Category Archives: Chiropractic Research

Low Back Pain, Right Here! – Sacroiliac Joint Dysfunction

Many people suffer from Sacroiliac Joint Dysfunction even if they don’t know it by name. Most often people come in complaining of low back pain right along the belt line usually radiating to the glutes. They can usually point to the source of their pain and they point right to the S.I. joint. This is usually Sacroiliac Joint Dysfunction, and it can cause serious pain. It often affects pregnant women more easily than others because of the hormone-induced relaxation of the pelvis along with increased weight and low back stress.

It is usually caused by trauma such as lifting heavy items while bending and twisting at the same time. It can be exaggerated by the same motion such as loading a dishwasher or front loading clothes dryer, or even vacuuming. SI dysfunction will often produce a functional inequality in leg length (one leg appearing longer than the other). This pain is often one sided and also confused with sciatica. If you have S.I. Dysfunction it can produce pseudo sciatica. S.I. Dysfunction is the cause of about 25% of all low back pain.

What can you do if you have S.I. Dysfunction. Chiropractic is the treatment of choice having about a 75% success rate in research (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804708/). Stretching the hip flexors and gluteal regions can help relieve some of the pain. The best thing to do is to see a chiropractor to restore proper function to those joints. If you have low back pain there is a 1 in 4 chance that it is S.I. Dysfunction.

 

“Ugly giant bags of mostly water!”

This quote is from Star Trek the Next Generation. It is an alien life form describing humans and Hydrateis very apt. I don’t know about the ugly part, but we are mostly water. While estimates differ, our bodies are made up of 55-75% water. Water affects every aspect of our function. Many of us are not getting enough of it. Some experts feel that up to 75% of Americans are chronically dehydrated. While working out you can loose 6-10% through sweat, and everyone knows you need water when you exercise, but that is obvious and our body is demanding water at that point.

Chronic mild dehydration has unknown effects. We don’t know what it does to us to be a little dehydrated for years. We do know that as little as 1% dehydration can cause a 5% decrease in cognitive ability and physical performance. This is the first time that our body will start to feel thirsty. You should be drinking before you get thirsty. If you’re thirsty then you’re already having symptoms of dehydration. We also know how important water is for us. Here are some symptoms that you may not associate with dehydration.

Some Lesser known Symptoms of Dehydration:

  • Craving for sugar
  • Headaches
  • Bad breath
  • Irritability
  • Chronic Illness
  • Chronic Pain

Some lesser known benefits of drinking water are:

  • Weight loss
  • Increased cognitive ability
  • Increased physical ability
  • Clearer skin
  • Decreased joint and muscle pain
  • Improved immune system

The next time you get the munchies, or a headache, or feel a little out of control or tired, try a glass of water.

The Effects of Drinking Soda on Your Health

Thanks to Dr. Gray for turning me on to this topic.  Let me start this post by saying that I drink soda.  I drink it about 6 times a year.  When I was in high school I ran cross country.  I also drank Mountain Dew as often as I could.  One season I noticed difficulty breathing and decreased energy when I drank soda, so I stopped.  I never really picked it back up.  I still drink it occasionally, but I do not buy it.  My wife puts it in punch for parties at times.  I felt better and ran better when I was not drinking soda.

Now as a health care provider I have a vested interest in topics like this for my patients sake I like to learn as much as possible.  After researching this topic I thought I’d pass on some facts to you.  The links may be dry but I like to back up my statements with research, and they have some good info.  So, here is soda in all it’s glory.

Drinking soda:

As a chiropractor my training includes nutrition and biochemistry.  Though I choose not to focus my practice on it, from time to time I do give nutritional counseling and supplement advice.  My advice for soda drinkers, quit!  It’s not a horrible thing on occasion, as I said, I myself will drink a soda from time to time.  Anything in excess is detrimental to your health.  For those of you who just can’t go a day without your soda.  Think about what that means.

If you want nutritional counseling many chiropractors offer it.  If you want to, you can even come and see me for it, I will likely refer you to a colleague who does that more exclusively, your health comes first, and I want you to get the best care/advice that you can get.  What I don’t want is your bones becoming weak and you falling and fracturing yourself or dying early due to diabetes complications.

Headaches – An Informative Post

There are many different types of headaches, but of all the people with headaches out there 90% of them have cervicogenic (tension) headaches.  These are headaches caused by a poorly functioning neck.  These are usually described as tightness, stiffness, or a pressure.

There are other kinds of headaches, migraines for example are periodic, severe, throbbing headaches that usually last more than a few hours, but less than a day.  They can make the sufferer sensitive to light and sound, and cause nausea even vomiting.  Migraines affect women more often than men.  Migraines are commonly heard of and talked about because of their severity, but are much more rare than cervicogenic headaches.

Billions of dollars are spent on headaches each year in the United States.  Headaches are a major cause of lost productivity and time off work.  One of the top reasons for seeking treatment, headaches are big money for drug companies, and big losses to businesses.

People can end up with a headache from stress, a car accident, whiplash, or any kind of trauma.  Headaches can occur a day or even weeks after the initial injury due to the cumulative nature of those kinds of injuries.  Many people think their headaches come on for no reason at all, but if they think back they will remember an accident, increased stress, playing to hard on the weekend, or something a few days ago.

Treatment for headaches traditionally has been over the counter analgesics and NSAIDS, and even stronger medications for more severe symptoms.  These medications can cause serious side effects, and recent studies indicate that we as a country may be over using these to the extent that thousands of people have serious complications every year from these relatively safe drugs.  Many times these pain medications do not work, and can even cause what is termed “analgesic rebound headaches.”

Chiropractic has a great success rate with treating headaches.  It has been found to be better at providing pain relief (with less side effects) and reducing frequency than medication.  Chiropractic addresses the root cause rather than just the symptoms.  When treating your headaches your chiropractor (which could be me if you’re in Utah) should be addressing 3 major things: First reducing the pain, second improving neck function overall, and third proper strengthening of the neck to reduce future risk of re-injury.  While chiropractic is particularly good at resolving cervicogenic headaches it has also been shown to be effective with some types of migraines, and other headaches.

If you are experiencing headaches, don’t reach for that Aspirin bottle.  Reach for the phone and contact your chiropractor.  You will receive better, safer relief, and have less chance of recurrence.

Is Chiropractic Safe?

This is a controversial question, though I’m not sure why. The short answer is, yes, it is safe. The easiest way to tell is to look at malpractice insurance premiums. Insurance companies don’t mess with risk. They charge an arm and a leg if they think you are a risk. Can anyone say preexisting condition? The average premiums for different professions will tell you who has risk of problems, and does not. Here let me show you some numbers (source):

Approximate Malpractice Insurance Premiums

OB/Gyn
$120,000
General Surgeon
$75,000
Internal Medicine
$20,000
Family Practice
$15,000
Chiropractors
$2000-4000

In fact through out many studies proper chiropractic treatment has not been shown to cause anything more than short term soreness at the site of treatment.

Now here’s where it gets controversial. And people may say, wait a minute studies have shown more than that. It’s true there have been rare serious problems seen after chiropractic treatments. The problem is that they are so rare that research has not been able to prove a causal link to chiropractic, or to rule it out. In fact the most recent and complete study showed that the biggest risk is no greater visiting a chiropractor than visiting a medical doctor (second source). These problems are so rare that it is nearly impossible to prove one way or the other.The big one that you’ll hear about is stroke, and the risk is estimated (due to lack of concrete evidence) to be somewhere between 1 in a million to 1 in 5 million. You can see how difficult it would be to do a study with 1 million chiropractic neck pain patients, let alone 5 million. In contrast, the mechanism of treatment seems like it could cause stroke in a predisposed patient, because in those predisposed people, simply turning your head to look at something could cause a stroke. Unfortunately there are no known tests to determine if a patient is at risk.

OK, so let’s put them out there. The possible risks of chiropractic treatment include, bruising, muscle strain, undefined soreness, headache, bone fracture, stroke. Now let’s put them in perspective. You are at least 5 times more likely to be killed by a freak asteroid falling on you than you are to have a stroke after seeing a chiropractor. Now how many people do you know that have been hit by asteroids? Bone fracture is another one of those rare things, and again will probably only happen when someone is predisposed. A person with osteoporosis, or suspected to possibly have osteoporosis, should not be adjusted with a full force method. This is why I usually leave this side effect out of the list when talking about proper chiropractic treatment. As for the headaches, soreness, and bruising, this kind of stuff will usually occur when a patient is unable to relax and the doctor uses a lot of force to get by that problem. It can occur in probably 30% of patients, because sometimes it is necessary to get the joint moving even knowing that the patient is unable to relax. This is something that should be discussed with the patient, and normally the soreness is less than 24 hours.

The last thing that I will say is that you should always bring negative effects to the attention of your chiropractor. Even if they are not caused by the doctor himself he should be aware of them, so that if they are serious he can take care of them or get you to an ER if needed. Some of the serious things to report are; intense pain, dizziness, vertigo, slurring of speech, vision changes, weakness, tingling, or numbness. They may be nothing, but you should let your doctor determine that.

Is Chiropractic Really Scientific?

The scientific method is the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.

With Chiropractic we recognize a problem when you come into our office in pain, we collect data through observation, taking a history, and testing. We then form a hypothesis and call it a differential diagnosis. We apply treatments that have either worked in the past for similar conditions or we suspect will work based upon our knowledge and understanding of the human body. If treatment does not provide results we acknowledge the lack of results and re-assess our hypothesis, and present additional treatments or referral.

The question implies an additional question; is chiropractic backed by solid evidence? This is a harder question. Only between 10-20% of all medical treatments are actually supported by solid evidence, according to Dr. David Sackett founder of the Oxford Center for Evidence-Based Medicine. This isn’t to say that only 2 in 10 people get evidence based care. There are thousands of treatments out there, and only a hundred or so are commonly used. Dr. Sackett guessed that, more than 20%of all treatments rendered were based on evidence. But he was unable to say how much more.

A recent study on the same topic found:

“…When compared to the many other studies of similar design that have evaluated the extent to which different medical specialties are evidence based, chiropractic practice was found to have the highest proportion of care (68.3%) supported by good-quality experimental evidence.” (source)

Chiropractic is relatively new on the scene as an organized profession, and has had to battle it’s way into the mainstream. As a consequence of this, more studies have been done on chiropractic treatments than many of the common medical treatments for the same conditions.

“There are considerably more randomized controlled trials which show benefit of Chiropractic than there are for many, many other things which physicians and neurosurgeons do all the time.”—Paul G. Shekelle, M.D., M.P.H., of the RAND Corporation, interviewed on ABC’s 20/20

So… by this evidence, chiropractic could be considered to be the most scientific health care profession.

What Does Chiropractic Adjustment Do?

This is a common question to chiropractors.  Chiropractic manipulation is not just joint popping. In fact the audible pop doesn’t even need to occur for a successful adjustment, though it often does, and some patients and doctors like to hear it. Research has found that “pop” or not, the same benefits are experienced.

The mechanism of why manipulation works is not fully understood. One thing that is understood is that it does work. Most of the simple explanations are incomplete or just plain wrong. The most recent research points to a more complex reason for the therapeutic effects of chiropractic manipulation. Many things are occurring at the same time that provide the benefits. There are some known things that can begin to explain why manipulation works. Here they are presented in no particular order.

1. Manipulation can reduce pressure on the nerves. Your nervous system is the control center of your body, and it is not without weaknesses.  Nerves and nerve bundles are soft tissue.  They don’t function well under physical pressure.  In fact it has been shown that inflammation, a bulging disc, or fragment floating around can interfere with proper nerve conduction.  The stuck joint as discussed previously can also physically be stuck pressing on a nerve, or could be causing inflammation that is pressing on the nerve, or could just be moving in a way that rubs the nerve.  In any case.  The adjustment can cause a relief of this pressure. through movement of the joint to the correct position, or motion.

2. Proprioceptive stimulation triggers the release of endorphins. These endorphins cause a near instant and temporary relief similar to pain medication making you less aware of the problem. This “trick” of the body can cause a secondary benefit, that of relaxing local tissues such as trigger points or tight musculature that may be “pinching” nerves.

Image by: Luis Solis

3. Manipulation provides improved nutrient supply. The cartilage and other structures inside of a joint have no blood supply. These structures get their nutrients through motion. The blood supply goes to the outside of the joint and nutrients move into the synovial fluid of the joint. Joint motion moves this fluid around thus providing fresh nutrients to all parts of the joint. If a joint becomes “locked down” by muscle spasm, scar tissue, a cast, or any other means for a prolonged period of time the joint begins to feel stiff. You know the feeling of needing to stretch after sitting in the car for a long time.

The facet joints in your spine are particularly vulnerable to this problem because they work in tandem and because of the body’s amazing ability to compensate. Your facet joints all work together, if one is injured it can become locked down to prevent further injury. When this happens you may get the desire to stretch or move your back. This usually works, but if all of the other joints compensate for the problem joint and take that added stress of movement on themselves then the problem joint stays locked down. Specific manipulation induces full range of motion and synovial fluid movement.

4. Neuromuscular retraining.  The brain also records these proprioceptive signals from the joints motion. Especially for chronic conditions the brain is in need of retraining regarding the motion of that joint. Manipulation takes a joint through its full range of motion. This new input is then stored and replayed in the brain, similar to muscle retraining that physical therapists will do, or physical training of athletes, when the body has done the motion enough times it “remembers” it.This retraining provides a functional correction that may provide pain relief.

Many other benefits have been observed, and still others suspected.Research is still going on and much more is needed.

Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is in the category of less common diseases that you may not know that your chiropractor can treat.  Don’t worry, you probably don’t have it.  Recently the topic came up and I promised to create a post to provide some basic information on the topic of AS.

AS RibbonFirst let me cover what it is.  AS is an inflammatory disease and can be classified as a type of arthritis.  It causes pain in joints and bones, particularly in the spine with the most common complaint being the low back.  In the most severe cases it can cause bones to fuse together.  It is much less common than your typical  osteoarthritis and is also harder to diagnose because of the similarity of its symptoms to so many other conditions.  When you walk into a doctor’s office complaining of low back pain, they won’t jump to the conclusion that you have AS.

Your chiropractor can diagnose AS using a combination of your health and family history, blood tests and radiologic tests, but they won’t usually go hunting for this condition.  It is more often found after other things are ruled out or discovered incidentally with X-rays for other conditions.  This is a sexist disease usually affecting men, but that doesn’t mean that women can’t have it.  AS is also not an illness that comes on late in life.  It usually makes its self known before the age of 35.  The cause of AS is unknown still, but is likely genetic, meaning that it runs in families.  As with most diseases whose causes are unknown there is no known cure yet.  There are however treatments.

Most medical treatments for AS focus on management of pain and symptoms, but there are some medications that have been found to slow the progress of the disease.  Your chiropractor should be able to help you manage or reduce your symptoms as well as slow down the progression of the disease without medication.  As always he should also keep in close contact with your other providers that may be treating you, most likely your  rheumatologist, and together they should come up with a plan of action specific to you.

Image by Cienpies Design http://www.cienpies.net

Image by Cienpies Design http://www.cienpies.net

The treatment with the best results for AS is improving your range of motion and flexibility with exercise, diet, and joint mobilization.  You can do much of it on your own at home with guidance from your provider.  Your chiropractor should already be using these tools to treat any low back pain, but they will be even more important if you have AS.  Your chiropractor may or may not adjust your spine depending on your condition, but managing your care does not require manipulation if you don’t want it.

In the past some practitioners would recommend not seeing a chiropractor for AS because possible risks were unknown.  No studies have found increased risk to people with AS when treated with chiropractic manipulation, and recent research indicated benefits even at the late stages of the disease.  While most of the research is focused on finding a cure to AS here’s a link to an excellent case study of improvement with chiropractic management of AS.

Scientific Studies Interpreted

JMPT

Journal of Manipulative and Physiological Therapeutics

Since the dawn of modern science answers to life’s questions have been sought through studies.  I highly recommend research and physicians using research to the advantage of their patients.  I encourage patients to stay informed through reading research.  In life, online, and even the media you hear things like, “oh it’s true, they’ve done studies.”  I’m not sure who “they” are and whatever study is being referred to probably didn’t mean what you thought it did.

ACA

American Chiropractic Association

Chiropractic, for good or bad, has been forced into research by the well-meaning movement of evidence based medicine.  This movement, as with most things, falls short when strictly applied to every scenario.  There are always too many exceptions.  One of the most well-known, and a great read, is a farcical review article discussing, “parachute use to prevent death and major trauma related to gravitational challenge.”  This article was actually published in the British Medical Journal in 2003.  It inferred that because there was no research studies to show the efficacy of parachute use that their use should be discontinued as a preventative health care measure.

ICL

Index to Chiropractic Literature

The truth is that most studies are either to vague or to specific or too something to be applied directly in real life situations.  They all have flaws and weaknesses.  Even the gold standard Double Blind Randomized Controlled Trial is not perfect.  Most of the good studies admit and disclose their bias so that readers can take that into consideration when determining usefulness.  If you don’t understand research bias don’t worry there are entire college courses dedicated to the topic, if you want to learn more you can begin here  Google results: research bias.

To make things simple for you, there is no perfect study because people are not perfect.   This principle becomes utterly clear in online debates that usually end in name calling and any truth lost to both parties.

Chiro.org

The Chiropractic Resource Organization

I often cite research on my blog, and sometimes people agree and sometimes they disagree with the research.  You are welcome to do so.  I highly recommend reading research for truth.  The best RCT can be useless and the anectdotal single case study may hold the answer to the problem you face.  Don’t discount evidence of any kind.  Read it for truth and accept the research for what it is, one possible view of a whole situation.

Menier’s Disease: New Research

Patients doing their own research on conditions occationally bring me something that they find interesting to get my opinion.  This recently happened with an article on MÉNIÈRE’S DISEASE AND JOINT INJURY.  The full title is “The Potential Role of Joint Injury and Eustachian Tube Dysfunction in the Genesis of Secondary Ménière’s DiseaseI thought I’d just share that review with you.

Meniere’s Disease is a disorder of the inner ear causing many different symptoms from vertigo to ringing in the ears to hearing loss.  The article really seems to be just an idea that the authors have been pondering and sought to find evidence to back up their idea.  Not very scientific in my opinion.  What they’ve really done is see if there is any validity to their hypothesis so that they can do further studies.

The ear has 3 sections, inner, middle, and outer.  The inner ear is sealed off and in your skull and is what does all of the work you might associate with the ear, hearing and balance.  The middle ear is simply a cavity with facilities to allow the outer ear to “talk” to the inner ear and is drained by the eustachian tube into the back of your throat.  The middle ear is usually where ear “infections” occur.  The eustation tube becomes blocked and can’t drain the middle ear so fluid builds up or an infection may grow.  If this occurs frequently, medical doctors sometimes, (instead of fixing the tube that your body has) insert additional tubes that drain to your outer ear.

The bones in your neck join the skull right behind your ear.  If you put your finger right there you feel a soft spot between the bump of your skull your jaw and your ear.  Those are the joints that the article talks about, the upper cervical spine and the TMJ.  The close proximity has always caused people to justify a relationship between those joints and the ear. Neurologically there has been no direct connection found that I’m aware of. These authors are proposing an indirect nerve connection in order to explain why TMJ or neck injuries can lead to Menier’s disease. 

From a chiropractic perspective their hypothesis also implies the reverse, that patients with Menier’s Disease might benefit from chiropractic management.  To be determined…