Tag Archives: conservative care

A Sign of Progress: AMA Endorses Chiropractic for Low Back Pain

About two weeks ago I was scanning the Florida Chiropractic Society’s website when I saw an article stating that the AMA (American Medical Association) recently came out with a report stating that chiropractic care should be sought prior to resorting to surgery.  This is actually a big deal due to the fact that the AMA has been a longtime opponent of the chiropractic profession as a whole.

(This isn’t some chiropractic conspiracy theory, this is fact.  Look up the Wilk v. AMA anti-trust suit or better yet check out the documentary Doctored for an interesting and somewhat disturbing history lesson.)

My initial reaction to this headline was one of surprise and refreshment. This is a sign of progress that the mainstream medical community is acknowledging chiropractic care as effective, and better yet, the option to be pursued prior to seeking surgical intervention.

The article specifically states that patients try chiropractic services and other conservative options such as acupuncture and physical therapy for the treatment of low-back pain.  According to the article, surgery is not usually needed and should only be considered if other therapies have failed.

The emphasis here should be on the bolded phrase above.  For many conditions, surgery is not usually needed and the risk often outweighs the reward.  A clear picture of what’s best for the patient becomes clouded when third party payers form alliances with the medical community and all too willingly cover these procedures.  This diverges from a patient centered care plan and directs us towards a dangerous, money motivated business at the patient’s expense.

Other examples of this include current scientific evidence not supporting the medical necessity for surgical intervention in idiopathic juvenile scoliosis, yet the procedure continues to be performed highly due to it being reimbursed by insurance.  These are kids we are talking about here.

Another example is the ever so popular carpal tunnel surgery. I cannot tell you how many people I’ve met that were advised to undergo this procedure.  Not taking into account that this condition is highly misdiagnosed and responds extremely well to conservative care.  Yet the procedure is pushed for a profit and the alternatives are dismissed as “quacks” despite the low success rate of the surgical procedure.

Last week I met a gentleman that had undergone back surgery (spinal fusion at L5-S1) and it wasn’t pretty. He had a well localized, non-radiating pain in his lower back for approximately three years, which lead him to a consult with a surgeon.

Since the surgery, this poor soul has now developed a new, more intense, stabbing pain in a different location (right SI Joint).  He wears a brace, limps slowly with an awkward, dragging gait, and can no longer carry out many of his activities of daily life, including lifting and standing for too long.  What’s worse is that the surgeon reassured him of his well-being pre-op, boasting a convoluted and misleading 90% success rate.

Did you know that the failure rate of back surgery is so high that there is an actual diagnosis and medical code for it?  Failed back surgery syndrome or post laminectomy syndrome is a name given to the condition when pain (many times worse than before) persists long after surgery.  Now an individual is left with an irreversible structural change and the dreaded thought of repeated surgeries.

Yesterday I received a text from a longtime friend advising me to check out Dr. David Hanscom on coasttocoastam.com. Dr. Hanscom is an orthopedic spinal surgeon who has turned to a more natural and holistic initial approach to chronic pain after being disheartened by a system filled with multiple surgeries on the same patient.  He discusses how in med school they are taught the aforementioned 90% success rate for spinal surgery, when in actuality he and all his colleagues were boasting a 25% success rate at best.

The hopeful sign of progress here is the symbolism of a potential rectifying reversal of the medical model.  The current status quo has patients opting for pills or surgery prior to traveling the conservative route.

Too often we see patients come in the door helpless and ravaged from trying everything else first.  Doesn’t it make sense to go the non-invasive, non-habit forming and side effect-less route first? Shouldn’t we be trying everything possible before cutting someone open and inserting hardware or providing them with life altering pills?

I commend the AMA for no longer ignoring the facts and shedding light on the truth, even if it does have the potential to cut into their piece of the pie.  Recognizing chiropractors as a top alternative for back pain is a start, but if you read my posts, you know we can do so much more.  Understanding and taking advantage of the intricate relationship the spine and our joints have with the nervous system opens the door to potentially effect almost all bodily function and provides physiological explanation for the previously mislabeled “chiropractic miracles.”

Manual practitioners like chiropractors should not be considered “alternative” at all, but the exact opposite.  A well trained chiropractor can provide explanations and potential treatments for numerous ailments well beyond back and neck pain.  Pigeonholing the profession to one or two conditions is a disservice to all and leaves the door open for continued reliance on harmful drugs and risky surgeries.

But like I said, it’s a start.

The good thing is, you have the choice to pursue both options.  The information is out there.  The treatment is available.  It is your responsibility to choose.  Don’t get me wrong, sometimes drugs or surgery are necessary and can be life saving.  However, in many cases, they should be considered the “alternative” or last resort, and non-invasive therapies like chiropractic, the first line of defense.

REFERENCES

http://jama.jamanetwork.com/article.aspx?articleid=1681414

http://www.chiroaccess.com/Articles/Idiopathic-Juvenile-Scoliosis–Surgery.aspx?id=0000349

http://www.ncbi.nlm.nih.gov/pubmed/1840393

Feet Hurt? Could be Plantar Fasciitis

Are you or someone you know plagued by a mysterious pain in the arch of your foot?  (Sounds like the start of an attorney’s commercial.)  Is it a sharp pain that starts in the heel and is usually worse when you get out of bed in the morning?  Is the tip of your heel tender to the touch, or does it hurt the arch of your foot to bend back your big toe?  If you answered yes, you may be suffering from something called plantar fasciitis.

Anatomically, fascia is fibrous, connective tissue that surrounds our muscles, blood vessels and nerves.  Physiologically, it is there to either bind some of our internal structures together or to allow various structures to slide smoothly over one another.  Specifically, our plantar fascia runs on the bottom (or plantar side) of our feet, from our heel to a row of bones before the toes called the meta-tarsals.

For various reasons this fascia can become strained or stretched leading to inflammation, irritation and pain.  It accounts for approximately 15% of all adult foot pain cases and is prevalent in 10% of runners (noted as the second most common overuse injury of the foot).  If you suffer from this or would like to take proactive steps to prevent this, here is a list of tips to help you out:

1) DROP THE WEIGHT

Obesity is a risk factor for the origination and sustainment of this condition.  This one is fairly simple to comprehend.  If you’re packing more pounds, there is more of a load to bear on your body, including the arches of your feet.

2) PRONATION MAY NOT BE THE ISSUE

Many of you have probably heard the term “pronation” before.  This is actually a natural and necessary process that occurs when we walk or run in order to transfer the load, provide more balance and optimal position for the big toe to effectively push off.

Prior to placing too much stock in a previous “pronator” label, one should look to strengthen and stabilize the hips, glutes and muscles of the foot (particularly the flexor hallicus brevis) in order to more efficiently and evenly distribute the load.

3) TAKE A SEAT

Activities that require spending a long time on your feet can also lead to and/or aggravate plantar fasciitis.  This is a similar mechanism to the obesity problem.  More time on the feet equals more of a load being transferred and absorbed by the feet.  Now, if you’re flat footed, overweight and on your feet all the time, you’re obviously increasingly susceptible to this issue.

Other risk factors noted include poor arch support in your shoes, limited dorsiflexion of the foot and tight hamstrings.  While Clarke Chiropractic and Wellness (and many other manual practitioners) can assist you in increasing the dorsiflexion in your foot and loosening up those hamstrings, the use of various shoe inserts to address pronation and arch support should be pursued with caution.

Make sure you see a professional who has the technology to scan your foot and design an insert tailor made to your unique foot.  Going the cheap route and picking up an insert from the Wal-Mart can cause more harm than good.

If the preceding pointers don’t do the trick, or you feel as though you are beyond the point of these “do it yourself” measures, there is good news.  An estimated 95% of plantar fasciitis cases respond to conservative care.  Even more uplifting is the fact that there is a manual method of stripping the fascia that I have personally utilized on numerous patients with outstanding results.  If you’re tired of the constant pain and discomfort and would like to try a fresh approach, please feel free to contact me and we’ll work to together in an attempt to resolve the issue.

In related news, I am excited to announce that Clarke Chiropractic and Wellness will be accepting appointments within the next couple of weeks.  The updated contact information will be found at the top right corner of the page.  I thank you all for following the website and look forward to working together in the future.

REFERENCES

http://www.ncbi.nlm.nih.gov/pubmed/7805100

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884155/

http://en.wikipedia.org/wiki/Fasciae