A herniated disc...a prolapsed disc...or a ruptured disc?

What's the difference between a herniated disc, a prolapsed disc, a ruptured disc, they all sound pretty scary, but guess what? There is virtually no agreement in the medical community as to the differences between the terms - their definitions are disputed all the time.

But what does the definition really matter? Isn’t it more important that we know there is pain? Isn’t that we know the cause of pain more important?

The fact is, different doctors will interpret MRIs and x-rays differently. A single film might lead to multiple diagnoses. The focus should be on getting the right kind of treatment for pain and helping restore function and ability, not splitting hairs with definitions. That’s why at Laurel Regional Chiropractic, we put the spotlight on your well-being.

The fact is, for back injuries and pain that are disc-related, doctors and surgeons will often prescribe surgery when it isn’t necessary or even recommended. It’s the last line of defense, not the first. At Laurel Regional Chiropractic, we take the non-surgical route by providing conservative treatments. Therapies like the mechanical traction, spinal manipulation, and physical rehabilitation can restore range of motion and improve muscle support. For everyone we see, we will create the right treatment plan for each individual patient.

If you have a herniated disc and are suffering, come in and see us. We’re here to help. Call us at 301-953-0256 for our office in Laurel, MD and make your appointment for a consultation.

David P. Chen, D.C.
Chiropractor in Laurel, MD

Upper Cervical Manipulation Combined with Mobilization for the Treatment of Atlantoaxial Osteoarthritis

This new case series, managed by the Department of Orthopedics, in the General Military Hospital of Beijing, China, involved 10 patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis. They were treated with upper cervical chiropractic adjusting, in combination with mobilization device therapy.

Outcome measures included self-reported pain using a numeric pain scale (NPS) (1-10, with 0 is no pain and 10 is the worst possible pain), physical examination findings, and radiologic changes.

The reported results were quite impressive:

Pre to post pain findings included a reduction of pain from 8.6 to 2.6.
Rotation of C1 upon C2 increased from 28° to 52°, effectively doubling upper cervical range of motion.
Restoration of joint space was observed in 6 patients.
Clinical improvement was rated as “good” to “excellent” by 80% of these patients.

Source: http://www.chiro.org/cases/ABSTRACTS/Upper_Cervical_Manipulation.shtml

David P. Chen, D.C.
Chiropractor in Laurel, MD 20708

60% of Surgical Candidates Avoid Surgery with Chiropractic

Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients”

It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.

This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.

Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.

While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain.

Source: http://healthfultips.com/?p=955

David P. Chen, D.C.
Chiropractor in Laurel, MD 20708

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

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

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

Chiropractic Management of Migraine Headache

A recent Norwegian systematic review of manual therapies for migraine prevention concluded that chiropractic spinal manipulation and some other conservative interventions appear to be equal to medications (propranolol & topiramate) in their ability to prevent migraines.

Although most of the published research supporting chiropractic treatment of migraine is based upon case reports, there have been other studies including a limited number of randomized clinical trials. A previous 2001 systematic review by Bronfort et. al. concluded that “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache.

Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. The Randomized Clinical Trials (RCTs) suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, due to the methodological shortcomings of the evaluated RCTs, future, well-conducted RCTs on manual therapies for migraine will be required.

Source: http://www.chiroaccess.com/Articles/Chiropractic-Management-of-Migraine-Headache.aspx?id=0000243

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

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

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

Chiropractic had the highest perceived benefit for back pain

A study published in the Journal of the American Board of Family Medicine reports on interviews with 31,044 individuals who used complementary and alternative medicine (CAM) for low back pain (LBP). The results are as follows:

The top 6 CAM therapies for LBP, starting with the most-used approaches are: chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.

Chiropractic use (76% of respondents) was larger than all the other 5 therapies combined.

Of those who used CAM modalities for back pain, 27% used it because conventional medicine did not help, 53% used it in conjunction with medical care, and 24% used it because their medical provider recommended it.

Chiropractic users scored the highest on their satisfaction and clinical benefits out of all 6 approaches. This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that spinal manupulative therapy (SMT) provided the greatest pain relief scoring higher than nerve blocks, opioid analgesics, muscle relaxants, acupuncture, or NSAIDs.

Reference: Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med. 2010;23(3):354–362.

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

Study shows little evidence of benefit for spinal fusion surgery

More Medicare patients are having complex back surgery even when there’s often an easier, less risky and less costly fix, according to a study in the Journal of the American Medical Association. The rate of complex fusion surgery for spinal stenosis, which causes lower back pain, increased 15-fold from 2002 to 2007, according to the study.
The study and an accompanying editorial suggest that aggressive marketing by implant makers, and greater physician compensation for high-tech procedures, may be influencing treatment. Meanwhile, taxpayers bear the expense, and patients face increased risks.

There are non-surgical approaches and treatments for spinal stenosis or degenerative disc disease. The symptoms can be treated with exercise, weight loss, chiropractic, and physical therapy. A study in the BMC Musculoskeletal Disorders concluded that distraction manipulation (DM) and neural mobilization (NM) are viable alternative to surgery for patients with lumbar spinal stenosis (LSS), and compares favorably with other non-surgical approaches that have been studied. The study further suggest that “As the efficacy of surgery does not appear to decrease if it is delayed in favor of a non-surgical trial, most patients with LSS should be treated non-surgically for a period of time before considering operation. DM and NM may be one non-surgical option that can be offered to patients.”

References:
Murphy, DR, Hurwitz, EL. Gregory, AA, Clary, R. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study. BMC Musculoskelet Disord. 2006; 7: 16.

Deyo, RA, Mirza, SK, Martin, BI, Kreuter, W, Goodman, DC, Jarvik, JG. Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults. JAMA. 2010;303(13):1259-1265.

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

Tips for Runners

As spring is approaching and running season is here, runners from all walks of life have started training for events over the next 6 months. Whether you are training for a 5k run/walk or the big marathon, there are a few simple things you can do to help prevent injury this running season. You can protect you knees, ankles and feet by keeping the muscles around the joints in shape and flexible. Here are some tips to help:

1. Warm-up: Always warm up prior to running, especially before explosive training like hills or speed work. Cold muscles are more prone to strains. A proper warm up will increase blood flow to the major muscle groups and improve muscle recruitment and performance. Start your work out with a light jog for 5 minutes before increasing your running intensity.

2. Get your muscles in balance: Many people have muscle imbalances that predispose them, especially runners, to lower extremity injuries. Traditional exercise programs do not address these imbalances and can in fact contribute to chronic injury patterns. The goal is to find an exercise program that addresses the instability and weakness of the hip and core stabilizers. Not only will you prevent injury with these types of exercises, but you will also improve your performance by running more efficiently. A qualified physical or exercise therapist can give you an effective exercise program.

3. Stretch: Make sure you stretch after every run. There is a lot of conflicting information out there about stretching, but the truth is that flexible muscles are stronger and more efficient. Remember to always stretch after muscles are warm (so after your warm up and after you are finished with your run). Hold each stretch 30 seconds and don’t bounce. You can actually increase your flexibility by being consistent with your stretching routine and stretching every day.

4. Hydrate: Your body is composed of about 60% water. When those levels are compromised your muscles do not perform or recover properly and are prone to injury. Athletes should consume ½ of their body weight in ounces every day. When you run, hydrate extra both before and after your run.

5. Get in alignment: Along with balancing your muscles, spinal alignment is very important in preventing sports injuries. Each and every muscle is controlled by nerves that pass through the spine. If one of those nerves is constricted one bit, the muscle it controls will not work correctly. Also, if your spinal posture is off, your running will do more harm than good and ultimately lead to a breakdown and problem with the spine, hip, knee or ankles. Being in alignment with good chiropractic care not only gets athletes out of pain but it prevents the body from breaking down. That is why Tiger Woods, Lance Armstrong and more than 80% of the distance runners in the last Olympics see chiropractors.

So, to stay on course and stay off the sidelines by following these 5 guidelines. If you are interested in getting your muscle balance tested and seeing if you are in alignment please feel free to contact us at Laurel Regional Chiropractic.

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

The Importance of a Well Aligned Body to Your Golf Game

Golf and chiropractic are a perfect combination. A chiropractor, along with a good golf instructor, can help you evaluate, treat, condition and train golfers. A chiropractor will look at the body in balance from head to toe, which is the essence of the golf swing. Anything interfering with the stance or the grip restrictions in the swing will have a profound effect on your golf swing. There are three fundamental causes of golf injuries: poor posture, lack of flexibility, and lack of balanced functioning of muscles. And, of course, poor swing mechanics is the fourth cause.

The golf swing is all about efficient energy transfer from the lower body into the hips, through each of the joints of the spine, into the shoulder girdle, down the arm, through the golf club, and finally into the golf ball. Posture at the address of the ball is important to position yourself to effectively transfer energy and hit that long straight shot you are visualizing. If back pain and dysfunction are impairing your posture, your swing will suffer. That means compensating during your swing that can lead to more biomechanical problems and pain in other areas of the body. Without good posture, pain can be a self-perpetuating cycle that inhibits your game.

Look at yourself in a mirror. Stand nice and tall with your hands to your side. Is one shoulder higher than the other? Now place you hands on your hips. Is one hip higher than the other? If you are serious about golf you should really be serious about your body. Most golfers will spend lots of money, time, and care on their golf equipment but spend little time with their most valuable equipment – that’s themselves. Take a few minutes every day to stretch before playing as it will make a tremendous difference.

Dr. David Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic

Effects of resistance training and chiropractic treatment in women with fibromyalgia

A recent study has found that resistance training is more helpful for women with fibromyalgia if it is combined with chiropractic treatment.

The randomized controlled study aimed to evaluate resistance training and resistance training combined with chiropractic treatment on the impact and functionality of fibromyalgia in women. 21 women with fibromyalgia, who had an average age of 48 years, took part in the study. They were randomly assigned to either resistance training or resistance training combined with chiropractic treatment, with 10 women in the first group and 11 in the second. Both groups completed 16 weeks of resistance training consisting of 10 exercises performed two times per week. The group assigned to receive both resistance training and chiropractic treatment also received chiropractic treatment two times per week.

The results showed that both groups increased upper and lower body strength and there were similar improvements in fibromyalgia impact in both groups as well as the strength domains of the functionality assessment. However, only the group receiving resistance training combined with chiropractic treatment significantly improved in the pre- to post-functional domains of flexibility, balance and coordination, and endurance.

One factor in the beneficial effects of the chiropractic treatment may have been that many chiropractors perform some myofascial release as part of their treatments. Myofascial pain is a common problem with fibromyalgia and it can cause exercise to be more painful and less effective.

Original article by: Panton LB, Figueroa A, Kingsley JD, Hornbuckle L, Wilson J, John NS, Abood D, Mathis R, Vantassel J, McMillan V. Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia. J Altern Complement Med. 2009 Mar;15(3):321-8.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/