Find a Chiropractor in Amarillo to Explore Health Benefits of Chiropractic Care
If you live in the Amarillo area, or even the Texas Panhandle in general, and are dealing with headaches, backaches, and joint pain on a regular basis, you must contact a chiropractor in Amarillo for a natural and efficient treatment option. People across the globe are these days experiencing the amazing health benefits of chiropractic care. Knowing that it is a non-invasive and holistic approach that can treat different health issues, Amarillo people are taking advantage of chiropractic care more and more these days.
If you listen to the Chiropractic Forward Podcast that I host or visit Creek Stone Integrated Care here in Amarillo, you will get to know that research-based chiropractic care is usually a drug-free process to heal a human body in a natural way, and that research and the medical field are more and more in favor of recommending chiropractic care in Amarillo. Certainly for spinal pain.
Some health benefits offered by Creek Stone and other chiropractors in Amarillo incorporate:
1. Improvement of posture
Daily chiropractic health adjustments can help you enhance your posture by helping you pay more attention to your spine, posture, and movement patterns. Some people get neck problems at a young age because of continually sitting in a position in front of an electronic device, PC, or TV. Hence, regular chiropractic care can help boost your posture, keeping you stronger and more mindful of proper biomechanics.
2. Improvement of sleep
These days, many people suffer from sleep problems. Nevertheless, many sleep issues are associated with body aches, stress, and pain. If you take care of these problems with dynamic chiropractic care, it will help you boost your sleep quality, providing you a better night’s rest.
3. Relieving stress
When in pain, the body and mind can certainly become stressed to a certain extent. This goes without saying. We tell patients all the time that pain can change a person. If you’ve ever experienced pain, you understand that it is a fact. Your body will instantly feel less stressful if it is balanced and moving correctly. According to the research highlighted on the Chiropractic Forward Podcast, this is the first-line way to treat stress, tension, and non-complicated musculoskeletal complaints.
4. No involvement of medications
Medications can surely help you get relief from your health problems in certain situations. But at what cost in regards to side effects? Haven’t we all seen the commercials for prescriptions that encourage us to make our physicians give them to us, but then warn us of the obstacle courses of side effects that are possible? That’s scary stuff. Some medications bring both negative and positive impacts. What if there were a way to take care of headaches/migraines, low back pain, mid back pain, neck pain, and joint pain in a way that didn’t not require medications?
Voila! All you need is to opt for a drug-free approach with the help of a doctor of chiropractic. Preferably this doctor of chiropractic in Amarillo found at Creek Stone Integrated Care.
Many times, we can give you relief from pains and aches without any use of drugs, resulting in a holistic way of treatment. With a preventative mindset going forward, we can usually keep it that way while raising the overall level of health.
Now that you have all the details regarding some awesome benefits of chiropractic care, what are you going to do? To lead a healthy and painless life, don’t hesitate to contact a chiropractor in Amarillo.
Call up an expert chiropractor in Amarillo
Call Up Dr. Jeff Williams, DC at Creek Stone Integrated Care in Amarillo, TX at 806-355-3000 today and let’s get you seen ASAP.
Researchers Argue Whiplash & Car Wreck Injuries Are Indeed Valid
All attorneys treating personal injury and car wreck clients/patients are familiar with the insurance companies’ claims that people aren’t really hurt or that whiplash cannot cause any real, chronic injury.
We have been treating personal injury patients since 2007, Dr. Williams has been an expert witness at trial, and we have seen hundreds of car wreck patients over the years.
These personal injury and car wreck patients most certainly ARE injured to some extent in almost every case. Even low-speed impact cases. Especially in low-speed crashes. When the vehicle doesn’t “crush,” the force of the impact is not allowed to “ride down” with the crumple of the vehicle. The force is transferred directly to the occupant in these types of crashes.
Regarding the mechanism of injury: forces of the collision caused compression, tension, shearing, and rotational forces converging in a rapid sequence which is virtually instantaneous. It is the timing, or the lack of time for the body to react to these forces, that causes the injury anatomically and scientifically.
Think about it this way: when you go from one speed to another speed in a millisecond, there is going to be damage to the tissues holding everything together. Most commonly damaged are the postural muscles. Those are the muscles keeping your body and head upright correctly.
Dr. Williams’s Advanced Certification in Whiplash Biomechanics & Traumatology has aided us in evaluating these car wreck patients, aided us in their case management, and aided us in backing every aspect of treatment by research citation in their narrative reports.
If you think Dr. Williams can help you here at Creek Stone after a car wreck, please call 806-355-3000 and let us get you in as soon as possible.
We are experienced in working with the attorney, working with you if you do not have an attorney, billing the other person’s insurance, or billing your own personal injury protection insurance.
It usually does not cost the injured person a dime to get checked and get treatment so call us at 806-355-3000 as soon as possible.
Freeman & Croft are research leaders and experts in the industry when it comes to whiplash, crash reconstruction, and the biomechanics involved in crashes.
They put together a paper in 1999 called “A review and methodologic critique of the literature refuting whiplash syndrome” that was published in the esteemed Spine Journal. Citation is included below.
Why They Did It
Many times, the insurance companies claim “Whiplash” is an idea or a theory but not necessarily a real thing, although medical research validated whiplash years ago. Some authors on the side of the insurance companies hoping to not cover medical costs or the costs of pain and suffering have published articles here and there taking the stance that injuries are unlikely or even impossible at certain speeds. Others have published articles suggesting any psychological issues after a wreck are based purely on financial gain or litigation. All of this, even though research has been there for years showing whiplash to be a serious issue as well as the other conditions a personal injury or car wreck patient may face such as concussion, psychological issues, etc..
How They Did It
- The authors of this paper reviewed the biomedical and engineering literature relating to whiplash syndrome, searching for articles that claimed there was no validity to whiplash injuries.
- Twenty articles were identified and included.
- The methodology described in these articles was evaluated critically to determine if the authors’ observations regarding the validity of whiplash syndrome were scientifically sound.
What They Found
- The authors of this paper found that all of the articles contained significant methodological flaws with regard to their respective authors’ statements refuting the validity of whiplash syndrome.
- The most frequently found flaws were inadequate study size, non-representative study sample, non-representative crash conditions (for crash tests), and inappropriate study design.
Conclusion
“As a result of the current literature review, it was determined that there is no epidemiologic or scientific basis in the literature for the following statements: whiplash injuries do not lead to chronic pain, rear impact collisions that do not result in vehicle damage are unlikely to cause injury, and whiplash trauma is biomechanically comparable with common movements of daily living.”
Citation
Freeman MD, Crotft AC, “A review and methodolgic critique of the literature refuting whiplash syndrome.” Spine (Phila Pa 1976). 1999 Jan 1;24(1):86-96.
https://www.ncbi.nlm.nih.gov/pubmed/9921598
New Information About Cold Laser You Can Use
Did you know that cold laser, also known as low level laser, has been around for years now, but it’s use is just starting to gain popularity?
It is not really cold though. They called it cold laser to take the danger out of the name. When we think of lasers, we commonly think of burning or cutting lasers. Cold laser isn’t anything like that. In fact, you don’t even really feel it at all. That is, outside of the benefits!
The good side of cold laser
Here is a list of just some of the conditions cold laser is commonly used for:
- Athletic Injuries
- Lower Back Pain
- Knee and Foot Pain
- Shoulder Pain
- Carpal Tunnel Syndrome and most other neurological pains
- Arthritis, Fibromyalgia, Muscle Spasm (degenerative joint conditions)
- TMJ Disorders
- Relief of Muscle (strains or tears) and Joint Pain, including knees, hands, and ankles
- Soft Tissue Injuries, Including Sprains and Strains, Tendonitis and Hematomas, Rotator cuff, Tennis Elbow
- Joint Disorders and Conditions, Including Arthritis, and Tenosynovitis
- Chronic pain, including Trigeminal Neuralgia and Chronic Neck and Back pain
- Other Musculoskeletal Injuries
- Chronic non-healing wounds
- Pre and post surgical treatment
- Anti-inflammation applications
- Disc herniations
The bad side of cold laser is that it is not covered under insurance plans, as they still classify cold laser as “experimental and investigational.” The vast majority of papers out there in the research world are in favor and in support of cold laser. You have to understand that. One must also understand that, these days it seems, insurance plans aren’t in any hurry to add more stuff to pay for. Wouldn’t you agree?
In 1967 a few years after the first working laser was invented, Endre Mester in Semmelweis University in Budapest, Hungary experimented with the effects of lasers on skin cancer. In his experiments, he was treating the backs of mice with different lasers. In doing so, he noticed that the shaved hair grew back more quickly on the treated group than the untreated group.
I can promise you that Mest had no idea where his research would lead in the 50 years that would follow his findings.
Here is a paper from 2014 published in the International Journal of Oral and Maxillofacial Surgery called “Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery?”
These researchers were looking for ways to help people to treat swelling and inflammation following facial surgery.
How They Did It
- 10 patients had surgery on both sides of their faces.
- The patients had cold laser treatment on one side of their face while they had a fake treatment on the other side of the face.
- The two sides were compared to see if it worked.
What They Found
- On the side treated with cold laser, swelling decreased significantly on day three, day seven, day fifteen, and day thirty.
- Self-reported pain was reduced on the treatment side at the one-day mark and at the three-day mark. The pain was gone on both sides by day 7.
Wrap It Up
The authors of this paper concluded, “This LLLT protocol can improve the tissue response and reduce the pain and swelling resulting from orthognathic surgery.”
That’s wonderful news. While it doesn’t have a lot to do with conditions that chiropractors normally treat, we chiropractors DO see plenty of swelling, pain, and inflammation in joints, in the back, and neck. It shows that cold laser does certainly have some use.
Another paper in a very prestigious journal called The Lancet over in England said, “We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.”
And then there’s this paper from 2003 we will cover quickly. It’s called “Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain” and written by A. Gur, et. al.. It was published in Lasers in Surgery and Medicine(Gur A 2003).
The researchers decide that, “Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP.”
That’s pretty cool, people!! Yet, insurance companies refuse to cover it. Do you smell something fishy here? We certainly do.
I don’t know how to make insurance companies cover something they don’t want to cover. However, I can tell you that their choice to make it an uncovered service does not mean it is not effective. On the contrary. I hope we have demonstrated that you should indeed seek treatment with cold laser.
If you have any questions regarding cold laser or musculoskeletal complaints in general, give us a call at 806-355-3000 and let us schedule you for a free consultation with our staff.
Best of health,
Jeff Williams, DC
http://www.amarillochiropractor.com
http://www.creekstonecare.com
Bibliography
Gur A (2003). “Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.” Lasers Surg Med 32(3): 233-238.
Spinal Decompression – Does It Work?
The short answer to the question, “Spinal Decompression – does it work?” is YES.
It absolutely works.
The first thing to know is that we would not offer spinal decompression in our office or charge for the service if it did not work. Of course it works. We only offer services that we can back up with research including other services we have here in our offices like cold laser, acupuncture, massage, physiotherapies, exercise/rehab, spinal decompression, and, of course, chiropractic care. Dr. Williams is very research-based and evidence-based. In fact, Dr. Williams hosts a weekly podcast called Chiropractic Forward discussing research papers and evidence-based chiropractic care. (http://www.chiropracticforward.com)
The second thing to know is that, in our office, NOTHING we do will EVER be based on financial gain. It is our policy to conduct business at the highest level of honesty and ethics. Dr. Williams has said time and time again, “When you treat people right, when you treat people as you would treat your own family members, finances tend to take care of themselves and we’ll never have to worry too much about that part of it all.”
So far, Dr. Williams is right!
That is how our office goes through the day in general for all services and all aspects. We treat our patients like they are our family and not like they are a dollar sign. Guaranteed. Our philosophy is to give our best recommendations for our patients’ care based on experience, research, and knowledge the patient does not have, and then to be here however the patient wishes to use us. We are here to help and support the patient in their journey but based on how THE PATIENT wants to take that journey.
Enough about us. Let’s get back to talking about Spinal Decompression.
Let us simplify the concept. The discs in our spine stay hydrated and
healthy by moving, bending, and by going through our regular activities throughout the day. If for some reason a disc gets injured or stops working correctly, the disc can become inflamed and start to hurt .The pain can range from mild discomfort is certain positions to extreme, severe discomfort that keeps a person from being able to function at all.
Luckily, spinal decompression can help this. Spinal decompression can start to restore function in the hurt area and can simulate the normal daily activities in a controlled way.
With spinal decompression, we cannot only simulate the movement that
keeps discs healthy, but we can also decrease the amount of pressure on the disc and on the spinal cord, as well as on the nerves that come from the spinal cord and go into the arms and into the legs.
Medical research has shown that spinal decompression can reduce disc bulges or disc herniation, and spinal decompression can help rehydrate a dehydrated disc. All of this can help our patients with the following conditions:
- Pain into the arms
- Numbness into the arms
- Tingling into the arms
- Pain into the legs
- Numbness into the legs
- Tingling into the legs
- Spinal stenosis
- Spinal degeneration
- Degenerative discs
- Disc injury
- Facet Arthropathy
In addition to spinal decompression, we use cold laser therapy to enhance and speed up the healing process. Also known as low level laser, cold laser is backed by research, is FDA cleared, and is effective in healing the disc faster, decreasing the inflammation, and decreasing the pain resulting from a fired up disc issue.
We call our one-of-a-kind service Cold Laser-Enhanced Spinal Decompression and it is a powerful one-two punch.
We have seen our patients cancel surgeries. We have seen our patients cancel spinal injections, nerve blocks, and dangerous medications.
All because they came to us and tried Cold Laser-Enhanced Spinal Decompression.
If you are hurting, come talk to us. Consultations are free.
If you have been diagnosed with spinal arthritis, degeneration, disc bulges, disc herniations, or stenosis, come see us now. Chances are, we can help. Call us at 806-355-3000 today.
Crazy Update On Runaway Healthcare Spending in America
It is good to see the medical world beginning to examine itself with a clear lens. We have seen them turn blind eyes to many things we notice and research notices. As we have mentioned, there has been little attention given to the updated recommendations in favor of chiropractic, massage, and acupuncture. It is yet to be known what, if anything, will change following the series of low back pain papers recently published in The Lancet (March21, 2018).
I have been mentioning how I feel that the opioid crisis has opened many, many doors recently in regards to the medical field, clinical pathways, and in they way they are starting to look at the costs. Kudos to those in the medical field for beginning to call out their own protocols and question them for effectiveness vs. risk. Some procedures may be effective here and there but, in general, if the squeeze is not worth the push, then there is little to zero return on investment and it should be abandoned. Obviously, one’s health is different than a business stat sheet, but the metaphor is a valid one I believe.
Obamacare was supposed to heal all of our healthcare woes, right? From what I can tell, all it did was squeeze out the middle class. The folks that make too much to be subsidized but do not make enough to not really care about the new jacked health insurance rates.
For example, the premiums here in Texas have doubled or tripled in many cases while the insurance companies cover less and less. The co-payments have gone from $15-$20 all the way up to $50 and even $100. The deductibles have gone from $250 or $1,000 all the way up to $5000 or $10,000. In addition, the insurance companies are now reimbursing healthcare providers less: in many cases, 3/4 less.
Did you know that here in Texas, where a medical radiologist was once reimbursed up to $28+ or so for reading a neck series, they now get paid in the ballpark of $7 for the same series? I promise the doctors are not living less of a life than they were prior to Obamacare. Not at all. But, what is likely happening unconsciously is they are probably reading more x-rays more quickly to attempt to make up for the reduction in their pay.
Would you agree that this may put patients at more risk? I’m not saying doctors make a conscious decision to put patients at risk but, if a professional in ANY industry has a house in town, a house and boat on the lake, 3 cars, timeshare on a private plane, and things of that nature, when their income is cut by 3/4 in some cases, they will tend to find ways to make that up in ways that make sense to them. Regardless of profession or industry.
Maybe Obamacare just makes them more efficient rather than raising the patient risk. I do not have the answer on this but I do know that radiologists are responsible for everything on a film and their license is at risk on each and every film. When the government cut their pay that dramatically, the government began putting people at more risk. In my opinion of course.
I am firmly on the side of the medical field on this issue. The same type of thing is currently happening with the chiropractic industry as well. We are being reimbursed at smaller and smaller rates. We are seeing our covered patients being turned into cash patients whether we like it or not. The co-pays and deductibles are so high, the could just as easily be cash patients for our purposes. For this very reason, you are seeing more and more chiropractors in America begin to look at changing over to a cash-based practice model and drop insurance contracts all together.
I’m not certain every bit of this discussion is completely on topic but let me tie it up and bring it home through the use of this research paper. This paper appeared in the Journal of the American Medical Association (JAMA) on March 23, 2018. It was titled “Health Care Spending in the United States and Other High-Income Countries” and was authored by Irene Papanicolas, PhD (Papanicolas I 2018).
Why They Did It
Healthcare spending in America is a long-time hot topic and issue that has never been adequately addressed. Part of the problem is that we Americans spend more than other high-income countries with little information that shows that any efforts to control expenses has done anything to help the problem.
These authors attempted to compare the big ticket items in healthcare in America with the same items in ten other high-income countries in an attempt to learn where improvement might be made here at home.
How They Did It
Information was mostly gained from the Organization for Economic Cooperation and Development (OECD) from 2013-16. The OECD is an international organization comparing underlying differences in structural features, types of health care and social spending, and performance for several high-income countries.
What They Found
- In 2016, Americans spent 17.8% of its gross domestic product on healthcare while the other 10 nations spent from 9.6%-12.4%.
- Surprise, surprise….pharmaceutical costs spending per capita in America was $1443 vs. from $466-$939 in the other 10 countries. American doctors and patients love those pills.
- 90% of Americans are insured while 99%-100% were insured in the other 10 countries.
- The U.S. has the highest proportion of private insurance when compared to the other 10 countries, which is 55.3%.
- When it comes to smoking, Americans actually have the second lowest rate sitting at 11.4%.
- When we talk about obesity, the US has the highest proportion at 70.1%. Others range from 23.8%-63.4% for comparison purposes.
- The US life expectancy was the lowest at 78.8 years.
- US infant mortality was the highest rate of the 11 countries.
- There was no real difference in the American physician workforce, nurse workforce, etc., when compared to the other 10 countries.
- America has comparable numbers of hospital beds.
- Americans use MRIs and CTs when compared to the other 10 countries.
- The US had similar rates of utilization for acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease, hip replacements, knee replacements, and coronary artery bypass graft surgery.
- Administrative costs of care in America stood at 8%, while the same measure in the other 10 countries ranged from 1%-3%.
- Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218,173 in the US compared with a range of $86,607 to $154,126 in the other countries.
Wrap It Up
The authors of the paper concluded that, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.”
My own wrap up would be that America spends twice as much money on healthcare while we have the highest rate of obesity, double the mount of pharmaceuticals, lower life expectancy, higher infant mortality, and higher administrative costs when we are compared to 10 other countries of similar income.
That’s not good, folks. Not good at all. When do the pharmaceutical companies stop controlling the medical profession and the medical profession turn it around to control the pharmaceutical companies? When does that happen exactly?
Did you know that, from 1948 until 1996, there was a TV ban on running liquor ads? You may see beer or wine ads but you would never see Jim Beam running a commercial between Alf and Different Strokes. But, how often do we see pharmaceutical ads on TV these days? It’s a shame to be honest. Shouldn’t the doctor be the one that is informed on medications rather than a 320 million people that are almost completely uneducated on pharmaceuticals? Should patients be going into doctors’ offices ready to pressure them into a certain medication because they saw it on TV?
It is absolutely insane and should have been stopped at the first mention of it. To make it fair or legal or whatever may be the case, they state a long laundry list of all of the things that may happen to you if you take it. But, the information is delivered and people are influenced.
If a patient goes in for something like erectile dysfunction, the doctor tells them what they need. They don’t tell the doctor!! Do you see the problem here? If the patient goes in for potential blood clots, the doctor should be telling them they need a certain type of thinner. That is not the patient’s place in any country on the entire planet.
Not only do the pharma companies control patient mentality in this way but they attempt control of the physicians. Pharma reps are skilled at what they do. They are highly trained and very well-paid to effect influence in their market’s physicians. They take them on dinners, bring the office lunches, pay for trips, etc. You can spot them at any doctor’s office you go to. Just look for the well-dressed person in the waiting room with a clipboard and a bag of goodies. That’s them!
I had a general practitioner that I had to finally fire. I had been living a bit unhealthy for several months when I went for a yearly checkup. My blood pressure was high. He immediately tried to put me on lifelong meds. I was overweight and drank a 12-pack of Bud Light here and there while traveling in a band playing music. You might say that I used to be a little bit ornery. Again, I was admittedly behaving badly. His diagnosis was that I was depressed and needed an antidepressant. Really?
Instead of trying some behavior modification, according to him, I needed lifelong blood pressure meds and lifelong antidepressant meds. Where does this mentality come from? What if we treat the CAUSE rather than the SYMPTOM?
First, I lost weight and started to behave. Guess what? My blood pressure returned to normal. As a result of ceasing traveling in a band, I basically quit drinking beer outside of social events. Boom! I was no longer depressed according to his definition.
This may seem like an extreme example to some but, it is my estimation that this sort of “doctoring” and “pill pushing” is far more common than one may even dream.
I am in no way against the medical field or against surgery or against medicine. I am against simple pill fixes. I’m against long-term meds when not needed. There are some conditions like diabetes or genetic high blood pressure that require long-term meds but, in many cases, they should be avoided. I’m against the medical field performing shots and surgeries and using opioids for musculoskeletal pain when the research is clear when it recommends chiropractic, massage, etc.. for those pains.
Basically, the medical field needs to stop thinking the pills are the be all-end all of healthcare and start looking more to the cause rather than just treating the symptoms. The physicians need to take the reins of their profession away from the pharmaceutical companies and wield the power over pharma that they attempt to wield over chiropractic and other alternative means of healthcare.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……
The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.
by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
Bibliography
Papanicolas I (2018). “Health Care Spending in the United States and Other High-Income Countries.” JAMA 319(10): 1024-1039.
Chiropractic: Evolution Or Extinction?
This week, I want to continue with discussions on low back pain (LBP) because that is the topic that is on fire at the moment. The momentum low back pain has picked up recently is a once in a lifetime rebooting of an entire thought process, of long-held clinical pathways, and of stubborn practitioner mentality and dogmatic beliefs.
I blame the national emergency we know as the “Opioid Crisis” for starting a more focused attack on low back pain. The statistics on low back pain are some incredible numbers. It’s the number one reason for disability in the world. That is truly impressive. However, low back pain as a global issue did not crop up in only the last several years. Granted, due to an older, aging population, it has increased, but low back pain has been a serious concern for many years at this point.
Yet, there were no global papers on low back pain. There were no articles in the journals for the American Medical Association and for the American College of Physicians recommending spinal manipulation (chiropractic adjustments) as an effective, first-line treatment for low back pain. We have simply never seen the attention based on the research that we have seen since the onset of the opioid crisis.
One must give kudos to the medical field in the sense that they recognize they have been partly the cause of the opioid crisis and, in turn, are taking steps to address the problem through new thinking and alternative means. Even if that means going against old dogmatic beliefs and against the common grain. I applaud the new directions. Although, there is still a very clear gap that will take time to fill in regards to what the practitioner is doing and what they SHOULD be doing.
We recently discussed a series of papers in The Lancet from March 21, 2018 that dealt with low back pain. The Lancet is one of the oldest and most respected medical journals in the world dating back to 1823 and the series of papers was compiled by an international, interdisciplinary group of experts. It is considered the best current information we have dealing with low back pain, it’s prevention, and going forward. I highly encourage you to read through the papers.
Since it would get a little boring going over the same three papers over and over, I am going to move along with other research and other information concerning low back pain.
I want to start with a paper that echoes the sentiments of The Lancet series in regards to the gap in what the evidence suggests and in what is actually happening in the real world. In all actuality, from here forward, I believe most of what we discuss on the topic of low back pain will somewhat echo the sentiments found in the recent Lancet papers.
Moving on, the papers we will discuss are arranged strategically and tell a story if you follow along.
To start, here is a paper from 2010 titled “Managing low back pain in the primary care setting: the know-do gap.” It was published in Pain Research & Management and authored by NA Scott, et. al. with the Institute of Health Economics in Edmonton, Alberta, Canada.
Why They Did It
The goal for these authors was to identify gaps in knowledge in regards to diagnosis of acute and chronic low back pain in a primary care clinical setting for primary practitioners in Alberta, Canada in order to further determine what barriers lie in the way of the primary practitioners adopting a multidisciplinary approach in the treatment process.
How They Did It
- The authors accepted papers from 1996-2008.
- The papers compared clinical pathway patterns found in the primary practices and in the guides and recommendations found through searching literature databases, websites of various health technology assessment agencies, and libraries.
- The data was organized qualitatively.
What They Found
The search for quality papers yielded 14 that were considered relevant. Knowledge gaps were identified in the primary practices for red flags, imaging use, advice for bed rest and sick leave for low back pain, medications, and recommendations of alternative treatment means such as chiropractic, acupuncture, physiotherapy, etc.
Wrap It Up
The authors stated that a “know-do” gap certainly exists. Meaning, there is a difference in what the research is telling primary practices to do for low back pain and in what they are actually doing in the real world. The authors plan to use this information to develop a plan to implement more multidisciplinary protocols for low back pain by educating the primary practitioners on the guides and recommendations[1].
If we are to talk about the “Know-do” gap, what is a common result of there being a gap in knowledge of diagnosis and treatment when compared to actual researched guides?
To help shed some light on this, let us look at a paper from March of 2018 by Richard Deyo, et. al. at the Department of Family Medicine at Oregon Health Science University in Portland, Oregon. This paper is titled “Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery)”
Why They Did It
Considering low back fusion surgery is typically performed to treat chronic low back pain, and considering that patients have the expectation of no longer needing opioids after a surgery, the authors were looking to discover three things:
- What amount of patients having long-term preoperative opioid use discontinued or reduced dosage after surgery?
- What amount of patients having had a smaller amount of preoperative opioid use initiated long-term use?
- What predicts whether a patient goes on to use opioids in the long-term after surgery?
How They Did It
- This was a retrospective cohort study
- There were 2,491 participants that had undergone lumbar fusion surgery to treat degenerative conditions.
- The researchers used Oregon’s prescription drug monitoring program to determine pre-op and post-op use of opioids by the test subjects.
- Long-term use was defined as more than 4 prescription refills 7 months after hospitalization, with at least 3 occurring more than 30 days after hospitalization.
What They Found
- 1,045 patients were identified as having long-term opioid use PRE-operatively.
- 1,094 were determined to have had long-term opioid us POST-operatively.
- From the long-term PRE-op patients, 71% continued long-term in POST-op use and 13.8% experienced episodic opioid use.
- A mere 9.1% of the long-term PRE-op patients had short-term use POST-op.
- In the group of patients that received no pre-operative opioids, 12.8% went on to use opioids long-term.
Wrap It Up
This paper suggests that the strongest predictor of whether a patient would use opioids long-term was the cumulative effect of PRE-op opioid doses. The paper also suggests that lumbar fusion surgery commonly had no effect on eliminating long-term opioid use, so patients that are unaware of the risks of opioid use run a risk of long-term use[2].
While I’m no orthopedic surgeon, I would ask, “Why are they doing lumbar fusions on stable segments in the first place considering the research showing that it should be a treatment of last resort?”
It should come after spinal manipulation, acupuncture, massage, exercise rehab, physiotherapy, cognitive behavior therapy, yoga, etc….. That is A LOT any sort of surgery should typically follow so why? Of course, I’m not making the money those folks make so, that may be the decision maker for some of them at least.
Moving from things going wrong to ways they can go right, there is this paper from the journal Pain from March 27, 2018 titled, “Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial by R. Evans, et. al. with the University of Minnesota’s Integrative Health and Wellbeing Research Program.” As a side note, Gert Bronfort was also listed as an author in this paper. If you are unfamiliar with Bronfort, he has authored several key papers previously.
Why They Did It<
The authors state that there is a “paucity” in high quality research on the matter of exercise vs. spinal manipulative therapy in the treatment of low back pain.
How They Did It
- The research was a multicenter, randomized trial
- 185 adolescents were included
- The participants ranged in age from 12-18 years old
- All had chronic low back pain
- Outcome assessments were measured at 12 weeks, 26 weeks, and at 52 weeks
What They Found
- The inclusion of spinal manipulative therapy (chiropractic adjustments) to exercise therapy had a greater effect on the reduction of low back pain severity over the course of a year.
- At the 26-week mark, the spinal manipulative therapy with exercise group had better effectiveness for disability and improvement over the exercise alone group.
Wrap It Up
The spinal manipulative therapy with exercise group had a significantly greater satisfaction with care at all time points. “There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a one-year period, with the largest differences occurring at six months. These findings warrant replication and evaluation of cost-effectiveness[3].”
We chiropractors have to love that paper now, don’t we?
Next, let’s look at a different level of recovery that deals with the way patients think as much as the treatment they undergo. Here is an article that appeared in HealthDay called “Overcoming Fear of Back Pain May Spur Recovery” by Steven Reinberg. The article was based on a recent paper that appeared in JAMA Neurology in April 16, 2018 published by lead researcher Anneleen Malfliet. It is usually wise to at least listen up when it’s in journals such as The Lancet or in the Journal of American Medical Association.
The research paper being cited once again echoes much of the sentiment laid forth in The Lancet low back series. Basically, their recommendations were as follows:
- We need to help patients think differently about their pain.
- We need to encourage patients to move in ways they had been afraid of.
- We need to teach patients with neck and back pain to remain active and/or increase their activity level gradually.
- We should avoid the use of scary or un-reassuring labels or diagnoses.
- We should not use pain levels as a reliable symptom or guideline to limit activity.
In short, research proved that patients following these guidelines showed less disability, a reduced fear of moving, and improvement in mental and physical outlook.
“Pain neuroscience education aims to change patients’ beliefs about pain, to increase their knowledge of pain and to decrease its threat,” Malfliet said[4].
Be sure to read the full article at:
https://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/overcoming-fear-of-back-pain-may-spur-recovery-732970.html
Now that we chiropractors are taking the step more and more into the spotlight as the experts in the treatment of biomechanical issues, what can we do on our end to ensure our colleagues can confidently refer to us and see us as peers for these issues?
I can tell you that, being in the ER one night as a result of a viral infection, not only was the virus running crazy through me but my neck was killing me as well. I thought I would ask the ER doc if he had any orthopedic exams up his sleeve that could determine what on Earth was hurting me so bad. Between you, me, and the light post, I already had a good idea but was curious as to what he knew and I thought it may be something that both of us could learn from.
It was. He did a Spurling’s move and that was about it before he gave up and said, “Honestly man, you probably know what’s going on better than I do.” And he was right. I did. But, it showed me that he was honest and that he saw me as an expert in my field and I appreciated it. Of course, he’s more of an expert in his field which is why I was there in the first place. We all have our part to play in the treatment of patients. Don’t we?
Back to my original point: how do we increase our profile as spinal, biomechanical experts. How do we increase interdisciplinary, interprofessional trust in who we are and what we can do for our patients?
I can tell you what NOT to do if that helps anything. I do not see any use for chiropractic terminology that our colleagues do not understand. I personally do not use the term subluxation. In the dictionary, it is described as a partial dislocation. What does that mean in the medical mentality? It means a shoulder that was almost dislocated but reduced naturally. It means something along those lines. It does not mean a slight misalignment of a vertebra that causes cancer or whatever other conditions some describe.
I understand chiropractors wanting to stay separate and distinct. I get it. But, there is a difference between being separate and distinct and putting yourself in a category nobody understands, that everyone thinks is out on the fringe, and that nobody knows exactly how to utilize.
If our profession is not careful, it will separate itself into oblivion now that physical therapist, physiotherapists, and the medical world in general have discovered something we have known all along. That is that spinal manipulation and mobilization is one of the best and most effective means of treating neck and back pain.
What has kept us safe from them taking our business all of these years is that they all thought we were crazy! For some, they were right, but the basic principle our profession is based on was one that evidence eventually backed up and proved. Now we are in danger of losing it if we do not learn that separate and distinct may not be the most effective means of conducting our business.
The last paper I want to discuss is one called “How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years” by Stanley Innes, et. al. It was published in Chiropractic & Manual Therapies in March 15, 2018.
Why They Did It
The authors wanted to determine what proportion of chiropractic students in Australia hold non-evidence-based beliefs from the start and what their beliefs are in the treatment of non-musculoskeletal health condition. In addition, the authors wanted to determine if the beliefs changed any over the course of their education.
How They Did It
- The study was performed in 2016.
- The information was taken from two chiropractic schools in Australia.
- The students answered a questionnaire with the following questions:
- How often would they give advice on five common health conditions in their future practices?
- What was their opinion about if chiropractic spinal adjustments could prevent or help seven health-related conditions?
- There were 444 responses to the questionnaire.
What They Found
- Students were highly likely to offer advice on non-musculoskeletal health conditions.
- The chances of a student doing so rose to the highest level in the last year of their education.
- High numbers of students held non-evidence-based ideas of the capabilities of chiropractic spinal adjustments in beginning which then tended to decrease in proportion until the last year. In the last year, the pattern reversed.
Wrap It Up
The authors were quoted as saying, “New strategies are required for chiropractic educators if they are to produce graduates who understand and deliver evidence-based health care and able to be part of the mainstream health care system[5].”
I want you to know that I am a chiropractic advocate. I want chiropractors to practice how they wish. I want the minimal practices to be comfortable and be as stripped down and as effective as they can be. I want the interdisciplinary doctors to do everything they can do to get people well and make a difference in lives. But I want them to do things in a way that is backed by science, that brings us to the center of healthcare rather than the fringes, I want us using terminology and ideas that garner confidence and respect rather than ridicule and scorn, and I want us all to thrive and prosper while we grow our incredible profession.
There will always be an internal feud amongst chiropractors. Likely, some of my close colleagues whom I respect immensely will take offense to what I am saying and to them, I can only say, “I’m sorry, but it’s the way I feel about it and it’s the way I see it.” Thank God we are all different. The same would be boring.
A colleague of mine told me he feels that philosophy and science can live hand in hand. I want to believe that too. I hope it is true. But, what I do know for a fact is that if we do not take this once-in-a-lifetime opportunity that opioids and low back pain has presented us, and move toward better integrating ourselves with the medical profession, I fully believe we will have our techniques and treatment stolen from us and we will cease to exist in our current form.
One constant you can always count on in life is change. I hope the inner-professional feuding does not keep change from happening quickly and in the right direction.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……
The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.
by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
References
- Scott NA, Managing low back pain in the primary care setting: the know-do gap. Pain Res Manag, 2010. 15(6): p. 392-400.
- Deyo R, Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery). Pain, 2018.
- Evans R, Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial. Pain, 2018.
- Malfliet A, Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain
A Randomized Clinical Trial. JAMA Neurology, 2018. - Innes S, How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years. Chiropr Man Therap, 2018. 26(8).
Review of The Lancet Article: Low Back Pain: A Call To Action (Part Three)
This week, we’re going to review the last of the three papers from a recent series published in The Lancet on March 21, 2018. If you don’t know the impact or why this series is so important, please review the last two episodes of the Chiropractic Forward Podcast at www.chiropracticforward.com or the last two articles of my blog over at amarillochiropractor.com/blog. That will get you up to speed. In short, the series on low back pain was compiled and authored by an international panel of experts on the matter. Essentially, the best of the best. This series is as up to date, as current, and as reliable as can be had at this point in our understanding of low back pain, so it is worth your time and attention.
This last of the three papers is titled “Low Back Pain: A Call To Action.”
Summary
We have already covered several times that low back pain is now the leading cause of disability globally and is only growing in significance because the global population is living longer. The issue may be more profound in low to middle-income countries. In addition, most low back pain doesn’t even appear to be directly related to any specific trigger or origin. Some of the key areas for improvement for the treatment of low back pain are in health & workplace policies as well as disability benefits and payments. They claim they are wasteful and can certainly stand a re-boot. In many cases, patients are being restricted from attempting resolution of the back pain via conservative approaches such as self-management support, specialized interventions like spinal manipulations (I added that part) and multidisciplinary rehab.
The panel suggests the following:
- Address the political aspect. They recommend calling on the World Health Organization to make low back pain one of its priorities by putting it on the target list in an effort to increase attention and decrease treatment that is not recommended initially. They recommend calling on political, medical, and social leaders to make sure public health initiatives are properly funded and geared toward the prevention of low back pain and treatment.
- Public health challenge.
- Change priorities – Make low back pain a priority. Create and implement ways to prevent it and combine these strategies with other strategies that are chronic and somewhat related. Strategies such as weighing the right amount, being active physically, and maintaining good mental health as well. These tactics treat more than simply low back pain. The panel also recommends strategies that can modify the factors putting the population at risk of developing low back pain.
- Change systems and change practice – Provide early recommendations for maintaining workload as much as possible and/or return to work as quickly as possible. Attempt to ensure early ID of people that are at risk of developing long-term, chronic disability as a result of low back pain. Address co-morbidities raising a person’s risk of developing low back pain and promote a healthier lifestyle in addition to altering disability benefits and get people back to work as soon as possible. And lastly, address low back pain through multidisciplinary rehabilitation in an effort to return the patient to work quickly.
- Healthcare challenge –
- Change culture – The panel appears to me to be promoting the use of a Public Relations campaign to focus and promote living well with low back pain, self-management, staying healthy, and to change the public perception of low back pain.
- Change clinician behavior – The recommendation is to place effort and finances into finding out the best way to change the way clinicians recommend care for low back pain and to fill the evidence/real world gap. After developing the best evidence-based systems, there will be a need to get everyone on the same team in regards to the way clinicians refer and treat, the patients, as well as the professional journals.
- Change systems – There is a need to develop and implement systems allowing a patient to receive the right care at the right time. Clinical pathways will need a reboot and will need to become consistent across interdisciplinary lines and differing clinical settings.
- Tackle Vested Interests – The panel discusses the fact that governments and insurance companies need to regulate in a manner consistent with evidence-based treatment for low back pain and eliminate conflicts of interest. Regulation through contracts, and payment schedules for treatments with little to no evidence for effectiveness.
The idea that a healthy weight and regular physical activity will help reduce low back pain must enter the global subconscious through public programs, especially in low to middle-income countries.
An assertion I fully agree with the authors on is that, thus far, healthcare dollars have been wasted on treatments that are ineffective and, many times, downright dangerous. The risk vs. reward ration just doesn’t make sense more times than not currently. Not to mention the issue of opioid addiction, which we all should know the stats on by now.
Boiling it down, the panel aims to get rid of practices that harm and create waste while, at the same time, opening the door to effective and affordable means of treating low back pain to patients in need. The authors are quoted here as saying,”Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”
The authors promote the idea of implementing a positive health concept as the umbrella idea aiming for prevention of long-term disability. This includes alternatives to treatments and cures and promoting more meaningful lives.
Another great quote from this third paper is as follows, “Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care.”
The panel also calls for an active monitoring system in order to assess and keep an eye on the recommendations and implementation as well as the outcomes of the changes.
To read more for yourself, follow this link to the third paper:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
If access is unavailable, just simply register at The Lancet. It is completely free of charge.
References:
Paper 1 – “What low back pain is and why we need to pay attention: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext
Paper 3 – “Low back pain: a call for action”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……
The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.
by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
Review of The Lancet Article: Prevention and treatment of low back pain: evidence, challenges, and promising directions (Part Two)
This week, I want to continue with the series published in The Lancet on March 21, 2018. For a quick re-cap, this series: The Lancet is one of the oldest and most respected medical journals in the world. It has been around since 1823. In addition to the credibility of the journal, this series of papers dealing with Low Back Pain was compiled and authored by the leading experts on the matter globally. On top of that, the experts were a group of interdisciplinary practitioners which meant they ranged from medical doctors and PhD’s, to physical therapists and chiropractors.
Essentially, EVERYONE had a seat at the table, so it is the general consensus at this point that this series of papers is as current, as credible, and as accurate as can be had at this point in time with our understanding of Low Back Pain.
The three papers were broken down as follows:
- What low back pain is and why we need to pay attention
- Prevention and treatment of low back pain: evidence, challenges, and promising directions
- Low back pain: a call for action
Last week, we reviewed the first of the three papers which was titled, “What low back pain is and why we need to pay attention.” We went through it note by note and section by section trying to strip away the embellishments to simply boil it down to a leisure read and, hopefully, an enjoyable learning process.
We will do the same this week with the second paper of the series titled, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”
I want to start this week in the same way we started last week: by discussing how the papers were accomplished.
How They Did It
For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:
- MEDLINE (PubMed)
- Scopus
- Google Scholar
- African Index Medicus Database
In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.
Paper 2 Summary:
Recommendations commonly offered for those with low back pain include:
- Pharmacologic implementation is not typically a first line choice
- Education supporting self-management
- Resumption of regular daily activities
- Resumption of exercise
- Psychological programs for those with low back pain that tends to linger
- Limited or non-use of medication
- Limited or non-use of imaging
- Limited or non-use of surgery
The authors state that these recommendations are derived from high-income countries and that they are concentrated on treatment rather than preventative recommendations.
The authors state there is an inappropriate high usage of the following treatments for low back pain:
- Spinal injections
- Imaging
- Opioids
- Surgery
- Rest
The authors also say that doing a lot of the same will get us the same results so, in going further, the treatments should be more in line with what evidence suggests is effective. Things like exercise and getting back to work as soon as possible. Makes sense to us!
In the rest of the paper, the authors identify some promising directions and solutions for low back pain including the redesign of clinical pathways, an integrated health partnership, and occupational interventions to get workers back when possible.
Prevention
- A 2016 systematic review with 30,850 adults showed that there was moderate quality evidence that exercise alone, or in combination with education, is effective for prevention of low back pain.
- However, the review was mainly for secondary prevention and the exercise program required an intense schedule of twenty 1-hour supervised sessions.
- A 2014 systematic review with 2,700 children that found moderate quality evidence that education is not effective. They also found that ergonomic furniture was likely no more help in preventing low back pain than regular furniture.
- Some key messages for Prevention were to use self-management, physical and psychological regimens, and some forms of complementary medicine. In regards to Treatment, there should be less emphasis on pharmacologic protocols and less instances of surgical intervention. Also, the authors write that, although their popularity in healthcare has been steadily on the rise, there should be less utilization of imaging, opioids, and spinal injections.
Treatment
- The authors cite three studies. The studies come from Denmark, the UK, and the USA.
- All three of the studies (Danish, UK and USA) recommend spinal manipulation as an effective regimen for low back pain. The UK study specifically recommends spinal manipulation in conjunction with an exercise protocol.
- As my own side note, in America, chiropractors perform 90% of all spinal manipulations. When we are discussing spinal manipulation and its role in treating low back pain, it is important to keep in mind which profession is the one being recommended. Although the authors do not come out and recommend chiropractic specifically, when spinal manipulations are recommended, it is a well-known fact that chiropractors are the doctors that are best-equipped to perform the treatment.
- Also in the US guidelines, there is a recommendation for the marked reduction of pharmacologic care.
- Some key advice coming from these updated recommendations (besides the use of spinal manipulation) is to assure patients they are not suffering from serious disease, that they will indeed improve in time, that they should continue as much movement and exercise as can be tolerated, they should avoid bed rest, and they should get back to work as soon as possible.
- The authors recommend physical treatments. Certainly for chronic low back pain, which refers to pain lasting longer than 12 weeks. Physical treatments included exercise programs targeting the patient’s’ abilities, preferences, etc.
- The authors stated that passive therapies such as electric stim, interferential, traction, diathermy, and back supports seem to be ineffective. As a side note, it’s strictly anecdotal, but this panel of experts are going to have a hard time convincing me traction, when done correctly, is not effective. I’ve seen patients avoid surgery from traction therapy alone.
- They say new recommendations encourage doctors to consider psychological therapies such as cognitive behavior therapies, progressive relaxation therapy, and mindfulness-based stress reduction alone or in combination with other physical and psychological treatment for chronic low back pain with or without radiculopathy having not responded to other treatments.
- If the condition persists and the patient is functionally disabled, the authors then recommend multidisciplinary rehab with supervised exercise, cognitive behavior, and medication.
- Of course, routine use of opioids is not advised.
- Recommend no spinal epidural injections or facet joint injections for low back pain.
- Do recommend epidural injections of local anesthetic & steroid for radicular pain, however, as we have discussed before, epidural steroid injections show short-term effectiveness only if they are effective at all and have no influence at all on long-term disability or future need for surgery. In my own research, epidural steroid injections have shown to increase risk of spinal fracture up to 21% after each subsequent injection.
- Surgery – the benefits for spinal fusion when the back pain was thought to be due to degenerated discs were about equal to the results gained with intensive multidisciplinary rehab and only a modest improvement over non-surgical treatment. In addition, surgery has obvious downsides like expense, recovery, medication, and the risk of adverse events. However, surgery may be indicated when the patient is suffering severe or progressive neurological symptoms and surgery may be indicated when patients suffer radicular pain, have failed first line treatment, and the symptoms can be traced via imaging to a disc or stenosis origin.
- Ultimately, the authors say low back pain patients have a tendency to resolve without surgical intervention, so waiting and trying to avoid surgery is certainly appropriate.
- Research dealing with low back pain in children or in low and middle income countries is limited, so a lot is unknown for those categories. However, the two studies that actually have been done in low and middle income countries (Brazil and Philippines) have similar results as those in high income countries.
The global gap between evidence and practice
This section masterfully demonstrates the difference between evidence-based medicine and what is really happening in the real world. When it comes to low back pain, the medical field is not adhering to research globally as they “overuse low-value care and underuse high-value care.”
- They start by stating that low back pain should be managed by primary care practitioners and then go on to list studies showing how it is being managed, in many cases, by emergency rooms, hospitals, and surgeons.
- Their next directive is to provide low back pain patients with education and advice on self management and then show how, in the real world, roughly only 20%-23% of practitioners seem to actually do so.
- The next directive is for low back pain patients to stay active and get to work or stay at work if possible. They go on to cite research showing how, in the real world, medical professionals are recommending rest and time off work. In India, for example, 46% of physiotherapists recommended rest to low back pain patients and in Brazil, rheumatologists recommended rest.
- The next comparison was for the guideline that imaging should only be ordered if the practitioner suspects a specific cause that would guide treatment and case management differently from normal care recommendations. In the USA, for example, from 2010-2013, the rate of imaging the low back with no red flags stayed consistent at 53.7%. If we thought that was excessive, the authors go on to cite information from India showing 100% of chronic low back pain patients in an orthopedic clinic underwent imaging for non-specific low back pain. Similar results were found through the other studies cited for low and middle income countries.
- The next comparison was for the guideline that the first line treatments should be non-pharmacologic. They found that this guideline is not commonly followed, citing research for high income countries demonstrating that 64.5% of low back pain patients in Australia from 2000-2010 were prescribed meds on the first visit. On a personal note, I had a patient here in the USA just this morning with acute low back pain that was prescribed pain meds on the first day. To be fair, his pain is severe but, they are not following guidelines and the meds have had no impact on his level of pain; still, he continues to take them as ordered. Medication for no effect essentially. In the lower and middle-income countries, the authors cite research showing that in South Africa, 90% of the low back pain patients going to a primary care physician received medication.
- The next guideline was that many times, there was advice to avoid electrical physical modalities such as diathermy, etc. In the high-income setting, Swedish physiotherapists recommend transcutaneous stim for low back pain to the tune of 38%. 75% of American PTs use lumbar traction, and a Spanish National Health Service study suggested 38.6% of physical therapy costs were for treatments known to have no effectiveness.
- The next guide comparison was that the use of opioids is discouraged. The authors go on to cite prescription rates from 2004-2009 and, to be honest, I think the opioid epidemic has likely caused the numbers cited to actually drop. Although opioid addiction is on the rise, it’s my opinion that it is now at the forefront of the national story. With the sort of attention it has demanded, I cannot imagine the numbers staying the same. That is my opinion, of course.
- Next guide was that surgery and interventional treatment should be very limited or possibly eliminated for low back pain. In the real world, this is not occurring. In the USA in 2011, spinal fusion was the reason for the most costs of any surgical procedure in the nation. US Medicare covered 2,023,481 epidural injections (a substantial increase from 2000-2011), 990,449 lumbar or sacral facet injections as well as 406,378 lumbar or sacral facet neurotomy treatments. Medicare also funded 252,654 sacroiliac joint injections. Two-thirds of Dutch spinal surgeons perform spinal fusion surgeries.
- The next guide comparison was that exercise is now recommended for the treatment of chronic low back pain. A 2009 paper the authors cited showed that 54% of Americans with chronic low back pain were not prescribed any exercise as treatment.
- The final guide comparison was done for the recommendation that a biopsychosocial framework guide the management for low back pain patients. In the USA, only 12% of chronic low back pain patients had been treated for their diagnosed depression in the year prior and only 8.4% were recommended cognitive behavioral treatment.
Promising Directions
Implementation of the best available evidence
The authors state here that some of the biggest issues toward implementation of new low back guidelines may be short consultation times, the practitioners having a decreased amount of knowledge on the guides, fear of being sued if missing serious pathology, and an effort to appease patients’ desires and, in my opinion, be the “good guy” in the patient’s’ eyes. However, the authors explain that there are some examples of successful implementation and that widespread use may be achieved through dispelling existing established practice patterns, repetition of the guides, and finding out what are the most effective and cost-effective treatments.
The authors suggest integrated education of health-care professionals surmising that such a thing could not only educate & innovate but also break through professional barriers that exist. Professional barriers such as exist between many in the medical field and the chiropractic field.
Clinical systems and pathways
The authors say that one solution could be a radical departure from current procedure and move toward a stratified primary care model known as STarT Back. This model is a two-part model with the first part consisting of a questionnaire to help the practitioner identify the patient’s risk of persistent disabling pain. The second part consists of treatments tailored to the patients level of risk according to the first part of the questionnaire.
Another option along these lines would be to redesign the entire case management paths from first contact all the way through to the specialized care practitioner. They argue that a current barrier to doing this is the fact that healthcare reimbursements are currently geared toward quantity rather than quality. Two programs the authors cited for examples of promising pathways are Canada’s Saskatchewan Spine Pathway as well as NHS England’s program.
Integrate health and occupational interventions
The authors argue in this section that healthcare and occupational health interventions need to be considered simultaneously when it comes to patients with low back pain and work disability issues. Return to work commonly happens before the absence of pain. Even hurting, people can still return to work. The authors tend to have a very strong recommendation on never leaving work or returning as quickly as possible.
Due to very specific examples, I have admittedly glossed over this section to avoid inaccuracies and unintended generalizations. I highly encourage your reading the paper on your own time for accuracy.
Public health interventions
In this section, the authors are discussing public relations: how to get the word out. How to change public perception of back pain. They cite a successful campaign in Australia that used television ads with prominent public figures serving as the spokespeople. They felt it was well-funded and was successful in part due to the proper messaging but also due to laws and public policies that supported the campaign.
Conclusions
There is a large gap between what evidence suggests and what practitioners are actually doing in their day-to-day practice and in the recommendations they commonly make. The authors admit that even the solutions put forth in this paper are based on relatively limited evidence. The following are quotes from the conclusion:
- “Focusing on key principles, such as the need to reduce unnecessary health care for low back pain, support people to be active and stay at work, and reform unhelpful patient clinical pathways and reimbursement models, could guide next steps.”
- “No single solution will be effective, and a collective, global effort will take time, determination, and organization. Without the collaborative efforts of people with low back pain, policy makers, clinicians, and researchers necessary to develop and implement effective solutions, disability rates, and expenditure for low back pain will continue to rise.”
A paper of this size and of this magnitude, and with the level of education of contributors honestly cannot be done complete justice by a review such as this. I admittedly hit the high spots. I am more focused in some areas than in others. More specific for some topics and more general in others. That is the nature of a summarization and I hope I am allowed that latitude.
If you are research minded, if you are a low back pain patient, or if you are a practitioner regularly coming in contact with low back pain patients, it is my opinion that taking the time to read these three papers yourself is of utmost importance.
Please find the links to the papers in the “References” section and get it done. Together, we can make a big, big difference in the lives of our low back pain patients. Without a doubt.
References:
Paper 1 – “What low back pain is and why we need to pay attention: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext
Paper 3 – “Low back pain: a call for action”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……
The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.
by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
Review of The Lancet Article: Low Back Pain: A Major Global Challenge (Part One)
This week, we are going do a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow.
Those of us that are hungry for new research and the recommendations that arise from the body of literature being constantly created were excited last week about the release of significant reports coming out in a highly respected research journal called The Lancet.
Founded in 1823, The Lancet is published weekly is one of the oldest, most respected, and most well-known medical journals in the world. When it was announced a series of papers were to be published in The Lancet having to do with low back pain, as you may imagine, those of us interested in the research world and musculoskeletal complaints were all ears.
Not only was the article noteworthy due to its being published in The Lancet, but it was also exciting for those of us in the so-called alternative healthcare world because there were several Doctors of Chiropractic sitting on the steering committee for the series of reports. For some reason, chiropractors are still considered by many to be alternative, while this group of papers suggest chiropractic may be a lot more than simply “alternative.”
We chiropractors are typically not sitting at the table when the bigger discussions or decisions are made so, thanks to research that has been done prior to this, we are in the thick of it now it seems. And that is exciting to say the least.
There are a couple of things in my mind that stand out as reasons for such a series of papers. The first being that low back pain has become a major problem globally and shows no sign of stopping the growth of its impact. The second reason would be the ineffectiveness of the treatments commonly used or recommended. This includes surgery, epidural steroid injections, and, the most notable of failed treatments, opioids.
The series of Low Back Pain papers were compiled by a team of leading experts on back pain. The team was made up of an international spectrum of varied backgrounds. They met for a workshop in Buxton, UK, in June, 2016 to start the journey and the process of setting the outline and some sort of structure for each paper.
It was quite an undertaking from quite the group of experts. This is not a group of papers to be ignored since these authors and researchers are among the best of the best globally.
The papers were broken down as follows:
- What low back pain is and why we need to pay attention.
- Prevention and treatment of low back pain: evidence, challenges, and promising directions.
- Low back pain: a call for action.
In this article, I will cover the first of the three papers with plans to highlight the next two papers in the coming weeks so be sure to return for those important discussions.
How They Did It
For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:
- MEDLINE (PubMed)
- Scopus
- Google Scholar
- African Index Medicus Database
In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.
Summary of the introduction of the first paper.
- Low back pain is now the leading cause of disability worldwide.
- Only a small percentage have a well-understood, definite cause for their low back pain. Examples of well-known and understood causes are things like a vertebral fracture, malignancy, or infection.
- Things that seem to raise the risk of having low back pain complaints would be populations that smoke regularly, people that have physically demanding jobs or routine jobs or jobs that keep them mostly sedentary throughout the day and throughout the work week, people with physical and mental issues that add to a low back complaint or contribute to a low back complaint, and overweight/obese people. These populations are all at risk for developing low back pain.
- 540 million people were affected at any one time globally.
- A systematic review (3,097 participants) found several MRI findings had a reasonably strong association with low back pain, including Modic type 1 change, disc bulge, disc extrusion, and spondylolysis. To further define Modic 1 changes, in regular vertebral endplate bone, the trabeculae should be like a type of scaffolding. Within the trabeculae there is red bone marrow producing blood cells. In a Modic type 1, the trabeculae are fractured intermittently and the patterns are more erratic and the marrow is absent. In the marrow’s place now is serum which is the same substance one can find in a blister.
Symptoms Associated With Low Back Pain
Radicular Pain and Radiculopathy
- Radiculopathy is usually called sciatica and mostly occurs when there is involvement where the nerve root exits the spine.
- The authors noted that the term sciatica is used inconsistently by doctors and the public in general and should probably be avoided all together.
- The diagnosis of radicular pain relies on clinical findings, such as history of dermatomal leg pain, leg pain that is actually worse than the back pain, aggravation of the symptom when bearing down such as in coughing, sneezing, lying on your back and raising heels off of the table or in going from seated to standing, and straight leg raise test. The general rule of thumb for an SLR is that pain in the first 30 degrees of leg elevation hints at a disc origin, since that is the movement that first starts to tension the nerve at the root.
- Radiculopathy is not just the feeling of pain. Radiculopathy can also be weakness, decreased sensation, decreased reflexes, or all of those combined. In addition they can be identified with, or without, the presence of pain.
- Patients presenting with low back pain in addition to radicular pain or radiculopathy tend to have worse outcomes than those presenting with low back pain alone.
Lumbar Spinal Stenosis
- I tell my patients that the simplest way to explain stenosis is to say that a hole that nerves runs through has become smaller and as a result, the nerves sometimes have pressure on them that can cause them to be somewhat dysfunctional.
- Lumbar spinal stenosis is clinically characterized by pain or discomfort with walking or standing that radiates into one or both legs and can be eased when resting and almost always by lumbar flexion (neurogenic claudication). They call this the shopping cart sign. Meaning, if a person gets relief from leaning on a shopping cart, it sure may be stenosis. If it is aggravated by leaning back or by inducing a “swayback” type of movement, that sure may be stenosis. As a side note and from my own studies, if lumbar extension (or swayback) does not hurt, but then rotation in either direction at the endpoint of lumbar extension actually does increase the pain, then the patient is likely suffering from a lumbar facet complaint.
- Lumbar stenosis is commonly caused by narrowing of the spinal canal or intervertebral foramina as a result of a combination of degeneration such as facet osteoarthritis, ligamentum flavum hypertrophy, and bulging discs. Two or three of these factors can combine to reduce the size and space available for the neural structures to pass through. Obviously that can create issues.
- Experts tend to agree that the diagnosis of stenosis requires both the presence of the symptoms in addition to imaging findings demonstrating stenosis.
Other Causes of Low Back Pain
- Vertebral fracture, inflammatory disorders, malignancy, infections, intra-abdominal causes.
- The US guideline for imaging advises deferral of imaging pending a trial of therapy when there are weak risk factors for cancer or axial spondyloarthritis. What does that mean exactly? That means a trial of conservative care. The authors will delve further into this in the second paper from the Lancet series but I will butt my head in here with the opinion of the American College of Physicians. Their updated recommendations from February of 2017 reflect that doctors should be recommending Chiropractic, massage, and/or ice for acute low back pain and should recommend Chiropractic, acupuncture, and/or exercise/rehab for chronic low back pain. These recommendations are to precede taking even ibuprofen.
Prevalence
- Approximately 40% of 9 through 18-year olds in high-income, medium-income, and low-income countries report having had low back pain.
- Low back pain prevalence increased 54% since 1990.
- It is the number one cause of disability globally.
Work Disability
- Jobs are less-regulated in lower and middle income countries. Many times, employers and companies are unwilling to modify the job duties or the workload. As a result, having low back pain can be particularly concerning or difficult for an employee in these circumstances.
- To go along with jobs that are poorly regulated, heavy manual labor has no regulation or proper safety instruction adding to low back pain injury instances.
- In Europe, low back pain is the most common cause of medically certified sick leave and early retirement.
- In the USA, low back pain accounts for more lost workdays than any other occupational musculoskeletal condition.
Social Identity & Inequality
- MacNeela and colleagues reviewed 38 separate qualitative studies in high-income countries. They showed common traits, including worry and fear about the social consequences of chronic low back pain, hopelessness, family strain, social withdrawal, loss of job and lack of money, disappointment with health-care encounters (in particular with general practitioners), coming to terms with the pain, and learning self-management strategies.
- Froud and colleagues reviewed 42 qualitative studies from high-income countries, and found that many people living with low back pain struggled to meet their social expectations and obligations and that achieving them might then threaten the credibility of their suffering, with disability claims being endangered. Sometimes we have to almost force low back patients back into the workforce and, did you know that studies show in general that the sooner people are returned to work, the better they tend to recover from the low back pain complaint?
- Schofield and colleagues found that individuals who exit the workforce early as a result of their low back pain have substantially less wealth by age 65 years, even after adjustment for education. This is just an obvious statement. It makes sense that people that quit working earlier than 65 end up making less money by the time they reach 65. You can also throw the expense of dealing with a back pain complaint in on top of the loss of wages.
- Globally, low back pain contributes to inequality. At first, when I read this, it struck me as being silly. Everything’s about inequality these days isn’t it? Certainly in America it seems. But, this is a little different when you read through the explanation. The authors go on to say that in low-income and middle-income countries, poverty and inequality might increase as participation in work is affected. In addition, regulations on how to properly re-introduce a person into the workforce are absent, and workers are likely to be placed right back into the job they were originally injured without proper re-introduction. The authors felt this might place more strain on family and community livelihoods.
Cost of Low Back Pain
- Costs associated with low back pain are commonly tallied as direct medical costs, meaning the cost of the doctor’s bill. They are also tallied in terms of indirect costs, meaning the cost of being out of work and the loss of productivity at the workplace.
- Most studies underestimate the total costs of low back pain.
- Although we do not think of low back pain in these terms yet, the truth is that low back pain, in terms of a real problem as far at the cost to treat and the overall indirect costs, are right up there with the biggest issues the global population faces. Issues such as cardiovascular disease, cancer, mental health, and autoimmune diseases. That’s huge.
- In the USA, 44% of the population used at least one complementary or alternative health-care therapy in 1997; and the most common reason was low back pain. With 70,000 plus chiropractors in the United States, I can tell you with some confidence the profession most associated with alternative treatment for low back pain or spinal pain of any sort is chiropractic care.
- The USA has the highest costs, attributable to a more medically intensive approach as well as higher rates of surgery compared with other high-income countries. We see patients every week that have gone through needless surgeries. Surgeries for which there is plenty of high-level research proving its ineffectiveness, yet you see the popularity for these surgeries continuing to rise.
Natural History
- A systematic review (33 cohorts; 11,166 participants) provides strong evidence that most episodes of low back pain improve substantially within 6 weeks, and by 12 months average pain levels are low. However, two-thirds of patients still report some pain at 3 months and 12 months.
- The best evidence suggests around 33% of people will have a recurrence within 1 year of recovering from a previous episode.
Risk Factors and Triggers for Low Back Pain Episodes
- A systematic review (5,165 participants) found consistent evidence that people who have had previous episodes of low back pain are at increased risk of a new episode. Likewise, people with other chronic conditions, including asthma, headache, and diabetes, are more likely to report low back pain than people in good health.
- A UK cohort study found psychological distress at age 23 years predicted incident low back pain 10 years later. The Canadian National Population Health Survey with 9,909 participants found that pain-free individuals with depression were more likely to develop low back pain within 2 years than were people without depression systematic reviews of cohort studies indicate that lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of low back pain episodes. We know that obesity and lack of exercise has become an American trait that needs to be reversed.
- A systematic review found the genetic influence on the liability to develop low back pain ranged from 21% to 67%, with the genetic component being higher for more chronic and disabling low back pain than for inconsequential low back pain. Don’t we all have patients that present to us claiming that their bad back just runs in the family? Mom and Grandma had a bad back so that must be why they have a bad back is the common sentiment. It seems there may be a bit of validity there.
- An Australian case-crossover study (999 participants) showed that awkward postures, heavy manual tasks, feeling tired, or being distracted during an activity were all associated with increased risk of a new episode of low back pain. Similarly, work exposures of lifting, bending, awkward postures, and tasks considered physically demanding were also associated with an increased risk of developing low back pain in low-income and middle-income countries.
Psychological Factors
The presence of psychological factors in people who present with low back pain is associated with increased risk of developing disability even though the mechanisms are not fully understood.
Social and Societal Factors
- Cross-sectional data from the USA (National Health Interview Survey 2009–10, 5,103 people) found that those with persistent low back pain were more likely to have had less than high-school education and had an annual household income of less than US$20,000.
- Suggested mechanisms for the effect of low education on back pain include environmental and lifestyle exposures in lower socioeconomic groups, lower health literacy, and health care not being available or adequately targeted to people with low education.
- To go along with lower wages, the lower socioeconomic groups are commonly in routine and manual occupations and have increased physical workloads associated with disabling low back pain.
Conclusion
“Low back pain is now the number one cause of disability globally. The burden from low back pain is increasing, particularly in low-income and middle-income countries, which is straining health-care and social systems that are already overburdened. Low back pain is most prevalent and burdensome in working populations, and in older people low back pain is associated with increased activity limitation. Most cases of low back pain are short-lasting and a specific nociceptive source cannot be identified. Recurrences are, however, common and a few people end up with persistent disabling pain affected by a range of biophysical, psychological, and social factors. Costs associated with health care and work disability attributed to low back pain are enormous but vary substantially between countries, and are related to social norms, health-care approaches, and legislation. Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden.”
Source Material
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
Authors
Steering Committee
Rachelle Buchbinder – Australia
Jan Hartvigsen – Denmark
Dan Cherkin – United States
Nadine Foster – UK
Chris Maher – Australia
Martin Underwood – UK
Maruits van Tulder – Netherlands
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……
The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.
by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
