Piriformis Syndrome - What a pain in the butt!

Piriformis syndrome is referred to as sciatica resulting from compression of the sciatic nerve by the piriformis muscle.  Most patients state that they have buttock pain with numbness and tingling travelling down the thigh and upper leg, less reported is associated low back pain.  Other features include painful sitting; tenderness over the sciatic notch; pain with hip movements that stress the pirifomis (internal rotation) and relief with shortening of the piriformis (external rotation of hip, or walking with the toe pointing out).  The condition must be differentiated from lumbar disc herniation in younger people, and advanced degeneration or tumors that narrows the spinal or lateral canals in the older population. 

It is estimated that 15-20% of the population are predisposed to piriformis syndrome as the sciatic nerve passes through the piriformis muscle body rather than underneath, making it more susceptible to compression.  Other causes of piriformis syndrome include: muscle imbalance of weak hip extensors/abductors and tight hip flexors/adductors caused by prolonged sitting; overuse injuries in a sitting position, such as rowing or biking; stiff sacroiliac joints causing gait changes and shearing of the piriformis; and overpronation of the foot causing the knee to turn inward and piriformis to compensate. 

Conservative treatment will generally resolve the symptoms, and can include: ice, NSAIDS or acupuncture for inflammation and pain control; avoiding aggravating activities (uphill running, biking, rowing); stretching tight muscles and strengthening weak muscles; massage or using a tennis ball to target tight muscles; manipulation to restore SI joint function; gait correction with orthotics; and tissue healing with therapeutic laser. 

How Chiropractic Neurology helped Sidney Crosby

If you follow hockey at all, you would know that its star player, Sidney Crosby, has been sidelined with a concussion since early January 2011.  As with most head injuries, there is no predicting how long recovery would take or if full recovery is possible.  After eight frustrating months, and uncertain if he would ever again play the game he so excelled at, Sidney turned to Dr. Ted Carrick, the father of chiropractic neurology, in a desperate attempt to help with his ongoing balance and spatial orientation problems, caused by a disruption in his vestibular system. 

Dr. Carrick assessed Sidney, and determined that his injury caused him to not be able to tell where his body is in space or where other objects in relation to him were in space, skills which are essential for an elite hockey player.  After determining what his brain dysfunction was, a treatment protocol involving various proprioception exercises to reeducate his brain and develop a new spatial grid were given.   This included eye exercises, balance exercise, multitasking exercises and sessions in a unique device called a gyroscope, which spins you around like a fair ride. 

After a week with Dr. Carrick, Sidney was sent home.  A few weeks later, on September 7^th, a high profile press conference was held to update the public on Sidney’s progress, and Dr. Carrick was at his side, explaining his unique therapy.  On September 17^th Sidney practiced with his team mates on opening day of training camp, without contact and without symptoms.  Sid the kid played his first game on November 21^st, scoring 2 goals and 2 assists, announcing to the hockey public that he was back. 

Currently a 400 person research project is underway at Life University in Georgia to try and validate Dr. Carrick’s treatment protocol, but as many in the field of head injuries would point out, concussions are unique to the individual and as such, so is the treatment prescribed.  Many in mainstream medicine remain skeptical, as they have never heard of Dr. Carrick, chiropractic neurology or his holistic approach to treating brain injuries.  But Sidney and his support team would tell you that it made the difference with getting him back on the ice. 

Source:  http://www2.macleans.ca/2011/11/03/rebuilding-crosbys-brain/

Managing Arthritis Naturally

 Many people with arthritic conditions rely on non steroidal anti-inflammatory drugs (Aspirin, Advil) which can produce intestinal ulcers and bleeding or Acetaminophen based drugs which can produce liver damage in long term users, and hence should be used sparingly.  Clinical studies have shown that degenerative arthritis and joint inflammation can be treated effectively with specific dietary changes and supplementation. 

Inflammation occurs when the body makes a hormone like substance, prostaglandin-2 (PG2), whereas PG1 and PG3 make non inflammatory products.  In our body, prostaglandins are made from the polyunsaturated fats that we eat.  Diets from high fat meat and dairy products make PG2 whereas diets with omega 3s from fish oil and flaxseed oil make PG3 and fats from evening primrose oil, borage oil and black current make PG1.  Vitamin B6, vitamin E, vitamin C, niacin, zinc, selenium and magnesium are also required to convert these essential fats into PG1 and PG3. 

Research reveals that certain herbals provide effective anti-inflammatory relief by blocking the synthesis of PG2 and other inflammatory chemicals without causing side effects of damage to the intestinal tract, liver or kidneys.  Curcumin, Boswellia, White Willow Bark Extract, Ginger Root Extract, Bromelain and Quercetin are herbal agents that have shown to provide relief for arthritic patients and also for other muscle, tendon or joint inflammatory conditions.

After controlling the pain and inflammation of arthritis, the next step is to provide the building blocks for repair of joint cartilage.  After age 40, the body loses the ability to manufacture optimal levels of glucosamine, the raw material for proteoglycans, and a major component of cartilage.  Hence supplementation with glucosamine sulfate can provide the body with the material to help repair and regenerate cartilage and halt further destruction of the joint.  Sulfur also plays a role in maintaining cartilage and reducing inflammation, hence the addition of MSM (methylsufonylmenthane) is often used in combination with glucosamine sulfate. 

The final step in managing arthritic conditions is to encourage movement of the joints.  This can involve both an exercise program to stabilize the joints, as well specific biomechanical manipulation to the joint to improve joint function and increase nutrition to the cartilage, thereby slowing the effects of degeneration.

How long will I need to come for treatment?

Frequency and duration of care are issues which the chiropractic profession has established formal guidelines in Canada since 1993.  This evidence based practice covers three areas: acute, uncomplicated pain; acute, complicated or chronic pain; and supportive or maintenance care.

Acute, uncomplicated pain applies to patients with pain of less than 3 weeks duration and with a common diagnosis of mechanical back pain (strain/dysfunction).  The protocol for these patients is to provide up to 3 treatments per week for 4 weeks.  If there is no improvement after 2 weeks, treatment should be modified.  If there is no improvement by 4 weeks or symptoms are progressive, treatment should stop and the patient be referred out to another health professional.  Typically, if the patient is showing improvement, there is an encouragement to return to modified activities and an exercise component is introduced with a decrease in visit frequency (e.g. to weekly) for another 4 weeks, for a total time of 8 weeks.  When maximum medical recovery is reached, the patient may either be discharged or maintenance care may be recommended.

Acute, complicated or chronic pain applies to patients with complications (significant trauma,   significant underlying spinal degeneration, a disc problem with neurological referral, etc) or chronic pain (recurrent, disabling attacks of spinal pain or pain for 12 weeks or more duration).  Treatment may be slightly more frequent (e.g. 3 times a week for 4-6 weeks, than 2 times a week for another 4-6 weeks) and for a longer duration (e.g. up to a total of 16 weeks).  Patients would be typically reassessed every 2-4 weeks to determine if there is improvement in symptoms and function, and whether to continue treatment or to refer to another health professional.  Advice on return to modified activities and specific exercise would be accompanied with a discussion on pain behavior.  If the patient has not returned to pre-episode status, a period of treatment withdrawal may determine if they have reached maximum medical recovery and whether they should be discharged or recommendations of supportive  care be given.  If maximum medical recovery has been reached, either discharge or maintenance care may be recommended.

Guidelines define two different forms of longer term chiropractic treatment.  Supportive care is for patients who have reached maximum improvement, but fail to sustain this improvement and who progressively deteriorate when treatment is withdrawn.  This treatment is determined to be therapeutically necessary, but must be determined on an individual basis.  Maintenance or preventative care is treatment for a patient who has no present symptoms but may seek to prevent recurrent episodes of back pain and promote health.  Typically, chiropractors have recommended monthly maintenance care.

Laser Therapy for Chronic Achilles Tendinopathy

Achilles Tendinopathy is common in many athletes following injury, and can lead to tendon degeneration, pain, loss of performance and eventual tendon rupture.  A study published in the American Journal of Sports Medicine investigated whether the addition of low level laser therapy (LLLT) for 8 weeks in addition to an eccentric exercise (EE) program would speed recovery and improve outcomes in recreational athletes with chronic Achilles Tendinopathy.

52 athletes with symptoms of at least 6 months of unilateral, activity limiting pain in the Achilles tendon were included.  They were randomized into two groups, the first group having EE and LLLT and the second group having EE with placebo LLLT.  LLLT and placebo LLLT were administered twice a week for 4 weeks, than weekly for 4 weeks.  EE were performed 4 times a week, consisting of unilateral calf raises performed on a step which started with body weight only, and progressed with weight in a back pack, beginning with 1 set of 15 reps and progressing to 12 sets of 12 reps.  Static stretching of the Achilles tendon was included.

 Outcomes were measured at 4, 8 and 12 weeks.  Pain intensity during physical activity was significantly better in the true LLLT group at every stage of assessment, and all secondary outcomes were also significantly better.  This study provides evidence that adding LLLT to an EE program may speed recovery and improve outcomes, up to 4 weeks following treatment.

Citation: American Journal of Sports Medicine 2008; 36(5):881-887.

Spinal Manipulation for Chronic Cervicogenic Headaches

Headache symptoms are very common, effecting approximately 16% of the population, and can be divided into three main categories:  migraine, tension and cervicogenic headaches.  Cervicogenic headaches are associated with neck pain and mechanical dysfunction of the cervical spine and therefore in theory should respond to spinal manipulation therapy (SMT) to restore normal neck movement. 

A 2010 pilot study looked at patients with chronic cervicogenic headaches.  The criteria included: at least 5 headaches a month for over 3 months; pain which started at the base of the skull and radiated over the top of the head to the front: and pain/reduced range of motion in the cervical spine.  The patients were randomly assigned to 4 treatment groups for the 8 week study:

·         High dose SMT (manipulation twice a week, totally 16 treatments)

·          Low dose SMT (manipulation once a week, with the second session per week for information only, totally 8 treatments)

·          High dose light massage (twice a week treatments, totally 16 treatments)

·         Low dose light massage (weekly treatments with a second session per week for information only, totally 8 treatments)

The results of the study were:

• There was no difference in the high or low dose SMT groups, but SMT was more effective than light massage.  At 8 weeks, the number of weekly headaches had decreased by 50% in the patients who received SMT.
• This difference was both statistically and clinically significant.  Overall there was a decrease in intensity/pain of the cervicogenic headaches, decrease in headache frequency; and decrease in medication intake which was sustained with the SMT groups.

This study supports that SMT can work as an additional intervention with cervicogenic headaches, best  in combination with soft tissue treatment, exercise and education.

Citation:  The Spine Journal 2010; 10:117-128

Maintenance Care for Chronic Low Back Pain

A landmark study which was accepted in January, 2011 to be published in Spine looked at maintenance spinal manipulation therapy (SMT) for chronic, non specific low back pain (LBP) and whether there was a reduction of pain and disability levels over an extended period of time.  About 85 % of LBP patients who seek treatment are of a non specific variety, where there is a lack of underlying pathology (bone or nerve).  LBP is considered chronic when it has been present for over 12 weeks. 

The study was divided into three groups:  control (sham manipulation), SMT for one month, SMT for 10 months.  Treatment was given three times a week for the first month of the study, with patients in both the SMT groups reporting significantly lower pain and disability than the control group.  Following the second phase of treatment (10 months), patients who received bi weekly maintenance SMT had significantly lower pain and disability scores than those patients who did not have maintenance SMT.  Although the outcome measures for both the SMT groups were similar after one month, the non maintenance SMT group gradually returned to pre treatment levels (similar to the control group) by the end of 10 months. 

Not only did the maintenance SMT group who received care over 10 months have better results regarding their pain and disability levels than those patients who stopped care after one month, they also had improved lumbar mobility and better perceptions of general health.  This study supports what chiropractors have been saying to their patients for years.  Once the initial phase of treatment has been completed to stabilize your back condition, it is beneficial to consider monthly maintenance care to keep your spine functional and hopefully avoid acute episodes of back pain.

Lowering Cholesterol and Triglycerides with Supplements

 Elevated cholesterol and/or triglyceride problems are very common in modern society, and are known to increase risk for heart attack and stroke.  Dietary changes which reduce high fat animal products and consuming food high in fiber are beneficial, but many people are prescribed statins to further reduce their levels of cholesterol and triglycerides.  Unfortunately, these medications have side effects such as muscular pain and liver damage. 

There are two natural agents that have proven cholesterol and triglyceride lowering effects that can be used to complement dietary changes and can be taken safely in conjunction with statin drugs.  Gum Guggul is a resin from a tree native to India that has received prescription status in India in 1986 due to its high level of efficacy in human clinical trials in lowering cholesterol and triglycerides.  Human studies have demonstrated that guggulsterone, the active ingredient in gum guggal, can produce a cholesterol reduction of 14-27 % in 4-12 weeks, and a drop of 22-30 % of triglyceride levels.  A striking feature is its lack of toxicity and side effects, unlike cholesterol lowering drugs. 

Artichoke Leaf Extract is known to increase bile secretion by the liver, which clears more LDL cholesterol from the blood stream as cholesterol is the building block of bile acids.  In a double blind, placebo controlled study of 143 people with high cholesterol, artichoke leaf extract reduced cholesterol by 18.5% as compared to 8.6% in the placebo group, and LDL cholesterol dropped by 23% as compared to 6% to the placebo group; and LDL to HDL ratios declined by 20% vs. 7%. 

To be effective, Gum guggul must be standardized to 50-75 mg of guggulsterone per day, and artichoke leaf extract a minimum of 400 mg taken two to three times daily.  As with all supplements, results may vary, but there is a concrete way to determine if this is supplement is effective.  Have your cholesterol tested and then do a three month trial of Adeeva’s CholesterolEx or similar product and have a follow up cholesterol test.  

Laser Therapy in the Management of Neck Pain

Medical researcher Dr. Roberta Chow, MD, PhD was the lead author of a paper which summarized 16 clinical trials on Low Level Laser Therapy (LLLT) and the management of neck pain.  All the studies used LLLT of varying frequencies, and were double blinded, with either a placebo or control group.  A total of 820 patients were included in the research, which included both acute and chronic neck pain.    

Two trials showed an improvement in acute neck pain with the LLLT group over the placebo group.  Five trials showed an improvement in chronic neck pain with LLLT over the control group.  Eleven trials had a reduction of pain intensity that was statistically significant.  Seven trials involved follow up to 22 weeks after the treatment trial. 

There were mild side effects with LLLT group, but this was no different than with the placebo group. As with any therapy, individual results may vary, but overall the trials showed immediate pain reduction in the acute neck pain patients, and up to 22 weeks of reduced pain in the chronic patients post LLLT treatment.

Citation:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61522-1/fulltext#article-upsell

What a Pain in the Foot!

Summer time is upon us, and so often shoes are exchanged for flip flops.  The problem with flip flops is that they offer little support, and if you have abnormal foot mechanics such as flat feet, you can develop a painful arch, a condition called plantar fasciitis.   

 Plantar Fasciitis is caused by the breakdown and inflammation of collagen fibers in the thick band on the bottom of the foot that maintains the arch.  The pain can develop gradually over time with the most common symptom being pain in the morning or after prolonged sitting, as the band has shortened but limbers up after a few steps. Xrays may identify a heel spur, which is caused by the prolonged pulling of the plantar fascia from the heel. Secondary complications can develop as the difficulty in walking produces abnormal mechanics causing stress to knees, hips and the lower back.

Risk factors in developing plantar fasciitis include:

·         Increasing age as the ligaments are less supportive

·         Flat feet or high arches which causes faulty foot mechanics

·         Runners or ballet dancers who put abnormal stresses on the feet

·         Obesity and pregnancy places increased weight on the feet

·         Occupations which require prolonged standing

·         Improper shoes which lack arch support

Treatment includes:

·         Rest from activities that require being on the feet

·         Ice and oral anti-inflammatory (Aleve) or creams (Voltaren)

·         Laser, acupuncture or other modalities to increase healing

·         Massage therapy to relax and stretch the fascia and increase blood flow

·         Manipulation of a rigid mid foot to return normal function

·         Orthotics to support the arch and distribute weight for better mechanics

·         Exercises to stretch and strengthen the plantar fascia

·         Taping the arch to maintain support

·         Advice to avoid going barefoot, wear supportive shoes, and maintain a healthy weight

·         Severe cases may require steroid injections when unresponsive to conservative treatments but caution should be used as steroids weaken the collagen fibers

Often there is a combination of treatment that is required to be successful at keeping plantar fasciitis under control.  While individual results may vary, I have had success with laser treatments (approximately five), soft tissue stripping of the fascia of the arch, manipulation of the mid foot, and fittings with orthotics.  Home advice of using a 500 ml ice water bottle to offer both inflammation control and massage, as well as doing stretches also complement the therapy. 

So if you are finding you still want to wear your fancy summer shoes, take care of your feet so you don't develop that chronic pain in the foot!

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Low Level Laser Therapy in Treatment of Osteoarthritis of the Knee

A double blinded, randomized and controlled trial in patients with knee osteoarthritis was conducted to evaluate the efficacy of infrared low level laser therapy (LLLT) (also known as cold laser or therapeutic laser).  90 patients were randomly assigned to three treatment groups by a non-treating clinician.  The first group was given LLLT consisting of 5 minutes at 3 Joule dose, the second group was given LLLT consisting of 3 minutes at 2 Joule dose, and the third group was given placebo LLLT.  All groups were also given an exercise program.  Patients received 10 treatments and the exercise program was continued during the 14 week study.

Patients were evaluated with respect to pain, degree of active knee flexion, duration of morning stiffness, painless walking distance and duration, WOMAC Osteoarthritis Index scale.  Statistically significant improvements were made in all parameters such as pain, function and quality of life measure post therapy compared to pre therapy in both active laser groups.  Improvements in all parameters of the active laser groups as opposed to the placebo laser group were also statistically significant.  This study demonstrated that different dose and duration of laser therapy regimes were safe and effective for treating osteoarthritis of the knee.

Citation: Lasers in Surgery and Medicine33:330-338 (2003)

Manipulation or Microdiskectomy for Sciatica?

A 2010 clinical study compared the clinical efficacy of spinal manipulation against microdiscectomy in patients secondary to lumbar disc herniation.  Forty patients who met the criteria (failed at least 3 months of nonoperative management including treatments with analgesics, lifestyle modifications, physiotherapy, massage therapy and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. 

Significant improvements in both treatment groups compared to baseline scores were observed in all outcome measures.  After one year follow up, there did not appear to be a difference in outcome based on the original treatment received.  60% of the patients who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.  Of the 40% left unsatisfied, surgical intervention conferred excellent results. 

The conclusion of the study was patients with lumbar disc herniation failing medical management should consider spinal manipulation followed by surgery if warranted. 

Citation: http://www.jmptonline.org/article/S0161-4754(10)00211-3/abstract

Canada's Costly Spine Surgeon Backlog

A May 13, 2011 Globe and Mail article written by Lisa Priest emphasized the waste and mismanagement in our health care system in regards to back pain.  Back pain is very common, with 80 % of the population suffering from a severe episode in their life.  Upwards of 85% of this back pain is diagnosed as mechanical or non specific back pain.  The small minority have more severe neurological or bony involvement, yet high tech tests such as MRI or CT are ordered by doctors, and with a 60% false positive rate, often find abnormalities that have nothing to do with the symptoms, but lead to a referral to a spine surgeon.

The unnecessary tests are leading to massive health care costs - $24 million a year in Ontario alone.  The avalanche of referrals has caused 60 of the 120 spine surgeons in Canada to close their practices to new patients at some point.  In an unscreened practice, upwards of 90% of the patients that attend a spine surgeon are not surgical candidates, creating a logjam for patients who truly need the referral and surgery. 

 Dr. Daryl Fourney of Saskatoon states that “the overwhelming majority of people with spine problems can be treated with physical treatments, whether it be exercises or spinal manipulation or medications”.  Dr. Fourney pioneered a program in Saskatchewan to train family physicians to discern which patients need to see a spinal surgeon.  There is an incentive built in, with access to diagnostic imaging and expedited surgical referrals for their patients.  The province has started to see a reduction in referrals to spine surgeons.

Hence the prescription to reverse the gridlock is a triage system, made up of primary care physicians, physiotherapists and chiropractors, to help differentiate patients who potentially need surgery.   Patients who then do not require a referral to a spine surgeon would be sent to other health care providers for treatment, and tracked to see if the treatments are working.  The Ontario government estimates this would require $3 million a year, but save the health system upwards of $20 million or more in unnecessary testing and referrals. 

Atlas Realignment and Blood Pressure Reduction

A 2007 pilot study in the Journal of Human Hypertension showed a sustained blood pressure lowering effect with a procedure designed to correct atlas vertebrae misalignment similar to that seen by giving two different antihypertensive drugs at the same time.  The study design was randomized, double blind, with a placebo control and had 50 participants.

The practitioners in the study were from the National Upper Cervical Chiropractic Association (NUCCA) who limit their practice to precise, delicate manual alignment of the C1 or atlas vertebrae.  Unlike other vertebrae which interlock, the atlas relies on soft tissue to maintain alignment, and therefore is vulnerable to displacement.  Minor misalignment of the atlas vertebrae can potentially compromise the brainstem neural pathways and vertebral arteries.  

The study was 8 weeks in duration, with a blood pressure baseline originally taken and weekly thereafter along with atlas measures pre and post adjustment.  Outcomes in changes from the treatment showed a reduction of systolic blood pressure (-17 +/- 9 mm Hg NUCCA vs -3+/- 11 mm Hg control) and diastolic blood pressure (-10+/- 11 mm Hg NUCCA vs -2+/- 7 mm Hg control).  Most antihypertensive drugs yield an 8 mm Hg drop in blood pressure.  What is most impressive is that the reduction in blood pressure persisted at 8 weeks and was not associated with pain or pain relief or any other symptoms that could be associated with a rise in blood pressure.  

Citation: Journal of Human Hypertension (2007),1-6

Therapeutic Laser Therapy

Therapeutic Laser Therapy, is also known as Cold Laser Therapy or Low Level Laser Therapy.  Laser therapy works by injecting photons of visible and invisible light deep into tissues.  Cells contain chromophores and cytochromes in the mitochondria, which has the ability to absorb the light energy and convert it to chemical energy.  This chemical energy is utilized by the tissue on a cellular level to accelerate healing and reduce pain.  There is over 2,000 clinical studies that have proven the success of therapeutic lasers in the healing of neural muscular-skeletal conditions. 

The biostimulating effects of laser include:

• Reduction of pain by increased endorphin release
• Decrease inflammation by increasing lymphatic circulation
• Increased vasodilation to allow oxygen rich blood to injured tissue
• Accelerate tissue regeneration by increased production of enzymes and ATP, used for cell energy
• Speed up the healing process by increased collagen synthesis, which is the basis of all muscles, ligaments and joints

The benefits of laser therapy include:

• non invasive, not painful
• no side effects as the cell cannot be overstimulated
• safe as cold laser does not produce heat and therefore  cannot cause tissue damage
• few contraindications
• effective as able to penetrate up to 4 inches below the skin

The Health Canada approved and Canadian made laser that I just purchased is a Theralase TLC-1000 http://www.theralase.com/. While with all therapies, the individual results may vary, low level laser offers another type of treatment at our multi-disciplinary clinic.

Myth #4: Chiropractic is Addictive

One criticism of chiropractic is that once you start going, you will go for the rest of your life.  The fact of the matter is that there is no cure for back pain, and there is a reoccurence rate of 80% of back pain within one year of the acute episode.  Our bodies are under constant stress, physically from our work, home and play; chemically from the food we eat to the environment we are in; and also mentally from the fast paced lifestyle of today.  Hence chiropractors often recommend two types of maintenance care following an acute episode. 

Supportive care is defined as treatment for patients who have reached maximum improvement, but who fail to sustain this improvement or progressively deteriorate when treatment is withdrawn.  Preventative care is treatment for a patient who has no present symptoms, but seek to prevent pain and disability, promote health and enhance quality of life.  More people are taking charge of their bodies and imbracing wellness and optimal health as opposed to the reactionary medical model who seek care after disease has taken place. 

A well designed medical trial on manipulation in essence adopted the chiropractic model of an initial course of intensive manipulation followed by maintenance treatment at a reduced frequency, and reported this to be effective.  This trial covered three contentious issues in maintenance care:  whether the benefits of spinal manipulation derive from specific treatment or placebo effect; whether there are objective biomechanical benefits of manipulation and whether continued care has a legitimate role.  To view an abstract of this article, click  http://www.ncbi.nlm.nih.gov/pubmed/21245790

Myth#3: Chiropractic is dangerous

Much publicity has been given to neck manipulation and risk of stroke.  This serious complication is extremely rare, with statistics of vertebral artery damage following neck manipulation at 1 in 1 million adjustments or 0.0001%. The 2000-2010 Task Force on Neck Pain and its Associated Disorders reviewed 32,000 research papers and provided the first definitive evidence on actual risk rate and causation of neck manipulation and vertebrobasiliar artery (VBA) stroke.

The Task Force  analyzed the database covering 109 million person years that recorded all primary medical care practitioner (PCP) and chiropractic (DC) visits and all the VBA stroke admissions in the province of Ontario for eight years.  They concluded that there was no evidence of excess risk of VBA stroke associated with chiropractic compared to primary care.  The slight increase of risk associated with patients consulting either a PCP or DC is "likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke".  They explain that any motion can lead to a stroke where there has already been damage to a vertebral artery, such as turning to back up the car, extending the neck at the hair dresser, or simple range of motion testing which can lead to release of the embolus and cause a stroke. 

For a summary of this report go to http://www.chiropracticcanada.ca/ecms.ashx/Doc/EntireStrokeStudy.pdf

Myth #2: Chiropactic is unscientific

Over the past decade, there has been an explosion of chiropractic research, the most of any complementary health profession.  In Canada, much of this activity is being driven by the Canadian Chiropractic Research Foundation, which has helped to establish 10 research chairs at universities across Canada and given grants to assist Doctors of Chiropractic to complete their PhD studies.  The research is supporting what chiropractors have been doing for years, restoring normal joint function through spinal manipulation and active rehabilitation with exercise is one of the most effective treatments for uncomplicated back pain.  Current information on chiropractic research in Canada can be found at http://www.chiropracticcanada.ca/en-us/research.aspx

Myth #1: Chiropractors aren't real doctors

A Doctor of Chiropractic (D.C.) has very similiar education to other medical professions that use the title doctor.  There is a requirement of a minimum of three years of full time university study to apply to Chiropractic College, with upwards of 80% of the class having an undergraduate degree.  The Chiropractic program is four years of full time study consisting of 4450 hours and includes courses in anatomy, pathology, orthopedics, neurology, radiology, biomechanics and chiropractic therapy.  Chiropractic students attend clinic for three years, and often have hospital rotations in that time.  After graduation, students write a set of national board exams, and than apply for a provincial license, which may include more exams and continuing education.  What gives a profession the ability to use the title "doctor" is that he/she has enough education to be able to diagnose medical conditions and determine appropriate treatment.  This is not too dissimiliar to dentists, optometrists, naturopaths, medical doctors or veterinarians.

The Canadian Memorial Chiropractic College in Toronto is the only English speaking chiropractic college in Canada and has been established for over seven decades.  It has a reputation of being a world class educational and research institute among the chiropractic profession.  For more information on chiropractic education go to http://www.cmcc.ca/page.aspx?pid=290.

Blogger Baby Steps

Hello Virtual World

I have taken the leap to blogging for increased exposure of evidence based chiropractic to the world.  My other forays into the technological age had been the setup of our office website http://www.whitehousewellness.com/ and monthly e-newsletters.  With increased confidence, I am going to start a blog to hopefully educate the public about chiropractic and also to dispell many chiropractic myths. 

Thanks for coming along for the ride with this "x-generation" chiropractor.