Monthly archives

September 2008

Office Etiquette in Vancouver

Just a quick post today after experiencing something in my office that drives me nuts – Cell Phones.

I’ve never been a huge fan of big signs asking you to turn off cell phones, I think they are tacky and usually I don’t have to ask anyone twice to turn off their phone. Most times, people are very apologetic if a cell phone accidentally goes off during a treatment.

In reality, I’m not bothered at all if the occasional cell phone rings. What drives me nuts is when people actually get up off the table to pick it up.

In my chiropractic practice, I work mainly out of one room. Each person has their allotted time and usually I am not running in and out. Unless its an absolute emergency, I never leave the room to take a phone call or speak to someone. My patients expect me to be fully present for their appointment, and I expect the same thing.

Is this unreasonable? Does anyone else have any experience with this, or more effective ways of putting a stop to it other than mentioning that its not appreciated?

Okay, rant over!

Cut in Half your Risk of Early Death

All of my patients can now stop rolling their eyes every time this Comox Valley Chiropractor tells them to stop smoking, exercise more, eat well and drink moderately. My patients are quite used to my preachings on living a healthier lifestyle, and now (as if I didn’t have enough research to back me up) a new article has been posted in the British Medical Journal extolling these virtues.

This 24-year long study followed a group of over 77,000 women between the ages of 34 and 59 who had no signs of heart disease (when the study began). They wanted to determine the relation of their health to 5 lifestyle factors:

  1. Being overweight
  2. Smoking
  3. Excessive drinking
  4. Poor Diet
  5. Little physical activity

Over the years 8882 of the women died – 1790 from heart disease and 4527 from cancer. Each of the above lifestyle factors was found to significantly increase the chance of dying from any disease (not just those listed above). Another interesting fact is that women who drank moderately (up to one drink per day) actually had less chance of dying from heart disease than those who did not drink at all.

While it may seem like a tall order to follow the recommendations of this study, it really doesn’t need to be that complicated. You don’t need to hit the gym, lift weights and run ten miles everyday. Often, a healthy lifestyle is all about the little things.

Quitting smoking is a must. No if, ands or buts. If you are having trouble, both acupuncture and low intensity laser therapy are safe and effective options. You don’t need to give up your wine or spirits, simply moderate it to a one-drink a day maximum.

Simple diet choices can significantly improve your nutrition, while decreasing obesity. Choose whole grain foods, less red meats and cut out the soda and excess sugar. As for exercise, walking to work or the corner store will ensure that you achieve the 30 minutes of exercise per day that is considered minimum.

Revamping your entire life to begin an unsustainable nutritional and exercise plan is not the answer – you need to make sure you take small steps in the right direction and change your lifestyle in a comfortable way. These simple changes can literally mean cutting your risk of early death by 50%.

Disc Degeneration – Is It Genetic?

In my view, disc degeneration is somewhere along the lines of death and taxes – inevitable and it affects everyone. However, while everyone may show the signs of disc degeneration (on X-ray), what that actually means in terms of pain, quality of life and disability varies from person to person.

Intervertebral discs (IVDs) are crucial when it comes to support, stability and proper motion in the spine. They are also prone to breakdown and degeneration which can contribute to low back pain. How much contribution IVDs make to low back conditions, and how to treat them, are hotly debated issues.

A recent review article in the Journal of Orthopaedic & Sports Physical Therapy states that surprisingly, the biggest predictive factor for disc degeneration is genetic factors as opposed to lifestyle factors (heavy lifting, smoking, vibration exposure). Even weight lifting, when performed properly, did not lead to an increase in the presence of degeneration.

I can’t count the number of times someone has come into my office after receiving the diagnosis of “disc degeneration” from a set of X-rays recently taken. This is always a misleading diagnosis, as patients will often assume it is a permanent condition which is causing their pain and that there is nothing to be done about the irreversible process. This Comox Valley Chiropractor has become quite adept at communicating to them that this is a normal process of aging and rarely does it lead to serious disease. The best ways to combat the progression is through a healthy lifestyle including cardiovascular exercise and strength training. It should also be made clear that lumbar traction (or decompression) has not been consistently shown to help disc problems, even if practitioners do have great marketing campaigns with expensive machines!

Knee Surgery Ineffective

A research study published this week in the New England Journal of Medicine states that Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”

Researchers followed two groups of patients with knee arthritis randomly assigned to receive either knee surgery or physical therapy plus over the counter medication. A follow up at two years showed no difference in pain level and quality of life between the two groups.

This study is not the first to demonstrate the ineffectiveness of knee surgery for osteoarthritis. A study in the July 2002 edition of the New England Journal of Medicine demonstrated that the outcome after knee surgery was no different than that of placebo treatment (incisions but no surgery).

Knee surgery is a common procedure recommended for arthritis sufferers for the simple reason that it has always been done. Now, there is mounting evidence that conservative care is just as effective as the surgery, never mind being less invasive, safer and less of a cost on the health care system.

It is my opinion that as responsible health care consumers, we must make smart informed choices on treatment options. Practically speaking, for most conditions it is wise to choose the most conservative form of therapy first and save the most invasive (surgery) for later. The worst thing that will happen with most conservative therapies is that you don’t improve. Conversely, the worst consequences for surgery include infection, sepsis and death (especially with all the drug resistant bacteria in hospitals such as c. difficile).

The effectiveness of many common surgical procedures (including those for low back pain) is starting to be questioned. If you would like to learn more about what your options are for conservative therapy, please contact your Comox Valley Chiropractor.

Management of Chronic Low Back Pain

Chronic low back pain has been the subject of much research and funding, with very little relevant information coming from the effort. It is a very difficult condition to manage, and its effect on society can be valued into the billions of dollars. However, it is also a condition that is seen with much frequency at the office of this Comox Valley Chiropractor.

A recent study in the prestigious journal Spine set out to analyze the evidence-based management of chronic low back pain with electrical stimulation, interferential current, ultrasound and hot/cold packs. These modalities are used often in the offices of manual medicine practitioners, usually with the goal of relieving pain and inflammation.

What was surprising about this study was the blatant lack of evidence to support the use of these modalities, especially given that they are so prevalent.  No eligible studies of good quality were even found for interferential current, ultrasound and hot/cold pack therapy, leading to the suggestion that these modalities should be avoided. Of the 6 studies that were found for electrical stimulation, 4 were of very poor quality and the remaining 2 found benefit only in the short term. These results suggest that electrical stimulation should be used as only one component of a short term treatment plan (and not on its own).

This article was part of a special edition of Spine in which many different treatments were analyzed for their effectiveness. The general consensus is that not enough research exists to choose one specific treatment over another, however “when viewed optimistically, the articles in this special focus issue do suggest that a reasonable approach to CLBP (chronic low back pain) would include education strategies, exercise, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization, or massage, and possibly acupuncture.”  Haldeman S, Dagenais S. What have we learned about the evidence-informed management of chronic low back pain? Spine J. 2008 Jan-Feb;8(1):266-77.

If you have any questions about chronic low back pain, feel free to contact your Comox Valley Chiropractor.

Chronic Shoulder Pain? Probably Rotator Cuff Tendonitis…

One of the most common things that this Comox Valley Chiropractor sees in my practice is rotator cuff tendonitis. I’ll treat at least 2-3 per day, sometimes as a primary complaint but usually as an add-on to other complaints. Most often, the problem with be chronic and will have been around for many months. Most people believe that since the pain is not too bad, it will go away on its own. Sadly, it often doesn’t, but progressively gets worse as time goes on.

The rotator cuff of your shoulder is a group of small muscles which help to co-ordinate the movement of your arm bone in your shoulder socket. When they aren’t functioning properly, the head of the arm bone doesn’t rotate smoothly in the socket and you will get clicking, clunking and pinching of the tendon of one of the muscles. This will result in pain with certain arm movements such as lifting it up to the side, putting on your coat or opening the door. Often it will be accompanied by night pain, resulting from sleeping on the sore side.

Rotator cuff problems are fairly straightforward to diagnose with a proper orthopedic examination. Once diagnosed, the goal of therapy should be to restore proper functioning of the rotator cuff and the shoulder joint. In our Comox Valley Chiropractic office, this entails active release therapy for the muscles, joint mobilization and manipulation, kinesiotaping and many home stretching and strengthening exercises. Once the shoulder has regained a full and painless range of motion, it is imperative that the muscles are strengthened in order to prevent the problem from coming back.

Another option which works well, especially for chronic and stubborn cases, is low intensity laser therapy. Although current research has variable results, I have had great success with laser therapy in my practice. Once specific case involved complete resolution of left-sided shoulder pain in two treatments, and no further recurrence in the last 6 months. What makes this case more remarkable is that the patient had previously had rotator cuff surgery on the other shoulder, and was slated to follow the same course for the left side.

The most important thing to remember about rotator cuff problems is that the sooner they are diagnosed and treated, the faster they get better. Leaving a rotator cuff for too long can make recovery a longer process, and can increase your chances of developing frozen shoulder syndrome which has a recovery time measured in years. If you have any questions about rotator cuff pain, feel free to contact your Comox Valley Chiropractor.