Comox Valley Chiropractor – Tips for your Health

Health tips from your 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.

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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.

 

MRI and the Wary Chiropractor October 4, 2008

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Here in Vancouver, the wait time for a non-emergency MRI can be upwards of 6 months unless you’re lucky enough to get in on a cancellation. It is not uncommon in my office to have people recovered well before their MRI appointment comes around. It often spurs a conversation about the need to get an MRI, specifically for low back disc and nerve problems. Often, the patient will want to go for the scan anyways, just to see the state of their discs and get a good picture of what’s going on. I frequently disagree with this idea, for the simple fact that an MRI is not always what it seems.

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What do I mean by this?

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It has been well documented in the research that when it comes to the low back, MRI findings do not predict the occurrence of actual low back pain. One of the first studies on the subject was published in the New England Journal of Medicine in 1994. They took 98 people who had never had low back pain and gave them an MRI. What they found was that 52% of all people had at least one disc bulge, with 27% having a disc protrusion (more severe). 38% had a problem at more than one level, with the likelihood of finding problems increasing with age. This led the authors to conclude that the finding disc bulges or protrusions in people with low back pain is frequently simply a co-incidence.

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A better designed study was published in 2001 in the Journal of Bone and Joint Surgery.  In this study, the authors subjected 67 people without any symptoms to an MRI in 1989. They found that 31% of these people had some sort of disc abnormality. They then followed up with these same people 7 years later to determine if the abnormal findings in 1989 had lead to the development of back pain in later life.  While they did find that the second scans showed more abnormalities than the ones done seven years earlier,  the findings on the scans did not predict whether someone got low back pain or how bad the pain was.

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In my opinion, there are very good reasons why someone should go for further scans – a history of cancer, progressing neurological problems, or severe worsening of the problem to name a few. It is, however, important to realize that an MRI may just be a red herring in the search for the cause of the problem. It is especially important in this day and age of ballooning health care costs to use our resources in the wisest manner possible, and not as a first line of investigation if its not warranted.

 

Disc Degeneration – Is It Genetic? September 21, 2008

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In my view, disc degeneration is somewhere along the lines of death and taxes – inevitable and it affects everyone. However, while everyone may show the signs of disc degeneration (on X-ray), what that actually means in terms of pain, quality of life and disability varies from person to person.

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Intervertebral discs (IVDs) are crucial when it comes to support, stability and proper motion in the spine. They are also prone to breakdown and degeneration which can contribute to low back pain. How much contribution IVDs make to low back conditions, and how to treat them, are hotly debated issues.

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A recent review article in the Journal of Orthopaedic & Sports Physical Therapy states that surprisingly, the biggest predictive factor for disc degeneration is genetic factors as opposed to lifestyle factors (heavy lifting, smoking, vibration exposure). Even weight lifting, when performed properly, did not lead to an increase in the presence of degeneration.

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I can’t count the number of times someone has come into my office after receiving the diagnosis of “disc degeneration” from a set of X-rays recently taken. This is always a misleading diagnosis, as patients will often assume it is a permanent condition which is causing their pain and that there is nothing to be done about the irreversible process. This Comox Valley Chiropractor has become quite adept at communicating to them that this is a normal process of aging and rarely does it lead to serious disease. The best ways to combat the progression is through a healthy lifestyle including cardiovascular exercise and strength training. It should also be made clear that lumbar traction (or decompression) has not been consistently shown to help disc problems, even if practitioners do have great marketing campaigns with expensive machines!

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Management of Chronic Low Back Pain September 10, 2008

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Chronic low back pain has been the subject of much research and funding, with very little relevant information coming from the effort. It is a very difficult condition to manage, and its effect on society can be valued into the billions of dollars. However, it is also a condition that is seen with much frequency at the office of this Comox Valley Chiropractor.

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A recent study in the prestigious journal Spine set out to analyze the evidence-based management of chronic low back pain with electrical stimulation, interferential current, ultrasound and hot/cold packs. These modalities are used often in the offices of manual medicine practitioners, usually with the goal of relieving pain and inflammation.

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What was surprising about this study was the blatant lack of evidence to support the use of these modalities, especially given that they are so prevalent.  No eligible studies of good quality were even found for interferential current, ultrasound and hot/cold pack therapy, leading to the suggestion that these modalities should be avoided. Of the 6 studies that were found for electrical stimulation, 4 were of very poor quality and the remaining 2 found benefit only in the short term. These results suggest that electrical stimulation should be used as only one component of a short term treatment plan (and not on its own).

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This article was part of a special edition of Spine in which many different treatments were analyzed for their effectiveness. The general consensus is that not enough research exists to choose one specific treatment over another, however “when viewed optimistically, the articles in this special focus issue do suggest that a reasonable approach to CLBP (chronic low back pain) would include education strategies, exercise, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization, or massage, and possibly acupuncture.”  Haldeman S, Dagenais S. What have we learned about the evidence-informed management of chronic low back pain? Spine J. 2008 Jan-Feb;8(1):266-77.

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If you have any questions about chronic low back pain, feel free to contact your Comox Valley Chiropractor.

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Top 5 Ways to Avoid Morning Pain July 15, 2008

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One of the most common things I hear in my Comox Valley Chiropractic clinic is a complaint of pain in the morning. This can happen for two main reasons.

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Most people think that their morning pain is due to sleeping on an old pillow or mattress. It is true that an un-supportive mattress or pillow will hold the body in an improper position for the duration of the night. This can slowly but surely irritate your spine and all its structures resulting in pain and stiffness upon waking. However, this is not the main cause of pain in the morning.

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In my opinion, this pain results from the aggravation of an already existing condition. Most musculo-skeletal conditions heal faster and feel better with exercise, and feel worse when you have to sit or stand in one position for too long. When you have a pre-existing condition that is giving you some problems, or perhaps one that hasn’t started to hurt yet but is on the verge of appearing, it can be very sensitive to sleeping positions. A stiff spine coupled with staying in one position for 6-8 hours (tossing and turning doesn’t count!) is a recipe for more pain when you get up.

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So, what do you do? Here are my top 5 tips for avoiding this pain (in the order you should try them):

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1. Exercise more. Regular cardio exercise will help to keep the spine healthy and flexible, and can often work out the stiffness that builds up after 8 hours at the computer. The more active you are, the more your body will tolerate longer periods of time spent inactive.

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2. Stretch more. A good round of stretching before bed, and regularly throughout the day, will ensure good flexibility of the spine. Flexibility helps to keep the spine healthy, whether active or inactive.

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3. Get a new pillow. You don’t have to go out and spend excessive amounts of money at the start. I usually tell my patients to simply get a new regular pillow. If that doesn’t do the trick, then start looking into more specialized pillows. Different people respond to different pillows, so you need to find the one that works best for you.

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4. Visit your Comox Valley Chiropractor. If you have tried 1 through 3 and can’t seem to get the pain under control, it may be that you need some help. Chiropractic treatment will restore the proper functioning of the muscles, joints and nerves of your spine allowing you to maintain your health with the above options. Sometimes when the dysfunction has built up you need some help to get rid of it.

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5. Get a new bed. If your bed is older than 10 years old, or all other options haven’t worked, this is a good idea. I recommend buying a bed on the firmer side, and adding a mattress pad to soften it up if needed. If you buy a bed that is too soft to begin with, there is not a lot you can do. You spend 1/3 of your life in bed sleeping, and so its a good idea to take the purchase of this important piece of furniture seriously.

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If you have any additional questions, please feel free to contact your Comox Valley Chiropractor for more information.

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Stop Smoking Now! May 26, 2008

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I’m sure by now everyone knows of the harmful effects of smoking. Besides the well known side-effects, most people don’t know that smoking increases your risk of back and neck pain due to the toxic effect of nicotine (and other toxins) on your discs, nerves and spine.

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Nicotine is a highly addictive substance. For many smokers, quitting smoking can seem almost impossible. Regardless if you smoke three packs a day for 40 years or if you smoke one pack a day for 10 years, Rachel Shoniker’s Stop Smoking Detox Program can help you successfully quit. This program tackles the physical and psychological aspects, while enabling the body to cleanse of nicotine and harmful chemicals.

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Rachel’s centre, Revitalize Now!, offers a comprehensive program consisting of:

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Laser Therapy

They combine low-level laser technology with the ancient practice of acupuncture to successfully help you quit smoking. By stimulating acupuncture points on the ears, hands and legs with a low-level laser and bio-electrical stimulation, they trigger the release of endorphins – the body’s natural feel-good chemicals. Instead of feeling irritable and anxious, laser therapy allows you to calmly adjust to your new lifestyle as a non-smoker.

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Benefits:

  • Alleviates withdrawal symptoms
  • Reduces stress
  • May help to reduce craving
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Guided Imagery

When trying to quit smoking, many people start with positive intentions but they are unable to maintain them. Guided imagery is an excellent complement to laser therapy. Revitalize Now! uses a powerful CD that was developed by a psychotherapist who is widely recognized as a leader in the field of guided imagery.

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Benefits:

  • Reinforces your resolve to remain smoke-free
  • Reduces psychological cravings for nicotine
  • Completely relaxes you
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Detox

After years of inhaling thousands of toxins, detoxifying your body is imperative.

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It’s been estimated that there are more than 4,000 chemicals found in cigarette smoke, including: benzene (found in gasoline and pesticides); formaldehyde (used for embalming dead bodies); acetone (ingredient in nail polisher remover); ammonia (makes nicotine readily absorbed); and benzopyrene (a tar that causes cancer). Cleansing your body is imperative in order to revitalize your health.

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Their detox program consists of high-quality supplements and infrared sauna therapy to help you rid your body of harmful toxins.

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To learn more about how Revitalize Now! can help you finally quit, check out www.revitalizenow.ca for more information or to book your free initial consultation with Rachel.

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