffer from severe chronic pain. Back problems constitute 25% of all disabling occupational injuries and are the fifth most common reason for visits to the clinic; in 85% of such conditions, no definitive diagnosis can be made.” (pg. 10410) The reference to no definitive diagnosis is reflective of allopathy, or in common terms, the medical community.

 

 

In contrast, Peterson ET. AL. (2012) reported “investigate outcomes and prognostic factors in patients with acute or chronic low back pain (LBP) undergoing chiropractic treatment. In chronic LBP, recent studies indicate that significant improvement is often fairly rapid, usually by the fourth visit, and that patients initially receiving treatment 3 to 4 times a week have better outcomes. Patients with chronic and acute back pain both reported good outcomes, and most patients with radiculopathy (neurogenic) also improved” (pg. 525). “At 3 months, 69% of patients with chronic pain stated that they were either much better or better. This is unlikely to be due to the natural history of low back pain because these patients have already passed the period when natural history occurs “(pg. 531).  As a note, this author has been caring for chronic back pain sufferers for 34 years and my personal observation is that 90%+ of all patients feel better and have significantly increased function in a short amount of time. However, for the purposes of this article, I will utilize the published 69%.  

 

Cady (2014) wrote “In addition to the pervasive personal suffering associated with this disease, chronic pain has a substantial negative financial impact on the economy. Direct office visits, diagnostic testing, hospital care, and pharmacy costs are only a portion of the picture, with combined medical and pharmacy costs averaging $5,000 annually per individual (Pizzi, 2005). Chronic pain results in a significant economic burden on the healthcare system, with estimated costs ranging from $560 to $635 billion 2010 dollars, more than the annual cost of other priority health conditions including cardiovascular disease, cancer, and diabetes (Gaskin & Richard, 2012). Moreover, the estimated annual costs of the workplace impact of pain range from $299 to $335 billion from absenteeism and reduced productivity (Gaskin & Richard, 2012).” (pg. 1-2)

 

We have already established that 10% of adults suffer from chronic pain and that back pain constitutes 25% of that population and chiropractic helps 69% of chronic sufferers. Therefore if 25% of all chronic pain is back pain and chiropractic helps 69%, then the numbers extrapolate as follows: 

 

Economic burden on the healthcare system:

$560-$635 billion x 25% (back pain) = $140-$159 billion

$140-$159 billion x 69% (chiropractic helps) = $97-$110,000,000,000 (billion)

 

Absenteeism and Reduced Productivity Costs

$299-$335 billion x 25% (back pain) = $75-$84 billion

$75-$84 billion x 69% (chiropractic helps) = $52-$58,000,000,000 (billion)

 

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

 

Unfortunately, the likelihood that a medical provider in any subspecialty will encounter chronic pain and its complications will only increase in the future as the population advances in age and body mass. In addition, based upon the statistics there needs no extrapolation as to who should be the primary spine care provider or first option to treat chronic back pain or any mechanical back pain (no fracture, tumor or infection). We have verified that allopathy (medical doctors) not being able to conclude a diagnosis 85% of the time, where chiropractic has verified diagnosis and solutions 69% (or my 90% +) in verified scientific outcomes.

 

 

The conclusions are not an indictment against medicine, it is a conclusion based upon science to put billions back into our economy while first helping those in chronic pain with a “best outcome” solution.

 

 

References:

  1. Block, C. K. (2014). Examining neuropsychological sequelae of chronic pain and the effect of immediate-release oral opioid analgesics (Order No. 3591607). Available from ProQuest Dissertations & Theses Global. (1433965816). Retrieved from http://search.proquest.com/docview/1433965816?accountid=1416
  2. Peterson C., Bolton J., Humphreys K., (2012) Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment, Journal of Manipulative and Physiological Therapeutics, 35(7) 525-533
  3. Apkarian V., Sosa Y., Sonty S., Levy R., Harden N., Parrish T., Gitelman D., (2004) Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density, The Journal of Neuroscience, 24(46) 10410-10415
  4. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

 

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Published in Low Back Problems

Case Report


by Donald Capoferri DC, DAAMLP


Title: The Efficacy of Chiropractic Adjustments in the care of Migraine Headache with patients presenting with cervical disc bulge. 


Abstract: Objective: To explore the efficacy of chiropractic adjustments, and non-surgical spinal decompression in the treatment of cervical spine disc conditions presenting as neck pain, migraine headache, dizziness and visual disturbances. Diagnostic studies included physical examination, computer aided range of motion, orthopedic and neurological examinations, plain film x-ray studies, brain MRI, cervical spine MRI examinations.  Treatments included specific spinal adjustments, low level laser therapy and spinal decompression.  The patient’s outcome proved excellent in reduction of neck pain, headache severity and frequency as well as elimination of dizziness and visual disturbances.


Key Words: Migraine, chiropractic adjustment, disc bulge, spinal decompression.


Introduction: On 11/19/13 a 37-year-old female presented for examination and treatment of neck pain, migraine headaches with associated dizziness and visual disturbances.  The patient denies and recent injuries. 

Presenting Concerns: The patient reports neck pain in the cervical occipital region as a 4 on the Verbal Analog Scale of 0 meaning the complete absence of pain and 10 being unbearable pain.  The duration of the current symptom picture is 2 years and 1 month.  The patient further reports episodic migraine headaches starting at the upper cervical region and progressing into her occipital area.  These episodes are accompanied by dizziness and visual disturbances described as kaleidoscope vision.  At the time of the initial consultation these episodes were occurring 2-3 times per week.  The patient reports being afraid to drive her car due to concerns about headache onset.  The patient reports past consultations with her medical doctor who diagnosed her with vertigo and previous chiropractic care without results.  The records from both consultations were reviewed personally. 

Clinical Findings:  The patient presents with complaints of neck pain, headaches, dizziness and visual disturbances of 2 years duration.  The patient is a 37-year-old female who is a mother of 2.  The ages are 16 and 3.  

Her vital signs are:

Height - 5 ft. 0 inches

Weight - 130 lbs.

Handedness - R

Blood Pressure - L - 107 systolic and 78 diastolic 

Radial Pulse - 75 BPM

The patient’s Review of Systems and Family History were unremarkable.

Palpation/Spasm/Tissue changes:  The patient was evaluated by palpation and observation with the following findings: Bilateral cervical spine spasms rated at +2 in the cervical-occipital region.  Orthopedic testing was unremarkable.  Range of motion examination revealed mildly decreased left lateral flexion, moderately decreased flexion, right lateral flexion and extension. No pain was produced during range of motion examination.

Neurological Examination: Biceps, Triceps and Brachioradialis reflexes were rated at a +2 bilaterally.  Sensory examination revealed normal sensation bilaterally for dermatomes C-5 through T1.  Motor/Muscle testing revealed 5 out of 5 bilaterally for Deltoids, Biceps, and Triceps, Forearm and Intrinsic Hand muscles.



Radiographic findings: reversal of the cervical curve with altered C5/C6 disc space is noted. (Fig. 1, (A) (B) A small osteophyte is observed on the posterior inferior body of C5.  Flexion malposition of C5 is also noted.  (Fig. 1, (B).

Fig. 1,  (A), (B) show loss of the cervical lordosis, flexion malposition of C5, partial collapse of C5/6 anterior disc space.





Fig. 1. (B) shows upon magnification a small posterior-inferior osteophyte.





Fig. 2,  (A), (B) shows in T2 MRI images (A) is Sagittal and (B) is Axial a 

C5/6 central disc herniation contacting the ventral cord. 


Diagnostic Focus and Assessment: 
Diagnoses considered are: Brain Tumor, Cervical Disc Displacement, and Cervical-cranial     syndrome.  A brain MRI was ordered and produced normal findings.  Diagnostic reasoning included the C5/C6 disc/osteophyte complex and the encroachment into the ventral aspect of the central canal and contact with the cervical spinal cord. (1) Peter J. Tuchin, GradDipChiro, DipOHS, Henry Pollard, GradDipChiro, GradDipAppSc, Rod Bonillo, DC, DO.  Received 29 June 1999.  Another consideration was the treatment schedule because the patient lives 60 miles west of the clinic and 2 treatments was the ordered therapeutic schedule.

Therapeutic Focus and Assessment:  Assessment of the cervical spine MRI both sagittal and axial views of the C5/C6 and C6/C7 segmental levels revealed adequate space between the cervical cord and posterior vertebral elements.  It was determined that conservative management of this patient was appropriate.  Therapeutic focus was reducing the pressure of the C5/C6 disc/osteophyte complex on the ventral cord.  Promoting healing of damaged nerve tissue and restoring more favorable position and motion of vertebral segments C5/C6.  The modalities used to treat this patient were:

1.     Specific Spinal Adjustments: utilizing a Sigma Precision Adjusting Instrument to introduce a percussive force of 20 lbs. with a maximum of impact number of 50.

2.     Spinal Decompression: A Hill Spinal Decompression table was utilized with 8 lbs. of pull maximum and a cycle of 5 minute at maximum and 5 minutes at reduction to 50% over a 25 minutes treatment session.  The patient completed 18 sessions in total.  

3.     Low Level Laser Therapy was used to promote healing on a cellular level using a Dynatron Solaris system.  Treatments consisted of 30 seconds of exposure to an 860-nanometer beam at C5/C6 and C6/C7 levels.

Follow-up and Outcomes: The patient’s compliance to the treatment schedule as rated at 9 of 10.  Completion of the recommended 18 treatments required 1 week longer than anticipated.  For personal reasons the patient missed 2 treatment sessions but made them up by adding a week to the estimated completion date. Upon discharge examination the patient reports her neck pain on the Verbal Analog Scale a 2 of 10 with 0 being the complete absence of pain and 10 being the worst pain imaginable. She further reported her headaches as a 1 on the Verbal Analog Scale.  Both symptoms were constant since 10/01/11.  This is duration of 25 months prior to her first visit. Her symptoms of dizziness and visual disturbances have been absent since 12/13/13.

Discussion: Headaches and Migraine Headaches are a big health     problem. It has been estimated that 47% of the adult population have headache at least once within last year in general.  More than 90% of sufferers are unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost workdays due to migraine. (2) Schwartz BS1, Stewart WF, Lipton RB.

              J Occup Environ Med. 1997 Apr; 39(4): 320-7.

 This case report is very limited because it represents the experience and clinical findings for just 1 patient. However a study of the references included with this report as well as reports by care providers as well as testimonials from patients indicates that more study should be invested in the relationship of the cervical spine, its structures and biomechanics during the diagnostic workup on headache and migraine patients.  

Informed Consent: The patient provided a signed informed consent.

Competing Interests: There are no competing interests writing of this case report.

De-Identification: All the patient’s related data has been removed from this case report.

References:

1. Schwartz BS1, Stewart WF, Lipton RB.

J Occup Environ Med. 1997 Apr; 39(4): 320-7.

Lost workdays and decreased work effectiveness associated with headache in the workplace.

Wikipedia, The Free Encyclopedia. (2010, July). Human musculoskeletal system. Retrieved from http://en.wikipedia.org/wiki/Musculoskeletal

2. Vernon, H., Humphreys, K., & Hagino, C. (2007). Chronic mechanical neck pain in adults treated by manual therapy: A systematic review of change scores in randomized clinical trials, Journal of Manipulative and Physiological Therapeutics, 30(3), 215-227.


3. Peter J. Tuchin, GradDipChiro, DipOHS, Henry Pollard, GradDipChiro, GradDipAppSc, Rod Bonillo, DC, DO.  Received 29 June 1999

A randomized controlled trial of chiropractic spinal manipulative therapy for migraine


4.Mark Studin DC, FASBE (C), DAAPM, DAAMLP, William J. Owens DC, DAAMLP Chronic Neck Pain and Chiropractic. A Comparative Study with Massage Therapy.

5. D’Antoni AV, Croft AC. Prevalence of Herniated Intervertebral Discs of the Cervical Spine in Asymptomatic Subjects Using MRI Scans: A Qualitative Systemic Review. Journal of Whiplash & Related Disorders 2006; 5(1):5-13.

6.  Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.

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Published in Case Reports

 

Neck Pain (Torticollis), Headaches, Dizziness, Radiating Pain, Nausea, Depression, Confusion, Ringing in the Ears Show Good Outcomes With Chiropractic Care

A report on the scientific literature 


By: Marc D. Weiss, D.C., DAAMLP

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

Although neck pain is the number one bodily injury or pain complaint from the general population in the west, many studies verify that chiropractic care for common neck pain has been effective.  It has also been generally recognized that chiropractic care has helped a myriad of maladies and we are just starting to see those outcomes or positive results in the scientific literature to verify what both chiropractors and their patients have been reporting for over 100 years. The following study looks at outcomes of chiropractic treatment for neck pain and concurrent complaints throughout the Netherlands.

Rubenstein ET. Al (2007) used 79 chiropractors who each recruited approximately 10 patients. The patients were between the ages of 18-65 and had not received treatment 3 months prior to beginning this study. Participants who were treated for neck pain in this study all had different levels and frequency of visits with the chiropractor. Chiropractic spinal adjustments were the primary form of treatment. Each patient was asked a series of questions to assess their treatment success during each visit as well as during follow up appointments at 3 months and 12 months. Every symptom, including fatigue, headaches, nausea, and depression, significantly decreased from visit to visit, and significantly increased after the visits ceased.

This study covered a large area of patients with varying degrees and specifics of neck pain, as well as chiropractors with varying methods of treatment. Unlike many studies that gather data on effectiveness of treatments, especially pharmaceutical companies, this study showed statistics of both success in curing neck pain as well as adverse effects that arose during and after treatment. Only 5 of 4891 patients in the study group reported worsening of pain at the end of the study, which was 12 months after treatment. Also, only 2 of 4891 patients reported worsening of pain at the 3 month mark, which is when treatment for neck pain stopped.

The most prevalent improvement of neck pain in patients occurred during their first three visits. Additionally, most symptoms other than neck pain also improved during the first 3 months of treatment. Almost 50% of the patients were fully recovered when interviewed at their fourth visit. Almost 75% of the patients were fully recovered when interviewed at the three and twelve month follow up visits.

The following graph was presented by Rubenstein ET. Al (2007)

 

As you can see from the above graph, by the 2nd visit to a chiropractor, there has been significant improvement that continues to improve by the 4th visit. Although these patients initially sought care for neck pain, this study shows that many complaints respond favorably to chiropractic care and each complaint requires more independent research. The most impressive stastistic was 99.4% of people in the study would visit a chiropractor again at the 2nd visit and 98.7% at the 4th visit. That alone gives more insight than most other variables. If it wasn't successful, those numbers would not be there. 

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

Reference:  

  1. Rubinstein S., Lebouf-Yde C., Knol D., de Koekkoek T., Pfeifle C., van Tulder M., (2007) The Benefits Outweigh The Risks For Patients Undergoing Chiropractic Care For Neck Pain: A Prospective, Multicenter, Cohort Study, Journal of Manipulative & Physiological Therapeutics 30(6) page 408-418
  2. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69.Spine,[Epub ahead of print]1-33.

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Published in Neck Problems

Harvard Report Points to Chiropractic Care for Pain Relief

& The Safety of the Chiropractic Adjustment

By

Noah Herbert, D.C., CCSP®

William J. Owens DC, DAAMLP

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

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

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

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

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

 

References:

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

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Published in Low Back Problems

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

 

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

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
Migraine Headaches and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
Thousands of people in the United States suffer with headaches and many do not realize there are different types of headaches that are a reaction to a variety of causes. One of the major tenants of Chiropractic is to find the cause of the problem instead of chasing symptoms. Although Migraine headaches are truly caused by changes in the flow of blood in the brain, many people refer to any headache that is severe enough to negatively affect their day a “migraine”. Many of these cases are people who have headaches on a regular basis, and for whatever reason, they slowly get worse over time. This usually results in increases in medication dosage, prescription of more dangerous drugs with more side-effects and decreases in quality of life. The research paper being reviewed stated “The estimated costs of migraines in the United States is over $17 billion per annum [year]”.1 (p 91)
This research study that was published in 2000 was titled “A randomize controlled trial of chiropractic spinal manipulative therapy for migraine”. This was designed “To assess the efficacy of chiropractic spinal manipulative therapy [Chiropractic Adjustment}  in the treatment of migraine”.1 (p 91). This study followed others that had delivered similar results. 
The authors state “However, the level of evidence is steadily increasing to the point where there is now seen to be a moderate level of efficacy for Chiropractic SMT [Spinal Manipulative Therapy/ AKA Chiropractic Adjustment] in the treatment of headaches or migraines”1 (p95). The paper also reported “The mean number of migraines per month was reduced from 7.6 to 4.1 episodes. The greatest area of improvement was medication use, for which participants were asked to note the use of medication for each episode. A significant number of participants recorded that their medication use had reduced to zero by the end of the 6-month trial”.1(p95) Expressed in other terms, 72% of participants reported significant improvement! 
When administered by trained Doctor of Chiropractic, adjustments to the neck are safe and effective. This study has also show that Chiropractic care results in the reduction of medication utilization, some of which have significant long term side-effects having a profound effect on your long term health. Chiropractic chooses to use a safe and scientifically effective approach to the management of migraine headaches and if you are suffering, Chiropractic care is just what the doctor ordered!
1.       Tuchin PJ; Pollar H; Bonello R. A randomize controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 23(2): 91-5, 2000. 

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Published in Headaches-Migraines

Neck Pain, Headaches and Chiropractic

A report on the scientific literature 


 By

William J. Owens DC, DAAMLP
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
A recent study on chiropractic and conditions concluded that 18.7% of patients present with initial complaints of neck pain, making neck pain the 3rd most common reason for a chiropractic visitation7.  Bogduk and Aprill hypothesized that one of the most common causes of neck pain is related to mechanical dysfunction of the cervical spine”1. Additional reasons can be herniated intervertebral disc or pinched nerves.
 
It has been found that spinal manipulative therapy is one of the most used therapies in the management of mechanical neck disorders. There is more and more research published that shows that neck pain and headache related to mechanical dysfunction in the neck responds well to chiropractic care. Your doctor of chiropractic has the training to determine whether your pain is coming from a mechanical source. If you have to take pain killers to get through your day, experience headaches and have limited range of motion in your neck or shoulders, chiropractic care is a safe and effective treatment. 
 
The following studies were recently published on the topic of chiropractic and neck pain treatment.
 
 “…a single cervical manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain”1
 
“Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”2
 
“According to a recent survey of complementary and alternative therapy use, chiropractic was frequently selected for the relief of head and neck pain,' accounting for 18 to 38 million manipulations performed annually” 2
 
“The overall results demonstrated improvement in mechanical neck pain and LBP of patients while under chiropractic care”3
 
“The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain”.4
 
“In patients with chronic spinal pain syndromes, spinal manipulation (chiropractic adjustments,) if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit” 6
 
 
 
 
 
 
 
 
 
REFERNENCES:
1.      Raquel Martinez-Segura, PT, DO, Cesar Femandez-de-las-Penas, PT, Mariana Ruiz-Saez, PT, CO, Cristina Lopez-Jimenez, PT, DO, and Cleofas Rodnguez-Blanco, PT, DO. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther 2006;29:511-517.
2.      McMorland G; Suter E. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther 2004;27:547-553.
3.      Mitchell Haas, D C Elyse Groupp, PhD, Mikel Aickin, PhD,Alisa Fairweather, MPH, Bonnie Ganger, Michael Attwood, Cathy Gummins, DC,and Laura Baffes, DC. Cevicogenic headache and associated neck pain: A randomized pilot study. Journal of Manipulative & Physiological Therapeutics, 2000 Jun; 23(5)
4.      Dabbs V; Lauretti WJ.A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther 1995; 18:530-6
5.      Reinhold Muller, PhD,'' and Lynton G.F. Giles, DC,PhD. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther2005;28;3-ll
6.      Bradley S. Polkinliorn, DC, and Christopher J. Colloca, DCChiropractic Treatment of Postsurgical Neck Syndrome With Mechanical Force, Manually Assisted Short-Lever Spinal Adjustments.J Manipulative Physio Ther Volume 24 • Number 9 • November/December 2001.
7.      Andrew McHardy, MChiro, Wayne Hoskins, MChiro, Henry Pollard, DC, MSportSc, PhD, Rorey Onley, MChiro, and Ross Windsham, MChiro. Chiropractic treatment of upper extremity conditions: a systematic review. J Manipulative Physiol Ther 2008;31:146-159

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Published in Neck Problems