 As medical providers we swear to "do no harm." So when considering the whole patient and taking into consideration the cost, overmedication, and medical harm associated with the management of low back pain, it is important for clinicians to consider the power of their diagnostic labelling words.
The study above provides evidence that the use of certain words such as "arthritis", "degeneration", and "disc bulge" when treating a patient with low back pain results in poorer patient perceptions about their condition. A patient who hears these words will likely have a lower expectation of their recovery, a higher chance of surgery and a greater perceived seriousness of their pain. Words like "lumbar sprain", "non-specific low back pain", and even simply "episode of back pain" have better patient beliefs and outcomes related to their low back pain, shifting their perspective and enabling them to feel more comfortable with accepting a non-invasive low risk medical treatment option like chiropractic rehab. Clinical guidelines recommend giving advice and reassurance to help reduce or avoid unnecessary tests and treatments for non-specific low back pain. Consistent recommendations include:
The study found that providing reassurance does not remove the negative effects of the labels arthritis, degeneration and disc bulge. Overall, this study suggests that clinicians might consider avoiding labels like arthritis, degeneration and disc bulge. Instead, clinicians could consider using labels like an episode of back pain, lumbar sprain or non-specific LBP when communicating with patients with low back pain. In chiropractic school we were trained ad nauseam to use incredibly specific diagnoses such as "Acute traumatic facet syndrome with associated myospasm, deep referred right leg pain and lumbar intersegmental joint dysfunction complicated by chronic degenerative hypertrophic osteoarthritis and Grade I L5/S1 spondylolisthesis." I have been a practicing physician for a while now and I whole-heartedly agree with this study. I have learned that my words greatly matter to what a patient thinks and how they believe they will progress over the course of care for their low back pain. While a working diagnosis like the one above may be beneficial knowledge to the treating clinician and could certainly impact the prognosis, it means nothing to a patient. Explaining in full medical detail to a patient what every bit of the diagnosis means to a patient could be detrimental to the success of treatment, leaving them feeling hopeless and that surgery may be inevitable. As clinicians we must be better for our patients. They deserve it!
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Inflammation can have both positive and negative health effects. Acute inflammation works with the immune system to address infectious and non-infectious cellular damage. (1) However, when inflammation becomes chronic, it can seriously impact health. For example, studies have shown a correlation between chronic inflammation and all-cause, cancer, cardiovascular, and cerebrovascular mortality. (10)(12)
You can find the following recommended supplements at https://us.fullscript.com/welcome/spokane-wellness Curcumin Curcumin (Curcuma longa)600–1,000 mg, total per day, minimum 8–10 weeks (4)(13)
Omega-3 fatty acids (EPA/DHA) Omega-3 fatty acids (EPA/DHA)2.5 g, total per day, minimum 12 weeks (7)(15)
Probiotics Probiotics1.6 × 109 CFU, total per day, minimum 8 weeks (8)(11)
Quercetin Quercetin≥ 500 mg, total per day, minimum of 8 weeks (2)(9)(14)
The following protocols were developed using only a,b,c-quality evidence Learn more about our rating scale References
Proton pump inhibitors (PPIs) are a class of medications commonly prescribed to reduce stomach acid production and treat conditions like gastroesophageal reflux disease (GERD) and peptic ulcers. While effective, their long-term use may be associated with different nutrient deficiencies. (Eusebi 2017)
The mechanism of PPIs primarily involves reduced stomach acid production. However, stomach acid is important for absorbing certain nutrients. Vitamin B12 absorption, for example, depends on sufficient gastric acid to separate the vitamin from food proteins. Similarly, stomach acid is needed for the optimal absorption of minerals like iron, zinc, and magnesium. Reductions in stomach acid can also affect vitamin C absorption, which is sensitive to changes in gastric pH. Consequently, prolonged use of PPIs may impair the body’s ability to absorb these important nutrients, potentially leading to specific deficiencies and related health concerns such as an increased risk of infection, kidney damage, and dementia. (Eusebi 2017) Assessing nutrient levels before and throughout the course of PPI therapy, with subsequent tailored supplementation based on these findings, may benefit patients using PPI medications. (Eusebi 2017) You can find the following recommended supplements at https://us.fullscript.com/welcome/spokane-wellness Vitamin C Vitamin C
Vitamin B12 Vitamin B12
Iron Iron
Magnesium Magnesium
Zinc Zinc
Evidence ratingThe following protocols were developed using only a,b,c,d-quality evidence Learn more about our rating scale References
Disclaimer: The content provided is not intended to be for medical diagnosis or treatment, is not a substitute for your professional judgment, and is not meant to provide you medical or professional advice. Statements regarding dietary and other health care supplements have not been evaluated by the FDA, and are not intended to diagnose, treat, cure, or prevent any disease.  A functionally unstable spine may be the cause of a person's back pain. It is a painful disorder thought to result from a loss of the spine’s ability to maintain appropriate mechanical stiffness throughout it's NORMAL range of movements. In biomechanical terms, spinal stiffness refers to the spine’s ability to prevent unwanted movement or buckling. People often think of stiffness as a bad thing. It isn't always. When a muscle contracts, it creates both force and stiffness. Spinal stiffness is necessary to perform basic daily movements. With minimal amount of force, muscles around the spine act as guy wires, a tensioned cable designed to add stability to a free-standing structure.
It is important to note that a functionally unstable spine is not synonymous with hypermobility or radiographic instability. Hypermobility and radiographic instability is where spinal joint motion is excessive BEYOND normal joint movement. This is typically demonstrated on appropriate imaging. Some indicators that a functionally unstable spine may be the cause of a person's back pain often include:
40-60% of typical back pain patients experience recurrence or low level chronic symptoms, but a pattern of sudden flare ups caused by minimal loading events may be linked in this instability phenomena. The theory behind this is that poor stability increases the risk of a “spinal buckling” under minimal weight, often just bodyweight movements, and triggers episodes. This accumulative repetitive buckling makes it difficult for the patient to truly feel a healing of their back pain. The safest and most effective conservative treatment for patients with a functionally unstable spine is through an effective spine stabilization exercise routine. Stabilization exercises are designed to improve spinal stability, relieve pain and increase movement performance. A large number of muscles cross the spine, and all contribute to the modulation of lumbar stability and movement to some extent. Multiple imaging studies have demonstrated muscle atrophy in patients with chronic back pain. A stabilization exercise routine is designed to target these areas of muscle atrophy to improve strength and reduce muscle fatigue over time. Some of the muscles that are most commonly weakened and atrophied in patients with a functionally unstable spine are:
Most people are surprised to learn that the diaphragm, which is mainly involved in breathing, is a key muscle in creating spinal stability. As the roof of the cylinder of muscles that surround the spine and assist with stability, the diaphragm is a major contributor to intraabdominal pressure and therefore lumbar stability. The diaphragm contributes to this spinal stiffness before the initiation of large limb movements to assist with spinal stability and greater strength of the arms or legs. Some of the most effective stabilization exercises studied include:
Once these exercises are mastered, a person suffering from a functionally unstable spine can gradually progress to various bodyweight loading strategies that would ordinarily be seen a training weight training environment. This type of training of the spine will carry over into the performance of functional activities, daily living activities, and work ultimately resulting in reduced episodes of functionally unstable back pain. If you feel your back pain is the result of a functionally unstable spine, please click the link below to request an appointment!  Incorrect use of a proper back pack can be just as damaging as using an improper back pack. Our growing children use their back packs for many years. Repetitive loading of heavy back packs combined with poor ergonomics can be a source of dysfunction in their body and can lead to chronic back and shoulder pain. Smart choices now are important to your child's health long after their school days are gone.
Signs that your child's back pack is inappropriate for them or that they are wearing the pack incorrectly include:
When purchasing a new back pack one should look for:
Maintain regular adjustments with your chiropractor to detect and correct spinal problems before they cause pain and dysfunction in your growing child. Additional tips for proper back pack ergonomics:
 When a patient is diagnosed with a lumbar disc herniation, what is the best treatment?
Best Answer: Both conservative and surgical options are backed by research. Though the ultimate decision of which route to choose should be made by the patient based on their individual goals and needs after an honest discussion with their surgeon. Now let's talk! Lumbar disc herniations are a very common condition affecting the spine of young and middle-aged folks. The incidence of lumbar disc herniations within certain populations has been estimated to be greater than 50% though often the disc herniations is asymptomatic, meaning without symptoms. A disc “injury” quite often happens in the absence of any pain and you don’t even know about it. Medicare estimates that spending on lumbar discectomy procedure, a surgery to remove disc material, exceeds $300 million annually. Back pain related disorders may or may not always be the result of a disc herniation but are a common cause of disability nonetheless. The American health care system spends over $1 billion annually to address back pain conditions. The structure of the disc is composed of circular, basket woven-like annular fibers made of collagen, proteoglycans, and a variety of regenerative cells that surround a gel like structure called the nucleus pulposus. The disc serves to dissipate forces exerted on the spine as well as give space between the vertebra above and below the disc so the nerves have room to exit the spine. As we age, the disc tends to lose water content and height. This loss of hydration and disc collapse can increase strain on the annular fibers which may lead to bulging, a protrusion or extrusion of disc material that would be seen as a herniation. The joint made up between the two vertebral bones and disc is called the intervertebral joint. It is classified as a fibrocartilage joint and can also be referred to as a symphysis joint, similar to the pubic symphysis of the pelvis. If you know anything about symphysis joints, you know that they are EXTREMELY STRONG and they certainly don't slip out of place, giving the impression that discs are inherently weak. It takes about 740lbs of force to compress the disc height 1mm in young subjects and 460lbs of force to compress the disc height 1mm in older subjects. End story is that discs are VERY strong. With all that said, back pain may still occur due to disc bulging without pressure on the spinal canal or nerve roots. However back pain with radiculopathy can occur when pressure or irritation of the extruded disc material contacts the thecal sac or lumbar nerve roots. The pain commonly felt with radiculopathy can be felt as electrical, shooting, pins and needles, numbness, tingling, or weakness into the leg. Often patients will experience this as "Sciatica". Sciatica is a description of any of the symptoms above felt in the leg as a result of pressure or irritation of the specific nerve roots levels of L4, L5, or S1. The good news is that 90% of patients with lumbar disc herniations will improve without substantial medical intervention like surgery. Too many people think that once you have a disc herniation (or disc bulge), that you’ve got it for life. Discs have the ability to heal. A patient should not be fearsome of low back pain, even if pain is caused by a disc injury. Regarding treatment, the research supports both conservative management and surgical intervention as viable options for the treatment of lumbar disc herniation even when radiculopathy is present. Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results studies show similar outcomes regardless of type of management. It should be noted that contrary to popular belief of some including surgeons, the size of a lumbar disc herniation does not predict outcomes or the need for surgery. Research indicates from many studies, multiple medical association position statements, and my own clinical experience treating these disorders validates this notion. This is consistent with findings from a 2010 study which found that even massive disc herniations can successfully be treated conservatively. In fact, on several occasions patients with nearly complete spinal canal narrowing were successfully managed without surgery, some as great as 85.1%. Literature suggests that less than 10% of disc herniation cases ultimately require surgery. The typical patient with lumbar disc related pain will often present to their primary care physician first. However research supports chiropractors being a great first contact for these patients. In fact, medical costs may significantly be reduced when a patient visits a chiropractor first. Initial management of these disorders should include regular movement within a patient's tolerance, exercise guidance, manipulation of the spine, proper nutrition and supplementation, and adequate sleep. A patient should not be told to completely rest. Many of these patients are able to continue lifting. In most instances, radicular symptoms will go away within six weeks. Patients with symptoms that persist beyond six weeks will often be referred for advanced imaging like magnetic resonance imaging (MRI) in order to identify the area of disc pathology and to determine if they are also candidates for more invasive treatments like injection or surgery. If you are suffering from back pain, please click the link below to request an appointment!  Thirty-one million Americans have low back pain at any given time.1 One half of all working Americans admit to having back symptoms each year. 2 One third of all Americans over age 18 had a back problem in the past five years severe enough for them to seek professional help. 3 And the cost of this care is estimated to be a staggering $50 Billion yearly–and that’s just for the more easily identified costs!4
These are just some of the astounding facts about Americans and their miserable backs! Is there any wonder why some experts estimate that as many as 80% of all of us will experience a back problem at some time in our lives?5 Because back problems are this common it’s probably going to happen to you too! Shouldn’t you find out what to do about it before it happens rather than after? Why wait until you’re hurting to learn about your treatment options? When you’re hurting you may not give this important decision the time and attention it needs to make the best choice. Here are the facts about manipulation as a treatment for back problems: Manipulation is one of several established forms of treatment used for back problems. Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today’s growing emphasis on treatment and cost effectiveness, manipulation is receiving much more widespread attention. In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research–a federal government research organization–recommended that low back pain suffers choose the most conservative care first. And it recommended spinal manipulation as the ONLY safe and effective, DRUGLESS form of initial professional treatment for acute low back problems in adults!6 Chiropractic manipulation, also frequently called the chiropractic adjustment, is the form of manipulation that has been most extensively used by Americans for the last one hundred years.7 Satisfied chiropractic patients already know that DCs are uniquely trained and experienced in diagnosing back problems and are the doctors most skilled in using manipulation for the treatment of back pain and related disorders.8 As a public service, the American Chiropractic Association (ACA) urges you to make an informed choice about your back care. To learn more about the federal government’s recommendations and how chiropractic manipulation may help you, contact a Doctor of Chiropractic in your area. References:1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116. 2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98. 3. Finding from a national study conducted for the American Chiropractic Association. Risher P. Americans’ Perception of Practitioners and Treatments for Back Problems. Louis Harris and Associates, Inc. New York: August, 1994. 4.This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994. 5.In Vallfors B, previously cited. 6.Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994. 7.The RAND Corporation reported from its analysis of spinal manipulation research literature that 94% of all spinal manipulation is performed by chiropractors, 4% by osteopaths, and the remainder by medical doctors.  Did you just sprain your ankle? I did recently. It hurts! Ankle sprains occur so often that sometimes it can be easy to overlook helpful treatment strategies to accelerate the healing because, well, they will heal on their own, right?
Ankle sprains are the most common lower extremity injury in sport. The most common is an inversion sprain where the foot rolls under the inside portion of the ankle. There are eversion sprains and diastasis (aka "high ankle") sprains, but these are less common.  Now more than ever it seems the world wants effective means by which to naturally boost the immune system. We've already learned a lot about what strengthen our immunity before this pandemic and even more afterwards. What we know is that functional impairment of antigen-specific T cells is a hallmark of chronic infections and viral disease. There are many considerations for boosting immunity and T cell function. Supplements most notable for this are:
Want more tips and tricks on keeping your body healthy and strong? Hit us up at Gaitway Chiropractic @ Spokane Wellness in Spokane, Wa. 509-466-1366 References:
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. What conservative treatments for pain do Chiropractors and physical therapist typically use?12/18/2020  Effective conservative treatments for musculoskeletal related pain that you will most often find in the chiropractic or physical therapy clinic include:
Of course, there exists other conservative treatment options like nutritional needs analysis, topical analgesics, acupuncture, brain based therapy, hypobaric oxygen therapy, etc. However, the list above is what most often what a Chiropractor or physical therapist might recommend to you. Before you decide which treatment or combination of treatments you decide to go with, it is important for you to be an equal team member in the decision making process of your own health. Want tips and tricks on getting rid of headaches, back pain, neck pain, shoulder pain, hip pain, knee pain for good? Hit us up at Gaitway Chiropractic at Spokane Wellness in Spokane, Wa. 509-466-1366 Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. |
Dr. Jared Wilson, DC, MSDr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters degree in Exercise and Sports Science. Archives
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