North Dallas Chiropractic Blog – All Injury Rehab

The other day I was asked by an insurance company to give my reasoning for ordering an MRI within the first 3 days.  OK, in that case, why order or take an X-ray, why do an exam, why do any orthopedic tests?  Before I go off too much, here was my response, and by the way, if you want more reasoning, just let me know.

Dear Sir or Madam,

 When ordering an MRI within the first 3 visits, here are just a few of many reasons for doing so: 

 ·X-rays only show a portion of the patient’s potential injuries, it will not show a soft tissue injury; an injury which could possibly be adversely effected by certain types of treatment.

 ·When coming up with a treatment plan, a physician needs to know what he or she is treating and what the proper course of care would be, such as needing to be referred out for a surgical consult or any other specialist.

 ·It is imperative that conditions be diagnosed as soon as possible in order to treat the problem before further injury occurs.

 ·An MRI could find a soft tissue injury which could be dangerous to continue to work at their job, an injury that could have been missed on an x-ray.

 If you need further reasoning or have questions, please feel free to call me at the number above.

 Sincerely,

 Brian Starry, D.C.

Visit us at All Injury Rehab for more information and to set up an appointment.

From the moment we get out of bed everyday, to the moment we get back into bed, and maybe even while sleeping improperly in the the bed itself, or sleeping in a bad bed, we are causing trauma to our spine.  Here is a great article on ways to reduce this trauma:

Wanted: An End to Back Pain
4 Ways to Prevent an All-Too-Common Condition
By Kevin Wong, DC

    When was the last time you or someone you know suffered an episode of back pain? Chances are it wasn’t that long ago. It might have forced you to miss work, take painkillers, anti inflammatories or other medication, or just deal with the pain longer than you wanted to. Wouldn’t it be wonderful to do some simple things to try and prevent back pain from happening in the first place? Here are a few easy ones to get you started.
   

    In the new millennium, the health care pendulum has swung from treating symptoms toward prevention. It is a way of thinking that is analogous to going to the dentist for your six-month check-up or taking your car in for regularly scheduled maintenance – you avoid problems before they start, rather than waiting for something to happen and then “dealing with it.” By that time, your car may be in the junk yard and you may be relegated to long-term medication or even surgery.

    Back pain is the perfect example of a symptom too many people treat instead of preventing, and the consequences are staggering. It is the most frequent cause of activity limitation in people younger than 45 years old. Approximately one quarter of U.S. adults reported having low back pain lasting at least one whole day in the past three months and 7.6 percent reported at least one episode of severe acute low back pain within a one-year period. Low back pain is also very costly: Approximately 5 percent of people with back pain disability account for 75 percent of the costs associated with low back pain.

    Americans spend at least $50 billion per year on back pain – and that’s just what gets reported. With all that said, how are you going to prevent back pain? Here are four things you can start doing today to reduce your risk of suffering back pain and its costly (physically, emotionally and financially) consequences:

1. Get Adjusted by Your Chiropractor
Your muscles, bones and ligaments are stressed continuously by normal daily activities: driving, sitting at the computer, lifting your kids, doing exercise and countless other things. These little stresses add up over time and misalign the joints of your spine, arms and legs. The misalignments can then lead to muscle tightness, spasms, joint stiffness and pain. Although chiropractors commonly see patients who are in pain, getting spinal tune-ups when you are feeling “fine” will keep you feeling fine. Adjustments will put the
bones and joints into healthier positions, which will also help muscle tone.

    Generally, if you get adjusted while you’re in pain, it will take longer to heal, whereas if you get regular or maintenance adjustments, you can avoid terrible episodes of pain before they even start. That’s because keeping the spinal and extremity joints in good alignment will help your nervous system and immune systems function at their best. Even when you think you are feeling good, chiropractors can make sure you stay that way.

2. Practice Proper Ergonomics
Think safety: When you make your everyday activities safe to perform, it will help reduce the undue stress on your body. This includes having your computer work stations at home and at your office set up properly for your body. Generally speaking, the keyboard height should be the same height as when your arms are
comfortably at your side with the elbows bent. The mouse should also be close to your dominant wrist while your arms are at your sides.

Avoid poor posture: Whenever you sit, it is safest to sit on a full-back chair with plenty of support. Crossing the ankles is fine, but do not cross your legs. This puts tremendous pressure on the lower back, contributing to back pain. Also, if you are experiencing low back pain, it’s a good idea not to sit on the couch or sofa, since they are typically too soft and unsupportive for the low back.

Low Back Pain:
One Symptom, Many Potential Causes (Including the Following)
· Strenuous activity, overuse or improper use (repetitive or heavy lifting, vibration, pressure, etc.)
· Physical trauma, injury or fracture
· Obesity (often caused by increased weight on the spine and pressure on the discs)
· Poor muscle tone in the core or stabilizing muscles of the back
· Tightness, spasm, injury and strain of back muscles
· Joint problems (e.g., spinal stenosis – narrowing of the spinal canal, which compresses the spinal cord and nerve roots)
· Protruding or herniated (slipped) disk
· Arthritis or degeneration of vertebrae due to stress and the effects of aging – osteoarthritis, spondylitis (inflammation of the spinal vertebrae), compression fractures, etc.

Lift properly: When lifting items, use the legs and the trunk of the body rather than the arms. Always bring objects closer to your abdomen or chest, as that is the center of gravity and support for most people. Try to avoid bending the back while you lift.

Sleep well: The most supportive position for the body during sleep is on your back with a pillow under your knees. The next best position is on your side with a pillow between your knees and your head on a pillow that is thick enough to span the distance of your neck to the shoulders. A neck pillow that is too thin will kink the neck and could lead to neck and upper back pain down the road.

3. Exercise Regularly
We all know how important it is to participate in some type of regular exercise. Some of you already do that. Whether it be walking, playing sports or going to the gym, make sure you set up a program that keeps you consistent. Exercise helps the human body in so many ways, but one of the most important aspects involves stretching and strengthening of your back muscles. Often these muscles are referred to as core muscles of the body because they are located very close to the spine. The core muscles help move and protect your spine when it is stressed or strained. By keeping them flexible and toned, you prevent pain and injuries from happening. When you are developing an exercise plan, talk to your doctor for ideas on what areas of the body you should specifically focus on to get maximum results, both in terms of overall fitness and protecting the back from injury.

4. Avoid Unhealthy Lifestyle Habits
Stress. Emotional stress can cause muscle tension, which can lead to back pain (it also can lead to heart problems, chemical imbalances, an inability to sleep and a host of other bad things). It’s always hard to maintain balance in your life between work, family and play, but it goes a long way toward helping your
emotional stress.

    Reducing stress can be as simple as scheduling some quiet time to be alone, doing yoga or meditation, taking a bath or just sitting and doing breathing exercises. Whatever activity you find relaxing or energizing, take time to do it. Down time allows you to unplug from the world and get grounded. It also allows your body to reset itself so you can deal with the next crisis or problem that’s sure to arise. Poor nutrition. Watching what you eat is another important factor to consider, because excess weight literally “weighs you down,” which can contribute to back pain. Quite simply, losing excess weight in a healthy manner will take pressure off your lower back and reduce stress on the vertebrae. It is truly amazing that our society is now making an active transition from listening to symptoms or pain to preventative health care. Now is the time for you to be able to take a more active role in deciding how your future health will play out. Armed with the tips discussed above, you can make changes now that will help your back and your overall well-being for years to come. The power of health is in your hands.

The Back Pain Epidemic
Back pain has become an epidemic in our modern society – up to 85 percent of all people will experience back pain at some time in their life, and it is the fifth most common reason for all physician visits in the United States. According to the statistics, if you’re in a room with three other people, one of you has suffered low back pain for an entire day or more in the previous three months and only one of you (if they’re lucky) will avoid suffering back pain at some point in their lifetime.

Kevin M. Wong, DC, a 1996 graduate of Palmer College of Chiropractic West in San Jose, Calif., practices full-time in Orinda, Calif. He is also an instructor for Foot Levelers, Inc.

Visit us at All Injury Rehab for more information and to set up an appointment.

EMG, or electromyogram is a test used to record the electrical activity of muscles. Active muscles produce an electrical current that is usually proportional to the level of muscle activity. Another name for an EMG is a myogram.

There are two types of EMG — the intramuscular EMG and the surface EMG. The intramuscular EMG is the test most commonly ordered and involves inserting a needle electrode through the skin into the muscle in question. Surface EMG (SEMG) involves placing the electrodes on top of the skin overlying the muscle to detect the electrical activity of the muscle.

EMGs can detect abnormal muscle electrical activity in many diseases and conditions, including inflammation of muscles, pinched nerves, damage to nerves in the arms and legs, disc herniation, and degenerative diseases such as muscular dystrophy, Lou Gehrig’s disease, Myesthenia gravis, among others. The EMG helps to distinguish between muscle conditions in which the problem begins in the muscle and muscle weakness due to nerve disorders.

We typically order EMGs when we want to find out if a patient’s pain is related to a pinched nerve or disc herniation most commonly. Most pain conditions that we see  are related to soft tissue injuries such as injuries to the ligaments, tendons, or muscles which do not require EMG testing. These injuries may refer pain down the arm or leg or to other sites. Almost all pain, in our experience, responds well to therapy (at least 85% of all cases seen here). If a patient has a pinched nerve, this person can be experiencing 10/10 level of pain, 24 hours per day, 7 days per week. The patient may experience true numbness, weakness, and decreased grip strength, for example. An EMG in this case helps determine cases of radiculopathy or pinched nerves.

In the nerve conduction velocity (NCV) test, the nerve is electrically stimulated by one electrode while other electrodes detect the electrical impulse “down stream” from the first electrode. The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to calculate the speed of impulse transmission (the nerve conduction velocity, or NCV). A decreased speed of nerve conduction indicates nerve disease.

The NCV test is often done at the same time as the EMG in order to exclude or detect both nerve and muscle conditions. The interpretation of an abnormal NCV test depends on why the test was done in the first place. It may indicate damage to a nerve from trauma, diabetic or peripheral neuropathy, herniated discs, polyneuropathy, or myasthenia gravis or Guillain-Barre Syndrome, among other things.

We take a very thorough history on each and every patient, as this is the key to determining the root cause of a patient’s pain. EMG/NCV tests are not something that we frequently order considering the number of pain patients who come through our doors, because we find that most conditions respond very well to therapy. Degenerative disc disease, arthritis, bulging discs, spondylolisthesis, and many other conditions are most typically due to an underlying soft tissue weakness/injury – to the ligaments, tendons, or muscles. These types of conditions respond very well to therapy. The history from the patient is one of the key factors to determining the need for these types of studies. The experience of the physician and clinical team at asking the right questions, can be the difference between getting an expensive test that you may or may not need. If a nerve injury is suspected as being the cause of the patient’s pain, then an EMG/NCV study may be ordered.

Visit us at All Injury Rehab for more information and to set up an appointment.