THE HUMAN BODY has more than 600 muscles & joints and is designed to MOVE!
Chiropractic Care restores MOVEMENT to maintain FUNCTIONAL BALANCE.
What is Chiropractic?
Chiropractic is a Greek term meaning "Treatment by Hand". It is a branch of health care specializing in the correction of biomechanical disorders of the spinal column and peripheral joint system. Chiropractors have long recognized the importance of a wellness focus (considering the role of the mind, body & spirit) when dealing with health care.
Chiropractic care is not an alternative to traditional medical care but a complement to it. It is the aim of chiropractic care to work together with other health professionals in a multi-disciplinary fashion to the benefit of the patient. Chiropractic care is considered drugless and conservative.
The explanation of chiropractic care as putting bones back into place to remove nerve interference is no longer valid or acceptable. The description of chiropractic care is now one of:
Correcting biomechanical dysfunction in the joints (joint restriction / dysfunction) and soft tissues with spinal manipulation and soft tissue therapies (trigger points, massage, stretches).
Utilizing physical therapy modalities (electrical current, ice, heat) to promote healing, reduce inflammation and to relax splinting of muscle
Giving rehabilitative exercises (flexibility, strength, endurance), to assist in injury recovery and prevent re-occurrence of injuries and symptoms.
Educating patients on the nature of the injury, posture, exercise, lifestyle, and prevention.
If your examination revealed areas of your spine that are malfunctioning, this can often result in nervous system compromise, impairment to the muscles that support the spine, damage to soft tissues of the spine, and sets in motion a degenerative process. Researchers refer to this five-part problem as the Vertebral
What To Expect & Rehabilitation
The major objective in the first visit is,
by a thorough history (using various questionnaires, diagrams, and direct one to one history taking),
and examination (using appropriate orthopedic and neurological exams, imaging as necessary (x-ray's, etc),
and specialized chiropractic analysis (assessing function of joints, the relationship between sites of muscle and joint dysfunction and pain; referred pain, postural effects, compensation reactions),
to render an accurate diagnosis so that it may be determined if chiropractic treatment will benefit the patient.
Once a diagnosis is established a specific and appropriate treatment program is initiated or the patient is referred to the appropriate health care provider (medical doctor, specialist (orthopedist, rheumatologist, etc., massage therapist, physiotherapist)) who may best serve their condition.
Possible treatment situations:
Uncomplicated Acute Pain is less than 3 weeks duration, with no significant trauma. The patient exhibits progressive recovery from an injury at a rate greater than or equal to the expectation from the natural history (4-8 weeks).
Complicated Acute and Chronic Pain is more than 3-6 weeks in duration, and has significant trauma. The patients exhibits regression or delayed recovery in comparison with expectations from the natural history. Complicating factors are: pain for more than 8 days prior to treatment, severe pain, 4 or more previous episodes of pain, underlying structural changes re-injury during the course of treatment.
Supportive Care / Elective Care- Supportive care is therapeutically necessary care for patients who despite rehabilitative exercises and other lifestyle modifications, fail to sustain therapeutic gains (relief from pain) after treatment withdrawal. Reasons may include ongoing stress at work and activities of daily living.
Elective Care is at the option of the patient who wishes to maintain optimum function with preventive/maintenance care. Some patients, for example, wish to have functional pathology (joint fixation / restriction) treated before pain and disability develop.
Treatment
SPINAL & PERIPHERAL MANIPULATION is the primary form of treatment in chiropractic care. Manipulation is necessary to restore proper motion to joint ligaments and assist them in attaining normal joint movement. Manipulation involves a fast (high velocity) short (low amplitude) thrust, directed at the joint, and generally is followed by a "pop", which is gas (CO2) releasing from the joint. The effect of the adjustment is to increase the space in the joint and effectively lengthen the ligaments that hold the bones together. The adjustment is considered very safe and proven very effective for conditions of low back pain, neck pain and headaches.
JOINT MOBILIZATION involves placing tension on the joint ligaments. The mobilization is more aggressive than a stretch and the position is repeated. Mobilization is designed to reduce ligament tightness, adhesions and thus injury.
ELECTRICAL STIMULATION is a proven therapeutic treatment for the relief of pain and the promotion of soft tissue healing. Electrical impulses are passed into the soft tissues in the area of the injury, which promotes the release of endorphins and natural painkillers to help relieve pain. The electrical gradient created also promotes soft tissue healing so the injury heals faster.
HOME EXERCISE therapy is a set of balanced exercise designed to improve levels of fitness by promoting flexibility, strength, and cardiovascular fitness. Home exercise will speed the rate of recovery and improve fitness thus, preventing re-occurrences of injuries and help keep your body healthy in the long run.
Stretches - involves lengthening muscles to improve flexibility. Since most injuries, involve both muscles and ligaments, stretching is important to assist in restoring soft tissue health and integrity.
Strengthening - stabilizes the spine and extremities to provide better balance and better support for the joints.
Cardiovascular Fitness - endurance exercises increase blood flow to the soft tissue and promote healing.
CYROTHERAPY THERAPY / ICE therapy constricts blood vessels, numbs painful areas and relaxes muscle spasms. Ice is used for acute (recent) injuries or eruptions of chronic injuries.
Diagnostics
LOWER BACK PAIN
80% of people will be disabled by low back pain during their adult lives.
It is the third most frequent reason (after respiratory disorder and headache) that people consult a health practitioner.
The World Health Organization describes disability from low back pain as epidemic.
50-60% of workers’ compensation cost is from back pain.
The British Medical Research Council Trial by Meade et al, published in the British Medical Journal in June 1990 with long term follow up results published in August 1995.
This was an independent study and subsequently endorsed by the British Medical Association.
It is well-designed, large, and compared chiropractic with medical/physiotherapy hospital out patient practice.
The study showed excellent short and long-term results for chiropractic patients, for patients with both acute and chronic pain, for patients with moderate or severe pain.
Researchers expressly argued for greater use of and government funding for chiropractic services because of superior effectiveness and cost-effectiveness.
The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-back Pain, Manga et al, a government commissioned report published in 1993 by health economists from the University of Ottawa. Manga et al looked at all the international evidence, from hard science to workers’ compensation and other economic data, and concluded: “In our view, the constellation of evidence of:
The effectiveness and cost-effectiveness of chiropractic management of low-back pain.
The untested, questionable or harmful nature of many current medical therapies.
The economic efficiency of chiropractic care for low-back pain compared with medical care.
The safety of chiropractic care.
The higher satisfaction levels expressed by patients of chiropractors.
The U.S. and UK government sponsored multi-disciplinary Guidelines for management of Low Back Pain, December 1994.
These review the controlled trial evidence and recommend:
Spinal manipulation and over-the-counter medication (Acetaminophen, Ibuprofen) for most patients with acute low back pain.
Patients should be encouraged to remain active and be given appropriate education in posture and exercises.
Not to rest or ‘wait and see’.
NECK PAIN
Neck pain is a common musculoskeletal complaint and often is the result of repetitive strain injuries (as found with assembly workers or computer operators) and motor vehicle accidents (whiplash) or trauma.
There is now a clear movement in health care towards early active treatment including spinal manipulation, mobilization, stretching, exercise and early return to work / activity and medical and chiropractic specialists warn against passive management and counsel against extended rest and dependency on drugs and stress that the primary goal is the recovery of function.
Quebec Task Force Report. Redefining Whiplash and its Management, May 1995, which is an evidence-based guideline on management from an international interdisciplinary panel. The main issues regarding the management of neck pain are:
The same principles apply as in the management of low back pain.
The Report supports the safety and effectiveness of cervical manipulation in treating neck pain.
It is the Task Force consensus that the use of short term spinal manipulation and mobilization by trained persons, the use of non-steroidal anti-inflammatory (NSAIDs) and analgesics, and active exercises are the most helpful and appropriate in treating uncomplicated neck pain.
The Task Force further recommends that prolonged use of soft collars, rest or inactivity probably prolong disability.
The Task Force finds that scientifically unproven therapies include cervical pillows, postural alignment training, acupuncture, spray and stretch, electrical stimulation, ultrasound, laser, short wave diathermy, heat, ice, massage, epidural or intrathecal
Early Mobilization of Acute Whiplash Injuries. Mealy, et al in the British Medical Journal, 1986. This is a randomized study, which followed patients with acute soft tissue whiplash injuries:
There were two groups:
Given the standard treatment of rest and initial immobilization with a soft cervical collar.
Given “active treatment” of ice in the first 24 hours and then appropriate manipulative techniques and daily exercises. The researchers found that the patients receiving the early active treatment (#2) had a statistically significant increase in cervical spine movement but not those given the standard treatment (#1) and group #2 had a significant decrease in pain and they concluded that early active management was preferred.
The immediate Effect of Manipulation versus Mobilization on Pain and Range of Motion in the Cervical Spine: A Randomized Controlled Trial, Journal of manipulative and Physiological Therapeutics, Cassidy, Lopes, et al. Shows the spinal manipulation has better immediate effects than mobilization in terms of increased ranges of joint motion.
The Appropriateness of Manipulation and Mobilization of the Cervical Spine, (Research and Development) Corporation of California, July 1996. Rand is a non-profit private corporation, which conducts research and development for the US government and the private sector.
The RAND Report recommends:
Cervical manipulation and mobilization for neck and headaches.
Cervical manipulation is far safer than a number of medical treatments given for the same symptoms (mortality rate for cervical spine surgery is 6,900 per million, serious gastrointestinal events from NSAID’s are 1000 per 1 million)
HEADACHES
A comprehensive US study (1992) estimated that approximately 27 % of females and 14 % of males suffer from severe headaches and that over 10 million Americans (4%) suffered moderate to severe disability from various forms of headache.
A 1993 paper in the journal Headache calculated that headaches resulted in 74.2 million days of restricted work activity per annum in the US with an estimated cost of $1.4 billion dollars in lost productivity.
A 1992 Canadian study found that 14% of Canadians suffer from migraine headaches, and that 50% of these have significant disability – 36% suffer chronic tension headaches with an 18% disability and 14% suffer from both tension and migraine. It was calculated that over 7 million workdays per year were lost because of headaches.
From the point of view of the patient, given the high incidence of headaches, the issue is whether medical physicians or chiropractors should treat headache sufferers. There is a clear role for both.
Medical leaders acknowledge that there is still grave confusion in the diagnosis of headaches. It was only in 1988 that the International Headache Society recognized cervicogenic headache (headache as the result of pain radiating from the facet joints of the C2 and the C3 vertebrae) as a distinct entity and thus common forms of headache include primary types (benign – the headache pose no danger to the patient other than the headache itself); migraine, tension, cluster and cerviogenic and secondary types (those caused by underlying disease and pose a serious threat to the patient’s health) of which there are hundred’s of possible causes and include tumor (space occupying lesion) temporal arthritis, meningitis, acute glaucoma and subarachnoid hemorrhage.
There is a good body of research studying the cervical spine and headaches. Some studies include:
A Controlled Trial of Cervical Manipulation for Migraine, Australian, New Zealand journal of Medicine, Parker et al, 1978. One of the first clinical trials ever conducted on spinal manipulation and migraines.
Compared chiropractic manipulation, medical manipulation and mobilization by physical therapists. All groups of patients benefited from treatment, chiropractic patients benefited most on all measures (complete cure, frequency of attack, mean duration, mean disability, mean intensity of pain)- a follow-up study showed that the patients who improved maintained this benefit after 20 months.
The Efficacy of Cervical Adjustments (Toggle Recoil) for Chronic Headaches with Upper Cervical Subluxation, Whittingham, 1995.
Results after treatment and at 6 months follow-up, measured subjectively (Neck Disability Index, Sickness Impact Profile, pain drawings and daily headache diaries) and objectively (cervical range of motion, pressure algometry) showed a statistically significant improvement (decrease in chronic headache) in the patients treated with spinal manipulation but not in the control group patients.
Spinal Manipulation vs. Amitriptyline for the treatment of Chronic Tension-Type Headaches. JMPT, Boline, DC, Kassam, PhD et al, 1995.
Compared the effectiveness of spinal manipulation and medication (Amitriptyline) for the treatment of tension headaches.
Found that the patients in the spinal manipulation group showed a reduction of 42% in headache frequency, 32% in headache intensity and a 30% decrease in usage of over the counter medication and a 16% improvement in functional health status while the medication group showed an improvement of only 6% or less in all the outcome measures.
Subluxation Complex
Spinal Kinesiopathology is abnormal motion or position of spinal bones. Physical trauma such as improper lifting, car accidents, repetitive motions, and poor sleeping habits can cause spinal problems. Without proper alignment your spine can experience uneven wear and tear. Each spinal joint must move properly for optimum health.
Histopathology is abnormal soft tissue function. Discs, ligaments, and other soft tissues can malfunction, too. These important soft tissues have a poor blood supply, so proper healing often requires continued care even after the relief of obvious symptoms. Swelling and inflammation increases the damage to soft tissues.
Neuropathophysiology is abnormal nervous system function. Improper motion or position of spinal bones can irritate delicate nerves. This can impair the function of the tissues, organs, and systems controlled by these nerves. Nerves can become overexcited and hyperactive or choked and compressed. This can be experienced as numbness, tingling, or pain shooting down an arm or leg.
Myopathology is abnormal muscle function. Muscles supporting the spine can weaken and atrophy, or become tight and go into spasm. Unfortunately, scar tissue and adhesions penetrate these malfunctioning muscles, changing their elasticity. Muscles that support the spine can be damaged with scar tissue, and over-developed muscles on one side of your spine can cause individual spinal bones to twist and lose proper function. Fibrosis makes is difficult to retrain the muscle to support the spine properly.
Pathophysiology is abnormal function of the spine and body. The body responds with bone spurs and spinal decay, fusing malfunctioning spinal joints. Degenerative changes can be seen in other organs and tissues which have been deprived of normal nerve control.
Factors that may affect the injury include:
Degenerative Joint or Disc Disease - Arthritis, wear and tear on the bones and joints.
Muscle Imbalance / Weakness - the strength of the muscles.
Tight soft tissues - muscle adhesions, shortened ligaments.
Nerve Irritation - nerve irritation will cause symptoms such as numbness in the extremities, weakness, and loss of reflexes.
Structural Problems - such as fallen arches, scoliosis, poor posture, etc. may affect the injury.
Repetitive Strain - repeated movements and forces on the body can cause and influence injuries. (such as factory work, regular daily activities)
Family history - Family history of certain injuries may influence your present condition.
Occupation - jobs requiring prolonged sitting or standing, repetitive work, etc.