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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Healing Elbow Pain March 8, 2009

Golfer's Elbow

Golfer

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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.

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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.

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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.

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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.

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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 February 15, 2009

Pelvic Pregnancy Pain

Pelvic Pregnancy Pain

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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.

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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.

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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.

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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.

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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.

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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.

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Dr. Debbie Wright is a practicing 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.