Monthly Pain Update – May 2022

Chiropractic Care Is Cost-Effective for Managing Low Back Pain

For over 100 years, individuals have sought out chiropractic care to address musculoskeletal conditions (like back pain) outside of the traditional medical model, which can include medications, injections, and surgery. In addition to reducing pain and improving function, chiropractic care can benefit the healthcare system (and the individual patient) by not only being more cost effective but also by reducing the need for additional care and procedures.

In a study published in 2019, researchers reported on the outcomes of 95 patients who presented at an Ontario multidisciplinary community healthcare center with either sub-acute or chronic low back pain. The research team noted that 70% of the patients who received chiropractic care experienced improvements in pain and disability at a cost to the healthcare system of about $1,042. Because most of patients did not require additional medical care, it's estimated that the introduction of chiropractic treatment in this setting reduced healthcare costs per patient by between $2,022 and $6,136. This finding is similar to that of a 2021 study in which researchers reviewed Medicare claims concerning 28,160 older adults with chronic low back pain and concluded that long-term costs were lower when the patients received chiropractic care as their front-line treatment versus opioid therapy.

In addition to cost savings during the initial phase of care, a 2021 study that examined five years of Medicare claims data found that seniors with chronic back pain were two times more likely to experience an escalation in care (which is associated with an increase in total healthcare expenses) if their initial treatment involved opioids than if their first form of care was spinal manipulative therapy (the primary form of treatment provided by doctors of chiropractic).  A 2022 study found that patients with spinal pain who see a doctor of chiropractic as their first treatment choice are less likely to fill an opioid prescription, receive a spinal injection, or see a specialist within the next six months than those who initially consult with a medical physician. An analysis of Medicare data from 2012-2016 revealed that older adults with spinal pain who consulted with a doctor of chiropractic first were 56% less likely to fill an opioid prescription in the following year.

Aside from reducing costs because of saving on medications, advanced imaging, and more invasive procedures, by not requiring such services, the patient is at a substantially reduced risk for potentially harmful side effects, adverse events, or complications. In fact, a review of Medicare claims revealed that seniors who sought treatment for chronic low back pain in 2013 were 42 times more likely to experience an adverse drug event in the following five years if they initially chose opioid analgesic therapy versus spinal manipulation therapy.

Not only may chiropractic care help the low back patient get out of pain and back to their normal activities in a shorter time frame, but it may also reduce their need for additional healthcare service, which can result in savings to the patient and the healthcare system.

Chiropractic Management of Tennis Elbow

When an individual experiences pain in or near the wrist, the first thought may be carpal tunnel syndrome (CTS), but there are many conditions that affect the upper extremities. One such condition is lateral epicondylitis, which is more commonly known as tennis elbow.

Lateral epicondylitis is a condition that occurs when the tendons—most commonly the extensor carpi radialis brevis tendon—that help bend the wrist backward become inflamed. This can lead to pain near the elbow, the forearm, and the wrist, as well as cause a weak grip. Much like carpal tunnel syndrome, tennis elbow is rarely the result of a single traumatic event but rather the cumulation of small traumas over time that largely go unnoticed until the symptoms interfere with the ability to carry out daily activities. While most commonly associated with tennis players, lateral epicondylitis can also affect anyone whose work or hobby involves repetitive movements that work the wrist and forearm.

The chiropractic approach to tennis elbow is very similar to that of carpal tunnel syndrome. The patient’s treatment plan may include manual therapies, physical therapy modalities, specific exercise instruction, dietary medications (to reduce inflammation), ice therapy, and activity modification. Treatment may also include an orthotic called a tennis elbow brace or counterforce brace. This type of brace may come in a variety of materials and is placed just beyond the crease of the elbow and pulled tight enough to provide support but not so much as to cut off circulation. The goal of the brace is to create a temporary attachment (usually worn for four to six weeks) so the injured tendons can rest and heal. Unlike the wrist brace used for carpal tunnel syndrome patients, the counterforce brace is not usually worn at night.

Speaking of wrist bracing, a 2021 study found that the wrist cock-up splint commonly used by CTS patients can also benefit those with tennis elbow. In the study, which included 40 lateral epicondylitis patients, participants received usual care (stretching exercises, ultrasound therapy, and deep friction massage) or usual care with the addition of a wrist brace. After three weeks, the patients in the usual care plus wrist split group reported greater improvements in wrist pain, grip strength, and range of motion.

As with other musculoskeletal conditions, the goal of treatment is to reduce pain and improve function so that the patient can resume their normal activities as quickly as possible, without undergoing more invasive procedures. However, if the condition does not respond to a conservative approach, a doctor of chiropractic will co-manage the case with an allied healthcare provider or refer the patient to a specialist.

Chiropractic Management of Tennis Elbow

When an individual experiences pain in or near the wrist, the first thought may be carpal tunnel syndrome (CTS), but there are many conditions that affect the upper extremities. One such condition is lateral epicondylitis, which is more commonly known as tennis elbow.

Lateral epicondylitis is a condition that occurs when the tendons—most commonly the extensor carpi radialis brevis tendon—that help bend the wrist backward become inflamed. This can lead to pain near the elbow, the forearm, and the wrist, as well as cause a weak grip. Much like carpal tunnel syndrome, tennis elbow is rarely the result of a single traumatic event but rather the cumulation of small traumas over time that largely go unnoticed until the symptoms interfere with the ability to carry out daily activities. While most commonly associated with tennis players, lateral epicondylitis can also affect anyone whose work or hobby involves repetitive movements that work the wrist and forearm.

The chiropractic approach to tennis elbow is very similar to that of carpal tunnel syndrome. The patient’s treatment plan may include manual therapies, physical therapy modalities, specific exercise instruction, dietary medications (to reduce inflammation), ice therapy, and activity modification. Treatment may also include an orthotic called a tennis elbow brace or counterforce brace. This type of brace may come in a variety of materials and is placed just beyond the crease of the elbow and pulled tight enough to provide support but not so much as to cut off circulation. The goal of the brace is to create a temporary attachment (usually worn for four to six weeks) so the injured tendons can rest and heal. Unlike the wrist brace used for carpal tunnel syndrome patients, the counterforce brace is not usually worn at night.

Speaking of wrist bracing, a 2021 study found that the wrist cock-up splint commonly used by CTS patients can also benefit those with tennis elbow. In the study, which included 40 lateral epicondylitis patients, participants received usual care (stretching exercises, ultrasound therapy, and deep friction massage) or usual care with the addition of a wrist brace. After three weeks, the patients in the usual care plus wrist split group reported greater improvements in wrist pain, grip strength, and range of motion.

As with other musculoskeletal conditions, the goal of treatment is to reduce pain and improve function so that the patient can resume their normal activities as quickly as possible, without undergoing more invasive procedures. However, if the condition does not respond to a conservative approach, a doctor of chiropractic will co-manage the case with an allied healthcare provider or refer the patient to a specialist.

Headaches, the Neck, and Chiropractic Care

Complementary and alternative medicine (CAM) is a term used to describe non-mainstream healthcare approaches—which includes chiropractic care—that are used in conjunction with or in place of conventional medicine. Because the usual treatment approach for headaches often involves medications like nonsteroidal anti-inflammatory drugs (NSAIDS) and acetaminophen—which can cause side effects can affect the stomach, liver, and/or kidneys with prolonged use—nearly 50% of adults with headaches have used some form of CAM.

In a 2021 literature review, two researchers from McMaster University in Ontario reviewed clinical practice guidelines for either migraine or tension-type headaches and found recommendations for dietary supplements, oxygen therapy, herbal medicine, electrotherapy, acupuncture, behavioral therapy, manual therapy (chiropractic), homeopathy, and Chinese medicine referenced in the guidelines. Despite the fact that many of these approaches are supported by promising research, the researchers noted that only about 25% of American medical students, residents, and clinicians receive CAM training, and hence, often do not mention CAM options to their headache patients.

For patients whose headaches originate from dysfunction in the cervical spine (a cervicogenic headache) the data show that chiropractic care can be an effective treatment option. In one study, patients received either no treatment, sham treatment, or cervical spinal manipulation for 17 months. The results showed that the patients who received manipulative therapy experienced better outcomes with respect to headache frequency, pain, and disability, and any negative side effects were few, mild, and transient. The authors concluded that spinal manipulative therapy is a safe treatment option for patients with cervicogenic headaches.

Interestingly, several studies have also found that patients with migraines and other forms of headache often exhibit musculoskeletal abnormalities in the neck, such as trigger points in the cervical muscles, that when addressed lead to a reduction in headache severity and frequency. This suggests a few possibilities: cervical dysfunction may play a role in the headache process for non-cervicogenic headaches, patients with cervicogenic headaches may not have received a correct diagnosis, or cervicogenic headaches may often co-occur with other types of headaches.

When a patient initially consults with a chiropractor to manage their headaches, they’ll undergo a thorough examination of the head, neck, and even the shoulders, mid back, and low back to identify any potential contributing causes. Then, their doctor of chiropractic will employ a multimodal treatment approach to address these issues that may include spinal manipulation, soft tissue therapies, physical therapy modalities, specific exercises, nutritional counseling, and more. If necessary, they will co-manage the patient with allied healthcare providers.

Contrarian Whiplash Facts

While any sudden back and forth motion can lead to a whiplash injury, the most common cause is a motor vehicle collision. Because these incidents often result in litigation, there has been plenty of research on whiplash associated disorders that has produced conclusions that may be contrary to what some might expect.

CRASH SPEED: While it’s easy to see how high-speed crashes can cause injury, it’s more difficult to understand how injuries can occur at low speeds. While vehicular damage is rare when collisions occur at speeds less than 8 mph, experiments involving crash test dummies, high-speed cameras, and incredibly sensitive sensors suggest that the risk for a cervical spine injury in a 7-mph crash is 54%. While the risk falls when an impact takes place at slower speeds, a collision at any speed can still cause harm.

SYMPTOM ONSET: Even though neck pain and other whiplash associated disorder (WAD) symptoms can become present immediately or within hours of the injury, some people experience a delay in the onset of WAD signs and symptoms. This delay may only last a day or two but for some, weeks or even months may go by with little to no indications of a WAD injury. This is why some researchers advocate immediate evaluation following a whiplash event, regardless of symptoms. Obviously, if signs and symptoms appear, get evaluated by your chiropractor ASAP as studies also show patients who are treated promptly tend to do better.

HIGH RISK FOR CHRONIC WAD: While many patients will experience an improvement in symptoms within the first month, especially if they maintain their usual activities and receive prompt care, it’s estimated that as many as half of WAD patients may experience persistent symptoms up to a year later. The current evidence suggests that patients with initial headache, fatigue, shoulder/upper back pain, blurred vision, dizziness, or difficulty concentrating, sleeping, or swallowing may be at increased risk for chronic WAD and may require a more comprehensive treatment approach.

Doctors of chiropractic are trained to both evaluate and treat patients with whiplash associated disorders, often using a multimodal approach that may include manual therapies, rehabilitative exercises, physical therapy modalities, nutritional advice, and encouragement to continue to carry out regular activities within pain tolerance. If necessary, he or she may also team up with allied healthcare providers such as neurologists, physical and occupational therapists, orthopedists, and the patient’s medical physician.

 

Chronic Conditions That Benefit from Exercise

 

 

When we were younger, getting sufficient physical activity just came with being a kid. We played outside with friends, ran around during recess, participated in organized sports, and attended physical education classes. But as we age, we tend to become less physically active, only exercising at prescheduled times for a run, at the gym, or on a stationary bike at home—if at all. Unfortunately, the average adult becomes less active as they age, just when they probably need exercise the most to stay both mentally and physically healthy. In addition to helping maintain a healthy weight, keeping up energy levels, and looking and feeling better, exercise can also help in managing several chronic health conditions.

 

• HEART DISEASE: Aerobic exercise can improve heart muscle strength and endurance as well as aiding in weight loss and lowering blood pressure.
• DIABETES: Regular exercise can help insulin more effectively lower blood sugar levels, control weight, and boost energy.
• ASTHMA: Exercise has been reported to stabilize asthma by reducing the frequency and severity of attacks.
• BACK PAIN: Regular low-impact aerobic exercise increases the strength and endurance of the deep spinal muscles that help maintain an upright posture. In addition, the compressive forces on the spine from running or walking help to draw nutrients into the spinal disks, keeping them hydrated and healthy.
• ARTHRITIS: In general, exercise of all types can reduce arthritis-generated pain and improve joint mobility.
• CANCER: Several studies show that engaging in exercise while undergoing cancer treatment may reduce fatigue and improve outcomes.
• PARKINSON’S DISEASE: Tai Chi, boxing (without head contact), and dancing have been reported to reduce both the physical and cognitive impairments associated with Parkinson’s disease.
• DEMENTIA: Researchers have observed that engaging in exercise can improve blood flow to the brain, which can provide cognitive benefits. It’s also suggested that exercise may slow cognitive decline and even keep mild-cognitive impairment from progressing to dementia.

 

Of course, consult with your healthcare provider before starting any exercise program to assess your current fitness level and to identify any issues that may indicate a different form of physical activity may work better for your unique situation. If you have aches and pains, your doctor of chiropractic can also provide treatment to help restore normal joint motion and show you stretches you can do at home before and after your workout to reduce the risk of injury as you engage in a new fitness routine.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.