Category archives

treatment options

Human Error to Blame for OR Deaths

I don’t normally like to reference the newspaper for any sort of health information, but I came across this article last weekend and decided to make an exception.

Based on figures from a national adverse events survey, it is estimated that up to 920 people die in BC each year from preventable human mistakes in surgery. And that is only based on reported adverse events. How many mistakes are not reported, or blamed on other issues (patient’s poor health, it was a risky surgery etc.).

This article highlights a changing tide in the public. More and more patients are starting to question the safety of hospital and surgical procedures that are performed everyday. They are looking to take a more proactive approach in their own safety in health care. Recently, the first “Empowered Patient Conference” was held in BC and was a rousing success.

In my opinion, hospital care and/or surgery is an important and valuable tool for those who need it. We are lucky in Canada to have such an excellent critical and urgent care system. However, many people head in that direction much sooner than is needed. People need to start looking at all their options and choose the least risky/invasive therapy first. I don’t think its too dramatic to say that your life may depend on it.

Vancouver Sun Medical Deaths July 01 2010

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Rotator Cuff Rehabilitation

In the opinion of this Courtenay chiropractor, problems with internal rotation of the shoulder are often a major component of the rotator cuff issues seen in my office.

In office, I will employ soft tissue therapy, chiropractic adjustments and taping to help restore proper function to the rotator cuff and surrounding structures. I also believe it is important to arm the patient with exercises to do at home. One of the most important stretches out there is the Sleeper Stretch.

A great explanation of the sleeper stretch can be found here, with pictures to clarify.

If you have pain putting on your coat, or unhooking a bra, then you may have problems with internal rotation and impingement in the back of your shoulder. See a professional for a correct diagnosis, and ask them about the Sleeper stretch. It can be used to help alleviate the problem, and as a precaution to prevent it from returning.

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.

Chiropractic Success in Hospitals

A great article (which can be found here) recently appeared in the Toronto Star talking about academic research and collaborative practice amongst Chiropractic doctors. With new Chiropractic research chairs being added each year (University of British Columbia, University of Alberta, McMaster University to name a few), more and more people are realizing that Chiropractors have a valuable contribution to make to understanding the spine and its problems.

One such contribution came in the form of a pilot project at St. Michael’s Hospital in Toronto, Ontario. This program saw chiropractors added as staff to treat patients in a collaborative way with other departments (such as the family medicine department). The project has been a huge success.

For those of us who see the results of chiropractic care first hand, it makes perfect sense to have chiropractors on staff in a hospital. The few times I’ve been to the ER with a bad sprain or broken finger, I can’t believe how many people I see waiting 8 hours with back pain. Most of those people will simply be given an X-ray, pain medication and discharged in the same state in which they came in.

I know that if they had come to my office instead, I could have at the very least made them feel better than when they arrived. More importantly, chiropractors are educated in differential diagnosis, which means we can determine when someone should go to the ER instead of being in our office. On two different cases this year I sent someone back to the ER or their family doctor only to find out that the diagnosis was ureter cancer and a tumor of the nerve sheath.

Including chiropractors in a hospital setting is a great way to ensure patients get quick and effective relief from their pain, and also to save time and money on needless diagnostic tests or harmful medications.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor (soon).

Chiropractic Care for Neck Pain – Is it Safe?

A current study published in Spine set out to determine the relationship between benign adverse events (reactions to treatment) and outcomes (neck pain and disability, perceived improvement) in a group of people who received chiropractic care for their neck pain.

529 patients participated in the study. 56% of the participants reported an adverse event during the first 3 treatments, and only 13% graded it as “intense”. Muscle or joint pain events were the most common types reported, and none of the events were considered serious.

The researchers found that if someone reported an “intense” adverse event during any one of the first 3 visits, they were less likely to report recovery on the fourth visit. What is interesting about this is that they didn’t have significantly more neck pain or disability than those who didn’t experience an adverse event.

At a follow-up 3 months later, those who had “intense” adverse events experienced the same recovery and pain reduction as those who didn’t have any adverse events.

The bottom line here is that even if someone reports an adverse event or reaction after treatment, it did not negatively affect their outcomes or recovery at 3 months. Moreover, it was only those who had an “intense” adverse events that reported less recovery in the short term (13% of participants).

It is also important to note that out of 4,891 treatments, no serious adverse events occurred. This adds validity to the current view that “the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Easing Chronic Muscle Pain – What works?

Myofascial Pain Syndrome can be defined as chronic muscle pain. This pain originates around certain points of pain and sensitivity in your muscles called trigger points. A recent study was published in the Journal of Manipulative and Physiological Therapeutics that sought to identify and review the most common treatments for myofascial pain syndrome.

This study identified many different types of treatment used, and some of them are as follows:

  • Spray and Stretch – vapo-coolant spray followed by muscle stretch
  • Soft Tissue Massage
  • Ischemic Compression – compressing the trigger point in the muscle
  • Occipital Release Exercises – a form of massage and mobilization for the occiput (base of skull)
  • Strain/Counter-strain – stretching a muscle and then having the patient contract that muscle
  • Myofascial Release – compressing and tensioning the trigger point while stretching the muscle through its full range
  • Chiropractic Spinal Adjustments

Immediate (after treatment) benefits were demonstrated with the chiropractic adjustments, spray and stretch, compression, massage and strain/counter-strain. The authors therefore concluded that there is moderately strong evidence to support the use of these manual therapies for the treatment of trigger point pain. These treatments, however, didn’t show as strong benefits as long term solutions.

Recommendations for other types of treatment for trigger points and myofascial pain syndrome can be drawn from this review.  They are as follows:

  • There is strong evidence that laser therapy is effective.
  • There is moderately strong evidence that electrical therapy is effective on a short term basis.
  • There is moderately strong evidence that acupuncture is effective for up to 3 months after treatment.
  • There is limited evidence for modalities such as muscle stimulation, interferential current, an other such stims.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Healing Elbow Pain

Golfer's Elbow
Golfer

Tennis elbow and Golfer’s elbow are the common names for conditions that involve the elbow. Tennis elbow tends to affect the outer elbow, while golfer’s elbow affects the inner elbow. These two spots correspond to where the forearm muscles attach into the elbow – the muscles that extend the wrist on the outside and the muscles that flex the wrist on the inside.

There are several theories as to why these conditions develop, but the most commonly cited cause is that of overuse. Using the example of tennis, the stress to the forearm muscles of hitting hundreds (if not thousands) of balls leads to small micro-trauma of the muscle attachment point. This causes tiny micro-tears which do not get a chance to properly heal before they are stressed again – a typical repetitive strain injury.

Symptoms of this condition include pain over the outer or inner elbow, point tenderness over the bone in that area, weakness or soreness of the muscles with use, morning stiffness and in some cases pain or tingling spreading down the arm towards the wrist. A good examination must be done to differentiate this problem from a nerve or joint irritation in the neck that is referring pain to the elbow.

In my office, I tend to see more of these conditions arising from computer and mouse use as opposed to the traditional sports-related causes. In these cases, I find it is imperative to assess and treat the neck and shoulder as well as the elbow and wrist. Treatment will often involve chiropractic adjustments to the neck, mid-back, shoulder, elbow and wrist. Other good options include soft tissue therapy, kinesiotaping and low intensity laser therapy. I am not a huge fan of splints as they are often over-used and will further weaken the muscles you are trying to rehabilitate. However, there are certain cases where they are helpful.

Because the offending activity that caused the problem cannot always be stopped (i.e. computer work), a good stretching and strengthening plan is essential. Below you will find some videos of basic forearm stretching, as well as a good mobilization for tennis elbow. The key with any repetitive strain injury is to be able to stretch and relax the muscles on a regular basis. I recommend stretching out the forearms once every 20 minutes when on the computer. It takes less than a minute and can spare you from months of recovery if you let the problem get too big.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Pelvic Pain in Pregnancy

Pelvic Pregnancy Pain
Pelvic Pregnancy Pain

Pelvic pain is one of the most common conditions to accompany pregnancy. This problem can range from some soreness in the hips and back to debilitating pain which prevents someone from standing or walking for any length of time.

In pregnancy, your body will produce a hormone called “relaxin” which loosens your ligaments and makes your joints less stable. This is done in order to ensure that the baby can pass through the pelvis easily.

This decrease in stability of the pelvis and hips can lead to stresses on the joints that cause pain and disability. This is especially likely when your belly begins to grow and your posture changes. Having an unstable pelvis makes you less able to deal with these changes.

Pelvic pain can begin anywhere from 8-12 weeks and last until delivery. Depending on the nature, location and severity of the problem, chiropractic can be an effective solution for this condition. Muscle work, taping, and adjustments to the restricted joints of the spine (NOT the loose ones) can help to take pressure off the pelvis and reduce pain.

Another option which is highly recommended is a trochanteric belt.  This belt helps to stabilize the pelvis and relieve the symptoms. An example of a trochanteric belt can be found here, and you can find them in your local sports medicine/rehabilitation supply store.

Pelvic pain may linger after delivery, and its important to continue treatment until the symptoms subside. In addition, you should be given home exercises which will help during and after pregnancy, and will help to restore stability after your delivery.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Alexander Technique Can Help

As a Comox Valley Chiropractor who’s practice is mainly comprised of back pain, neck pain, headaches and other limb pain, I often hear of people’s adventures with other forms of treatment.  Many of these techniques are “named techniques”, or in other words they are named after the person who invented them. One of the techniques I hear about from time to time is the Alexander technique, and I dind’t give it much thought until this article appeared in the British Medical Journal.

In this study, 579 patients were randomly assigned into 4 different groups, and each intervention was applied with and without general exercise prescription:

  1. Normal care from a GP
  2. 6 massage therapy treatments
  3. 6 lessons of Alexander technique
  4. 24 lessons of Alexander technique

Questionnaires were completed at 3 and 12 months. Overall, there was little improvement in the control group, while at 3 months significant improvements were found in the other 3 intervention groups. The massage benefits did not last through 12 months, while both the  Alexander technique lesson groups maintained their benefits. In fact, the group which received 24 lessons acutally showed a better result at 12 months than at 3 months. When exercise was added to the interventions, it significantly improved the outcome of the 6 lesson group, but not the 24 lesson group.

This is a very large and well-structured study showing the potential benefits of the Alexander Technique in improving pain and disability levels for chronic back pain patients. Obviously this is just one study, but the fact that this study involved many clinics and many different practitioners gives it more validity. Below you will find a video produced by the BMJ demonstrating the Alexander Technique and describing their research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

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