Back Pain Alexandria, VA

Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic, i.e., not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

What Causes Back Pain?
The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements-for example, picking up a pencil from the floor-can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Back injuries are a part of everyday life, and the spine is quite good at dealing with these often "pulled" muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes some pain last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.

Will Back Pain Go Away on Its Own?
Until recently, researchers believed that back pain will "heal" on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily but will most likely return. The study demonstrated that in more than 33% of the people who experience low-back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.1

Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own.2 Those studies demonstrate that low-back pain continues to affect people for long periods after it first begins.

What Can I Do to Prevent Long-Term Back Pain?
If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.3 The relief they feel after a month of treatment is often greater than after seeing a family physician.4

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5

How Can I Prevent Back Pain?

Don't lift by bending over. Instead, bend your hips and knees and then squat to pick up the object. Keep your back straight, and hold the object close to your body.
Don't twist your body while lifting.
Push, rather than pull, when you must move heavy objects.
If you must sit for long periods, take frequent breaks and stretch.
Wear flat shoes or shoes with low heels.
Exercise regularly. An inactive lifestyle contributes to lower-back pain.
What Should I Tell My Doctor of Chiropractic?
Before any treatment session, tell your doctor of chiropractic if you experience any of the following:

Pain goes down your leg below your knee.
Your leg, foot, groin, or rectal area feels numb.
You have fever, nausea, vomiting, stomach ache, weakness, or sweating.
You lose bowel control.
Your pain is caused by an injury.
Your pain is so intense you can't move around.
Your pain doesn't seem to be getting better quickly.

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References
1.Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May;26(4):213-9.
2.Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.
3.Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.
4.Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.
5.Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003;23(2):14-15.

Dr. Joshua M. Brooks
Alexandria VA, 22304

Diagnose headaches with cervical flexion-rotation test

Headache is one of the most common presenting complaint of chiropractic patients. A recent study compared the findings and identified the diagnostic accuracy of the cervical flexion-rotation test (FRT) between subjects with probable cervicogenic headache (CGH), migraine without aura (Migraine), and multiple headache forms (MHF).

Sixty subjects were evaluated: 20 with CGH, 20 with Migraine, and 20 with MHF. The average range of unilateral rotation to the most restricted side was 25 degrees, 42 degrees and 35 degrees for groups CGH, Migraine and MHF, respectively. Range of rotation was significantly reduced in the CGH group when compared to groups Migraine and MHF. The study found that “An experienced examiner using FRT was able to make the correct diagnosis 85% of the time (P<0.001)…”

This recent research continues to confirm the importance of a simple flexion rotation test (FRT) in the differential diagnoses of headaches. Many headache cases are often similar in terms of presenting symptom and the FRT has demonstrated in multiple research studies to be highly sensitive to identifying cervicogenic headache from migraine and multiple headache forms.

Reference: Hall TM, Briffa K, Hopper D, Robinson K. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. J Headache Pain. 2010 May 28.

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

Shoulder Injuries Attributed to Resistance Training: A Brief Review

Kolber, MJ, Beekhuizen, KS, Cheng, M-SS, and Hellman, MA. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res 24(6): 1696-1704, 2010-The popularity of resistance training (RT) is evident by the more than 45 million Americans who engage in strength training regularly. Although the health and fitness benefits ascribed to RT are generally agreed upon, participation is not without risk. Acute and chronic injuries attributed to RT have been cited in the epidemiological literature among both competitive and recreational participants. The shoulder complex in particular has been alluded to as one of the most prevalent regions of injury. The purpose of this manuscript is to present an overview of documented shoulder injuries among the RT population and where possible discern mechanisms of injury and risk factors. A literature search was conducted in the PUBMED, CINAHL, SPORTDiscus, and OVID databases to identify relevant articles for inclusion using combinations of key words: resistance training, shoulder, bodybuilding, weightlifting, shoulder injury, and shoulder disorder. The results of the review indicated that up to 36% of documented RT-related injuries and disorders occur at the shoulder complex. Trends that increased the likelihood of injury were identified and inclusive of intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique. A majority of the available research was retrospective in nature, consisting of surveys and descriptive epidemiological reports. A paucity of research was available to identify predictive variables leading to injury, suggesting the need for future prospective-based investigations. (C) 2010 National Strength and Conditioning Association

Questions on pain relievers.

Several years ago, I worked with a chiropractor who used to tell patients not to take any pain medication. I disagreed with that approach, as I felt multiple strategies are often needed, especially for severe pain. Then he was in a car accident. He found chiropractic care extremely helpful. He also expressed considerable more appreciation for "the little brown M&M's", and he found it necessary to take them every four hours. He became much less dogmatic in telling people how to deal with pain. I feel it's important to not judge people who rely on medication to help with their pain. I also try to use whatever techniques that are available to relieve pain so that medication is ultimately unnecessary.

I get asked about pain medicine a lot. As a chiropractor, I'm not licensed to prescribe medications. I don't make recommendations for starting or stopping any medicine, including over the counter medications. I am not opposed to medicine, and recognize their neccessity in the healthcare of many people. I also feel if you can get by without it, you're often better off. When I'm asked, I'll defer to the patient's primary care doctor. I do need to ask patients questions about medications, especially pain medicines, as it gives me information on what's happening to the patient. It's fairly common for people to come to me because pain medication is not working for them. People often get in the habit of taking pain medicine on a daily basis without asking their doctor. Most over the counter pain medicines recommend that it not be taken for more than ten days without consulting a doctor, some patients I've seen have been taking them daily for years.

A recent Danish study looked at over a million individuals. It found the likelihood of heart attack or stroke increased 29% in patients who took ibuprofen. It was not just people who took medicines for long times. People who took high dosages, even for as short a time as only two weeks, saw an increase in heart problems and stroke. Naproxen was not found to have the same heart related side effects as ibuprofen. This was the first major study that saw this increase in cardiovascular problems in patients who had no prior record of cardiovascular problems. Heart problems were also seen with the less commonly used prescription medicines diclofenac and rofecoxib. As I've said, it's good to talk to your primary doctor if you have questions on changing a medicine. While this study saw benefits with naproxen in terms of heart disease, there are other side effects that may be more relevant to your health.

I was hesitant to blog about this because pain medication is a complex topic. As I said at the start, I'm not inherently against medicine. I don't want people who have to take pain medicine feel bad for taking it. I don't want people who'd be better off taking it to avoid or stop taking it. More studies will come out, likely making this an even more complicated subject. The techniques used in chiropractic are several orders of magnitude safer than pain medications. It's very common for us (the doctors at ABC Clinics) to see painful conditions that we can resolve with chiropractic care and physical therapy. If you have questions how we can help, please call or email.

Rosa Rehab Receives 2010 Best of Temple Hills Award

Press Release

FOR IMMEDIATE RELEASE

Rosa Rehab Receives 2010 Best of Temple Hills Award

U.S. Commerce Association’s Award Plaque Honors the Achievement

NEW YORK, NY, June 4, 2010 -- Rosa Rehab has been selected for the 2010 Best of Temple Hills Award in the Chiropractors category by the U.S. Commerce Association (USCA).

The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2010 USCA Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.

About U.S. Commerce Association (USCA)

U.S. Commerce Association (USCA) is a New York City based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.

The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.

SOURCE: U.S. Commerce Association

CONTACT:
U.S. Commerce Association
Email: PublicRelations@us-ca.org
URL: http://www.us-ca.org

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Evidence Supports the Use of Therapeutic Ultrasound for Joint Osteoarthritis

A Cochrane systematic review (January 2010) and another recent clinical trial (May 2010) both provided support for therapeutic ultrasound (US) in the management of patients with osteoarthritis (OA).

The objective of the Cochrane systematic review was to compare therapeutic US with sham or no specific intervention in terms of effects on pain and function safety outcomes in patients with knee or hip OA. The authors concluded that, "In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee."

The clinical study examined the short- and long-term efficacy in patients with primary hip OA with regard to pain, functional status, and quality of life (QoL). Forty-five patients with primary hip OA were enrolled into the study. The authors concluded that, "addition of therapeutic ultrasound to the traditional physical therapy showed a longitudinal positive effect on pain, functional status, and physical QoL in patients with hip osteoarthritis. The use of therapeutic ultrasound in the treatment of hip osteoarthritis should be encouraged."

References: Köybaşi M, Borman P, Kocaoğlu S, Ceceli E. The effect of additional therapeutic ultrasound in patients with primary hip osteoarthritis: a randomized placebo-controlled study. Clin Rheumatol. 2010 May 26.

Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003132.

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

CHIROPRACTIC AGAIN SHOWN TO BE MORE COST-EFFECTIVE

Chiropractic Again Shown to Be More Cost-Effective
New Study Compares Chiropractic to Medical Care in "Real-World" Setting
By Editorial StaffOne of the reasons many companies are hesitant to include coverage for services such as chiropractic is the claim that inadequate scientific data verify the effectiveness of these forms of care.
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A new study published in the Archives of Internal Medicine,1 combined with the results of a survey conducted by the Kaiser Family Foundation,2 may finally put an end to the question of how chiropractic affects the cost of health care, and whether it is more effective than traditional medical procedures for the treatment of back pain.
"Prior to this, no study had ever linked chiropractic benefits to lower utilization levels in a real-world employee setting," commented Douglas Metz, DC, a co-investigator on the Archives paper. "Our study shows that systematic access to managed chiropractic care may prove to be not only clinically beneficial, but can reduce key cost factors that drive up employer health costs in traditional care settings."3
The Archives study was sponsored by American Specialty Health Plans (ASHP) - an organization that offers coverage for alternative health care providers such as chiropractors, acupuncturists and massage therapists, which is added to traditional insurance policies - and was conducted by Health Benchmarks, an independent health services research organization. Health Benchmarks reviewed four years of claims data on back pain from two groups: one group of 700,000 health plan members with chiropractic care coverage, and a second group of 1 million members who were in the same health plan as the first group, but who had no chiropractic coverage. Aside from chiropractic care, patients in both groups had access to the same physician network; the same rules on referral to specialty care, diagnostic tests, and hospital and surgery approval; and the same exclusions and limitations.
The analysis found wide discrepancies in health care costs for patients with and without chiropractic coverage:
The overall per-member, per-year health care cost of members with chiropractic coverage was $1,463 - $208 less than the cost of members without chiropractic coverage. This amounted to a 12 percent reduction in annual costs incurred by the health plan for members with chiropractic coverage.
The per-member, per-year health care cost of chiropractic patients with neuromusculoskeletal conditions was 13 percent lower compared to the same group of patients without coverage of chiropractic care. Similar reductions were seen in annual per-capita hospital costs and ambulatory services.
The greatest differences were seen when the authors reviewed cases of treatment related specifically to back pain. The average cost per back pain episode for patients with chiropractic coverage was 28 percent lower than for back pain patients without chiropractic coverage.
Back pain patients with coverage of chiropractic had a 41 percent reduction in hospitalizations for back pain, a 37 percent reduction in MRI scans, a 23 percent reduction in the use of X-rays, and a 32 percent reduction in the incidence of back surgery, compared to back pain patients who did not have chiropractic insurance coverage.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Chiropractic had the highest perceived benefit for back pain

A study published in the Journal of the American Board of Family Medicine reports on interviews with 31,044 individuals who used complementary and alternative medicine (CAM) for low back pain (LBP). The results are as follows:

The top 6 CAM therapies for LBP, starting with the most-used approaches are: chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.

Chiropractic use (76% of respondents) was larger than all the other 5 therapies combined.

Of those who used CAM modalities for back pain, 27% used it because conventional medicine did not help, 53% used it in conjunction with medical care, and 24% used it because their medical provider recommended it.

Chiropractic users scored the highest on their satisfaction and clinical benefits out of all 6 approaches. This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that spinal manupulative therapy (SMT) provided the greatest pain relief scoring higher than nerve blocks, opioid analgesics, muscle relaxants, acupuncture, or NSAIDs.

Reference: Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med. 2010;23(3):354–362.

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

Chiropractic, Health Care Reform and Discrimination?

I wanted to take a break from posting interesting new study abstracts in order to address an issue that many people may not be aware of. As we all know by now, out congress recently passed some sweeping changes to the health care system in this country. Part of this legislation (the Patient Protection and Affordable Care Act (PPACA)) contained an "anti-discrimination" clause (Section 2706). This clause assures that chiropractors, optometrists, podiatrists, and other physicians without an "M.D. or D.O." after their names, are treated fairly and equally within the new health care system.
Blatant discrimination against other types of physicians has been a policy of the American Medical Association for many years, as evidenced by the landmark legal verdict of Wilk vs. AMA in 1971. We chiropractors were very pleased to see Section 2706 included in the bill that was passed. We thought that perhaps the days of animosity between professions was finally at an end and we can ALL work together for the good of our patients.

Recently the AMA drafted a resolution that states:

"RESOLVED, That our American Medical Association immediately condemn and work to repeal new Public Health Service Act Section 2706, so-called provider “Non-Discrimination in Health Care,” as enacted in PPACA, through active direct and grassroots lobbying of and formal AMA written communications and/or comment letters to the Secretary of Health and Human Services and Congressional leaders and the chairs and ranking members of the House Ways and Means and Energy and Commerce and Senate Finance Committees (Directive to Take Action"

It seems that just when we thought we were entering a new era of cooperation and trust, we are again reduced to fighting "turf wars" over such issues as patient access, titles, and coverage by insurance.

If you are currently seeing a chiropractor, podiatrist, optometrist, or any other licensed physician that Section 2706 may effect, PLEASE contact your senator or congressman (or woman) and tell them to preserve Section 2706 in the current legislation.

I'll leave you with a quote from Dr. Benjamin Rush, co-signer of the Declaration of Independence and one of our founding fathers:

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic."

Dr. Louis S. Crivelli II
Chiropractic Physician
Greenbelt, MD