Is Chiropractic Care Cost Effective?

The U.S. currently spends more money per person for heathcare than any other nation. Sadly we have found that we are not very healthy as individuals. The World Health Organization ranks us 37th in the world behind Costa Rica and before Slovenia. It is obvious that we are not getting our moneys worth. Back and Neck pain has been estimated to be the 3rd most expensive condition to treat in the U.S. behind heart disease and cancer. Since we spend so much it is just a matter of time before government steps in and says what is effective and what is not. There will be a huge fight over it because there are some very powerful groups that do not want change. So how does chiropractic stack up? There has been quite of bit of research on this subject and here are a few examples. In 2007 Guidelines were published by the American Pain Society and the American College of Physicians. These guidelines found that chiropractic adjustments were effective for acute, subacute and chronic lower back pain. A 2011 study looked at the Guidelines and found chiropractic care to be cost effective for subacute and chronic lower back pain and there was insufficient evidence that it was effective for acute back problems. This same study found NO MEDICATIONS to be cost effective for lower back pain. A large study of BC/BS of 85,000 patients found chiropractic care to be 20-40% less expensive than traditional medical care. Another group associated with United Healthcare demonstrated that chiropractic care produced large improvements in disability at low episode costs. Another study in 2010 showed that chiropractors were able to help 60% of those patients who were scheduled to have back surgery. In the U.S. it is estimated that this alone could save $3 billion a year. There have been numerous studies showing that when doctors follow evidence based guidelines for lower back pain (of which spinal manipulation is a very effective treatment) significant costs are saved. Sadly it has also been proven that most MDs are not following established Guidelines for lower back pain. I believe that the average cost of a chiropractic treatment program is about $487. The average cost of a hospital based MRI is about $2500. You can see using a chiropractor as part of your healthcare team can help you put money back in your piggy bank.

Is your medicine safe?

You think you are safe if you follow your doctors orders but are you? There seems to be a large growing problem with prescription medicine abuse that seems to have the policy holders in the U.S. concerned at this time. Since the 1990's prescriptions for narcotics has increased 300% in the U.S.

In the U.S. the second leading reason to see a physician is musculoskeletal problems. Most of the treatment of these ailments is with prescription medication and according to the Centers for Disease Control the most frequently prescribed opiate (a narcotic) is Vicodin. Vicodin is hydrocodone with Tylenol added to it. Tylenol increases the effectiveness of hydrocodone. There are approximately 139 million prescription written for Vicodin every year. In the year 2008 about 36,000 in the U.S. died from prescription drug overdose, which has TRIPLED since 1990. It is estimated, according to the CDC, that 4.6 million Americans are addicted or abuse this prescription drug. Also those on Medicaid and those living in rural areas (like Lampasas) are more likely to be addicted to this medication. Most of the current research involving lower back pain states that the use of these powerful narcotics does not help the patient get better any quicker. Another powerful narcotic is Oxycondone. In the U.S. it is prescribed for moderate to severe pain. The international Narcotics Control Board states that in 1998 11.5 tons of Oxycondone were produced worldwide. In 2009 about 135.9 tons of this medication were produced world wide and the United States accounted for 82% of the world wide consumption. This medication is a very strong narcotic that has had a problem of abuse and illegal use in the U.S. So why would a chiropractor care about this? In the U.S. back pain is the second leading reason to see a physician today (right behind upper respiratory infections). So a lot of these powerful medications are being prescribed for back pain. The problems is all of the current research into treatment of back pain has stated that these medications do very little to help a patient get over a bout of back pain, yet they seem to be prescribed more and more each and everyday. This summer the Journal of the American Medical Association Internal Medicine published a study with showed that medical doctors are ignoring published guidelines for the treatment of back pain. Research has demonstrated that NSAID (Tylenol, ibuprofen, aspirin), spinal manipulation, and exercise are the best treatments for this condition. Powerful narcotics have shown to provide little to no benefit for back pain, but prescriptions are up 51% for these medications. The authors of the study have "significant concerns" that this maybe leading the crisis of increased deaths due to prescription medication. Do yourself a favor. If you or someone you know is suffering from lower back pain and they are on these prescription medications, show them this blog, and have them call our office to schedule an appointment so that we can help them get rid of their pain safely and effectively.

Current Chiropractic Research

Spinal Manipulation for the treatment of back and neck complaints has been well documented. I think it has been researched to death but the government continues to shell out money for lower back pain research. By the way a recent study (Lancet 2013, JAMA 2013) have demonstrated that lower back pain is the number one disabling condition in the World today. What does this mean well it means more people miss days at work for back pain than any other single condition. So I guess we can not study lower back pain enough. The largest chiropractic study ever is currently underway. With funding from the House Armed Services Committee the Palmer College of Chiropractic, RAND Institute and the Samueli Institute are conducted a 3 phased study called ACTS (Assessment of Chiropractic Treatment). ACTS I is currently underway and it is comparing medical care vs. medical care plus chiropractic care for the treatment of enlisted military personnel. ACTS II is looking at chiropractic care and how it effects reflex and reaction time with military Special Forces. ACT III will look at strength, balance, and long term outcomes of lower back pain in enlisted military personnel and if they are eligible to be deployed. The results of this study will probably not be released for about 5 years though. Another recent study (Spine, April 2013) demonstrated that spinal manipulation group of patients showed a faster and quicker reduction on symptoms than those patients given a NSAID. Another recently released study demonstrated that the type of practioner that you first see determines you likelihood of having lower back surgery. This study showed that for the same diagnosis if you went to a chiropractor first you had a 1.5% chance of lower back surgery. If you went to an orthopedic surgeon first you chances of surgery were 42.7%. I also have been fortunate enough to be involved in a research project. The University of Pittsburgh School of Health and Rehabilitation Services is the sponsor of this research entitled Foundations of Evidence Informed Practice (EIP). This research project is for chiropractors only and my part will start in Jan 2014. It is an attempt to have the average chiropractor practioner develop better evidence based practice in his or her daily chiropractic practice. I am excited to be part of this research project with over 1500 Doctors appling to be part of it and they only excepted 325.

Lower Back Exercises

Many patients have asked what exercises do I need to do to keep my back pain from returning? Current research indicates that lower back pain has a very high rate of reoccurrence about 60-80% within a two year period. Doing daily core exercises can lower this rate to under 30%.

Remember I suffered from a ruptured disc in 2009 and have been doing some daily stretches/exercise since. I do them in the morning and they take about 10-15 minutes to do so they do not take very long. So if you are in acute pain something that you can do is the knees to the chest stretch which is demonstrated above. Pulling your knees to your chest will take tension off of the sciatic nerve and this may give some people relief. Some people find that knees to the chest is to uncomfortable so they need to try this back extension stretch.

Try to hold for 10-15 seconds and then relax. Repeat this several times and then several times during the day. When not in acute pain you can try some "core" exercises. I like using the exercise ball because in my personal research I have found that the "balancing" type of exercises seems to strengthen smaller muscles in-between the vertebrae. So I start out on a ball doing the dog pointer. That would be laying on your stomach with the ball underneath and lifting your left arm and right leg off and holding that position for 15-30 seconds and then do the other arm and leg.

Another one is to lie on your back and put the ball under your heels and straighten the back and hold for 30 or more seconds.

. One of the last ball exercises that I do it to lie on my back on the ball with knees bent. Then straighten one leg at a time holding for 15-30 seconds and then do the other leg. I then do two more exercises without the ball. The first is called a plank. You get on your elbows and on your toes and hold your body straight in that position for 30-60 seconds. This one, for me, is one of the harder ones to do. I had to build up to this exercise because at first it did bother my back.

The last exercise that I do is a side plank with is up on the elbow on your side like this picture. I hold this one for 30 seconds.

So these are the exercises that I do each morning before work. I have found out with the ball exercises that you do not notice an increase in strength but you will notice your balance getting better. As always if a certain exercises is sore you can continue to do it, but if you have an exercise which "ouch" hurt you must stop immediately.

Evidence based Healthcare

Evidenced based healthcare is the new buzz word in healthcare. What it means is that you are treated according to the latest researched evidence for that condition. Basically it is trying to give you the most "bang for your buck." Many conditions have been researched to find the best "evidence based" treatment approach. Well what about back pain? What does the evidence show? First off we have found out the number one disabling condition the WORLD today is lower back pain. More people miss more work or are laid up due to back pain than due to any other single condition followed by major depression and then other musculoskeletal disorders. So what has the research "proved" is the best treatment? You may be surprised to find that spinal manipulation (which is mostly performed by chiropractors) has one of the highest levels of research associated with successful treatment of lower back pain. The research also demonstrated that NSAID (non steroid anti-inflammatory drugs), such as aspirin, Advil, Aleve, Tylenol are effective. These medicines, in research, have been shown to do as well as the stronger medications like Vicodin, Flexeril, and those types of medications which have potentially severe side effects. The third recommendation for the treatment of back pain was exercise. These are the three most "evidence based" treatments for lower back pain. (Rand 1992, AHCPR 1994,) Those with questionable research were epidural steroid injections and lower back surgery. A recent study has demonstrated that if you saw a chiropractor as your first doctor for lower back pain you had a 1.5% chance of lower back surgery. If you saw a surgeon as the first person that you saw for your lower back pain you had a 42.7% chance of surgery (Spine December 12, 2012). The average cost of a chiropractic treatment program is about $552 (Health Affairs, 2013: 32 (1): 45-52) and the average cost of lower back surgery is around $50,000. $50,000 for a treatment that is not very effective. So the research suggests that you try NSAID and if that does not help you condition you should consider seeing a chiropractor. Several studies also indicate that lower back pain has a very high rate of reoccurrence 60-80% within a two year period. Exercises can lower that reoccurrence to below 30%. We treat our patients using the latest evidence based guidelines. We use spinal manipulation coupled with exercise therapy and we have had very good success. It is now time for the rest of the U.S. to catch up to this treatment. Here is a link to an algorithm for the treatment of back pain. http://www.tihcij.com/Articles/Algorithms-for-the-Chiropractic-Management-of-Acute-and-Chronic-Spine-Related-Pain.aspx?id=0000381

Mechanical Lower Back Pain

Mechanical Lower Back Pain

There are three types of lower back pain; sprain/stains, mechanical, and compressive. 85% of Americans will suffer some form of mechanical lower back pain sometime in their lifetimes. It is by far the most common and the most disabling.

Mechanical back problems often have multiple problems of the muscles, ligaments, discs, and facet joints. It is also most common in ages 25-60. A lot of studies believe that the problem is cumulative trauma mostly from work related problems. I don’t buy that, I believe it is more likely related to deconditioning of the body as we age. Most Americans sit all day which is the worst position for your back and puts more stress on the lower back area then most other activities. The more will sit the more our core muscles weaken which is supposed to support and hold the spine. I think this is exactly what happened to me when I hurt my back. I have no history of trauma and all I did was take a nap on the couch and roll off. Well everyone knows that rolling off a couch should not cause severe back pain, but it did. The question for me is why it did. My conclusion over the years I allowed myself to get out of shape and my muscles that support the spine (core muscles) had also become weak. This had happened over many years and probably many decades. When I twisted to get off of the couch these muscles did not support the spine and it moved pinching a nerve.

With mechanical types of injuries it is my opinion that physical medicine (such as chiropractic) is much more effective than treating it with pharmacological medicine and research has continually shown this to be true. So you can take all the medications that you want, but until you address some of these underlying mechanical and strength and weakness problems the pain will most like return.

Whiplash

Whiplash what is it and how to treat It

With all of the construction on Key Ave I thought discussing “whiplash" would be a good topic. Whiplash is a term that was coined in around 1928 which describes the injuries an individual gets to his neck and back following a motor vehicle accident. Up until the advent of the automobile “whiplash” was not a very common occurrence. The easiest way to describe whiplash is a sprain or strain to the neck. It can cause a variety of symptoms such as neck pain, neck stiffness, headaches, arm/shoulder pain, back pain and numbness and tingling into the extremities. It can take 24 hours to several days for these symptoms to show up. Many times people believe that injury is related to automobile damage; the more damage the more injury. This is not always the case. Many times severe injuries can occur with little to no vehicle damage. One of the reasons that this can occur is if the accident caused rapid acceleration (moving very quickly) that can cause more damage to the structures of the neck. Generally getting hit from behind by another vehicle on wet pavement causes more damage to the neck than dry pavement due to acceleration. Getting hit on snow or ice will cause more damage than being hit on wet pavement. I read somewhere that being hit by a Volkswagen on ice is about the same as being hit by a city bus on dry pavement. Here is link to an animation of a whiplash injury

http://www.youtube.com/watch?v=b5Bv_gtPu-8&feature=related

So what do you do if you have pain associated with a “whiplash”? One the most highly regarded studies to date was the Quebec Task Force on Guidelines for the Management of Whiplash-Associated disorders. They really did not do any new research they just reviewed all the current research and their findings. They found the most effective treatment to be manipulation and mobilization and range of motion exercises. Medications can be used but should be limited to no more than 3 weeks. A cervical collar should not be worn for longer than 72 hours. So if you are unfortunate enough to have a “whiplash” disorder give our office a call and we will get you back on your feet ASAP, and most automobile insurance companies will pay 100% of the medical costs.