Monthly archives

October 2008

Carpal Tunnel in Pregnancy

For those of you waiting for my  next post on chiropractic myths, never fear – the next one will be up soon. In the meantime, here’s a short video post on why carpal tunnel is so prevalent during pregnancy and what you can do about it. The website I refer to in the video is Pump Ease, so check it out! If you have any further questions, you can contact this Comox Valley Chiropractor for more information.

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How Much Chiropractic Treatment Do I Need?

Each new patient that comes in for a consultation in my Comox Valley Chiropractic office receives a personalized and detailed report of findings. In this report, I explain the patient’s diagnosis in everyday language and what that actually means with respect to their spine or other joints. I explain what I think caused the problem, and why they were so susceptible to the injury. We talk about what the treatment is going to entail and the results I hope to see. I then will go through the various stretches and strengthening exercises that are necessary to address the problem when the patient is out in the world. Finally, I always sit down and discuss my proposed treatment plan and make sure that it sounds reasonable to the patient.

Every chiropractor uses their own education and clinical judgment to determine what a patient will need in terms of treatment. This will vary from person to person based on such characteristics as their age, the nature of their injury (car accident? workplace injury?), their previous history, their response to treatment, how active they are, genetic factors etc. etc. etc. The bottom line is that you can’t determine how much care someone will need until you see them, evaluate them and then see how they respond to an initial course of care.

In my office (and I would like to stress I speak ONLY for myself), I will usually start off with a course of 6 visits over the course of 3 weeks. This plan consists of the initial visit, 4 subsequent visits and then a re-evaluation. Its with this re-evaluation that we can see how much improvement has been achieved, and we can perform all the testing done on the first visit for comparison purposes. At this point, we will have a much better idea of recovery time. If more treatment is needed, the frequency of treatment will usually go down with time (i.e. from twice a week to once a week).

People who come in with simple uncomplicated pain – mild ache in the low back or a crick in the neck – will often be feeling better by the 4th or 5th visit (or sooner!). I usually will schedule the re-evaluation 1-2 weeks later in order to ensure that the problem hasn’t returned and that the home program is working. People who have very chronic complaints, are in great amounts of pain, have been in a car accident or have suffered a workplace injury will take longer. I’ve had people get better in one visit, and people who take 2 years.

I do speak about prevention with most of my patients. Its not something I push on them, I simply educate them on the benefits and its up to them if they want to do it. I would say about 50% of my patients seek preventative care, anywhere from once per month to once per year. The other 50% pop in for a course of visits when they hurt themselves. When you look at each of these groups, the funny thing is that on average I see them both for the same amount of treatment.

I welcome your questions and comments, as I am sure every chiropractor and every person has a different opinion on this subject.

The Top 4 Chiropractic Myths

Day in and day out in my Comox Valley Chiropractic practice, I encounter new patients who confess that they didn’t try a chiropractor sooner due to hearing negative (and misleading) information. I spend a lot of my time explaining the true situations behind they myths they’ve heard. Over the next few weeks, I’ll expand upon my favourite 4 myths that I hear again and again. They are as follows:

  1. Chiropractic is addictive – once you go, you have to keep going back for the rest of your life.
  2. Chiropractors aren’t doctors, they have very little education compared to medical doctors.
  3. There is no evidence to show that chiropractic works.
  4. Chiropractic treatment is dangerous.

I will start with myth #1 – once you go to a chiropractor, you have to go over and over again, and keep going for the rest of your life. This one amuses me for many reasons, not the least is which its a perfect example of why people seem to measure chiropractic with a completely different yardstick than any other health profession.

I like to compare chiropractic to dentistry. Most of us are born with a beautiful and healthy mouth of teeth. Over our lifespan, we are encouraged to go to the dentist twice a year for check-ups, cleanings and the occasional cavity filling. If we are diligent with our prevention, hopefully we will never have to have a tooth pulled or a root canal performed.

Similarly, you are also born with a beautiful and healthy spine. Over our lifetime, our spine will also undergo stress and strain due to our relative inactivity, prolonged sitting and excessive amount of computer work (similar to too much candy and soda for the teeth). Just because you can’t see your spine every day in the mirror, doesn’t mean that stress doesn’t accumulate – just ask someone with bone spurs. Seeing a chiropractor for prevention, or treatment of small episodes of back pain, will help to avoid those major episodes which can lead to more invasive treatment such as surgery.

So, are you addicted to your dentist? What would happen if you didn’t go? You’d either have a horrible set of teeth, or you would be forced to go for major work when the pain became too unbearable. Also, more research is starting to surface between a healthy mouth and a decreased risk of heart disease.

What would happen if you didn’t go to a chiropractor? Your episodes of back pain would probably still resolve, albeit much slower and with more of an effect on your life. Its possible that the simple back strain you didn’t address would just keep coming back over and over, until it ended up becoming a chronic condition.

People don’t become addicted to chiropractic. They simply discover a simple and effective treatment to get rid of their aches and pains quickly, so that they don’t become major events. That being said, in my opinion a good chiropractor will also be providing home stretching and strengthening exercises that will help the patient to maintain as much self-sufficiency as possible. So why do we completely accept regular visits to the dentist, but scream bloody murder when a chiropractor suggests preventative care?

In my next post, I’ll discuss what is considered a normal treatment plan in my office and what I think is reasonable for preventative care. “How long until I get better?” is the most common question I have to answer in my office.

Chiropractic the Cost-Effective Solution in a Recession

Unless you’ve been hiding under a rock in the last few weeks, you’re aware of the financial crisis that is affecting the world. With governments stepping in with millions (and billions) of dollars to bail out companies and banks alike, its time to realize that this is going to start affecting all government delivered services. In Canada specifically, this means inevitable consequences for the most expensive provincial ministry – Health.

In various provinces over the years, chiropractic care has been de-listed from the necessary health care services which are covered under the provincial plan. Each time, projected cost savings has been listed as the reason for the cut. By axing chiropractic services, the government can save 15-20 million per year in payments. What they don’t seem to realize (or they do and don’t care) is that people who would have sought out a course of $40 chiropractic visits for their back pain will now cost the system much, much more for an MD visit, prescription medication, an unnecessary X-ray or MRI, specialist consults and possibly surgery.

This phenomenon has been documented in several instances in the literature. The largest and most comprehensive study to date was a 2004 study in the Archives of Internal Medicine.  The authors analyzed the claims data of 1.7 million California residents – 1 million without chiropractic benefits in their plans, and 700,000 who had chiropractic benefits included.

What they found was that those people with chiropractic coverage spent 12% less per year on total health care costs. They also used less X-rays and MRIs, had fewer surgeries and hospitalizations, and spent 28% less money each time they had a back pain episode.

The authors concluded that having chiropractic benefits as part of a plan helped to reduce the overall cost of the plan in four ways:

  1. People choosing chiropractic were choosing a safer treatment with less side effects. Side effects will lead to increased cost due to the fact that they then need to be further managed.
  2. People would substitute chiropractic in the place of more expensive and less effective medical care, specifically for spine related conditions.
  3. Chiropractic was more conservative and less invasive than some other medical treatments.
  4. Chiropractic has lower health service costs than other common forms of health care.

Its time to start making health care decisions that will pay off in the future, and stop sacrificing long term viability for short term gain. Chiropractic has been shown to be an effective and cost-effective form of treatment for spine and spine-related problems. Health care policy decisions need to start being made based on evidence and research, and not on which lobby group is the strongest.

Pain Medication Reduces Breast Cancer Risk?

Nothing irritates me more than reading incredibly misleading health related headlines in the Vancouver Sun with my morning coffee. Thus was the case this week when I was greeted with this headline upon sitting down in the kitchen: “Aspirin May Prevent Breast Cancer“.

Now, before you run out and start buying Costco sized aspirin bottles, let’s take a closer look at this study. First of all, its an observational study which means that an association was found between women who take pain relievers and a lower risk of breast cancer. It is important to note that an association does not necessarily equal causation (i.e. the drugs don’t necessarily cause a lower breast cancer risk).

Off the top of my head, I can give you one scenario that could be occurring. Maybe women who are more active have more aches and pains from exercise, and therefore take more pain relievers. The increased exercise could be causing the lowered breast cancer risk and the drugs are just a co-incidence. That’s the problem with an observational study – you aren’t controlling for many of these factors that can confound the results. A randomized controlled trial is needed to find clearer answers.

More importantly though, the toxicity of common pain relievers is enough in my mind to neutralize any benefit in terms of a reduced cancer risk. The authors of the study go so far as to admit that NSAID drugs such as ibuprofen (non-steroidal anti-inflammatories) have too high levels of gastrointestinal and cardiovascular adverse effects.

A very comprehensive evidence-based review of NSAID toxicity can be found here. While most of the data is based in the UK, they do list some interesting numbers for the US and Canada.  I’ve reproduced the summary table here:

Table 2: NSAID-related deaths and admissions to hospital

Event UK USA Canada
Annual NSAID prescriptions 25 million 70 million 10 million
NSAID-related admissions 12,000 100,000 3,900
NSAID-related deaths 2,600 16,500 365

In my opinion, that’s a staggeringly high number of deaths for something that is essentially just treating the symptoms of a problem. I’ve stopped being surprised at the sheer proportion of my patients who have absolutely no clue that NSAID medication carries any risks. They assume (as do most people) that since its available over the counter that it must be safe. Relatively speaking it is, but nothing comes without risks.

The bottom line from your Comox Valley Chiropractor? Think twice before you pop that ibuprofen like candy day after day, and look past the headlines when dealing with health related news!

Prevent Falls and Stay Active with Aging

I wrote in a previous post about the public education campaign launched by the Canadian Chiropractic Association which dealt with falls prevention for the elderly. That information can be found here.

It is well documented that injuries sustained from falls can be a huge factor affecting health into our later years. A recent study in the Archives of Physical Medicine and Rehabilitation demonstrates a simple home stretching routine which can help to improve functional levels.

Previous studies have shown that walking speed declines with age, and that this is an indicator of ones risk for falls and decreasing function. This recent study tested out two simple stretches in order to measure their effect on hip flexibility, and in return their effect on walking speed.

The two stretches were a standard calf stretch with one foot flat on the ground, and a hip flexor stretch supported in a shallow lunge position (see pictures). The stretches were done twice per day, 3 times per side and held for 45 seconds. This program went on for a total of 8 weeks.

When measured against a control group, the stretching group showed a faster walking speed and more hip and ankle flexibility.

It is important to note though that this study was done in a population of healthy adults with an average age of 72. We can’t extend these findings to those adults with health or joint problems. However, it does show some promise for chiropractors and other clinicians to begin to implement a simple home program with their aging patients.

MRI and the Wary Chiropractor

Here in Vancouver, the wait time for a non-emergency MRI can be upwards of 6 months unless you’re lucky enough to get in on a cancellation. It is not uncommon in my office to have people recovered well before their MRI appointment comes around. It often spurs a conversation about the need to get an MRI, specifically for low back disc and nerve problems. Often, the patient will want to go for the scan anyways, just to see the state of their discs and get a good picture of what’s going on. I frequently disagree with this idea, for the simple fact that an MRI is not always what it seems.

What do I mean by this?

It has been well documented in the research that when it comes to the low back, MRI findings do not predict the occurrence of actual low back pain. One of the first studies on the subject was published in the New England Journal of Medicine in 1994. They took 98 people who had never had low back pain and gave them an MRI. What they found was that 52% of all people had at least one disc bulge, with 27% having a disc protrusion (more severe). 38% had a problem at more than one level, with the likelihood of finding problems increasing with age. This led the authors to conclude that the finding disc bulges or protrusions in people with low back pain is frequently simply a co-incidence.

A better designed study was published in 2001 in the Journal of Bone and Joint Surgery.  In this study, the authors subjected 67 people without any symptoms to an MRI in 1989. They found that 31% of these people had some sort of disc abnormality. They then followed up with these same people 7 years later to determine if the abnormal findings in 1989 had lead to the development of back pain in later life.  While they did find that the second scans showed more abnormalities than the ones done seven years earlier,  the findings on the scans did not predict whether someone got low back pain or how bad the pain was.

In my opinion, there are very good reasons why someone should go for further scans – a history of cancer, progressing neurological problems, or severe worsening of the problem to name a few. It is, however, important to realize that an MRI may just be a red herring in the search for the cause of the problem. It is especially important in this day and age of ballooning health care costs to use our resources in the wisest manner possible, and not as a first line of investigation if its not warranted.