Comox Valley Chiropractor – Tips for your Health

Health tips from your Comox Valley Chiropractor

Chiropractic Success in Hospitals June 22, 2009

Filed under: Research,treatment options — drdebbie @ 2:10 pm
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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.

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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.

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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.

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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.

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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).

 

Exercises for Knee Arthritis May 29, 2009

Filed under: Comox Valley Chiropractic,exercise,Health Tips,Research — drdebbie @ 8:40 am
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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.

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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.

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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:

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  • 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)
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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Chiropractic Care for Neck Pain – Is it Safe? May 13, 2009

Filed under: Comox Valley Chiropractic,Myths,Research,treatment options — drdebbie @ 12:19 pm
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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.

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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.

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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.

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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.

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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).

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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.”

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Easing Chronic Muscle Pain – What works? April 29, 2009

Filed under: Comox Valley Chiropractic,Research,treatment options — drdebbie @ 8:16 pm
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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.

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

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  • 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
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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.

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

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  • 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.
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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Routine X-rays Not Needed March 25, 2009

Filed under: Comox Valley Chiropractic,Health Resources,Research — drdebbie @ 3:00 pm
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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.

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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.

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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.

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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.

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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.

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

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Alexander Technique Can Help February 8, 2009

Filed under: Comox Valley Chiropractic,Research,treatment options — drdebbie @ 12:36 am
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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.

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

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

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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.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

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Should I Get An X-ray? January 25, 2009

Filed under: Comox Valley Chiropractic,Health Tips,Research — drdebbie @ 12:03 am
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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.

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

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

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  • 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.
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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.

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

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Diagnostic Imaging Guidelines

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Dr. Debbie Wright is a practicing Vancouver Chiropractor.

 

Chiropractic is Safe and Effective November 16, 2008

Filed under: Comox Valley Chiropractic,Research,treatment options — drdebbie @ 1:29 pm
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Myth #4: Chiropractic treatment is dangerous.

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A great synopsis of the risks associated with chiropractic treatment was recently published in the Journal of Manipulative and Physiological Therapeutics. While the full text article can be found at the bottom of this post, the summary is as follows:

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This synopsis provides an overview of the benign and serious risks associated with chiropractic care for subjects with neck or low-back pain. Most adverse events associated with spinal manipulation are benign and self-limiting. The incidence of severe complications following chiropractic care and manipulation is extremely low. The best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible. (J Manipulative Physiol Ther 2008;31:461-464)

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This synopsis references a previous study published in Spine which found that the risk of experiencing a stroke following a visit to a chiropractor was equal to the risk of experiencing a stroke following a visit to a family doctor. It led the authors to conclude that “The increased risks of VBA stroke associated with chiropractic and PCP (family doctor) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” So, people who are already having a stroke will experience neck pain and headaches, and will logically go and see either their chiropractor or their family doctor. It is not the treatment of either of these practitioners that causes the stroke to happen.

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In summary, there are risks of adverse events with chiropractic treatment. These risks are small and self-limiting, and the risks of severe complications are very small. When compared to other common treatments such as taking medication or surgery, chiropractic is a very safe form of treatment for neck and low back pain.

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Synopsis of Chiropractic Safety

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

The Evidence Supports Chiropractic Care November 10, 2008

Filed under: Comox Valley Chiropractic,Research,treatment options — drdebbie @ 12:19 pm
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Myth #3: There is no evidence to support that chiropractic works.

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I don’t even know where to start with this one. The fact is that there is are so many studies done on spinal manipulation that a Medline search would be overwhelming. Instead of going through the many systematic reviews and meta-analyses that exist, I think the evidence is well summed up by an review exploring international low back pain guidelines. The review can be accessed here.

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Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the balance of the evidence shows that chiropractic spinal manipulation is effective in managing low back pain, and therefore is included in the recommendations. Here is a summary of their findings:

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Clinical practice guidelines for the treatment of acute lower back pain

  • Reassurance of the favourable natural history
  • Advice to stay active
  • Discourage bed rest
  • Acetaminophen, p.r.n.
  • Chiropractic spinal manipulative therapy
  • Advice against passive physiotherapy modalities, prolonged bed rest or specific back exercises.
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Essentially the investigators found that following these treatment guidelines (including chiropractic spinal manipulation) led to better outcomes than usual medical care. It is important to note that the guidelines don’t recommend chiropractic as a stand alone treatment, but as one component of a continuum of care.

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One of the authors of the study then went on to launch the 2-part C.H.I.R.O study (Chiropractic Hospital-Based Interventions Research Outcome study). The first part pitted chiropractic care (along with the above guideline recommendations) versus usual medical care. The people who received chiropractic care showed better functional and quality of life improvements. The results of this study have been presented at Canadian Spine Society Meeting, the International Society for the Study of the Lumbar Spine, and the North American Spine Society and will be published in an upcoming edition of Spine. A summary of the results can be found here.

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In the opinion of this Comox Valley Chiropractor, we are so far past establishing that there is evidence supporting chiropractic care. We are now heading in the direction of trying to establish how to best use this tool in the management of patients, or whether certain subsets of patients will respond more favourably. In the past 5 years, Chiropractic Research Chairs have been established at many universities across Canada in order to further chiropractic research.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Yes Suzy, Chiropractors ARE Doctors! November 2, 2008

Filed under: Comox Valley Chiropractic,Health Resources,Research — drdebbie @ 5:17 pm
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Myth # 2: Chiropractors aren’t doctors, they have very little education compared to medical doctors.

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This is a continuation of my post on the top 4 myths about chiropractic. Before I address the educational qualification of chiropractors, how about a refresher on what makes someone a doctor. In British Columbia, Chiropractic is regulated by our College under the Chiropractic Act.  The Act provides us this designation due to our right to diagnose. This means that we are able to determine a specific cause for a group of signs and symptoms with respect to spine and spine-related disorders. We have enough education and training to be able to come to a diagnosis, and more importantly, to determine when a condition is outside our scope of practice.

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As stated by Canadian Memorial Chiropractic College (where I attended), “The chiropractic curriculum encompasses a diverse range of knowledge including anatomy, pathology, biomechanics, chiropractic principles, diagnosis, and adjustive techniques.” The 4-year program focuses on diagnosis and treatment of musculo-skeletal injuries, and includes 4232 hours of instruction in subjects such as Neurodiagnosis in Chiropractic Practice, Differential Diagnosis, Systems Pathology, Clinical Biomechanics and Radiographic Interpretation. The requirements for admission into an accredited chiropractic program include minimum 3 years undergraduate study (as with medicine) but most students have  completed an undergraduate degree. That works out to 8 years of post-secondary education.

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Interestingly enough, a 2001 article in the Journal of Bone and Joint Surgery analyzed the curriculum of Canadian medical schools and discovered that on average only 2.26% of class time was devoted to musculo-skeletal injuries. This is surprising considering that in BC, one third of all visits to MDs are for spine and spine related conditions. The article concluded that “There is a marked discrepancy between the musculoskeletal knowledge and skill requirements of a primary care physician and the time devoted to musculoskeletal education in Canadian medical schools.”

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So it begs the question – if you have a problem with your back, what kind of doctor do you want to see? In my opinion, the information above speaks for itself.

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