Wednesday, June 25, 2014

Low Back Pain

 

Effective Diagnosis and Treatment of Low Back Pain


Effective Diagnosis of Low Back Pain
Healthy Backs and Regular Chiropractic Care
Regular chiropractic care helps your body function at peak capacity. Your body is a dynamic structure and, as in all finely crafted machines, it's possible for subtle things to go wrong. The problem, of course, is that as these problems are subtle we don't know about them until, in a sense, it's too late. Too late, that is, from the point of view of how long it may take to get better now that the problem's been going on for some time.
By receiving regular chiropractic care you're helping to nip various physical problems in the bud. For example, low back stiffness, which if left unattended might develop into a mechanical problem and ultimately a herniated lumbar disc, is identified at the outset and lessened or resolved by regular chiropractic care. By helping you improve your overall health and well-being, regular chiropractic care is a modern implementation of the old proverb, "an ounce of prevention is worth a pound of cure".
Here's an all-too-common situation. You develop low back pain that lasts for more than a few days and you're uncomfortable enough to go see your primary care physician. He or she tells you it's not clear what's going on and sends you for a magnetic resonance imaging (MRI) study of your lumbar spine. The study comes back showing one or two herniated intervertebral discs. [Intervertebral discs are cartilaginous shock absorbers interspaced between pairs of spinal vertebras.] Your doctor informs you that you have "herniated discs in your back" and prescribes medications and a course of physical therapy. Your doctor may even refer you to an orthopedic surgeon to evaluate the need for surgery on your back.
Now, all of these recommendations may be necessary. Or none of them may be necessary and all that's needed is some rest and an exercise rehabilitation program that you could do on your own if you were given the proper instructions. The culprit here is how the presence of the herniated disc or discs is interpreted. It's important to remember that not all herniated discs are a problem requiring a solution. In fact, a sizable proportion of such disc herniations (30% or more)1 represent the progression of natural processes and are not a problem at all.2,3 But many family doctors and even specialists are not appropriately trained in accurate differentiation among the various possibilities. When faced with MRI evidence of a herniated disc, such doctors see it as a disorder or disease that needs to be treated and fixed. Such an approach results in significant stress and leads to unnecessary procedures and financial hardship for many patients.
Given the frequency of occurrence of such instances of "over-diagnosis", how can a person with back pain expect to receive appropriate care? Of course, people as patients are usually not in a position to be able to overrule their doctor's recommendations. The answer lies in obtaining relevant information. Let your doctor know you're aware that up to one-third of normal persons have herniated discs, and ask whether it's possible that your disc herniation is in fact unrelated to your back pain and merely an incidental finding. Further, if your back pain is not accompanied by leg pain radiating below your knee, it may be that the disc herniation is not affecting spinal nerve roots and may be treated by very conservative measures such as rest followed-up with exercise.
Thus, not all disc herniations have the same impact on a person's health. Some represent normal findings, even if they are present in a person who has back pain. Let your doctor explain to you exactly why your particular problem requires more than watchful waiting. Your local chiropractor will be able to provide you with the very best expert advice and recommendations for any necessary treatment.
1Takatalo J, et al: Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine (Phila PA 1976) 36(25):2180-2189, 2011
2Spontaneous regression of herniated lumbar discs. Kim ES, et al: J Clin Neurosci 2013 Oct 24. pii: S0967-5868(13)00552-3. doi: 10.1016/j.jocn.2013.10.008. [Epub ahead of print]
3Endean A, et al: Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine (Phila PA 1976) 36(2):160-169, 2011

Thursday, June 12, 2014

Heavy Lifting

Heavy Lifting


Heavy Lifting and Back Pain
Chiropractic Care and Core Training
Core training focuses on the deepest muscular layers of your body, including small muscles such as the multifidi and intertransversarii that lie directly on the spinal column and help move individual spinal vertebras. In order to train these deep muscles properly, the spinal vertebras need to be able to move freely throughout their full range of motion. This is where regular chiropractic care comes in. Chiropractic care identifies, analyzes, and corrects sites of limited spinal mobility, making it possible for you to optimally train your core muscles.
Returning to fitness requires an ongoing commitment of time and effort. In order to get the most out of your investment in yourself, it’s important to make sure that your body will respond effectively to your exercise activities. Regular chiropractic care helps ensure that you’ll achieve such success.
All of us who’ve experienced a back injury of one sort or another have been told at some point to “avoid heavy lifting.” That type of advice appears to be a no-brainer or at least redundant, as no one whose back is hurting is going to try to pick up an air conditioner or even a 100-foot reel of garden hose. In this context, it’s important to remember the words of Shakespeare’s Cassius: “The fault, dear Brutus, is not in our stars, but in ourselves”. The problem isn’t the heavy lifting, as such. The real problem is in us, that is, in our overall level of conditioning or physical fitness.
Most back injuries don’t occur as a result of heavy lifting, but rather are caused by a seemingly innocuous event such as bending over in the shower to retrieve a bar of soap that has fallen to the floor. Other likely pain-producing scenarios are bending over to place a bag of groceries in the trunk o f a car bending over to tie a loose shoelace. None of these circumstances involved lifting extraordinary weight.  Rather, the common elements are lack of flexibility and lack of appropriate muscle tone and strength to support the weight of your body in a forward flexed position.
The problem isn’t lack of big muscles. Picking up a bar of soap or positioning a 15-pound grocery bag doesn’t require bulging biceps or massive lats. The problem is lack of conditioning. Most of us no longer do actual physical work on a regular basis. We spend the large majority of our day sitting, either working, reading, or watching entertainment on television or other devices. The result of such lack of activity is twofold. Muscles lose strength and muscle fibers are replaced by fat. Additionally, tendons and ligaments contract and become tight, losing their necessary composition of elastic fibers. The functional loss associated with these physiological changes is profound. We experience these change every time we feel a twinge, or worse, in our backs.
The fix is easy and primarily focuses on building up core muscle strength.1,2 Core training is directed toward your deep abdominal muscles. The main such muscle is the transverses abdominis, which surrounds your entire waist, protecting and supporting your lower back. You can think of this critically important structure as your internal weight belt. Activation of the core muscles is required for all effective physical activity.3 Without this essential foundation, any minor attempt at work, even bending over to pick up a pencil, can lead to disaster in the form of excruciating back pain.
Core training includes exercises such as the scorpion, lying windmill with bent legs, pushups, squats, and the plank. Many good books and numerous online videos are available to provide instruction in the performance of core exercises. Your chiropractor is experienced in rehabilitative exercise and will help guide you to the training methods that are best for you.
1Inani SB, Selkar SP: Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial. J Back Musculoskel Rehabil 26(1):37-43, 2014
2Brumitt J, et al: Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain. Sports Health 5(6):510-3, 2013
3Wang XQ, et al: A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17



Monday, June 9, 2014

Weekend Warrior




Sports and Chiropractic

Many professional, Olympic, college, high school, and weekend athletes have found the benefits of Chiropractic care. Injuries to the spine or extremity can restrict motion, reduce reflexes, impair balance and timing, decrease muscle strength and balance and cause over all decrease in performance. Athletes demand results, and chiropractic care provides them.
Chiropractic care helps restore function to the spinal joints and extremities that are not moving properly. This helps relieve pain, inflammation, and increase nerve function to the body. It will increase range of motion, and the healing ability of the body. By normalizing the spinal function of the body it will speed up the healing of the soft tissues and reduce the deconditioning effect of being out of action.

Dr. Skrien Has Helped With These Sports Related Injuries With Chiropractic and Active Care:
  • Tennis elbow
  • Golfers elbow
  • Rotator cuff and shoulder injuries
  • Knee problems
  • Ankle sprains
  • Foot problems
  • Low back pain
  • Neck pain
  • Stingers
  • And other sports injuries

He also helps athletes gain a competitive edge by designing specific chiropractic and active care programs for them.

Dr. Skrien is a Certified Chiropractic Sports Physician. He has taken specialized training in the sports field of chiropractic care. He has been helping athletes of all levels since 1993. 
Don’t stay on the side lines any more. Find out what others have, get in and have an evaluation today.

 http://chiropracticfamilyclinic.net/

Monday, June 2, 2014

Blood Pressure Guidelines For Care

Making Sense of Guidelines for Care


Senior Health Can Benefit from Chiropractic Care
Chiropractic Care and Chronic Health Problems
Chronic health problems such as high blood pressure and diabetes often require treatment plans from several different specialists. Effective treatment of high blood pressure may involve a person’s family physician, internist, and cardiologist. A person with diabetes may be receiving treatment from her internist and endocrinologist, and possibly from an ophthalmologist and even a neurologist. An additional key specialist involved in any of these scenarios is a chiropractor.
Of course, chiropractic care is not directed toward treatment of any disease. Rather, chiropractic care focuses on the health and well being of the whole person. By concentrating on biomechanics and the nerve system, that is, the integrity and functioning of the spinal column and spinal nerves, chiropractic care helps ensure that the body as a whole is working effectively. This means that whatever a person’s clinical circumstances may be, regular chiropractic care is essential to his or her long-term health. Your chiropractor is a key member of your health care team in any situation.
Not too long ago, the Eighth Joint National Committee (originally commissioned by the National Heart, Lung, and Blood Institute) released a new set of evidence-based guidelines for evaluation and treatment of hypertension (high blood pressure). The guidelines committee, comprised of 17 academics, spent five years reviewing evidence as preparation for developing the new recommendations.
The committee’s report represents nothing less than a sea change in the treatment of patients with higher-than-normal blood pressure readings. The primary shift is from a long-held standard of implementing treatment when a person’s blood pressure is higher than 140/90 mmHg. The new guidelines recommend beginning treatment only when blood pressure readings are higher than 150/90 mmHg. The new standard is a huge modification of decades-old practice methods, and has generated substantial controversy.1.2 Of course, a good portion of the pushback is from those who have a vested interest in maintaining the status quo, such as physicians who dispense medications from their office and earn substantial income from selling antihypertensive drugs at multiples of their wholesale costs. In addition to physicians who act as pharmacies, drug companies who manufacture antihypertensive medications also stand to lose significant revenue. But aside from considerations related to the practice of medicine as a business, the real issues should be focused on the benefits and harms to patients. In this context, it may be reasonably stated that fewer medications are, by and large, a good thing.
The new blood pressure guidelines have two primary impacts. First, for people over age 60, treatment for presumed hypertension should be initiated when blood pressure readings are higher than 150/90 mm/Hg. More than 7.4 million Americans over age 60 will be in the new safe range. Many of these millions of people have been taking antihypertensive medication for years, possibly needlessly as implied by the new guidelines. Next, for all those under age 60, there is insufficient medical evidence that a systolic blood pressure (the first number in the reading) threshold exists that would dictate treatment. In other words, for many years the systolic threshold had been 140 (as in 140/90 mmHg). Higher systolic readings virtually mandated antihypertensive treatment. Although the committee expressed its opinion that the systolic threshold of 140 mmHg ought to be maintained for those younger than age 60, even though evidence for such a threshold is weak. Thus, it may be that many millions more people have been taking antihypertensive medication without such recommendations being backed by sound scientific research.
The point here is not that people should stop taking their blood pressure medication.3 All such types of decisions should be made in consultation with the prescribing physician. The main consideration is having the ability to make informed choices. Some medication regimens may be appropriate. Some may not. Some may need to be reevaluated. As always, regular chiropractic care is of value by providing you with the best opportunity to achieve maximum good health.
1Mitka M:Groups spar over new hypertension guidelines. JAMA 311(7):663-664, 2014
2Kieldsen SE, et al: Hypertension management by practice guidelines. Blood Press 23(1):1-2, 2014
3Sheppard JP, et al: Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study. Br J Pract 2014, Jan;64(618):e38-46. doi: 10.3399/bjgp14X676447