Monthly archives

January 2009

Should I Get An X-ray?

images-6Diagnostic imaging – whether it be X-rays, CT or MRI can significantly improve patient care and give us information that can aid in recovery. When it comes to X-rays, there is some evidence that misuse of the service occurs, whether it be overuse or under-use. It is for this reason that the Chiropractic College of Radiologists (Canada) created evidence-based Diagnostic Imaging Guidelines to be used by chiropractors and other health care professionals.

With respect to the low back and mid-back, the guidelines state that diagnostic imaging is required in the following circumstances:

  • Mid-back or low back blunt trauma or acute injuries.
  • High-risk screening criteria for spinal injuries such as mid-line tenderness of the spine with palpation, altered consciousness or neurological problems.
  • Major trauma including pelvic trauma accompanied by inability to bear weight.
  • When spinal stenosis (narrowing of the canal the spinal cord or nerves run through) or other degenerative problems are suspected.
  • Lack of improvement with treatment, or worsening of the condition.
  • Presence of red flags – suspected underlying disease, infection or cancer, etc.

With respect to the neck, the guidelines state that diagnostic imaging is required under the following circumstances:

  • Acute neck trauma in someone who is older than 65, reports a dangerous mechanism of injury OR has numbness/tingling/weakness in their arms.
  • Non-traumatic neck pain WITH pain/numbness/tingling or weakness in arms.
  • Lack of improvement with treatment, or worsening of the condition.
  • Presence of red flags – suspected underlying disease, infection, cancer, instability of the neck, etc.

It should be noted that these guidelines do not recommend taking an X-ray of every patient who walks though the door. A large number of people have simple mechanical spine pain for which further imaging is not needed, thereby sparing the patient radiation exposure and the health care system more expense. However, there are some cases (as listed above) where it is prudent to get further investigation before proceeding with treatment. Your chiropractor is trained to be able to recognize when you warrant further diagnostic imaging.

A full copy of the diagnostic imaging guidelines for the spine can be found below.

Diagnostic Imaging Guidelines

Dr. Debbie Wright is a practicing Vancouver Chiropractor.

Rotator Cuff Rehab Exercises

Rotator Cuff Pain
Rotator Cuff Pain

It’s just as important to strengthen and rehabilitate the rotator cuff as it is to heal it in the first place. Treatment is needed to restore proper function, decrease inflammation and generally heal the shoulder joint. After this, it is crucial to ensure that the muscles that make up the rotator cuff are strengthened and stabilized so the same problem doesn’t happen again.

I prefer a two-part shoulder rehab program – early and late.

Early rehabilitation when the shoulder is not quite 100% is aimed at restoring proper functioning of the shoulder blade and shoulder joints (scapulo-humeral joint). This involves gently activating  the muscles around the shoulder blade, which include the rotator cuff muscles. Two examples of such exercises (which are listed in this research paper) are:

1.    Inferior Glide – Sit beside a flat surface (such as a table) that is slightly lower than your shoulder.  Raise your shoulder to 90 degrees and place your arm flat on the surface. Press down through your fist like you are attempting to return your arm to your side. At the same time, draw your shoulder blade down your back and hold for 5 seconds.

2.    Low Row – With your arm at your side, place your hand (palm facing you) on the front edge of a table or counter.  Extend your trunk and push your hand into the edge of the table like you are pulling your shoulder back. At the same time, squeeze your shoulder blades backwards and down your back and hold for 5 seconds.

Late shoulder rehabilitation involves more active movements of the rotator cuff including internal rotation, external rotation and abduction. I’ve included a copy of the handout I use below.

The main thing to remember about rotator cuff rehab is to make sure all movements are done in a pain-free zone. Any pain or pinching indicates impingement or irritation a structure and will further aggravate the condition. And finally, make sure you consult a health care provider in order to get a proper diagnosis for your shoulder, and get the right exercises to help your specific condition.

Rotator Cuff Exercises
Rotator Cuff Exercises
Rotator Cuff Exercises
Rotator Cuff Exercises

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Knee Pain Kinesiotaping

Ever since I started using kinesiotape in my office, I seem to be using it more and more for knee conditions. There are so many different ways to apply the tape, but I find sometimes that the most simple applications make the most difference. Here are some quick and easy applications of kinesiotape for knee pain. They are modifications of the listed technique that can be found in the kinesiotaping manual:

1. ACL instability

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2. MCL strain (inner knee strain)

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3. Patello-femoral syndrome (kneecap pain)

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Its best to seek out an accurate diagnosis first for your knee pain. If you find that kinesiotape works, it is a safe and effective way to control your symptoms and allow you to ultimately rehabilitate the knee.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Prevent Hockey Injuries

Most injuries in hockey tend to be traumatic – cuts, bruises, breaks and concussions from collisions with players, equipment or the boards. However for the more casual player, muscle injuries tend to be very common. Most weekend warriors are guilty of not enough strength and conditioning, and improperly warming up/stretching before the game.

The Canadian Chiropractic Association has developed an informative pamphlet to help hockey players stay healthy. Besides giving tips on how to prevent injury through proper equipment, they also lay out some stretches for both before and after the game. These stretches will help to prepare, and help recover, the most commonly injured and stressed muscles with hockey.

You can download the pamphlet by clicking on the following link:

Hockey Stretches

As I usually tell my patients, its way easier to prevent the problem from happening than to fix it once its bad. Take the time to stretch properly before and after your game!

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.