History of a Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in an auto collision are more likely to experience future neck pain. A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year. We found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index (adjusted HRR = 2.14; 95% CI 1.12–4.10). The study suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

Reference: Nolet PS, Côté P, Cassidy JD, Carroll LJ. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. Eur Spine J. 2010 Mar 7.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Chiropractic in the Treatment and Prevention of Sports Injuries

The study aims to investigate whether chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. The authors used two groups of male semi elite Australian Rules football athletes, matched them in several ways and randomly placed them in one of two arms of the study. All received the usual and customary management and medical care. Half also received chiropractic care which consisted of both soft tissue and high velocity spinal manipulation. The treatment plan was: 1 treatment per week for 6 weeks, 1 treatment per 2 weeks for 3 months, 1 treatment per month for the remainder of the season (3 months). The research evaluated several outcomes. When chiropractic care was added to conventional management, there was a significant reduction in lower limb strain injuries, time missed as a result of knee injuries, lower back pain, and there was improvement in health status. “In addition, although not statistically significant, there was a trend towards prevention of hamstring and primary non-contact knee injuries and there were no reported adverse outcomes from the intervention.”

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Medicare Patients Strongly Support Chiropractic

Medicare Patients Give Chiropractic High Marks
Results from demonstration project suggest feasibility of expanding chiropractic services in the Medicare program.
By Peter W. Crownfield, Executive Editor

The long-awaited final report on the Centers for Medicare & Medicaid Services (CMS) chiropractic demonstration project, conducted from April 2005 through March 2007, is good news for chiropractic, with 87 percent of patients surveyed giving their doctor of chiropractic a score of 8 or higher when asked to rate their satisfaction with care (1-10 scale), and 56 percent rating their chiropractor a perfect 10.

Moreover, in all but one of the demonstration sites (metropolitan Chicago), health care costs did not increase significantly with the addition of chiropractic services.

The demonstration project, "Demonstration of Coverage for Chiropractic Services Under Medicare," was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The project evaluated the effects of expanding coverage of chiropractic services in four different regions of the country: Maine, New Mexico, 26 counties in northern Illinois and one county (Scott) in Iowa, and 17 counties in rural Virginia. Approximately 40 percent of eligible DCs in the four regions participated in the project at some point or another.

Key findings from the summary report, relative to patient experiences with chiropractic care and analysis of chiropractic-specific Medicare costs during the project, include the following. To review the report in its entirety, visit www.acatoday.org/pdf/demo_report.pdf.

"Medicare beneficiaries reported good relief of symptoms and high degrees of satisfaction with the chiropractic care they received."

"The most frequent reasons given for seeking care from chiropractors were favorable earlier experiences (59 percent) and insufficient relief of symptoms by prior treatments of other health professionals (39 percent)."

"Clinical problems involved the back in 78 percent, neck in 50 percent, hip in 38 percent, and shoulder in 32 percent. Pain was the most frequent symptom, followed by difficulty walking. ... Sixty percent of [survey] respondents indicated that they received 'complete' or 'a lot of' relief of symptoms from their chiropractic treatments."

"Chiropractic care was felt to be easily accessible, and nearly 95 percent of respondents indicated that they had to wait no more than one week for appointments. Similarly high proportions reported that chiropractors listened carefully and spent sufficient time with them."

"Among users of expanded chiropractic services, visits increased by 60 percent overall and related Medicare expenditures increased by $34.8 million. ... Essentially, all of the increased costs occurred in urban non-HPSA [Health Professional Shortage Areas] and in Illinois, and especially in Chicago and its suburbs."

"Illinois accounted for 80 percent of the total increase in costs and also had the highest per-person increases in costs of $485 per person compared with increases of $136 per person in Virginia and $35 per person in Maine, and decreases in the other two states." [Per-person costs decreased by $178 in Iowa and $59 in New Mexico.]

"The types of prior treatments received from other health care professionals differed strikingly from those received by chiropractors, including pain pills in 58 percent, pain injections in 30 percent, both pain pills and injections in 22 percent, and surgery in 12 percent. ... The high reported use of pain medications and surgery in treatments received from other types of health care professionals suggests the potential for achieving cost offsets [by using chiropractic care]."

The stated purpose of the demonstration project was "for evaluating the feasibility and advisability of covering chiropractic services under the Medicare program (in addition to the coverage provided for services consisting of treatment by means of manual manipulation to the spine to correct a subluxation described in section 1861(r)(5) of the Social Security Act." Chiropractic was defined as "care for neuromusculoskeletal conditions typical among eligible beneficiaries and diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which such treatment is provided." Chiropractic care needed to conform with CMS's policy for reimbursement of chiropractic services, meaning treatment was for active conditions with reasonable expectation of improvement or resolution. Maintenance and prevention services were excluded per the CMS policy.

For additional background information on the Demonstration of Coverage for Chiropractic Services Under Medicare project, read "Details of CMS Demonstration Project Revealed" in the April 9, 2005 issue.


Chiropractor, Fairfax VA 22031

Spinal manipulation is more effective for chronic low back pain

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week.

Outcome measures were the Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6), assessed at baseline, discharge, and at 3, 6, and 12months. 205 patients completed the study. At discharge, the results showed that spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups; pain recurrences and drug intake were also reduced compared to back school or individual physiotherapy.

Reference: Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, Macchi C. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil 2010; 24: 26-36.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic

Treatment for Osteoporosis

Article from ACAtoday...

Osteoporosis: Not Just An Elderly Disease

It used to be that osteoporosis was considered a disease that affected only the elderly. We particularly associated osteoporosis with older women whose backs were slightly hunched over or those who could no longer stand up straight. Today, the truth is that an estimated 20 million American women suffer from osteoporosis, and 80 percent of them don't even know it.

Osteoporosis is a chronic, progressive condition that steals bone from the body, leading to fractures of the hip, spine and wrist. Older people can suffer disability and even death from osteoporosis-related fractures. Alarmingly, one in two women and one in eight men will suffer from an osteoporosis-related fracture in his or her lifetime.

Many people confuse osteoporosis with arthritis, and wait for swollen joints and discomfort before being tested. Even though osteoporosis is painless until a bone fracture occurs, it is important to find out how healthy your bones are now and if need be, adjust your lifestyle to avoid this brittle bone disease. The American Chiropractic Association recommends the following tips to maintain healthy bones:
Start a regular exercise program. Walking, skipping rope, jogging, playing racquet sports, swimming and aerobics are all helpful in reducing the risk of osteoporosis. Exercising for 20 minutes, three times a week, is helpful.

Although weight lifting exercises are generally recommended, the National Osteoporosis Foundation says those suffering from osteoporosis should consult their health care practitioner before beginning a weight lifting program because excessive strain on the bones could result.

Those with severe osteoporosis and who have suffered from fractures may find Tai Chi, a form of martial arts, to be a beneficial strength training exercise system.

People suffering from osteoporosis should be careful when bending and lifting heavy objects, including grandchildren. Bend from the knees, not the waist, when lifting, and try to avoid hunching while sitting or standing.

Be sure to include calcium in your daily diet. The National Institutes of Health's recommendations are 1,000 mg/day for post-menopausal women taking estrogen; 1,500 mg/day for postmenopausal women not taking estrogen, and 1,500 mg/day for men and women over 65 years of age.

If you are looking for a calcium supplement, try one that's highly absorbable, such as microcrystalline hydroxyapatite concentrate (MCHC), or one of the malates, fumarates, succinates, glutarates, or citrates. But don't overdo it. Taking more than the recommended amount of calcium may cause kidney stones.

Consider taking additional nutritional supplements, such as vitamin D, C, magnesium, zinc and silica after consulting with your doctor of chiropractic.

Eat a healthy, balanced diet, including fresh vegetables, fruit, nuts and seeds. Try broccoli, kale, collard greens, cabbage and turnip greens. Experiment with tofu, salmon, sardines and grains. Low-fat milk and/or yogurt are good sources of calcium. (A glass of low-fat milk and a cup of yogurt add 600 mg of calcium to your daily diet.)

Drink 8 eight-ounce glasses of water a day (herb teas, juices and coffee are not a substitute for water.) Avoid caffeine, carbonated sodas, alcohol, baked goods and junk food.

Watch your animal protein intake.
Chiropractic Care Can Help...
Talk to your doctor of chiropractic about ways to improve the health of your bones. Doctors of chiropractic are licensed and trained to treat patients of all ages and can help people suffering from osteoporosis lead healthier lives.


Chiropractor, Fairfax VA 22031

Study shows little evidence of benefit for spinal fusion surgery

More Medicare patients are having complex back surgery even when there’s often an easier, less risky and less costly fix, according to a study in the Journal of the American Medical Association. The rate of complex fusion surgery for spinal stenosis, which causes lower back pain, increased 15-fold from 2002 to 2007, according to the study.
The study and an accompanying editorial suggest that aggressive marketing by implant makers, and greater physician compensation for high-tech procedures, may be influencing treatment. Meanwhile, taxpayers bear the expense, and patients face increased risks.

There are non-surgical approaches and treatments for spinal stenosis or degenerative disc disease. The symptoms can be treated with exercise, weight loss, chiropractic, and physical therapy. A study in the BMC Musculoskeletal Disorders concluded that distraction manipulation (DM) and neural mobilization (NM) are viable alternative to surgery for patients with lumbar spinal stenosis (LSS), and compares favorably with other non-surgical approaches that have been studied. The study further suggest that “As the efficacy of surgery does not appear to decrease if it is delayed in favor of a non-surgical trial, most patients with LSS should be treated non-surgically for a period of time before considering operation. DM and NM may be one non-surgical option that can be offered to patients.”

References:
Murphy, DR, Hurwitz, EL. Gregory, AA, Clary, R. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study. BMC Musculoskelet Disord. 2006; 7: 16.

Deyo, RA, Mirza, SK, Martin, BI, Kreuter, W, Goodman, DC, Jarvik, JG. Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults. JAMA. 2010;303(13):1259-1265.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Chiropractic usage by intercollegiate athletes

It's estimated that more than one-third of the American public uses the services of doctors of chiropractic and other complementary and alternative medicine (CAM) providers each year. Among those who take full advantage of CAM's benefits are professional athletes; in fact, many pro sports teams now have chiropractors and other CAM providers as part of their medical or training staff. A new study shows that chiropractic and other types of CAM are extremely popular among athletes on the college level as well.

In this study, researchers gave a survey to more than 300 college athletes attending a Division I school in Hawaii. The survey asked the athletes about their use of different types of CAM in the previous year, along with their use of traditional medical care. Fifty-six percent of the athletes reported using some type of CAM within the past 12 months, with more women using CAM than men. Chiropractic was the second most popular form of CAM, just behind massage; 29 percent of the athletes said they had used chiropractic at least once in the past year.

While considerable evidence suggests chiropractic can improve the performance of elite athletes, there's just as much evidence which shows chiropractic care is effective for a variety of everyday problems, too. Back pain, neck pain and migraine headaches are just a few of the many conditions that can be treated by a well-trained doctor of chiropractic.

Source: Nichols AW, Harrigan R. Complementary and alternative medicine usage by intercollegiate athletes. Clinical Journal of Sport Medicine May 2006;16(3):232-7.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic