Wellness Care – Does It Really Work?

April 01, 2012

Like millions of Canadians per year, you may have originally come into your Chiropractors office with an injury. It was diagnosed, and treated and eventually the pain went away. Some of you continued beyond that initial intensive care to more corrective care and actually made some progress in dealing with the actual underlying issue whether it was faulty biomechanics, a misalignment, or perhaps some damage to your spine from a long standing injury. Now you have been recommended that you should continue on with maintenance care. In our office, approximately 60% of you will continue with maintenance care. Why? For most of us, much like regular dental check-ups, taking vitamins, and exercising, it inherently just makes sense. After all what constitutes a healthy spine? A health spine is simply put, one that is flexible and strong, and protects the spinal cord and nerves adequately. Our spines are subject to stresses 24 hours per day unlike your teeth, so stiffness and misalignments can and do occur over time in most of us. A really important key to remember is that the spine protects our nervous system. So a healthy spine = a healthy nervous system = a healthy body. Problems in the spine can build up over time, silently, without any symptoms, which if left uncorrected can create damage to the spine over time. It makes sense to take regular care of your spine. Most of us get that concept.

After a while and for a few of us, the question inevitably comes “well, I feel fine now – so why do I still need maintenance treatment?”  Really, it is no different from asking, “I’m not overweight, so why should I keep exercising?”, or “I don’t have a toothache so why should I go to a dentist?”  Like a lot of things, when the initial symptoms that drove you to our office, such as pain or stiffness, disappear, it is “out-of-sight, out-of-mind”.   We know it makes sense, but if we are no longer in pain, how do we really know that our health efforts are working? – whether that is regular chiropractic treatments, brushing our teeth, taking vitamins, or exercising. For some of us, the effects of regular chiropractic care are fairly immediate – we notice we think clearer, have more energy, sleep better at night, get sick less often, our sports performance is better, stronger, our mood is better, and we tend to make better health choices such as eating better.

Once we reach higher levels of health, the effects of regular care become less dramatic. After all, we are maintaining a higher level of health now. So we begin to question the methods that got us to that level to begin with. For instance, I hear quite often, “I feel healthy, so how do I know that vitamins are still working?”  We need a bit more reassurance that our time, money and effort spent on our health is really worth it.  We know it makes sense but it’s tempting to start to let some of our efforts go. This is where the research comes in.

What does the research show? The research from all areas of science – medical journals, physiology, neurology, biomechanics, immunology, anatomy, etc. show that having a flexible and strong spine (a “healthy” spine) can produce healthy effects not just in the spine but throughout our bodies. This can include healthy effects on our organs such as our bowels and lungs, our immune system, our mental state, and our entire neurophysiology!

Here are just a few recent interesting studies:

• From the Journal of Spine, a 2011 article by two medical doctors concluded that for chronic suffers of low back pain, “those patients who maintained spinal manipulation treatment maintained their good results while those patients who did not maintain returned to their pre-treatment”.  To obtain long-term benefit, this study suggests maintenance adjustments after the initial intensive manipulative therapy.
• A large research study of over 17,000 people showed that regular wellness chiropractic care reduced work loss by up to 75%.
• In a study by Professor F Splendori – Chiropractic therapeutic effectiveness, social importance, incidence on absence from work and hospitalization, Italy, 1988, it was concluded that regular Chiropractic care improves productivity and overall quality of life, and those under regular care consistently make healthier life choices.
• The first conventional HMO in the US to use chiropractors as a primary care physician found that after just two years of utilizing chiropractors, their hospitalizations were reduced by 80%, outpatient surgery was reduced by 85%, and prescription drug use was reduced by 56%.

A three year study published in Topics in Clinical Chiropractic in 1996 examined senior citizens over the age of 75 years of age and revealed that seniors who receive regular chiropractic care experienced the following:

• Chiropractic patients spend 15% less time in nursing homes and 21% less time in hospitals than the non-chiropractic patients
• Report “better overall health” on quality of life surveys (87% of seniors under chiropractic care described their health as “excellent” or “good”, compared to only 65% of non-chiropractic patients)
• Have fewer chronic conditions
• Were less likely to utilize prescription drugs than non-chiropractic patients
• Were more likely to exercise vigorously and be active in the community

The above are some of the multitude of research studies on maintenance care. One area of particular interest to me is the research on the effectiveness of regular chiropractic care on depression, anxiety and mental function which I will highlight in a future newsletter.

For now, I would give you one piece of advice – Get Adjusted Regularly!

(Written by Dr. Gordon Gertz)

January 3, 2012, 11:00 am

For Neck Pain, Chiropractic and Exercise Are Better Than Drugs

By ANAHAD O'CONNOR

Tony Cenicola/The New York TimesWhat’s the best treatment for neck pain?

Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.

The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.

But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.

“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”

Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.

“There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.

To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.

One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day. (A demonstration of the exercises can be found at www.annals.org).

After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.

A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.

Dr. Bronfort said it was a “big surprise” to see that the home exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”

In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”

He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.”

Dr. Corey Matthews

Idaho Chiropractic Group

403 S. 11th #110

Boise, Idaho 83702

343-6900   Fax:  343-0642

Email:  cmatthews@idahochiropracticgroup.com

Website:  www.idahochiropracticgroup.com

Some of the world's finest athletes that choose chiropractic as a part of their approach to conditioning, training, and lifestyle:

	Emmitt Smith - NFL - Football When asked how he stays in such great shape, Emmitt Smith often responds, "a good chiropractor."
	Tiger Woods - Golf Many people don't know that Tiger Woods rode upon a Chiropractic Float in the 1995 Pasadena Tournament of Roses Parade.
	Lance Armstrong - Cycling 4 Time Winner of the Tour De France. Lance's chiropractor has traveled with him on every Tour De France.
	Terrell Owens - NFL - Football "Those are the guys that put me on the field when I didn't think I had a chance to be on the field. These are professionals, and God put them in my life for a reason."
	Arnold Schwarzenegger - Bodybuilding, Fitness Arnold has been a huge supporter of chiropractic for many years. One of his old muscle beach buddies, Dr. Franco Columbo, is a chiropractor in Southern California.
	Bill Romanowski - NFL - Football His opponents are not thrilled at his good health. Romanowski is considered among the dirtiest players in the NFL, a linebacker with a Dick Butkus mentality.
	John Stockton - NBA - Basketball Utah Jazz player says about chiropractic, "it's been great for me, and for my family."

Chiropractic Care for Spinal Whiplash Injuries

By David BenEliyahu

Studies on the efficacy of chiropractic care for patients suffering with pain secondary to whiplash injury are appearing in the literature. In 1996, Woodward et al. published a study in Injury on the efficacy of chiropractic treatment of whiplash injuries.¹ The authors of this study were from the Department of Orthopedic Surgery in Bristol, England. In 1994, Gargan and Bannister published a paper on the recovery rate of patients with whiplash injuries and found that if patients were still symptomatic after three months, there was almost a 90% chance they would remain so.² No conventional medical treatment has been shown to be effective in these established chronic whiplash injury patients.^3,4 However, most DCs treating whiplash injury patients have empirically found high success rates in the recovery of these types of patients.

In the Woodward study, 93% of the 28 patients studied retrospectively were found to have a statistically significant improvement following chiropractic care.¹ Chiropractic care in this study consisted of spinal manipulation, PNF and cryotherapy. Most of the 28 patients had prior treatment with NSAIDs, soft collars and physiotherapy. The average length of time before the patients began chiropractic care was 15.5 months post-MVA (range of 3-44 months).

This study clearly documented what most DCs experience in clinical practice: that chiropractic care is an effective modality for patients injured in a motor vehicle accident. Symptoms ranging from headaches to neck pain, back pain, interscapular pain and related extremity pain with parasthesias all respond to quality chiropractic care.

The literature has also suggested that cervical disc injuries are not uncommon after whiplash injury.⁵ In a study published on chiropractic care for disc herniations, I demonstrated that not only do patients improve clinically, repeat MRI imaging demonstrates decreased size or resolution of the disc herniation in many cases.⁶ Of the 28 patients studied and followed, several had post-MVA disc herniations that responded well to chiropractic care, with good clinical and anatomical outcome.^6,7 In a recent retrospective study by Khan et al., published in the Journal of Orthopedic Medicine, on whiplash injured patients with respect to cervical pain and dysfunction, patients were stratified into groups based on degrees of good outcome to chiropractic care:⁸

Group I: Patients with neck pain only and restricted neck ROM. Patients had a "coat hangar" distribution of pain with no neurologic deficits; 72% had a good outcome.

Group II: Patients with neurological symptoms or signs and restricted spinal ROM. Patients had tingling, numbness and parasthesias in the extremity; 94% had a good outcome.

Group III: Patients had severe neck pain with full neck ROM and bizarre pain distributions in the extremities. These patients often described blackouts, nausea, vomiting, chest pain and visual dysfunction; 27% had a good outcome.

The results of this study showed that in group I, 36/50 patients (72%) responded well to chiropractic care: in group II, 30/32 patients (94%) responded well to chiropractic care; and in group III, only 3/11 cases (27%) responded well to chiropractic care. There was a statistically significant difference in outcomes between the three groups (p < .0001).

This study provides new evidence that chiropractic care is effective for whiplash injured patients. However, the study did not take into account those patients who also had back injuries, extremity injuries and TMJ injuries, and did not identify which patients had disc injuries, radiculopathy and concussive brain injury (most likely group III patients). In my experience, these types of patients respond better than 27% of the time with a more extensive model of chiropractic care, in conjunction with multidisciplinary providers.

These studies show what most DCs have already experienced that the doctor of chiropractic should be the primary care provider in these types of cases. It is my further opinion that in cases like the group III patients, care should be multidisciplinary so as to achieve the best possible outcome in difficult clinical cases.

References

1. Woodward MN, Cook CH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27(9):643-645.

2. Gargan MF, Bannister GC. The rate of recovery following whiplash. Eur Spine J 1994;3:162.

3. Barnsely L, Lord S, Bogduk N. Whiplash injury, a clinical review. Pain 1994;58:283.

4. Bogduk N. Post whiplash syndrome. Aust Fam Phys 1994;23:2303.

5. Schofferman J, Wasserman S. Successful treatment of Low back pain and neck pain after MVA despite litigation. Spine 1994;9:1007-1010.

6. BenEliyahu DJ. Chiropractic management and manipulative therapy for MRI documented disc herniations. JMPT 1994;17:177-185.

7. BenEliyahu DJ. MRI and clinical followup study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. JMPT 1996;19(9):597-606.

8. Khan S, Cook J, Gargan M, Bannister G. Symptomatic classification of whiplash injury and the implications for treatment. J Of Orthopedic Medicine 1999;21(1):22-24.