Archive for February, 2011
Acute low back pain patients demonstrate significantly greater improvement with chiropractic than “usual care.”
Dynamic Chiropractic Editorial Staff
With the publication of the Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study1 in The Spine Journal, one of the most frequently cited spine research journals in the world,2 the health care community at large may finally appreciate what the chiropractic profession has known for more than a century: Patients with acute mechanical low back pain enjoy significant improvement with chiropractic care, but little to no improvement with the usual care they receive from a family physician.
Published in the December 2010 edition of The Spine Journal, the study found that after 16 weeks of care, patients referred to medical doctors saw almost no improvement in their disability scores, were likely to still be taking pain drugs and saw no benefit with added physical therapy – and yet were unlikely to be referred to a doctor of chiropractic.
The study is “the first reported randomized controlled trial comparing full CPG [clinical practice guidelines]-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC [usual care] in the treatment of patients with AM-LBP (acute mechanical low back pain).” (Evidence-based clinical practice guidelines have been established for acute mechanical low back pain in many countries around the world, but sadly, most primary care medical doctors don’t follow these guidelines.) Researchers found that “treatment including CSMT [chiropractic spinal manipulative therapy] is associated with significantly greater improvement in condition-specific functioning” than usual care provided by a family physician.
The Chiropractic Hospital-based Interventions Research Outcome (CHIRO) initiative was “designed to evaluate the outcomes of spinal pain patient management strategies that involve a component of chiropractic assessment and/or spinal manipulative therapy, administered in a hospital-based spine program outpatient clinic.” The study utilized the CHIRO framework “to examine the effectiveness of current evidence-based CPG-recommended treatments for patients with AM-LBP pain.”
CPG “study care” (SC) was compared with the usual care (UC) provided by family physicians. Patients were first seen by a spine physician and then randomly assigned to either the SC group or the UC group.
Patients in the SC group received acetaminophen, a “progressive walking program” and up to four weeks of lumbar chiropractic spinal manipulative therapy. The manipulative therapy was provided “using conventional side-posture, high-velocity, low-amplitude techniques” to the lumbar region only, and only by a chiropractor.
Patients assigned to the UC group were referred back to their family physician, who was “simply advised to treat at their own discretion.” Patients in this group received treatment from “a variety of professionals including family physicians, massage therapists, kinesiologists, and/or physiotherapists.”
All care was provided at a hospital-based spine program outpatient clinic. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ), administered at the beginning of care and at 16 weeks, when acute low back pain is considered to become chronic. The RDQ was also administered at eight and 24 weeks.
Other Important Findings
After 16 weeks, “78% of patients in the UC group were still taking narcotic analgesic medications on either a daily or as needed basis.” (Only 6 percent of this group received chiropractic care.)
Condition-specific improvement after 16 weeks “clearly favored the SC group, with mean RDQ improvement scores of 2.7 in the SC group compared with only 0.1 in the UC group (p=.003).”
While the difference in improvement “was not quite significant at 8 weeks,” it was found to be “clearly significant at 24 weeks of follow-up (0.004).”
Both groups showed improvement in bodily pain and physical functioning, but “patients in the UC group uniquely showed no improvement whatsoever in back-specific functioning (RDQ scores) throughout the entire study period.”
The inclusion of NSAIDs and manipulation/mobilization performed by physical therapists were no more effective in treating patients than family doctors who offered patients advice and acetaminophen. The study found: “[T]he addition of NSAIDs and a form of spinal manipulative therapy or mobilization administered by a physiotherapist to the lumbar spine, thoracic spine, sacroiliac joint, pelvis, and hip (compared with a detuned ultrasound as placebo manipulative therapy), to family physician ‘advice’ and acetaminophen were shown to have no clinically worthwhile benefit when compared with advice and acetaminophen alone.” [Italics ours]
The study criticizes a 2007 report that had derided the efficacy of spinal manipulation by pointing out that the older report based its conclusions on the outcomes of therapies performed by non-chiropractors. The 2007 study concluded that patients “do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.”3 By contrast, the CHIRO study noted: “Although spinal-manipulative therapy is currently administered by many different healthcare professionals, including: chiropractors, osteopaths, orthopedic surgeons, family physicians, kinesiologists, naturopaths, and physiotherapists, the levels of training and clinical acumen vary widely. The study design used by Hancock, et al., therefore, differs from our study because [their study] did not use chiropracticspinal manipulation, and current guideline based care does not endorse any forms of spinal manipulation administered by any other practitioners.” [Italics ours]
- Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine Journal, 2010;10:1055-1064. www.ncbi.nlm.nih.gov/pubmed/20889389
- Brunarski D. “Impact of the Chiropractic Literature.” Dynamic Chiropractic, Dec. 2, 2010;28(25).
- Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, Spindler MF, McAuley JH. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet, 2007 Nov 10;370(9599):1638-43. www.ncbi.nlm.nih.gov/pubmed/17993364
This is the first of four studies in the works based on data gathered via the CHIRO initiative.
Rid yourself of insomnia with this calming pose sequence.
By Nora Isaacs
Uttanasana (Standing Forward Bend), supported
Benefit Quiets the nervous system.
Fold one or more blankets and place them on a chair so they cover the entire width of the seat. Stand facing the chair in Tadasana (Mountain Pose). On an inhalation, reach your arms up overhead and lengthen your spine. Exhale and fold forward until your forehead rests on the blankets. Rest your arms, including your elbows, on the blankets so they do not slide off when you relax them completely. Stay here for 3 to 5 minutes or as long as you’re comfortable. Inhale as you come out of the pose.
2:1 Ujjayi Pranayama (Victorious Breath)
Benefit Calms the nervous system.
Come to a comfortable seated position and breathe normally. Start Ujjayi breath on an exhalation: With your mouth closed, slightly close the root of your throat as though you were whispering and exhale for 2 counts. You should hear a smooth, audible sound (akin to the ocean, the wind in the trees, or even Darth Vader) coming from deep in your throat as you breathe out. Release the restriction in your throat and inhale normally for 1 count. As you become more adept, increase the counts to any ratio of 2:1, such as 4 counts exhaling to 2 counts inhaling or 6 counts exhaling to 3 counts inhaling. Do this breath for 3 to 5 minutes, followed by 10 to 15 minutes of meditation.
Viparita Karani (Legs-up-the-Wall Pose)
Benefit Triggers relaxation response, slowing heart, breath, and brain waves.
Bring a folded blanket or a bolster about 6 inches away from a wall (or farther away if your hamstrings are tight). Sit sideways on the support, with the right side of your body against the wall. On an exhalation, slowly turn to your right, lowering your shoulders down to the floor as you swing your legs up the wall. Adjust yourself so that your sitting bones drop down slightly between the support and the wall, the back of your pelvis rests on the bolster, and your shoulders rest on the ground. Bring your arms into a position that supports the opening of the front of your chest, whether out to your sides or reaching overhead on the floor. Relax your legs, face, and jaw. Stay here for 5 to 15 minutes. To come out, slide back off the support, turn to the side, and stay here for a few breaths before sitting up. You can do this right before bed or earlier in the evening. Make sure you don’t fall asleep in the pose; save your sleep for when you are in bed.
Benefits Helps keep spine aligned and reduces snoring.
Get into bed and turn to one side. Put a pillow between your knees and another under your head for support. Your head pillow should be just high enough to prevent your neck from side bending up or down; your whole spine should be straight when viewed from the side. Draw your bottom elbow and shoulder forward far enough so you do not lie directly on your arm. Optionally, place a third pillow in front of you and support one or both hands on it.
Benefit Releases craniosacral tension.
Caution Don’t use this position if you are prone to snoring or sleep apnea.
Lie on your back in Savasana (Corpse Pose). Bring your hands behind your head with the right hand touching the back of the head and the left hand on top of the right. The hands should be underneath the occipital ridge (the prominence at the base of the skull). Allow your elbows to rest on the bed and let your neck release into your hands so that your head is in slight traction. This is a great position to fall asleep in, although you don’t want to stay here all night with pressure on your hands and your shoulders stretching upward.
Ardha Adho Mukha Svanasana (Half Downward-Facing Dog)
Benefits Alerts the mind, stretches the back and legs, and relieves shoulder tension.
Stand at the side of your bed, with your palms resting on the bed. Step back, one foot at a time, so that the arms remain straight and the spine elongates as in a regular Downward-Facing Dog. Adjust your feet so that you feel you are getting a nice stretch through your shoulders, hips, and hamstrings. As you breathe, draw your hips away from your head and let your head gently descend between your arms. Stay here for 10 breaths.
Benefits Stretches the hip flexors and abdomen, opens the chest, and awakens the cardiovascular system.
From Half Downward Dog, come into a lunge by bringing your right foot forward between your arms, bending the right knee and keeping the left leg straight behind you. Try to keep the back heel on the floor. On an inhalation, bring the arms out to your sides and up overhead, lengthening the spine. On an exhalation, bring your hands back to the bed. Return to the Half Dog, then repeat the lunge on the other side. Do this sequence several times until you feel invigorated.
Side Twist Benefits Invigorates the body and gets the blood flowing.
Sit sideways in a chair, with the right side of your body alongside the back of the chair. On an inhalation, lengthen the spine. On a soft exhalation, twist to the right, bringing both hands to the back of the chair. Relax your right shoulder and make sure you aren’t cranking your neck so that it’s uncomfortable. On each inhalation, lengthen the spine, and on each exhalation, deepen the twist. Stay here for 10 breaths. Release back to center, then sit with the left side of your body alongside the chairback and repeat to the other side.
Nora Isaacs is a freelance writer and the author of Women in Overdrive: Find Balance and Overcome Burnout at Any Age. She tries to get eight hours of sleep at her home in California.
The popularity of chiropractic is at an all-time high, 80% of Americans will suffer from back pain at some point in their lives. Chiropractic is the best approach to healing most back pain.
Whiplash is an all-too-common consequence of the more than one million rear-end collisions that take place in the United States every year. Although the classic symptoms of whiplash (headache, dizziness, neck, shoulder, jaw and/or arm pain) may subside after a few weeks of appropriate care, it is estimated that nearly one in four cases will become chronic, resulting in long-term discomfort and disability.
Chiropractic may offer the best opportunity for relief from the pain of whiplash, according to a study published in the Journal of Orthopaedic Medicine. Ninety-three patients with chronic whiplash symptoms were divided into three groups based upon the nature and severity of their symptoms. All 93 patients received an average of 19.3 chiropractic adjustments over the study period (about four months).
Results showed that two of the three groups (patients with neck pain, restricted neck range of motion and/or neurological symptoms) improved under chiropractic care, with 85.5% reporting “some benefit,” 33.5% improving by two symptom grades, and 31% being relieved of all symptoms.
If you or a loved one is suffering from whiplash, make an appointment with a doctor of chiropractic. As the authors of this study conclude, when it comes to treating whiplash,”chiropractic is the only proven effective treatment.”
Khan S, Cook J, Gargan M, et al. Asymptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999: Vol. 21, No. 1, pp22-25.
For more information on whiplash, go to http://www.chiroweb.com/find/tellmeabout/whiplash.html