Category archives

Research

Cardiovascular Safety of Pain Meds Questioned

A meta-analysis recently published in the British Medical Journal questions the safety of common pain medications.  This article, which can be found here, analyzed 31 trials which contained 116,429 patients with more than 115,000 patient years of follow-up. These trials compared one type of non-steroidal anti-inflammatory medication (NSAID) to another, or to placebo. They looked for outcomes such as heart attack, stroke or death from cardiovascular disease.

They concluded that “little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful.” Vioxx and Prexige had the highest risk of heart attack, while ibuprofen and diclofenac showed the highest risk of stroke.

It should make us take pause that one of the most common over the counter pain medications (ibuprofen) was associated with a 3-times higher risk of stroke when compared to placebo. We need to start educating ourselves on the real risks associated with quick-fixes for pain, and start looking to treat the cause of our pain and not just the symptoms. Manual therapies such as chiropractic are a drug-free, non-surgical, safe and effective option.

The CBC has a somewhat-simplistic but interactive comparison of the 3 major over the counter pain relievers here.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Did That Go?

Before I jump into my post today, I’d first like to apologize for not posting for so long. It seems that I have taken to being a Comox Valley resident quite nicely, which means less work and more play. Too much time spent on the mountain, on the trails or in the ocean and not enough in front of the computer. Well, at least not enough to manage to blog.

Today, I’d like to discuss something that has significant bearing on all chiropractic practices – the crack! The cracking noise associated with adjustments (or cavitation, as it is properly termed) is something that is  perceived as a required outcome for most patients. People regularly ask “Did that go?” or “Did that work?” if they don’t hear a cavitation following and adjustment.

A new study in JMPT found that an audible cavitation was not necessary in order to experience the benefits of the adjustment. The authors measured 2 different variables associated with pain relief, and found that the adjustment reduced pain equally regardless of whether there was an audible cavitation or not.

So, it is the actual mechanism of the adjustment, the high velocity low amplitude thrust, that results in pain relief. Whether or not it creates an audible cavitation means nothing.



Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Gluteal Muscle Activation Exercises

It has been mentioned before in this Comox Valley Chiropractor Blog that improper activation of the gluteal muscle can lead to many lower limb issues such as knee pain (patello-femoral syndrome) or IT Band problems. A research study was recently published which sought to establish a group of exercises that were the most effective at activating the gluteal muscles.

The study, published in the Journal of Orthopaedic & Sports Physical Therapy, measured the EMG (muscle electrical activation) of the gluteus maximus and medius during various exercises. They came up with a group of 5 exercises which are the most effective.

1. Side lying hip abductions – abducting the top leg to 30 degrees.
2. Single leg squats – ensuring the knee stays above the second toe, and start with knee and hip at 30 degrees of flexion.
3. Single leg dead lifts – keep knee bent at 30 degrees to maximize hip and trunk flexion.
4. Lateral band walk – side-stepping against the resistance of a band tied around the ankles.
5. Side-hops – hopping sideways off the non-dominant leg to land on the dominant leg.

These exercises may not be appropriate for all patients and all conditions. Consult a professional in order to determine your diagnosis and any other issues you may have. A good home program lets you achieve the results you desire in terms of stability, with exercises that are easy to do and won’t result in further injury.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Preventing Back Pain in Adults

If you have been reading this blog, you know by now that back pain is a huge problem in our society. In affects over 80% of people at least once in their lives, and can lead to high costs in terms of diagnostic testing/imaging, treatment, medication, decreased productivity and time off work.

A systematic review was recently done in The Spine Journal to evaluate which methods were best for preventing back pain in adults. They evaluated studies including exercises, advice, back supports and other props, activity modification or social/workplace policy changes.

What they found is that the only intervention that consistently showed good results in preventing the occurrence of back pain was exercise. This reinforces the general tenet that you must get your back in motion for it to be healthier.

A simple, but consistent exercise plan is a vital component to healing existing back problems, and more importantly to stop them from recurring. Exercise, whether general aerobic or specific strengthening/mobilizing should be part of every patient’s plan of manangement.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Chiropractic Care as Pain Management for Mesothelioma Patients

Chiropractic care is often sought as a form of alternative medicine and complementary care to coincide with traditional medical treatments. Many cancer patients even elect to visit a chiropractor as part of their treatment regimen.

According to the Canadian Chiropractic Association, chiropractic doctors have a deep respect for the human body’s ability to heal itself without the use of surgery or medication. These doctors devote careful attention to the biomechanics, structure and function of the spine, its effects on the musculoskeletal and neurological systems, and the role played by the proper function of these systems in the preservation and restoration of health. A doctor of chiropractic is one who is involved in the treatment and prevention of disease, as well as the promotion of public health, and a wellness approach to patient care.

Cancer patients have included chiropractic care in their course of treatment to help control pain and alleviate headaches, tension and stress. Patients interested in alternative treatment, who strongly believe in the body’s ability to heal itself, may find chiropractic care particularly appealing. Alleviating severe headaches and movement pains during cancer treatment may make the treatment process more comfortable for cancer patients, including those battling mesothelioma.

Mesothelioma is a rare and aggressive type of cancer that develops in the mesothelial cells that make up the lining of the lungs, heart and abdomen. The primary cause of meosthelioma is exposure to a naturally occurring mineral known as asbestos. Mesothelioma is often difficult to treat as it is typically not diagnosed until it has reached later stages.

A study published in the Journal of Manipulative and Physiological Therapeutics examined the case of a 54-year-old man diagnosed with lung cancer (a cancer often related to asbestos exposure). He began seeing a chiropractor after experiencing very little pain relief one year after he underwent surgery to fight his cancer. The man experienced pain relief immediately after beginning chiropractic care and discontinued use of all pain medications after two visits to his chiropractor.

This case study provides a perfect example of how all types of health care practitioners can work together to ensure the best outcome for the patient – the main goal of any health care system.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Knee Pain? Look to the Hip!

Anytime someone comes into my Comox Valley Chiropractic office with knee pain, I always will look at their hips and pelvis for dysfunction. It is a logical step that most chiropractors will take.

Now, new research is emerging which is showing that a measurable relationship does exist between patellofemoral joint (kneecap) pain and altered hip mechanics.

This study published in the Journal of Orthopaedic & Sports Physical Therapy found a link between women with kneecap pain, increased internal hip rotation and weakness with hip extension. These subjects consistently showed weaker single leg squatting and jumping abilities, and had improper hip mechanics when running.

A comprehensive treatment strategy would involve normalizing the hip and pelvic function with chiropractic adjustments, working on the muscular tension with soft tissue therapy, and addressing the hip weakness with a gluteus medius and maximus rehab program.

The incidence of knee pain is very high in our society, especially in younger women. There are ways to help this condition, and it is not necessarily something you have to live with!

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Chiropractors Can Help Your Lower Limbs!

While most people out there think of Chiropractors as spine doctors, with the occasional headache thrown in for good measure, you may be surprised to know that up to 20% of our practice is comprised of extremity problems. By extremity, I mean anything in your arm or leg – your shoulder, knee, baby toe etc. etc.

An article in the Journal of Manipulative and Physiological Therapeutics reviewed all the research concerning chiropractic treatment of lower extremity conditions. What they found is that chiropractors have a big bag of tricks to deal with lower limb conditions – including manipulation, soft tissue therapy, exercise therapy and modalities such as laser and ultrasound.

While there was not a huge number of studies done on this subject, the authors did find enough good evidence to state that chiropractors can be confident in using these methods to effectively treat lower limb conditions.

What that means for the patient is that chiropractic care is another effective way of dealing with any lower extremity condition you may have, whether its achilles tendonitis, plantar fasciitis, knee osteoarthritis or IT band issues. Often time my patients will start an office visit with “You probably can’t do anything, but my <insert lower limb part here> is giving me problems”. They usually leave very satisfied with the results of treatment.

What this means for chiropractors is that we need to do a better job of educating our patients about our wide range of skills, and all the different ways we can help them.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Exercise for Chronic Pain

For years research has been conducted into the benefits of exercise for chronic low back and neck pain. Even though we know exercise is good for us, we don’t really know a lot about how it is prescribed in real-life situations (practice).  Recently, a large survey was done of 2700 people who reported having chronic neck or low back pain. The results are published in an article in Arthritis & Rheumatism.

Of these 2700 people, 48% had been prescribed exercise after visiting a physical therapist, chiropractor of family doctor in the past year. 33% of all people who visited a chiropractor were prescribed exercise for their pain, compared to 64% of PT patients and 14% of MD patients. Overall, the type of provider, as opposed to any characteristics of the patient was the greatest predictor of exercise prescription.

With chiropractic specifically in this instance, the rate of exercise prescription seemed to increase with number of visits. This supports the common practice pattern of reducing pain and increasing function before commencing rehabilitation.

This is a huge wake up call to all health care providers – exercise was prescribed to less than half the patients with chronic back pain, even though we know it is one of the most effective forms of treatment. We need to make sure we are getting our patients active, and helping them to stay that way!

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Exercises For Spine Stabilization

Over the years, research has clearly shown that exercise and stabilization of the lower back are key to making a full recovery from back pain. Stu McGill, a leader in this field of research has consistently guided our thinking in terms of specific exercises that optimally stabilize the spine, while minimizing the amount of stress and strain on its structures (disc, joint, ligament etc.).

An article published in the Archives of Physical Medicine and Rehabilitation further clarifies our knowledge when it comes to stabilizing exercises for the low back. This study focuses on the three main exercises recommended for back stabilization, and aims to help guide clinicians in determining how to progress patients through these exercises.

Curl UpCurl Up: This classic curl-up involves keeping one leg straight, one leg bent, both hands under the back and curling the shoulder blades up off the ground. Progressions can involve pre-bracing, adding in arm movements (dead-bugs), and deep breathing during the exercise.

Side Bridge

Side Bridge: This involves lying on your side with our elbow and knee on the floor, while lifting the hips up off the ground and holding. Progressions can involve using feet instead of knees as lower balance point and moving arm positions.

Bird DogBird Dog: This involves starting on all fours with hips and shoulders at a 90 degree angle. Progressions can involve raising one arm, one leg, opposite arm and leg together, and movements of the limbs while elevated.

These three simple exercises are easy for clinician’s to prescribe, and can be done safely by a patient with little or no supervision. Its important for us to take the time to teach these exercises properly, so patients can attain the improvements they need with minimal stress on their spine.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Computer Causing Neck Pain and Headaches?

I can’t tell you the number of patients I see on a daily basis who have serious neck pain and headaches from sitting at their computers all day. Many people have horrible set-ups with low chairs, high screens or laptops. Others simply sit in the position for hours on end without moving, only to go home and play video games or do more work on the computer. Returning to the same position day after day causes these problems to build up to a point where they just won’t go away.

A growing proportion of these people in my office tend to be students. That is why I was very interested in an article that recently was published in the journal Cephalalgia. 1,073 students were evaluated for neck pain and headaches, computer use and other associated factors.

Results showed that 26% of students reported suffering from headaches (interestingly, twice as many females as males). 20% reported neck pain and 7% reported both. The median computer use time per week was listed as 8.5 hours, with the overall range being 0-28 hours. When psycho-social factors were surveyed, females scored higher than males (more problems).

The researchers found that high hours of computer work was positively associated with neck pain, but not with headache pain. Higher psycho-social scores were found to be associated with higher incidence of neck pain.

This study not only shines light on the negative impact of computer use on adolescent health, it also shows that people of this age group do report a high amount of pain and headache symptoms. It suggests that in addition to manual treatment to relieve symptoms, that sufficient time be spent by the clinician educating the adolescent on ergonomics, posture and stretching.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.