Comox Valley Chiropractor – Tips for your Health

Health tips from your Comox Valley Chiropractor

Routine X-rays Not Needed March 25, 2009

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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.

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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.

 

Chiropractic Care Better Than “Usual Care” July 1, 2008

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A recent article in Lippincott’s Bone and Joint Newsletter caught this Comox Valley Chiropractor‘s eye concerning the effectiveness of chiropractic care when compared to “usual care” given by family doctors. The main author of the study is Dr. Paul Bishop, DC, PhD, MD, a professor of orthopedics at the University of British Columbia.

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The study was presented at the International Society for the Study of the Lumbar Spine in Hong Kong. The results indicated that following the existing clinical practice guidelines (which include chiropractic spinal manipulation) produces better outcomes than family doctor-directed care for acute low back pain patients.

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The guideline based care involved avoiding passive treatment, acetaminophen to control pain, reassurance and four weeks of spinal manipulation performed by chiropractic doctors at a frequency of two times per week. All patients returned to work within eight weeks.

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Using pain and disability questionnaires, the chiropractic treatment group was found to have a significantly greater improvement than those who received “usual care” from their family physicians.

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It was also stated that,

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“Typically, the family physician-based care involved excessive use of passive therapies such as massage and passive physical therapy, excessive bed rest, and excessive use of narcotic analgesics, Bishop added.”

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The evidence continues to mount that chiropractic care is an effective form of treatment for low back pain, and should be used as a first line of treatment for uncomplicated cases.

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