Early Treatment for Whiplash Injuries

For many people, the term “whiplash” conjures up a fairly uncomfortable image: being rear-ended by another car and having your head suddenly snapped back and forth by the impact.

Despite innovations in automotive design, whiplash injuries have become increasingly frequent in the past 30 years. Symptoms of whiplash can include serious and lingering neck pain, back pain, headaches and dizziness; no single effective treatment has been identified to deal with this chronic, frustrating condition.

But help may be on the way. A recent study in the journal of Spine suggests that early, active treatment is most effective for managing whiplash symptoms. In the study, “active” treatment consisted of repetitive motion exercises performed at home (10 times every hour, beginning within 96 hours of injury); “standard” treatment involved home exercises performed only a few times each day, starting two weeks after injury.

Results showed that 38% of patients receiving immediate, active treatment reported “no pain” at six-month followup, compared to only 5% of patients receiving delayed standard treatment. The authors note that this type of active home treatment is an “ideal form of rehabilitation” because it expends only small resources within the health care system.

It’s time to whip whiplash! If you or someone you know is suffering from whiplash, schedule an appointment today with us at Laurel Regional Chiropractic.

Reference: Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. A comparison of two treatment protocols. Spine 2000: Vol. 25, No. 14, pp1782-87.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

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Study Reveals Chiropractic Is Better Than Physical Therapy and Allopathic Care for Work-Related Low Back Pain

We've treated many work accident patients here at Laurel Regional Chiropractic, and quite often the patients received inappropriate care from either the hospital, medical doctor, or the physical therapy clinic. Here is a new study that concludes chiropractic is better than physical therapy and medical doctor for work-related low back pain.

OBJECTIVES: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD: A total of 894 cases followed 1 year using workers' compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

CONCLUSIONS: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

Statistically, this means you are twice as likely to end up disabled if you got your care from a physical therapist, rather than from a chiropractor. You’re also 60% more likely to be disabled if you choose a medical doctor to manage your care.

Reference: Cifuentes M, Willetts J, Wasiak R. Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence. Journal of Occupational and Environmental Medicine 2011 (Mar 14).

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature.

In my practice here in Laurel, Maryland, patients are often amazed that we can find, just by palpating, the "painful spots". Trigger points are extremely sensitive spots in muscle bands that trigger painful responses and are characterized by heightened discomfort in the patient and a noticeable hardness to the doctor or therapist. Trigger points are not just tender nodules, but they affect the surrounding muscle and tissues. Trigger point therapy (TPT) involves the application of pressure to these painful, tender areas in order to relieve their pain and dysfunction as well as pain in other parts of the body. The patients will find that trigger point therapy in combination with other physiotherapy modalities and chiropractic manipulation often provides pain relief. Here is a study in support of manual-type therapies and some physiologic therapeutic modalities for trigger points.

OBJECTIVES: Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs) are important aspects of musculoskeletal medicine, including chiropractic. The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS and MTrPs.

METHODS: The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and databases for systematic reviews and clinical guidelines were searched. Separate searches were conducted for (1) manual palpation and algometry, (2) chiropractic and other manual therapies, and (3) other conservative and complementary/alternative therapies. Studies were screened for relevance and rated using the Oxford Scale and Scottish Intercollegiate Guidelines Network rating system.

RESULTS: A total of 112 articles were identified. Review of these articles resulted in the following recommendations regarding treatment: Moderately strong evidence supports manipulation and ischemic pressure for immediate pain relief at MTrPs, but only limited evidence exists for long-term pain relief at MTrPs. Evidence supports laser therapy (strong), transcutaneous electrical nerve stimulation, acupuncture, and magnet therapy (all moderate) for MTrPs and MPS, although the duration of relief varies among therapies. Limited evidence supports electrical muscle stimulation, high-voltage galvanic stimulation, interferential current, and frequency modulated neural stimulation in the treatment of MTrPs and MPS. Evidence is weak for ultrasound therapy.

CONCLUSIONS: Manual-type therapies and some physiologic therapeutic modalities have acceptable evidentiary support in the treatment of MPS and TrPs.

Source: http://www.ncbi.nlm.nih.gov/pubmed/19121461

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

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Spinal Manipulation Eliminates Need for Surgery in Many Lumbar Disc Herniation Cases

Canadian researchers compared the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH). One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.

Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts. The research team concluded that 60% of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.

Reference: McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. Oct 2010;33(8):576-584.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708