North Dallas Chiropractic Blog – All Injury Rehab

For years Chiropractors have fought for thier right to properly diagnose, treat and help patients, effectively, safely, and without the use of medication.  More and more, people are seeking alternatives to dangerous drugs, and innefective surgies, to releive thier pain.  This has put a strain on physicians that prescribe medication and/or perform surgery, and many of them are having to sell thier yacht to continue raking in the dough.  So what does one do when one doesn’t get thier way, change the rules right?  And so it is that organized medicine is trying to use big money, politicians, and judges to force healthcare to play by THIER rules, by taking away the rights of all healthcare professionals to properly diagnose pastients, which is absolutely necessary in the plan of care for each individual.  If they have thier way, you would HAVE to go to a ”physician”  AKA medical doctor, to be assesed and diagnosed.  This would have huge ramifications for all, including those that have health insurance.  For example, if you have a sore neck, you would have to go to your MD and get assesed initially.  What would have been a safe and much cheaper fix by a Chiropractor, would now not be covered because an MD says that your diagnosis requires a regimine of expensive medication or worst yet surgery.  We work with medical doctors on a daily basis, and have a great relationship with them.  It is a fringe group that wants to push this down the throats of unexpected Americans for monetary gain and control of healthcare.  Control of healthcare you ask?  Sounds familiar doesn’t it?  At least the socialized healthcare that is trying to be pushed in washington is in public view and you can voice your opinion, ie MA Senator election, but this is behind the public’s back and isn’t getting the exposure as it should.  Voice your opinion, protect your healthcare, and have it the way you want it, not the way one group makes you have it.  Here is an addendum article for further reading:

Organized Medicine Pushes Back

Chris G. Dalrymple D.C., F.I.C.C.

Published 01/18/2010 – 6:56 a.m. CST

ABOUT THE AUTHOR Chris G. Dalrymple D.C., F.I.C.C.   Website: http://www.fixback.com   Email: cdal@fixback.com   In the full article found here the American Medical Association claims that “in 2009, physicians fought a blitz of scope-of-practice expansions by other health professionals on legislative, legal and regulatory fronts.  Organized medicine defeated attempts by naturopaths to seek licensure, prevented chiropractors from being able to perform invasive procedures and achieved further regulation of lay midwives. The efforts were among more than 300 scope-related bills the American Medical Association tracked last year. Physicians don’t expect the battles to let up, and with patient safety on the line, they are countering such efforts with some fresh tactics.” “In anticipation of another onslaught in 2010, physicians, with the help of AMA model legislation, plan to push lawmakers to establish state scope-of-practice review panels to evaluate plans by nonphysician health professionals who wish to expand their practice realm.” “The AMA also is helping states with model legislation requiring nonphysicians to identify their credentials clearly — for instance by wearing badges or limiting use of the term doctor.” “When legislative avenues fail, nonphysicians are turning to regulatory boards to expand their realm of expertise — a tactic that increasingly is landing scope debates in the courts, said Rocky Wilcox, vice president and general counsel at the Texas Medical Assn.” “In a recent win, a Travis County District Court judge, on Nov. 24, 2009, struck down a 2005 state chiropractic board regulation allowing chiropractors to perform manipulation under anesthesia and needle electromyography. The court said state law forbade nonphysicians from performing such surgical procedures. The TMA and Texas Medical Board sued the Texas Board of Chiropractic Examiners and the Texas Chiropractic Assn. over the regulation. An appeal is under way.” “The court also found, however, that state law may not preclude a portion of the board regulation allowing chiropractors to use the term “diagnose.” A trial on that issue is expected to begin in March.” If you want to understand WHY your state professional association is “political”, the AMA states it very clearly: “This is a problem that all states are having, and our view is the Legislature has the policy power to decide who can safely do certain things,” Wilcox said. “If these [regulatory] decisions are not challenged, then it allows agencies to go way outside of what the statute says, and allied professionals will be practicing medicine and diagnosing medical conditions when they are not qualified to do it. So it’s a safety issue….Pending a lack of resolution, we are looking at legislative remedies and would not foreclose the possibility of landing in a court of law.”  “Nonphysician health professionals and their boards say their scope and authority are being restricted unfairly, risking access to care.” “Texas Board of Chiropractic Examiners Executive Director Glenn Parker said chiropractors performing manipulation under anesthesia and needle EMG undergo extensive training and are well-qualified to do what he said were nonsurgical procedures. Moreover, they must be able to diagnose patients to determine if chiropractic or medical care is appropriate.” “The Texas case ‘brings up legal questions about the state of Texas allowing medical associations to determine what is and is not within the scope of chiropractors,’ Parker said. State chiropractors also are expected to push for legislative remedies, he added.” The AMA claims “team-based collaboration among physicians and other health care professionals is key to resolving access issues. “Do you want patients to have access to just anything or have access to a quality standard of care?”   This author eagerly awaits the day when the AMA decides to be a “team-player”.  So far it seems that they are merely attempting to “take away” the “turf” of other duly licensed and regulated healing arts professionals. For ways to voice your opinion, visit the Texas Chiropractic Association’s website. Visit us at All Injury Rehab for more information and to set up an appointment.

Often I’m asked what an adjustment is.  I explain to them that it is joint mobilization for your spine and or extremity.  If you have a few restricted segments of your spine or extremity, wether it be from recent trauma, a chronic condition, or just something from activities of daily living,  joint mobilization is for you.  Remember when you popped your knuckles the last time, we all do it and on a daily basis,  you get pain relief in your hand right?  You gain motion right?  Chiropractors are well trained in moving those joints where they are supposed to be.  Here’s a little article:

What is an adjustment?
A Chiropractic adjustment is the use of a specific force in a precise direction that helps normalize spinal function. The adjustment is applied to a joint that is fixated, “locked up”, or not moving properly. Adjustments help return the bones to a more normal position or motion, restoring body’s natural healing.

What does it do?
Adjustments help normalize spinal function and avoid bone and soft tissue degeneration. When nervous system function improves in this way, the body can begin the natural healing process.

What do adjustments feel like?
After the adjustment, many patients report a sense of well-being or a feeling of calmness. Others feel improved mobility. Inflammation or muscle spasms may delay these positive effects. Chiropractors excel at making adjustments comfortable and effective.

Is it safe?
YES! Chiropractic adjustments are so safe, even newborns and children receive adjustments to repair the damage caused from the birth process, learning to walk, or other childhood trauma. Each adjustment is tailored to each patient’s age, size, and unique spinal problem. After years of training, each Chiropractor has selected a variety of methods and become skilled in their delivery.

In fact, adverse effects of medical treatment is the principal cause of death in people under 45 years of age, as well as being the leading cause of morbidity and permanent disability. Costing Australians $401 million dollars per year and consumed 16% of Australia’s total annual health system expenditure for injury. 17% of hospital admission results in adverse events, 5% results in death, and 50,000 people per year are permanently disabled as a result of their medical treatment (from The report, Health System Costs of Injury, Poisoning and Musculoskeletal Disorders in Australia 1993-1994).

Yes! A New Zealand government study concluded that Chiropractic adjustments are “remarkably safe.” Taking an over-the-counter pain reliever is about 100 times more risky.

Why an adjustment?
A Chiropractic adjustment corrects Vertebral Misalignments. An adjustment helps your body to restore itself to optimum health! When the 24 bones that protect the spinal cord lose their normal position or motion, delicate nerve tissue can become choked or irritated. If a thorough examination reveals malfunctioning areas of the spine, Chiropractic adjustments are recommended to help correct this malfunction.

Each day millions of delighted people choose Chiropractic over drugs or surgery, as a common sense approach to better health.

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

Happy New Year!!!  Many resolutions include increasing activity, and for those that are not conditioned, injuries often occur.  Shoulder injuries are a very common thing that we see at our clinics.  Here’s an article explaining one of the causes:

By Todd Turnbull, DC, CCSP

The subscapularis muscle is an internal rotator and therefore is overused by almost every patient, especially those involved in throwing sports such as baseball. When a patient complains of shoulder pain, this is usually one of the factors that causes shoulder dysfunction.

Symptoms

The most common area of complaint is along the anterior humeral head or just a generalized region of pain in the shoulder joint. The onset of pain can be either acute, due to a specific mechanism of injury, or a gradual chronic condition that slowly develops. Strain can occur due to sleeping on the involved side, excessive throwing or a fall that traumatizes the shoulder.

Diagnosis

Evaluate shoulder range of motion bilaterally by having the patient elevate both elbows to horizontal. Have the patient internally rotate both forearms and look for a loss of end-range motion and/or an internal rotation of the whole scapula. Next, muscle test bilaterally and note the deficiency of the involved subscapularis.

Treatment

The subscapularis originates along the medial border of the anterior surface of the scapula and inserts into the lesser tubercle of the humerus. There are several approaches to correcting the subscapularis. Cross-fiber massage, instrument-based adjusting and/or contract, relax and stretch principles can all be utilized to obtain good results.

Cross-fiber massage of the belly can be accomplished by the doctor sliding their fingers into the axilla until the subscapularis muscle is found (usually an uncomfortable procedure for the patient). Adjusting instruments can target the origin while the patient’s arm is externally rotated. Contract, relax and stretch protocols tend to be less uncomfortable, but more time-consuming. Post-treatment evaluation should note increased strength and range-of-motion function and decreased pain.

Rehabilitation

Resistance-band strengthening exercises (multiple sets of 15 to 20 repetitions) should be incorporated a minimum of three times per week. I prefer that my patients first work their good side and then train the injured side.

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

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.

We’ve often heard that “you are what you eat”.  Well, what you eat can pain you, in more ways than one.

References
1. Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81:341-54.
2.Franco OH, Bonneux L, de Laet C, Peeters A, Steyerberg EW, Mackenbach JP. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. Brit Med J 2004; 329:1447-50.
3.O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008;51(3):249-55.
4. Aggarwal B.B., Shishodia S. Suppression of the Nuclear Factor-{kappa}B activation pathway by spice-derived phytochemicals: reasoning for seasoning. Ann N Y Acad Sci. 2004;1030:434-41.
5.Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses. 1992;39:342-8.
6. Chou R et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.
7.Bucci L. Nutrition Applied to Injury Rehabilitation and Sports Medicine. Boca Raton: CRC Press; 1995: p.167-76.

Getting A Handle On Pain And Inflammation
Anyone with chronic pain has typically tried non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen (Advil), or anti-pain medications like acetaminophen (Tylenol). Each medication is associated with side-effects, such as liver toxicity for acetaminophen and ulcers for NSAIDs. Interestingly, the second most common cause of ulcers is the regular use of aspirin and other NSAIDs.

In an effort to avoid the side effects associated with NSAIDs, many individuals seek out nutritional supplements that can be used as an alternative. There is a secret that must be understood before one searches out nutritional supplements to reduce pain and inflammation. Our diets substantially determine the inflammation levels in the body, which can directly impact upon the
development of pain.

The foods that cause inflammation and lead to pain include refined sugar, refined grains and related flour products (bread, pasta, bagels, etc.), refined oils, and obese meat. These inflammatory foods make up
approximately 80% of the average American’s calorie intake (1), and yet even 30-40% of calories from these foods is too much. Eating a diet comprised of the inflammatory foods creates a tsunami of inflammation within the body that will hit joint and muscle sooner or later causing pain and suffering. At this point, people start taking NSAIDs and Tylenol, and all the while continue to eat the same inflammatory foods that caused the problem.

In short, most people cannot turn off diet-driven inflammation and pain by taking medications or nutritional supplements. So it is important to make dietary changes to calm the inflammatory state. To expect that drugs and supplements will be curative is not reasonable.
Consider the term “nutritional supplement” it is supposed to supplement a healthy anti-inflammatory diet rather than one that is filled with the various inflammatory foods. The anti-inflammatory diet consists mostly of vegetables, fruit, raw nuts and potatoes in moderate amounts, and healthy proteins (lean meat, skinless chicken, fresh fish, omega-3 eggs or egg whites) (1-3). A little bit of dark chocolate, red wine, and stout beer are also anti-inflammatory. The best oils/fats include olive oil, coconut oil, and butter; and these should be used in moderation. A very popular oil supplement is fish oil that contains omega-3 fatty acids, which is famous for its anti-inflammatory properties.

Not well appreciated in America is that spicing our meals adds a substantial anti-inflammatory boost. Ginger, turmeric, rosemary, oregano, garlic, coriander, and nearly all spices tested thus far have proven to be anti-inflammatory (4).
Because NSAIDs cause ulcers and other dangerous side effects, researchers began to look for alternative substances that can reduce pain and
inflammation in a safer fashion. It was discovered that, when supplementing with ginger, certain individuals can substantially reduce chronic muscle and joint pain(5). For more acute pain, such as flair ups of back pain, research has shown that white willow bark can reduce pain as effectively as Celebrex over a 4-week period(6). Such studies led the American Pain Society and the American College of Physicians to view supplemental white willow bark as a recommended option for treating low back pain (6). There are also natural options for more acute injuries such as muscle strains and sprained joints. A unique enzyme called bromelain is found in pineapple and is known to have protein-digesting actions. It turns out that the inflammatory response associated with acute injuries involves the production of special proteins that are degraded by bromelain. Studies with bromelain and other enzymes demonstrate a reduction in recovery time after injury. In one study with ankle sprains, there was a 50% faster return to work and a 30% faster return to exercise (7).

In summary, if you desire dietary approaches towards a pain-free state, natural options are available. Basic dietary changes and certain key supplements can be very helpful. The most common symptom that brings a patient into a doctor’s office is pain that does not go away adequately, which is called chronic pain. Back pain, neck pain and headaches are some of the most common types of chronic pain.
David R. Seaman
DC, MS, DABCN

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

As a practitioner, I’m always asked about pain, I hope that this article clears up a few things.

To Your Health
November, 2009 (Vol. 03, Issue 11)
The Missing Pieces to the Chronic Pain Puzzle
By Dr. Kevin Wong
PAIN is a significant problem in our society, and the way too many of us deal with it, either by taking medication to temporarily relieve the pain or ignoring the pain altogether, foolishly hoping it will go away, is an even bigger problem, contributing to long-term disability and reduced quality of life. Here are a few important pieces to the puzzle that can help you deal with pain now and prevent future episodes – chronic pain- from ruining your life. How do you feel at this very moment? You can do a easy self-check just by moving your neck, shoulders, arms and legs around. Do you have any aches and pains anywhere? If your response is, “Don’t most people have pain somewhere in their body?” or “Doesn’t pain come with old age?” keep in mind that while that’s true, it doesn’t mean you have to accept it. And remember, pain isn’t just physical. The emotional stress it creates can be as hard on you as the pain itself. Let’s talk about ways you can find relief from your physical pain, which will undoubtedly lighten your emotional load at the same time.

Pain Defined
Pain is defined as an unpleasant sensation that can range from mild, localized discomfort to sheer agony. Pain has physical and emotional components. The physical part of pain results from nerves being stimulated. Pain may be confined to a specific area, as in an injury, or it can be spread throughout the body. Around the world, millions of people live with pain in some form or another, involving many different body parts, on a daily basis.
One of the most interesting things about pain is how each human being deals with it. Some learn to live with pain. Others can’t stand to feel even an ounce of it. The most common types of pain include arthritis, lower back, bone/joint pain, muscle pain and fibromyalgia (widespread pain, tenderness and fatigue in muscles,tendons and ligaments). Back pain is the most frequent cause of limited activities for people younger than 45 years old.

Acute vs. Chronic Pain
Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself. This type of pain comes on quickly and can be severe, but it lasts a relatively short period of time. In general, acute pain is in response to an event that happens to the body. It may be a result of surgery or an accident. Chronic pain is different. Chronic pain tends to stay around or progress over longer periods of time. Pain signals keep firing in the nervous system for weeks, months or even years. Oftentimes, chronic pain is resistant to traditional medical treatments. The emotional component of pain often comes into play in a chronic situation.

The Consequences of Pain
The loss of productivity and daily activity due to pain is substantial. Americans spend at least $50 billion per year on back pain, and that’s just for the more easily identified costs. Pain has a negative impact on an individual’s quality of life. It diminishes one’s ability to concentrate, do their job, exercise, socialize, perform daily tasks and sleep. Over time, this can lead to depression, isolation and loss of self-esteem. Researchers have found that depression is the most frequent psychological reaction to chronic pain. If you hurt an area of your body and do not restore proper, healthy movement patterns, you will end up with
problems later down the road. I can’t tell you how many patients I have seen who got in car accidents and hurt their neck and back, but waited to get treatment and used pain as the indicator for how they feel. Eventually, the pain went down or even away, but they were often left with problems in their bones and joints.
Common Causes and Sources of Chronic Pain
An initial injury like a trauma, fracture, sprain/strain, or serious infection may be the cause of the chronic pain. There could also be an ongoing cause like arthritis, cancer, an ear infection or injuries that never healed properly. Some people even suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), and psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). Quite simply, pain can come from anywhere in the body. The source can be the neck, shoulders, low back, hips and everywhere else. Many times, the location of the pain depends on how the injury happened. Perhaps someone injured their shoulder while throwing a ball. Maybe someone sprained their ankle while running. How about the person who falls down the stairs and hurts multiple parts of their body simultaneously?
Solving the Chronic Pain Puzzle
Pain is a complex puzzle. For certain cases, it takes complex solutions to help solve that puzzle. In some cases, the individual’s pain is so debilitating that it requires the use of X rays or other special imaging to visualize the problem that is occurring in the spine or extremities. It may be appropriateto use any of the following: Chiropractic, Chinese medicine, acupuncture, nutritional supplementation, massage/bodywork, yoga and psychological therapy. In some cases, it may even require over-the-counter or prescription medication (although the goal is to avoid relying on these because of the potential side effects). But there are definitely things you can do that can help you prevent and treat chronic pain. Let’s explore these strategies that, as you might have guessed, are all related to one another.
1. Posture: You have probably been told at different times of your life about the importance of good posture. “Sit up straight” or “don’t slouch” are probably familiar phrases to you. Proper posture is difficult to attain, so don’t stress yourself out about it. When you are sitting, put a rolled-up towel or sweatshirt in the small of your back. Sit all the way back to the rear of the chair so you feel the support in your back. When you stand, stand against the wall or a post so you can maintain erect posture. It is important to strengthen your core muscles, the muscles along the spine. Yoga, Pilates or a specific workout program with weights will help you achieve this. You may want to find a personal trainer to help you focus on specific exercises to help you achieve your goals.
2. Balance: As you develop strength, you begin to develop balance. Many of the positions utilized in yoga, Pilates and weight training work specifically on balance. Would you believe that your feet also have a lot to do with balance? The three arches you have in your feet must all be supported in order for the rest of your body to have good support as well. If one or more of the arches is flat, it can significantly affect the stress to your joints and your ability to exercise efficiently. Ask your chiropractor about analyzing your feet to see if you need arch supports.
3. Spinal Load and Stability: Understanding how to exercise or perform any type of sporting activity is crucial to your health. How many people do you know who lift weights incorrectly? On a daily basis, I see patients who have hurt themselves with physical activity. By being careful and doing your exercises properly, you can reduce the amount of spinal load (stress) and instability you create for your body. I cannot tell you how important it is to make sure your feet and all of the joints above them are healthy and moving properly. When your joints move well, you can perform activities optimally and with minimal stress on your body.
4. Alignment: Exercising makes your muscles stronger, which also helps maintain structural and bony alignment. Chiropractic care is hopefully a regular part of your life. Visits to your chiropractor at a frequency you both find appropriate will help you maintain your alignment.

Keep in mind that pain may be indicative of a serious underlying condition. Always talk to your doctor about any pain you are experiencing, particularly if it does not go away or worsens with time.
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.

Thanks to Michelle.

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I read this article the other day and thought to myself, people are paying for insurance, expensive by the way, only to play a game of coverage with the insurance company.  You think that you get what you pay for?  Read this:

Dynamic Chiropractic – November 4, 2009, Vol. 27, Issue 23

UHC Fined $536,000, Reopens 50,000 Claims

By Editorial Staff

The Missouri Department of Insurance, Financial Institutions and Professional Registration has levied fines totaling $536,000 against UnitedHealthcare (UHC) of the Midwest, a subsidiary of UnitedHealth Group, and ordered them to re-examine 50,000-plus chiropractic claims dating back to November 2004. The department determined that UHC violated state insurance laws by limiting coverage to 26 annual visits and failed to evaluate the medical necessity of treatment before denying submitted claims. UHC must reimburse chiropractors for any claims it finds were improperly denied, including interest; and must do the same for patients when applicable. According to a 2004 Missouri law, health insurance companies must cover at least 26 chiropractic visits per year without prior authorization unless the treatment is determined to be medically unnecessary.

According to a settlement announced in late August, the Missouri Department of Insurance made the following determinations regarding UHC of the Midwest and its illegal reimbursement activity, noting that in some instances, the insurer: used a chiropractic rider that limited coverage in a calendar year; denied payment of benefits by limiting coverage to 26 visits per calendar year; failed to pay benefits for medically necessary care, in that it denied claims on the basis that the insured and the provider failed to submit or resubmit a Complete Clinical Notification (CCN) in order to obtain reimbursement, relying solely on administrative requirements rather than on any basis in medical necessity or lack thereof; denied payment of benefits for chiropractic care by failing to make any determination on the medical necessity of additional visits and by requiring notification within the first 26 periods in a policy period as a condition of coverage; failed to pay the appropriate amount on the claims it partially covered; and denied chiropractic claims by improperly coding the denials on the claims.

“When Missourians entrust their health coverage to an insurance company, they expect and deserve to be treated fairly and legally. We have taken this action to make sure that happens,” said John M. Huff, director of the Missouri Department of Insurance. “We believe the review of these 50,000 files may determine money is due to other providers and possibly consumers.”

UnitedHealthcare has been in the news several times in the past few years for its coverage and reimbursement tactics. For example, as reported in DC in 2007, UHC implemented a policy in several states that limited reimbursement for physical medicine and rehabilitation services to licensed providers only. That meant if non-licensed staff (chiropractic assistants, etc.) performed those services, they were considered non-reimbursable. And later that year, the insurer declared chiropractic manipulative treatments for pediatric and headache patients “unproven” and therefore not a covered service – a policy UHC ultimately rescinded following a collaborative response by major chiropractic organizations including the American Chiropractic Association, International Chiropractors Association, Council on Chiropractic Guidelines and Practice Parameters, and Congress of Chiropractic State Associations. Chiropractors and chiropractic patients who do business with UnitedHealthcare of the Midwest can find out more about the settlement specifics and if they are eligible for reimbursement by calling the Missouri Department of Insurance consumer hotline (1-800-726-7390) or visiting www.insurance.mo.gov.

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Boosting Your Immune System

You encounter germs everyday, so it’s up to you to get your body in germ-fighting shape. Valerie Kasmiersky, MD, family medicine physician on the Baylor Plano medical staff, offers tips on boosting your immune system.

• Rest up: Genetics, age and activity level come into play when determining the ideal amount of sleep your body needs, but a good estimate is between seven and a half to nine hours a night.

• Clean up: According to research, almost 90% of sickness comes from germs on your hands. So wash your hands.

• Drink up: Water helps your entire body operate at its best. Aim for at least 64 ounces each day, and get more if you exercise frequently.

• Spice it up: Garlic is an effective disease fighter and can prevent bacteria from developing. Consider including garlic in your next meat or poultry dish.

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