Comox Valley Chiropractor – Tips for your Health

Health tips from your Comox Valley Chiropractor

Alexander Technique Can Help February 8, 2009

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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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Vitamin Water? No Thanks. February 1, 2009

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Thanks to Dr. Kinsler for reminding me that I haven’t yet ranted about this inane product.

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About 6 months ago a sales rep came around to our office and dropped off 2 massive cases of a brand of vitamin water. We usually carry some bottles of water for patients since we don’t have room for a water cooler in our waiting room (some people will actually look at us with scorn if we offer them tap water, even though Vancouver tap water continually beats bottled water on testing). We figured we’d hit the jackpot and didn’t have to shop for a while.

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Then I read the label. The amount of sugar is staggering, and even though it makes reference to fruit juice in the name of the product, there is nothing of the sort inside. What ever happened to getting your vitamins in your food? What ever happened to being happy with simple water to drink?

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This is just another example of misleading marketing to latch onto the health and wellness craze. You can read Rochester Chiro’s blog post to find out more about the class action lawsuit that is currently being filed against one brand of this product. Just goes to show you when it comes to health, don’t believe everything you read (especially if its advertising!).

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

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

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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.

 

Rotator Cuff Rehab Exercises January 18, 2009

Rotator Cuff Pain

Rotator Cuff Pain

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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.

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

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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:

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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.

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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.

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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.

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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.

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Rotator Cuff Exercises

Rotator Cuff Exercises

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Rotator Cuff Exercises

Rotator Cuff Exercises

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Chronic Foot Pain – Its Plantar Fasciitis! December 7, 2008

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The Plantar Fascia

The Plantar Fascia

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The plantar fascia of the foot is a thick band of connective tissue that supports the arch of the foot. It runs from the heel up towards the toes on the bottom of the foot. Excessive wear and tear on this structure can lead to inflammation and results in pain on the bottom of the foot or heel, which is often worse first thing in the morning or with too much walking. In certain cases, it can lead to the formation of a heel spur on the heel bone.

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In my experience, this condition usually builds up slowly over long periods of time. Excess stress on the plantar fascia due to fallen arches (flat feet), improper footwear or excess time spent on the feet can lead to the development of plantar fasciitis. Treatment is aimed at reducing the inflammation and supporting the arch of the foot if it needs it.

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In my office, anyone presenting with plantar fasciitis receives a low back, hip, knee, ankle and foot examination including gait (walking). Depending on the state of the arch, over the counter or custom made orthotics may be prescribed. Apart from restoring proper motion of the back, hip, knee and ankle, I tend to pay special attention to the movement of the foot bones that make up the arch (navicular and cuboid). I use active release therapy and/or muscle stripping with biofreeze to reduce the inflammation in the plantar fascia itself. Finally, I always end a session with application of Kinesiotape which often works wonders.

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A thorough home stretch plan is very important in this case, as you are on your feet all day. I usually suggest stretching the plantar fascia (pull back on your toes), calf muscles and shins. I recommend icing at the end of the day, which is best done by freezing water in a 500 ml plastic water bottle and proceeding to roll your foot forward and backwards on it. Further self-massage can be done with some moisturizer and your thumbs. For severe or stubborn cases, I will recommend that my patient wear a good supportive pair of running shoes at all times when in the house. Finally, low intensity laser therapy is a great option to boost healing of the plantar fascia especially when recovery is slow.

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I think that one thing all health professionals will agree upon is that you don’t want to let plantar fasciitis go. As with most problems, it is much easier to treat in the early stages. Listen to your body before it forces you to pay attention!

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Dr Debbie Wright is a practicing Comox Valley Chiropractor.

 

Daily Chuckle December 5, 2008

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Today's Reality

Today's Reality

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Sigh. So true.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

 

Chiropractic is Safe and Effective November 16, 2008

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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

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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

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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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How Much Chiropractic Treatment Do I Need? October 23, 2008

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Each new patient that comes in for a consultation in my Comox Valley Chiropractic office receives a personalized and detailed report of findings. In this report, I explain the patient’s diagnosis in everyday language and what that actually means with respect to their spine or other joints. I explain what I think caused the problem, and why they were so susceptible to the injury. We talk about what the treatment is going to entail and the results I hope to see. I then will go through the various stretches and strengthening exercises that are necessary to address the problem when the patient is out in the world. Finally, I always sit down and discuss my proposed treatment plan and make sure that it sounds reasonable to the patient.

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Every chiropractor uses their own education and clinical judgment to determine what a patient will need in terms of treatment. This will vary from person to person based on such characteristics as their age, the nature of their injury (car accident? workplace injury?), their previous history, their response to treatment, how active they are, genetic factors etc. etc. etc. The bottom line is that you can’t determine how much care someone will need until you see them, evaluate them and then see how they respond to an initial course of care.

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In my office (and I would like to stress I speak ONLY for myself), I will usually start off with a course of 6 visits over the course of 3 weeks. This plan consists of the initial visit, 4 subsequent visits and then a re-evaluation. Its with this re-evaluation that we can see how much improvement has been achieved, and we can perform all the testing done on the first visit for comparison purposes. At this point, we will have a much better idea of recovery time. If more treatment is needed, the frequency of treatment will usually go down with time (i.e. from twice a week to once a week).

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People who come in with simple uncomplicated pain – mild ache in the low back or a crick in the neck – will often be feeling better by the 4th or 5th visit (or sooner!). I usually will schedule the re-evaluation 1-2 weeks later in order to ensure that the problem hasn’t returned and that the home program is working. People who have very chronic complaints, are in great amounts of pain, have been in a car accident or have suffered a workplace injury will take longer. I’ve had people get better in one visit, and people who take 2 years.

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I do speak about prevention with most of my patients. Its not something I push on them, I simply educate them on the benefits and its up to them if they want to do it. I would say about 50% of my patients seek preventative care, anywhere from once per month to once per year. The other 50% pop in for a course of visits when they hurt themselves. When you look at each of these groups, the funny thing is that on average I see them both for the same amount of treatment.

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I welcome your questions and comments, as I am sure every chiropractor and every person has a different opinion on this subject.

 

 
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