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chiropractic

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Cardiovascular Safety of Pain Meds Questioned

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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.

Chiropractic Care as Pain Management for Mesothelioma Patients

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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.

Chiropractors Can Help Your Lower Limbs!

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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

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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 Knee Arthritis

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Osteoarthritis is the most common type of joint problem worldwide, with knee arthritis being the most prevalent. The chances of getting knee arthritis increase with age, weight, previous injury or heredity. There is mixed evidence to support various types of knee rehabilitation for osteoarthritis sufferers. A study in the Journal of Back and Musculoskeletal Rehabilitation set out to compare strength training to balance training in managing knee arthritis.

At the beginning of the study, there were no differences between the 2 groups of participants. One group performed only strength training exercises, while the other group performed a combination of strength and balance exercises. Based on various outcome measures such as pain, disability, stiffness, depression and physical function; the balance group performed significantly better after one year.

This study suggests that it is important to ensure that any rehabilitation program for knee arthritis should include simple balance exercises. Some of the exercises used in the study are as follows:

  • 25 m backwards walk
  • 25 m heel walk
  • 25 m toe walk
  • 25 m eyes closed walk
  • 30-second one-legged stand (with leaning in all directions with eyes open and closed)

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Chiropractic Care for Neck Pain – Is it Safe?

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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?

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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.

Routine X-rays Not Needed

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Following up on my previous post about the necessity of X-rays, I came across a review of the literature for low back imaging.

In 1994, the AHPR began recommending against imaging of the low back in the early stages of acute low back pain. This study was undertaken to investigate the relationship between the use of immediate X-rays for the low back and the clinical outcome of the case.

479 articles were identified and reviewed. The authors found no differences in long term and short term outcomes between those who were X-rayed immediately and those who simply received treatment.

They concluded that for patients who present with simple uncomplicated low back pain (no red flags present), X-raying their back did not lead to any greater improvements. Since there is no benefit to imaging the back, but there are draw backs (radiation exposure, cost), routine imaging should be avoided.

Ultimately, every clinician has to rationalize their decisions when it comes to the assessment and treatment of their patients. I will often explain my decision not to X-ray with the fact that the X-ray result will not change my clinical management of their case. We know already from previous studies that many things are seen on X-ray and MRI that don’t have clinical relevance and may actually confuse the issue.

If you would like to read the original article, it can be found here.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Healing Elbow Pain

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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

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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.