04.18.13

Chiropractic vs Drugs

Posted in Chiropractic, Manual Therapy Works, Pain Management, Truths About Back & Neck Pain at 12:08 PM by Dr. Greathouse

Organized medicine considers chiropractic as a “first-line” solution to the opioid epidemic.

Prominent among prescription drug related deaths and emergency department visits are opioid pain relievers (OPR), also known as narcotics or opioid analgesics, a class of drugs that includes Oxycodone, Methadone, and Hydrocodone, among others. OPR’s now account for more overdose deaths than heroin and cocaine combined!
DeBar et al. (2011) reports alarming recent data showing the significant increase in pain med prescription use and the need to seek viable alternatives.

In 2012, Dr. William Owens, a chiropractor from Buffalo, New York, was conferred as an adjunct associate clinical professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice. He was invited to participate in the research department, to consider a formal study showing the benefits of family practitioners comanaging cases with chiropractors.

Ciffuentes et al., 2011 showed that care provided by physical therapists or physician services was associated with higher disability recurrence than with chiropractic services. Additionally, those cases treated with chiropractic consistently tended to have lower severity, less pain med use and less surgery. Also, the cases were less costly and the patients experienced shorter initial periods of disability.

Other outcome studies show that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs was reduced by 37%.

Hey, for what it’s worth, this is pretty much par for the course! Chiropractic outcome studies have always been good. Of course, some chiros abuse the system and give us all a black eye, but, for the most part we do well in managing acute, subacute and chronic spinal problems as well as extremity problems too, like shoulders and knees etc.
Got a back or neck problem? I can probably help. Plus, I can probably teach you to help yourself! If I can’t help, I’ll send you to someone who can. I promise you that.

Chiropractic is a good place to start!

07.19.12

Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery?

Posted in Guidelines for Treatment, Injury, Truths About Back & Neck Pain at 2:23 PM by Dr. Greathouse

Commentary

What this abstract is telling us is that it’s probably best to wait a period of time before letting a physical therapist or a chiropractor  begin exercise or manual therapy on one’s neck after a motor vehicle accident! Too much too soon is bad. Additionally, if you’re not getting better after at least four weeks of care, something needs to change. That means different care or another opinion. I’ve done enough independent medical exams over the years to tell you that both disciplines (chiros and PT’s) can get a bit too over zealous in their attempts to make you better with too much too soon.

This review indicates not only does care too early delay your recovery it can lead to the development of chronic  pain and iatrogenic disability!  Iatrogenic means caused by the healthcare provider.

Typically  injuries are most painful for 3 to 10 days and will progressively lessen as inflammation reduces and repair begins. The PRICE Rule should be in effect at this time (Protect, Rest, Ice, Compress and elevate an extremity joint). Inflammatory cells and by-products, which are the source of chemically mediated pain, decrease significantly in numbers until the third week (Enwemeka 1989). Gradually, at the end of the acute inflammatory phase, functional range movements can begin.

Treating too long typically isn’t helpful either!

Treating over 8 to 12 weeks will not likely provide further remedial therapeutic benefit (won’t make you better). It may be palliative in nature (makes you feel good short term) but experts feel it leads to dependency on care. Kind of like the classical conditioning of  Pavlov’s dog, I hurt a little, therefore I need care. The goals of care should be to abolish/reduce pain, improve physical and functional capacity (as clinically indicated) and wean from care. Most long term therapeutic needs can be achieved with well prescribed exercises you can do at home. If you have exacerbations, then you return to care, but not on a regular basis after the natural history of healing.

For more info on soft tissue healing and management go to http://www.greathousechiropractic.com/physical_therapy__rehabilitation

Feel free to call me with questions: 725-6314

Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery?

Pierre Côté , DC, PhD , * and Sophie Soklaridis , PhD †

Study Design. Narrative review of the literature and commentary.

Objective. To discuss from an epidemiological and sociological

perspective whether the early clinical management of whiplashassociated

disorders can lead to iatrogenic disability.

Summary of Background Data. There is a lack of evidence

supporting the effectiveness of early rehabilitation care for whiplashassociated

disorders.

Methods. We describe the epidemiological evidence on the

effectiveness of early rehabilitation on health outcomes for patients

with whiplash-associated disorders and analyze from a sociological

perspective how the medicalization of this condition may have

contributed to increasing its burden on disability.

Results. The evidence from randomized clinical trials suggests

that education, exercise, and mobilization are effective modalities

to treat whiplash-associated disorders. However, the evidence from

large population-based cohort studies and a pragmatic randomized

trial suggests that too much health care and rehabilitation too early

after the injury can be associated with delayed recovery and the

development of chronic pain and disability. These fi ndings suggest

that clinicians may be inadvertently contributing to the development

of iatrogenic disability. The epidemiological evidence is supported

by the sociological concepts of medicalization, iatrogenesis, and

moral hazard.

Conclusion. The current evidence suggests that too much health

care too early after the injury is associated with delayed recovery.

Clinicians need to be educated about the risk of iatrogenic disability.

Key words: whiplash-associated disorders , rehabilitation , prognosis ,

iatrogenesis , chronic pain , disability . Spine 2011 ; 36 : S275 – S279

06.27.12

Subluxation: Dogma or Science?

Posted in Chiropractic, Truths About Back & Neck Pain at 11:27 AM by Dr. Greathouse

,

Link below:

http://chiromt.com/content/13/1/17

A little known fact about the chiropractic profession is the inner turmoil regarding the term “subluxation”. A subluxation is a slight malposition of the bones of a joint. Chiropractic coined the term, in it’s inception, to mean a spinal joint is out of alignment. With the subluxation came the premise that when the vertebra is subluxated it would naturally impinge on the nerve or nerves associated with that particular segment of the spine. Not only could this subluxation cause pain because of the malposition but because of the spinal nerve impingement it could also affect the health of the tissues and organs that the nerves go to. Pretty simple premise really, easy to understand and it makes some sense, after all the central nervous system is involved in bodily function. However, there’s a little glitch that science just won’t turn a blind eye to, and that is we simply cannot demonstrate that the darn thing exists. Yeah, the chiropractor feels around and finds a tender spot and cracks the spine and it sounds and feels like the darn thing was reset and it feels better too! But when we try to reproduce this assessment and treatment process, chiropractors are not in agreement as to what segment is out of alignment, what direction it’s out and when we actually manipulate we are never consistent with what we are trying to move, in other words we “adjust” different segments in error more consistently than the segment we are trying to adjust. Bear in mind that the outcomes remain about the same but we can’t prove it’s because the vertebra is out and we reset it or correct it. So, what’s a mother to do? We love our child the subluxation so we must continue to embrace it? At least 45% of chiropractors do embrace the premise fervently and others as well, to some degree, and then again a few reject it all together.

As for me, I think , perhaps, it’s ok to inform people that anecdotally we see some patients with problems other than back an neck pain or headaches improve with spinal manipulation but that the science to support it just isn’t there yet. This allows one (consumer/patient) to make an informed choice about what they are about to pay for.

Meanwhile, back on the farm as the debate continues, the rest of the healthcare world scratches and shakes it’s head… and moves on; without chiropractic I might add.


06.12.12

Low Back Pain – Manual Therapy Cost Effective

Posted in Chiropractic, Manual Therapy Works, Truths About Back & Neck Pain at 8:40 AM by Dr. Greathouse

“Evidence to date indicates that guideline-endorsed treatments such as interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP are cost-effective.”  Therapeutic exercise in conjunction with manual therapy or more specific “directional preference exercise”, as with McKenzie, has proven very effective for good outcomes and and cost effectiveness (when managed ethically).

For the entire article see this link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176706/?tool=pmcentrez

09.06.11

Attorneys as Back Pain Doctors?

Posted in Truths About Back & Neck Pain, Uncategorized at 10:36 AM by Dr. Greathouse

Attorneys as back pain doctors…

Yes! At least they would get to the bottom of things. I’m sure you’ve all heard on TV “Your honor, I object! That’s irrelevant.”  The same holds true for back and neck problems, especially now with MRI, which identifies all kinds of abnormalities, few of which are the cause of or relevant to the painful experience the patient is suffering from. Many patients are labeled with surrogate diagnoses followed by treatment that results in wasted time and money.

Evidence based research & study is now bringing to light the fact that we are failing miserably when it comes to treating benign back and neck problems; which, by-the-way, accounts for 80 to 90% of all back & neck problems. Unfortunately there’s nobody to object to or to sustain/overrule whether the findings are relevant or not. This is kind of like the fox in the henhouse, so to speak, in some situations.

Subsequently, cost has sky rocketed and outcomes and disability are actually worse. We keep coming up with bigger and better ways to diagnose and treat but we’re not getting better! Attorneys would at least determine what’s relevant and what’s not before further addressing the problem.

Probably the biggest issue with spine pain is the disc herniation; likely the scariest and most worrisome of findings. While in fact, it’s very common and not relevant in most cases. Studies are now revealing we commonly have degenerative disc disease, degenerative arthritis and disc herniations but don’t have back pain or leg pain.

See my website for some answers on disc herniations.

http://greathousechiropractic.com/home

07.27.11

Is Chiropractic Care Essential to Child’s Spinal Development?

Posted in Back Facts (spine), Chiropractic, Spinal Hygiene, Truths About Back & Neck Pain at 12:22 PM by Dr. Greathouse

Growing Up Right

Why Chiropractic care is essential to your child’s spinal development.

See article: http://toyourhealth.com/mpacms/tyh/article.php?id=1450

Is chiropractic really essential to spinal development? Of course the answer is unequivocally no. I can say that without reservation because there’s no data to support such a statement. As far as aligning the spine goes, well, we can’t support that statement either.

This is the kind of stuff that chafes my tuchus. Don’t get me wrong, there’s some good stuff in this article. Kids can benefit from chiropractic care just as adults do and we can educate on the importance of good posture, body mechanics and ergonomics.  But don’t promulgate such innuendo as; chiropractic care is essential to your child’s spinal development.

If your child complains of back or neck pain a chiropractor is qualified to assess, differentially diagnose and treat them. Some chiropractors will go a step further and tell you they can treat other ailments other than musculoskeletal problems and there is some anecdotal evidence of that. That’s OK as long as you are made aware of the anecdotal level of evidence and you are still willing to try it.

Most pediatricians will not recommend chiropractic care, likely because they have no clue as to what we do. What they likely do hear from their patient’s parents is all sorts of healing claims and of course that doesn’t sit well with them either. Chiropractors can help a lot of folks out there but the MD gets too much hyperbole feedback from their patients about chiropractic care claims and simply writes us off much of the time.

For good spinal health and development, in my opinion, children must be taught good spinal hygiene (mobility maintenance – posture – body mechanics – ergonomics) early on, just like dental hygiene training.

03.13.11

A Physical Therapist’s View of Back Care

Posted in Truths About Back & Neck Pain at 11:55 AM by Dr. Greathouse


"The health care system is collapsing.  Eventually (and it's already
happening), people will not be able to afford a gazillion non productive
visits and insurance companies WON'T pay for it."

The above excerpt comes from a physical therapy discussion board and gives you some insight to the turmoil that
that goes on within. The therapists on this board are primarily made up of outcome oriented therapists. They
commonly lament about lack of specificity, over utilization (too many visits) and poor outcomes associated with
many physical therapists and their methods. 

Physical therapists aren't the only healthcare providers who are guilty of these transgressions. Chiropractors
are arguably much worse, at least from my perspective. Surgeons, as well, must face the music.

Meanwhile, healthcare consumers are still faced with finding providers who are goal and outcome oriented, offering
clinically indicated services with known outcome expectations.

01.25.11

Beware of Back Pain Red Herrings

Posted in Truths About Back & Neck Pain at 1:08 PM by Dr. Greathouse

A “red herring” is an inaccurate clue or finding which distracts from the issue in question; in this case what’s causing the spinal problem.

Probably the smelliest of the red herrings is the disc herniation found on an MRI; which can lead to a nonproductive surgical procedure. Most experts agree, you must exhaust conservative care first before surgery in most cases. The success rate for nonsurgical procedures is high.

Studies indicate that a relatively high percentage of the population has a disc herniation without symptoms.  (Weisel S. W..  A study of computer assisted tomography: the incidence of positive CAT scans and asymptomatic groups, Spine Journal 1984; 9; 549-51)

90% of disc herniation suffers get better with conservative care (nonsurgical), as indicated by Ian McNabb M.D., an expert in back care and research.

12.08.10

Truths About Back & Neck Pain Part One

Posted in Truths About Back & Neck Pain at 9:23 PM by Dr. Greathouse

This is an introspective look at an age-old problem.
I have nothing but empathy for back pain sufferers because they are faced with an impossible decision process on what to do about their pain in a world of indefinite opinions by a multitude of health care providers (HCP) that rarely agree on a diagnosis or a treatment approach; even among same specialties. The last time I counted there were at least 22 specialties that addressed back pain.
Back pain is truly a diagnostic conundrum. Regardless of what diagnosis your doctor or therapist gives you, it’s likely not supported in the literature. It may make sense and you may even agree with it because it seems so sensible, but the truth is, 85% of all back pain has no specific diagnosis and is categorized as “non-specific” by all health care guidelines. This is not a diagnosis!
Gunnar Andersson states…  “Our treatment success rate can be no better than our diagnostic success rate.”  Gunnar Andersson, MD, PhD, Chairman, Department of Orthopaedic Surgery, Rush University Medical Center
An inaccurate diagnosis poses a big problem! Without an accurate diagnosis the prescribed treatment cannot be accurate either, thus leading to poor outcomes. The back pain sufferer unwittingly rolls the dice in high hopes that the recommended doctor or clinician will make them better. When treatment doesn’t help, ongoing doctor shopping commonly ensues, resulting in a great deal of lost time and money, not to mention the suffering in some cases.
For example, in spite of the fact that we can see arthritic changes, disc degeneration and even disc herniation on x-ray or MRI, doctors cannot reliably state that those findings are the cause of your symptoms. Chiropractors cannot find a vertebra out of place; much less put it back in place. Massage therapists can’t diagnose tight muscles as a cause and physical therapists cannot reliably prescribe exercises that will make you better. Of course, I don’t want to bore you with the entire list, but there are very few models of assessment and care that are valid and reliable.
The only way these theories can pass the muster is when specific criteria can be met, and to date (December 2010), very few qualify.
This is likely one reason why outcomes are actually worse today than in the past and cost continues to skyrocket ($90 billion in 2009 for low back pain)! Back pain is big business! One has to wonder whom the care is designed to benefit, the patient or the provider of care! This might be why providers are slow to embrace more valid & reliable methods of assessment and care.
Finding the answers has been my “Holy Grail” over the past 28 years of my career. I’ve spent over 450 post doctorate continuing education hours and countless hours online reading the literature, looking for the most valid & reliable methods and protocols to better assess and treat back pain. The best I’ve found thus far is the McKenzie method, AKA, Mechanical Diagnosis and Treatment (MDT) method. It’s unsurpassed by any other protocol available!
Let’s put things in some perspective. We know that certain forms of care do work. For example, manual therapy or manipulation or “adjustments” do work! Massage helps, physical therapy in all its forms sometimes helps. All of these forms of care work some of the time, but none of them work consistently all of the time. Science hasn’t determine when or why they work. So, these forms of care are really put forth in a global fashion; much like treating all chest pain with an antacid.
What has proven to work is subcategorization.  Most experts would agree that pain is produced either by inflammation (chemical) or mechanical means (abnormal stress on tissue), and both, in some circumstances. That might be why an anti-inflammatory helps a little, but, an adjustment or manipulation seems to help in addition to the anti-inflammatory medication.
The MDT method reliably identifies some specific mechanical subgroups (causes) of spine pain in the nonspecific group of pain sufferers. This is HUGE in the field of physical medicine because with that information we can more reliably address the 85% non-specific population and further break it down into subgroups that we know will more likely respond to mechanical forms of care, as well as those who might additionally benefit from ant-inflammatory care.
With this, two very important things happen: Ø First, once a specific mechanical fault can be reliably identified, outcomes improve dramatically.Ø Second, it identifies those who will not likely improve with mechanical means of care thus eliminating the ongoing trial & error care that we’ve grown accustom to, saving time & money.
Not only does MDT identify those who should respond to mechanical forms of care it also provides specific algorithmic means of treatment protocol to follow, which further eliminates trial & error physical medicine approaches to care.
Just remember, there’s a lot of hype out there among all disciplines (all healthcare providers). I’m offering an honest contemporary appraisal of your problem followed by a more specific treatment approach on my part with physical medicine procedures or a referral to the appropriate health care provider that best suits your needs.
Last but not least, if you or someone you know is considering spinal surgery for a disc problem please encourage them to consider this alternative. All avenues of conservative care should be exhausted before surgery. This method literally works wonders on disc problems in many cases.