New Study Confirms Benefits of Wellness Care!

Mechanicsville, Virginia — There are a few questions we as chiropractors get asked with some frequency.  One of them is some variation of, “Do you have to go to the chiropractor for the rest of your life if you start treatment?”  Or some combination of questions that are aimed at getting an answer to this.  And as far as I know chiropractors have always advised wellness care (or maintenance care) after a course of acute/corrective care.

Like anything related to health and wellness, it takes maintenance or we lose it.  This isn’t too controversial.  We can’t just brush our teeth once.  Or eat one well balenced meal.  Or go to the gym once and expect a lifetime of results.  So if someone has a damaged or injured spine (causing headaches, sciatica, low back pain, neck pain, disc bulgesmigraines, or numbness for example), it takes work to restore function and help symptoms.  Next, it takes some attention to maintain the ground chiropractic restores.

The medical option is to maintain a course of pills and drugs.  If you have high blood pressure, you take medication for life.  If you have high cholesterol, you take a pill for the rest of your life.  If you have osteoporosis, you take another pill the rest or your life.  If you have arthritis pain, you take another pill for the rest of your life.  Sometimes surgery is needed to put out a “fire.”  But I don’t know any surgeon that would claim surgery restores function back to 100% the way one would be prior to surgery.  Just the presence of scar tissue means one can’t be 100% ever again.    In fact, some surgeries are so notoriously problematic, due to the secondary issues it brings about, they have their own diagnosis.  For example, “failed back surgery syndrome” is an actual diagnosis.  All of this to say, for the person who needs treatment, wether chiropractic or medical, the reality is there is a lifetime of maintenance needed after treatment.  [The necessity of maintenance care has been discussed before on this blog.]

So the question is, is wellness care (regular adjustments after pain has resolved and function restored) beneficial?  There is a recent study that supports that:

Does Maintained Spinal Manipulation Therapy for Chronic Non-specific Low Back Pain Result in Better Long Term Outcome? Spine (Phila Pa 1976). 2011 Jan 17.

Dr. Stephanie Maj summaries it nicely:  I’ve quoted her blog below -

“1. One third of them received 12 treatments of sham SMT over a one-month period.

2. One third of them received 12 treatments of SMT during a one-month period, with no follow-up care during the next nine months, and

3. One third of them received 12 SMT visits during the first month, followed by “maintenance” SMT every two weeks, for the next nine months.

To determine any difference among these 3 care groups, researchers measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline, and at 1-month, 4-months, 7-months, and at 10-months

RESULTS: Patients in manipulative groups (groups 2 & 3) experienced significantly lower pain and disability scores than the sham group at the end of the first 1-month period.

At the 10-month follow-up, only the maintenance group maintained improvements in pain and disability, while the group that only received 1-months care had reverted to their pretreatment pain and disability levels.

CONCLUSIONS: This is the first medically managed trial that clearly demonstrates that maintenance care provides significant benefits to those who suffer from chronic low back pain.

Let me know what you think!

Stover Chiropractic, P.C.
9097 Atlee Station Road, Suite 118 MechanicsvilleVA23116 USA 
 • (804) 559-1100

Upper Cervical Chiropractic – Free PDF Ebook

Mechanicsville, VA – If you are poking around this web site for information on upper cervical chiropractic care, I came across  an nice resource.  A free ebook on upper cervical chiropractic.  Check it out.  http://www.orthougm.com/upper_cervical_chiropractic_association.html

New Childhood Asthma and Bedwetting Research

Mechanicsville, Virginia — New research has just been published that describes and discusses changes in asthma, bedwetting and allergy symptoms in a four-year-old child receiving chiropractic care. The article describes a 4 year old child that has allergies and bedwetting problems, who started chiropractic care.

The chiropractic care involved spinal and cranial adjustments.  After a period of 32 weeks under care the child no longer had asthma symptoms and the bedwetting had stopped.

The skeptic in me always wonders if the bedwetting would have stopped over that time anyhow, but the asthma relief doesn’t make me as skeptical.  However, there is a growing body of studies and case studies that are showing chiropractic seems to create a significant change or quick resolution to bedwetting.

Even better the medications that are avoided if chiropractic works is enough to give it a try.  Dr. Stephanie Maj has a good summary of the medications that are prescribed for these problems and the dangers of taking the medications, which comes from webMD.

Some other good references are listed below:

Changes in Asthma Symptoms and Bedwetting in 4 yr old Child Receiving Chiropractic Care. A Postles, H Taylor and K Holt. Chiropr J Aust 2010; 40: 34-6.

Asthma and Enuresis. Zell, P. International Chiropractic Pediatric Assn. Newsletter May/June 1998Case management of nocturnal enuresis Hough DW, Today’s Chiropractic July/August 2001 p. 59/66.ADD,

Enuresis, Toe Walking. International Chiropractic Pediatric Association Newsletter May/June 1997. From the records of Rejeana Crystal, D.C., Hendersonville, TN.

Chiropractic management of primary nocturnal enuresis. Reed WR, Beavers S, Reddy SK, Kern G.J Manipulative Physiol Ther Vol. 17, No. 9 Nov/Dec 1994.Bed-wetting; two case studies. Marko, RB Chiropractic Pediatrics Vol 1 No 1 April 1994.

Functional nocturnal enuresis. Blomerth PR. Journal of Manipulative and Physiological Therapeutics 1994:17:335-338.Nocturnal enuresis: treatment implication for the chiropractor. Kreitz, BG, Aker PD. J Manipulative Physiol Ther 1994:17(7): 465-473

Enjoy-

How Long Do You Need to Get Treated?

Mechanicsville, Virginia — At Stover Chiropractic I’m almost alway asked, “How long will it take until I’m going to feel better?”  Or, “How many treatments is it going to take to get better?”  I learned some interesting information from Dr. Stuart McGill’s book, Low Back Disorders: Evidence-Based Prevention and Rehabilitation.  In a section titled: Can Back Rehabilitation Be Completed in 6 to 12 Weeks? Dr. McGill makes some great points are relevant to the questions patients ask.  This information can help inform and instruct both me and my patients about expectations.

Dr. McGill explains the idea of a 6 to 12 week rehabilitation time seems to have originated from animals  (reviewed in Spitzer, 1993).  The problem is not all human patients get better so quickly.  Evidence shows mechanical and neurological changes linger for years subsequent to injury.  This includes various motor control parameters with muscle atrophy and other disorders.  It is not just a matter of gross damage healing that should be included in evaluating treatment plans.  Plans should be made while considering the reality of the following studies.

- Ligaments have been shown to take years to recover from relatively minor insult (Woo, Gomez, and Akeson, 1985).

- Many reports have documented the cascade of biomechanical change associated with initial disc damage and subsequent joint instability and secondary arthritis, which may take years to progress (e.g. Brinckmann, 1985; Kirkaldy-Willis, 1998)

- Vertebral osteophytes (bone spurs) were most highly associated with end-plate irregularities and disc bulging (Videman and colleagues 1995)  The spurs are generally accepted to be secondary to disc and end-plate trauman but take years to develop.

Thus, back pain that lingers for more than a few months very much mechanically based.  The chiropractic subluxation fits this model perfectly.  Chiropractors have said for years that complete correction from a long standing subluxation, with secondary degeneration (osteoarthritis) will often take months and up to two years to heal.

Dr. McGill asks the question, “Can these back troubles linger for a lifetime?”  He makes the interesting observation that the elderly appear to complain less about back pain than young folks.  It appears the cascade of changes that lead to pain generally does not last longer than 10 years (and who wants to wait that long).  McGill starts to sumarize with an important qualification, “although the bad news is that the affected joints stiffen [my emphasis] during the cascade of change, the good news is that eventually the pain is gone.  To summarize, the expectation that damaged low back tissues should heal within a matter of weeks has no foundation.”  “Troublesome back are generally not a life sentence.”

This is encouraging in some ways and very insightful as to what to expect.  That is, healing a spine is slow.  But please understand what he is saying.  He says the PAIN is not a life sentence.  Stiffness, poor posture, and vertebral subluxations and the associated neurologic impact will remain.  These are different problems.  Dr. McGill never said the joint stiffness in the cascade of changes would go away.  It is that stiffness that correlates to chiropractic subluxations.  For that reason, we need to be diligent over a lifetime to maintain healthy spines and nervous systems with good “spinal hygiene.”

Ill-Advised Low Back Rehabilitation Recommendations

Mechanicsville, Virginia — I’m trying to work my way through the book Low Back Disorders: Evidence-Based Prevention and Rehabilitation, by Stuart McGill PhD and he make some very interesting points at the beginning of the book.  McGill points out that there have been many oversimplifications of low back treatment that resulted inadequate treatment practices and recommendations.  He really takes some shots at advice we’ve all heard (even if you don’t have low back problems).  They questionable recommendations are as follows:

- Strengthen muscles in your torso to protect the back.  It turns out several studies show muscle strength cannot precut who will have future back troubles (Biering-Sorenson, 1984).  It turns out muscle endurance is actually protective.  He goes on to say, “optimal exercise therapy occurs when the emphasis shifts away fro enhancement of performance and toward the establishment of improved health.  In many cases the two are mutually exclusive!”  Sounds like chiropractic to me.

- Bend the knees when performing sit-ups.  The literature is hard to bring together.  Believe it or not, Axler and McGill (1997) showed there is little advantage to one knee position over the other.  In fact there are far better ways to challenge the abdominal muscles while producing far lower lumbar spine stress.

- Performing sit-ups will increase back health.  There is mild literature support for the belief that people who are fit have less back trouble.  In fact, enough sit-ups will cause damage in most people.  Increased fitness clearly has support and is good, but the way in which fitness is increased appears to be critical.

- To avoid back injury when lifting, bend the knees, not the back.  If you can believe it, research that has compared stooping and squatting styles of lifting have not produced a conclusion as to which style it better!!

- Tight hamstrings and unequal leg length lead to back troubles.  There is little support for these notions.  It may surprise some that I’ve included this.  We as chiropractors are concerned when we see these two things in patients.  Unequal leg length is a significant finding for us.  But what isn’t said above is to Dr. McGill, “back troubles”, actually means: PAIN.  I would agree, hamstrings that are tight and unequal leg length are not good predictors of PAIN, but they are predictors of bio-mechanical problems.  Specifically, the possible presence of subluxations are indicated by unequal leg length measurements (functional differences, not anatomical).  However McGill closes by saying to “perform the provocative tests and discover whether these postural variables are true exacerbates in the individual and thus are justifiable targets for therapy.”

- A single exercise or back stability program in adequate for all cases.  This seems obvious, but some “gurus” advocate the strengthening of just one muscle group as a cure all to enhance stability.  Virtually all spinal muscles can be important to the stability of the low back.  Damage to any [emphasis mine] of the spinal tissues from mechanical overload results in unstable joint behavior.  His point is that the potential problems are numerous and regardless of which tissue is injured, there are complex problems that may need to be addressed.  “No simple, or single, approach will work for all cases.”

Good News, Bad News, and…

Mechanicsville, Virginia — I wanted to give a brief report about the weekend.  I went to Roanoke for the fall convention of the Unified Virginia Chiropractic Association.  Very helpful sessions.  One of the sessions emphasized how most folks with musculoskeletal pain, injuries, or chronic pain syndromes are not getting better today the way they did 20 years ago.  The point was we have more toxins in the environment (that get in our bodies), more prescription drugs in our system, and our food is not as nutrient rich as it used to be.  One, both, or all of these make it hard for our bodies to heal from injuries or allow an adjustment to correct subluxations.  So the solution is often a combination of chiropractic and proper supplementation.  In the past just the adjustment was enough.  I’ll continue to learn more on the topic.  It was encouraging to know there are more solutions out there for tough cases.

We also held elections for board members.  Yours truly will remain a board member.  I will represent the East portion of the 4th district…  For those who wouldn’t know, that is the Richmond area stretching a path south to the North Carolina border.  Also for those who didn’t know, I’ve held the position for more than 8 years!  It has been good fun, and as I see it, important for patients and the profession.  The next two years are going to be so important with Obamacare moving from legislation into actual reality for the general public.  Chiropractors need to be a part of the process for the benefit of all of our patients and the general public that hasn’t yet made it into our offices.

2 Ways to Exercise Your Brain

Mechanicsville, Virginia — The eighth best way to exercise your brain: Smile. How is that? It turns out smiling repeatedly helps interrupt mood disorders and strengthen the brain neural ability to maintain a positive outlook on life. There was even a study that feelings of depression were alleviated when Botox was used to eliminate frown lines! (Finzi E, Wasserman E. Treatment of depression with botulinum toxin A)

Laughing, interestingly, doesn’t do the trick. Different neural pathways are involved, and at times laughter isn’t associated with “warm fuzzy” feelings. We can usually tell when we hear a nervous laugh, or laughter designed to mask fear or surprise.

The key is to trigger a smile response. For example Newberg and Walden, recommend happy music. This has been shown to be particularly effective in helping deal chronic or serious disease. I guess this means funny doctors will get better results!

The seventh best way to exercise your brain: Stay Intellectually Active. Not many would disagree with that I’m sure. It is well documented that if you don’t use neurons (no matter where they are in your body), you will lose them. “Intellectual and cognitive stimulation strengthens the neural connections throughout your frontal lobe, so it’s particularly important to exercise this specific part of your cortex…” “A highly functioning frontal lobe also makes it easier to diet, exercise, and avoid tempting activities that have health risks.”

It turns out, intellectual stimulation, in nearly any form, lowers your propensity to react with anger or fear. The recommendation is to spend as much time as possible doing intellectually stimulating activities (chess, mahjong, visual/spatial exercises, games, reading fiction or nonfiction, listening to books, writing in diaries, attending lectures, going to museums, something for everyone). But if you can believe it, math exercises and crossword puzzles apparently don’t help (Hambrick, Salthouse, Meinz; Predictors of crossword puzzle proficiency and moderators of age-cognition relations)! More believable is the warning they give against video games. The authors point out studies that show one may become more aggressive and coping skills are reduced. Turn off those Playstations.

“Engaging in religious and spiritual issues and problems will also simulate brain function. Reading scriptures, reflecting on meaning, discussing issues with friends, and seriously thinking about the deepest issues facing humanity are outstanding ways of activating complex circuits in your brain.” So spend all the time you need to figure out the big questions in life. Why are we here? Why is there something instead of nothing? Why is there good in the world? What makes something beautiful? Should I go to the chiropractor? All questions we should take time to answer. I’ll give you a great answer to the last question in the next post.

8 Ways to Exercise Your Brain

Mechanicsville, Virginia — Most people have read or heard lists of things to do to exercise your brain.  You know, crossword puzzles, memory games, get active, learn a musical instrument, and so on.  Everyone of them is great.  Just knowing we can exercise our brain is helpful.  As a matter of fact, the Proceeding of the National Academy of Sciences published research revealing that people who are physically inactive increase their risk of Alzheimer’s by 250%!  Wow.

At Stover Chiropractic, P.C., we want your nervous system to work well.  As well as it can in fact!  Every treatment you get helps in that sense.  But there are things each person can do to help outside of our office. Below I’m going to list eight ways to exercise your brain.  But I need to say there are three things that are foundational and therefore not included, but must be done.  The first is: see your chiropractor so you can be adjusted as needed.  The brain and nervous system can not work optimally with subluxations and it has been shown that adjustments increase brain function.  The second is: sleep.  Sleep deprivation will disrupt normal neural functioning.  The third is: eating the proper nutrients for your brain.  There is not space in this blog to cover all the recommendations for nursing your brain, but it must be done.

Now to the list.  This comes from a book titled: How God Changes Your Brain, by Andrew Newberg, MD and Mark Robert Waldman.  The title is deceiving, but it did get my attention.  Which is what it is supposed to do right?  The book is about how religious activity (broadly speaking) impacts neural function.  Then it goes on many interesting tangents, most are helpful.  Do not read the book if you are looking for some spiritual insight on your relationship to the Christian God or the other monotheistic religions.

Here they are (in descending order):

8. Smile

7. Stay Intellectually active

6. Consciously relax

5. Yawn

4. Meditate

3. Aerobic exercise

2. Dialogue with others

1. Trust (faith) – The book lists it as faith.

Some obvious ones and maybe not so obvious right?  We’ll look at them closer in the following posts.

What Type of Headache Do You Get?

Mechanicsville, Virginia — Headaches are common, but not normal.  If we are healthy and functioning as we should, we should not get even one headache.  This, despite what TV commercials tell us!

The problem is most of us are not perfectly healthy and there are things in our lives that prevent optimal function.  This can be as obvious as diet, rest, and stress.  Or as significant as subluxations.  Or combinations of both.

It turns out chiropractic if very helpful for most migraine sufferers.  At Stover Chiropractic, P.C., fortunately we can find the cause of the headache pain and correct it in most cases.  I don’t want to make it sound simple, but for most, a cause can be found.

It turns out there are several kinds of headaches, with different symptoms and physiologic triggers.  The most common types of headaches are tension, migraine, cervicogenic and cluster.  Migraine headaches unique issue we will talk about them in another post.

Tension headaches are the most frequent type in the general population.  Most commonly it starts with tension and tightness in the neck (especially at the top), and shoulders.  The pain then progresses to the base of the skull.  Often the forehead and temples will ache as well.

Cervicogenic headaches originate from problems in the neck.  Often preceded by awkward neck movement or position.  Like painting ceilings, working in odd positions (mechanics, electricians) or injuries to the neck.  This headache is usually associated with decreased range of motion in the neck and pain in the shoulder, neck or arm.

The cause of tension and cervicogenic headaches is related to irritation of nerves that lead to the scalp and the base of the skull.  Those nerves exit the spine in the neck and particularly the upper cervical region.  It is important to evaluate the neck and spine for subluxations to make sure they are not a part of the problem.

Any therapy that helps with relaxing the muscles will likely help.  However, if the tension or nerve irritation is caused by structural misalignments it will always be temporary to massage tight muscles.  Chiropractic will be a better solutions to the structural issues and nerve irritation.

Cluster headaches are another category of headaches.  They are rare.  Most suffers are men (85%).  It is characterized by intense bouts of pain in very specific focal points.  It occurs in clusters, minutes to hours in length.  Typically the pain centers around one eye.  Sometimes nasal congestion occurs on the affected side of the face.  For that reason it is suspected sinus problems are a trigger.  In my experience these are tough for chiropractic to solve.  That being said it is important to keep in mind that these headaches are multi-factoral.  I find it is often the case that a subluxation in the neck is a trigger or aggravating factor for people who suffer with these.  So if a subluxation can be corrected, pain intensity and frequency decreases.

What can be done other than chiropractic care to prevent headaches?  Check these ideas out:

1.  Manage stress – relaxation exercises, directed meditation, breathing exercises, taking breaks from work, vacation (> 4 days).

2.  Exercise regularly – Cardiovascular exercise helps muscles and sense of well being

3.  Watch your posture – The muscles that support the neck and head are often put under increased stress with poor posture.

4.  Drink plenty of water

Hope this helps.  Migraine headaches next time.

What is a normal spine?

A basic understanding of a normal spine is important if you want to achieve one.  There are curves that should be in the spine.  These are seen from the side.  They are labeled primary and secondary curves.  The primary curves are formed in the uterus.  A baby spine is curved by the shape of the uterus and how we are positioned in the uterus.  This is the curve we see at shoulder-blade level and the shape of the sacrum and tailbone (in the pelvis).  The secondary curves are found in the neck and low back.  The neck and low back contours or curves are called lordotic curves.

It is the inadequate development of the secondary curves that create the conditions encourage subluxations and lead to scoliosis.  If these conditions are corrected early, complete correction of minor curves is possible, which prevents further progressive scoliotic change.

It should quickly be added that scoliotic changes can occur even with normal secondary curves in place.  However, subluxations and/or disturbances in the righting reflex (proprioception) are present in these cases.

The take home information is how important it is to prevent activities that could be harmful to the normal development of the curves found in the neck and low back.