02.22.11

Tune-ups

Posted in Spinal Hygiene, Uncategorized at 2:10 PM by Dr. Greathouse

Tune-Ups

Are Regular Interval Visits Good for You?

You Be The Judge

Dr. James E. Greathouse

What are tune-ups? A chiropractic tune-up may also be called palliative care, or wellness care, but in general it’s interval care on a regular basis, of variable frequency to work out the kinks that may be developing in your spine.

Supportive care is provided for those who, for various reasons, have recurrent problems and require care in order to prevent condition worsening.

This is a controversial subject within chiropractic as well as among lay people and other health care disciplines.

For a theoretical rational of why these tune-ups may actually be beneficial please see information below.

Spinal Problems Are Common If you haven’t experienced a back or neck problem yet, chances are you still will at some point. If you have suffered a back or neck problem, studies show you are likely to experience recurrent problems. The highest rate of incidence occurs between 30 and 50 years old, and typically does not involve a significant traumatic event. These are just a few statistical facts.

While chiropractic care isn’t the only effective way to treat spinal problems and it isn’t the end all to management; manual therapy may be a helpful component to prevention and management of problems once they do occur.

Ongoing Problems More Common Than Conventional Wisdom Reports: von Korff based his skepticism of low back pain’s benign natural history on his report that 69% of recent and 82% of non-recent onset patients were still experiencing back pain one year later (146). He later published that 33% of those contacted one year after their low back pain onset were still experiencing back pain with at least moderate intensity, 15% were still having severe back pain, and 25% continue to report substantial activity limitations (147).

In 1998, Croft et al. reported the results of interviews with 490 low back pain patients 3, 6, and 12 months after seeking care for their low back pain. (35) His results were similar to von Korff’s. Only 21% had completely recovered at 3 months. Interestingly however, just as in the 1996 Dillane study, 90% had stopped consulting with their doctors by three months, further discrediting care seeking as a surrogate for recovering. Even at 12 months, 75% of those surveyed indicated they were still not fully functional or without symptoms. A number of other studies also challenge the overly optimistic view of low back pain’s natural history. (26, 113, 142)

These data would seem to be a more accurate reflection of these patients natural history and also clearly portray a far less benign natural history than what guidelines continue to report.

Recoveries Followed by Recurrences Are Common: The second important characteristic of low back pain, and where there’s little controversy, is that it commonly recurs in the form of episodes; as many as 75% who experience their 1st episode of low back pain have a recurrence. (77, 119, 142) 
Croft: “the message from the figures is that, in any one year, recurrences, exacerbations, and persistence dominate the experience of low back pain in the community.” (35) 
Both Croft and van Korff’s data indicates that recurrent episodes often progressively worsen. (35, 147)

Waxman et al. conducted a three-year population based survey concluding that recurrent low back pain is “a mutable (variable) problem with acute episodes blending into longer periods resulting in more disability as time progresses.” (153) “Most persistent disabling back pain is preceded by episodes that, although they may resolve completely, may also increase in severity and duration overtime.”

Family physicians do notice this trend as well. A survey indicated there was nearly universal agreement as to the high rate of recurrences that commonly worsen overtime. (54)

Possible Contributing Factors To Spinal Pain

Sedentary or Inactive Lifestyles Lead to Spinal Stiffness: 
Experimental studies indicate that fixated (immobilized) joints eventually show signs of microscopic adhesions that limit flexibility and extensibility of the tissues. These fibrotic (scar) changes occur in the absence of trauma/injury. These changes result in a related loss of water (dehydration) necessary to lubricate the tissues. Furthermore, because movement affects the orientation of regular ongoing collagen synthesis, the collagen in the immobilized joints was found to be laid down in a more haphazard “Haystack” arrangement (non-conducive to movement). This orientation restricts tissue (and joint) mobility further by adhering to existing collagen fibers. (Maxey; Magnusson, Rehabilitation 2001, p 5)

Annotation: Although these studies are based on fixating joints, it’s reasonable to deduce, that over time, people who are more sedentary or do not regularly stretch or move the spine and maintain an active lifestyle will be prone to similar loss of joint mobility.

Spinal Stiffness & Degeneration Are Common Age Related Problems

It has been documented that the human spine shows signs of degeneration as early as four years old. This degeneration process continues in a linear pattern with varying degrees of severity, until death. It has been maintained that by age 30, there is no lumbar disc that does not show age related degenerative changes. (Ombregt, Bisschop & Veer: A System of Orthopedic Medicine; p729)

The spine stiffens as we age (Grieve).

Age related degeneration is not only due to inactivity but also from microtrauma (normal wear & tear) and repair, many times coupled with episodic, excessive, cumulative & repetitive stress and overload injury. Connective tissues do not regenerate if damaged, but are replaced by inferior fibrous scar tissue. (Evans 1980; Hardy 1989). Scar tissue is less flexible. 

The Stiffening Process is Slow and Insidious 
(Commentary) It’s likely that as gradual degeneration occurs and build-up of scar tissue takes place, the joints gradually become stiffer and joint movement is gradually reduced (hypomobility); which is a form of joint dysfunction.

As the process advances, it may become more evident on x-ray in the form of degenerative changes; ligament calcification and thinning joint spaces. It also becomes more self evident as stiffness and achiness is experienced.

The literature clearly recognizes that degenerative arthritis is a non-inflammatory process and commonly a non-painful, age related process. For example, it’s not uncommon for an individual to experience a painful back or neck, see a doctor, have x-rays taken, and discover that they have moderate to advanced degenerative arthritic changes, but never had prior episodes of pain.

Although a non-inflammatory condition, the stiffness of the tissues probably predisposes one to strains and sprains, which does lead to inflammation and pain to varying degrees.

Muscle Response

In stiffened joints, receptors (nerves that sense movement) can cause both abnormal facilitation (tightness) and inhibition (relaxation/weakness) of muscles (Liebenson, page 19). Thus, stiffened joints can potentially create muscle imbalances, which can lead to inappropriate or abnormal muscle responses to movement. Commentary: When muscular imbalance and joint dysfunction take place, strains and sprains are probably more likely to occur.

Supplementing With Hands On Joint Movement Possibly a Key Component

A key dynamic to getting things moving again is the passive (hands-on) component of spinal joint mobilization.

This is evidenced by x-ray stress studies, whereby it is demonstrated that when actively moving the spine, as in stretching or normal movement, the hypomobile (stiff) segments do not move. Consequently, actively stretching may not ensure all segments are re-establishing movement.

Passive forms of joint movement (hands-on), augments the movement that active stretching fails to achieve, ensuring that the hypomobile (stiff) segments are encouraged to regain movement and joint nourishment.

Remobilization: After repeated mobilizations, these joints gradually return to some degree of normalcy. (Maxey; Magnusson) Rehabilitation 2001, p 5)

Avert Back Problem With Spinal Hygiene

By combining passive joint and soft tissue mobility work (hands on manual therapy), on regular intervals, as well as regular active spinal movement exercises, it may be possible to preserve & improve joint and soft tissue mobility. Thus, in theory, this reduces the chances for acute episodes of pain or injury. In a sense, it’s very similar to dental hygiene.

Your Involvement Is Necessary

Regular active spinal movement exercise, as well as improved postural and body mechanic behaviors, continue to be a necessary continuum for optimal spinal joint and soft tissue health to maintain gains from passive procedures and to reduce the effects of daily stress on the joints. A more active lifestyle is necessary as well. Remember, moderation is a key!

You’ll Be Pleasantly Pleased With The Results!

You will be pleasantly pleased with how much better you feel after passive joint movement has been performed, especially when you are just feeling a little achy and stiff!

Our tune-ups typically include 10 minutes of moist heat, passive manual therapy, including muscle work; so it’s  much like a mini-massage with the extra component of spinal joint mobilization. Typically, these visits are very relaxing and relieving of aches & stiffness. A real feel good experience that likely helps preserve and improve joint & soft tissue flexibility and mobility.

“An ounce of Prevention”

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