Exercise As Good As Surgery for Knee Pain

Considering knee surgery? You may not want to rush into the operation room, a new study suggests.  The study shows that physical therapy and exercise are as effective as surgery for knee arthritis and torn cartilages.

The researchers recommended that patients try physical therapy before surgery, since exercise carries less costs and risks.

Every year nearly half a million surgeries are conducted for torn meniscus. A meniscus is C-shaped cartilage in the knee which helps distribute the body’s weight evenly across the joint. Although tears to the meniscus don’t always causes symptoms, it can produce significant pain.

People with arthritis are more likely to have a torn meniscus, making it difficult to distinguish whether knee pain is the result of arthritis or a tear. This also means it’s challenging to know when surgery will help.

To see whether some patients could avoid knee surgery, researchers compared surgery with physician therapy in a group of 351 patients with arthritis and meniscal tears. Patients assigned to physical therapy were given the option to crossover to surgery. While some PT patients did opt for surgery later on, those who stuck it out with therapy for six months to a year had the same improvements as people who had surgery.

The findings confirm that patients with knee pain can avoid the adverse effects of surgery by pursuing conservative options first. Research suggests that chiropractic care, combined with exercise and weight loss, is another effective way to relieve knee pain naturally.

Reference

Katz, et al. Surgery versus physical therapy for meniscal tear and osteoarthritis. The New England Journal of Medicine 2013; doi: 10.1056/NEJMoa1301408.

Arm and Shoulder Pain After Auto Accidents

Arm and shoulder pain are common symptoms after an auto injury. There are three common ways that arm symptoms can develop after a car crash.

First, shoulder symptoms may actually be due to neck injury. If the ligaments or discs in the neck are injured, they can cause problems with the nerves that travel from the arm. This type of injury can result in either immediate or delayed arm and shoulder symptoms.

Second, the violent force of an auto collision can directly damage the shoulder, arm or wrist. This type of injury usually results in shoulder and arm pain soon after the collision.

Third, the shoulder and arms can become painful from tension in the neck and back caused by whiplash injury. This type of shoulder pain may take a few weeks or months to develop after the crash.

Watch our videos below, or browse our articles to learn more about arm and shoulder pain after whiplash.

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Chiropractic and Family Practice Physician Treatment Outcomes for Chronic, Recurrent Low-Back Pain

Despite the large number of patients with chronic low back pain there is little data on treatment effectiveness for this group. The authors of this feasibility study sought to answer some of the many questions on clinical management of chronic low back pain, including: “How do differences in the treatment processes relate to variations in outcomes among different types of practices and providers?” and “What is the relative benefit of different care strategies?”

In this study, forty-five chiropractors and thirty-three medical physicians collected data on patients with acute and chronic low back pain over a period of six months. This study dealt with the chronic low-back pain group consisting of 93 chiropractic patients and 45 medical patients. Physicians and patients completed questionnaires on the first visit. Follow up included a telephone interview with patients at seven to ten days, and a mailed questionnaire at one month and at three months. Physicians completed a follow up questionnaire on all subsequent visits. Patient questionnaires were administered in the waiting room before the first visit, and contained six parts. Socio-demographic information was collected. A condition specific questionnaire on low-back condition before treatment established baseline. A visual analog scale (VAS) measured pain severity. Pain quality was documented, and limitations on functional activities were assessed. General health was assessed using the Medical Outcomes Study 36-item Questionnaire (SF-36), with additional questions to screen for depression. The follow-up telephone interview included an assessment of patient satisfaction using a five point ordinal scale. The mailed follow up included a condition specific questionnaire, VAS, a questionnaire to document pain quality, and the functional limitation questionnaire.

Within the two provider groups patients differed in age, sex and employment status. Family practice physician patients tended to be older, female, less likely to be employed outside of the home, and less educated. Baseline measures of psychosocial health were similar for both groups but chronic depression of two years duration was seen in 31% of medical doctor patients compared to 14% of chiropractic patients. On general health measures at baseline, family practice patients tended to have poorer general health, with slightly greater physical impairment, and more bodily pain.

In general, chiropractic patients showed greater improvement than the medical patients at the one month follow up. Significant differences were seen in patient satisfaction, with chiropractic patients reporting greater satisfaction with information and treatment provided. The difference between the chiropractors and medical doctors was particularly evident in patient satisfaction with overall medical care. Of the patients that responded to the one-month mailed follow-up, 56% of chiropractic patients reported that their low back pain was better or much better, compared to only 13% of medical patients. Nearly one third of medical patients reported their low back pain as worse or much worse.

The authors conclude, “Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians.” The researchers note that although there is, “…ample evidence in the literature to support a specific benefit from manipulation for patients with acute low-back presentation, there is a paucity of research on the benefit of manipulation for patients with chronic low-back pain.” They hypothesize that:

“…outcome may be heavily influenced by the nature of the chiropractor-patient interaction, including more frequent visits and a process that engages the patient as a partner in the healing encounter.”

“The influence of nonclinical factors appears to receive support from this study in that good outcome for medical patients was largely dependent on good psychological health at baseline, whereas the outcome for chiropractic patients was not. It may be that chiropractors dealt more effectively (successfully) with the psychosocial components of chronic low back pain…”

This feasibility study was limited in a few respects. There were fewer medical clinic patients enrolled than there were chiropractic patients; this is largely due to the complexities of multi-physician clinics, and did not affect patient characteristics. Self-selected treatment groups are known to be biased in observational studies, and not all patients responded to the one-month questionnaire. The authors state that their purpose was “…not to study efficacy as in a randomized clinical trial but to characterize patients and practices and to explore relationships at they exist in the community.”

Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and on-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Journal of Manipulative and Physiological Therapeutics 2000;23(4):239-245.

Wrist Pain and Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common and painful disorder that affects around 3 percent of women and 2 percent of men. It can cost those affected by it as much as $30,000 over their lifetime. Chiropractic care is a noninvasive, drug-free way to treat carpal tunnel syndrome. Watch our videos in the playlist below, or browse our articles to learn more about Carpal Tunnel Syndrome.

 

Carpal Tunnel and Wrist Pain Treatments

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Chiropractic, Muscle Relaxants and Back Pain

Chiropractic for back painOver ¾ of adult Americans experience lower back pain at some point in their lives, and nearly 1 in 5 experience it each year, making it important to determine which treatments are most effective. This double-blind study looked at the effectiveness of treating subacute lower back pain (LBP) with chiropractic adjustments when compared to treatment with muscle relaxants or a placebo (sugar pill).

The 146 subjects who completed the study were between 21 and 59 years old, with uncomplicated LBP lasting from 2 to 6 weeks at the start of the study. Those with underlying spinal disease or malformations were excluded. Each subject underwent chiropractic and radiographic evaluation at the initial evaluation visit. Pain was evaluated at the initial visit, and again at 2 weeks and 4 weeks.

Pain was evaluated using the Visual Analog Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire, and the Zung Self-rating for Depression scale. Shober’s test for lumbar flexibility was also given at the initial visit and again at 2 weeks.

At the initial visit, subjects were assigned to one of three groups with treatment administered over a period of 2 weeks:

  • Chiropractic adjustments and placebo pill
  • Muscle relaxants and sham adjustments
  • Placebo pill and sham adjustments (control group)

All subjects were also allowed to take acetaminophen to evaluate the need for additional self-medication.

7 chiropractic adjustments were given over the 2-week treatment period to the chiropractic adjustment group. Adjustments were tailored to the patient’s needs, and included upper cervical and lumbar (neck and back), sacral (lower back) or pelvic adjustments.

Sham treatments were designed to mimic normal visit length, dialog and procedures without the actual adjustment occurring.

Practitioners administered cyclobenzaprine HCL (5 mg), carisprodol (350 mg), and methocarbamol (750 mg) in bottles labeled “A,” “B,” and “C” to treat the subjects in the muscle relaxant group. Usage and dosage were determined by the medical practitioner’s clinical judgment, with the combination of medications determined by effectiveness and adverse reactions. Subjects could halve or double the dosage in bottles “A” and “B,” or switch to bottle “C” for bottle “A” if excessive drowsiness occurred, and were instructed to discontinue medication if side effects were severe. Acetaminophen was also offered in a bottle labeled “D.” The placebo groups were given exactly the same instructions, only their bottles contained placebos.

While the study was meant to be blind (the subjects would not be able to tell if they were receiving real or sham adjustments or medications), there was a higher tendency for the groups that received true chiropractic treatment and that received the muscle relaxants to perceive that treatment was given, and a higher perception in the sham treatment group that treatment was not given. This could be due to the effectiveness of the treatment, however.

During the 4 weeks of the study, pain was significantly reduced in all groups. Initially, the group that received chiropractic adjustment had overall higher baseline VAS scores, but after treatment, their scores were lower than the other groups, indicating an even more impressive level of improvement in the chiropractic subjects.

The change in reportedpain among the 3 groups was statistically significant: subjects in the chiropractic group reported greater pain reduction than the control group. While scores on the Oswestry Disability Index improved for all groups over the 4 weeks studied, the greatest improvement in scores occurred in the chiropractic group.

Depression and Shober (lumbar flexibility) scores improved in all 3 groups during the 4 weeks, with no difference between the groups.

GIS evaluations (which measure the physician’s assessment of improvement) showed that patients given chiropractic adjustments improved more than subjects who received muscle relaxants or placebos did.

The authors concluded:

“Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.”

Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics 2004;27:388-398.

Sports Injuries and Chiropractic

Sports injuries and chiropracticChiropractic is an integral part of the care that many professional athletes receive. Many Olympic athletes also take advantage of the benefits of chiropractic. Just because you aren’t going to the Olympics doesn’t mean that you too can’t improve your health and performance with chiropractic care.

When it comes to sports injuries, weakness or improper stretching can put you at risk of injury. In addition, an untreated injury may result in further or even permanent damage. It is vitally important to get proper care for any sports injuries, preventing the development of chronic problems.

There are two basic types of sports injuries: the first is the result of a trauma inflicted by a collision, a slip or a fall. The second type is caused by the over-use of a muscle group or joint whereby the repetitive movement of the same area causes an inflammation or injury.

As chiropractors, we’re trained in treating sports injuries, we can advise you in the best way to heal an injury and how best to prevent it from recurring. Treatment can range from massage therapy to joint manipulation, or specific exercises that target problem areas and strengthen previously injured or weakened muscles and joints.

Any sporting activity should be preceded with a warm-up session. It is best to increase the frequency or duration of workouts slowly and progressively as strength and fitness levels increase. Fatigue or stress can be risky when working out, as it puts you at a higher risk of injury.

Working in conjunction with a qualified trainer and a chiropractor can help you stay in great shape and prevent injuries.

If you’ve suffered a sports injury, give our office a call.

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Chiropractic and Athletic Performance

Preventing Sports Injuries with Chiropractic

Chronic Back Pain, Chiropractic Effective

This study based used a practice-based, observational model to look at the effectiveness of intervention in a selected group of patients with both acute and chronic lower back pain (LBP).  It compared the efficacy of chiropractic intervention with standard medical care in both types of LBP.

2780 patients were enrolled in the study over a 2-year period (1994 to 1996) from the practices of 60 DCs (1855 patients) and 111 MDs (925 patients) in 51 chiropractic and 14 general practice clinics. Patient data was obtained at the initial visit through a questionnaire administered in person, and the patients were followed up with 7 mailed questionnaires at regular intervals over a period of 4 years. Mailings were sent at 2 weeks, 1 month, 3 months, 6 months, and 1 year after the initial visit. In phase 2, patients were followed up at 24, 36, and 48 months.

Patients were eligible if LBP was their primary complaint, and was of mechanical origin; they were excluded if manipulation was contraindicated, or the back pain was of nonmechanical origin (such as from organic referred pain).  Acute patients were those whose back pain was of less than 7 weeks duration; chronic back pain patients were those whose back pain was of 7 weeks duration or longer.

The physicians in the study delivered a variety of treatment methods. Chiropractic physicians gave care that included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical physicians gave care that included prescription drugs, an exercise plan, and self-care advice; roughly 25% of these patients were referred for physical therapy.

The primary outcomes measured were present pain severity, and functional disability, which were measured by questionnaires mailed to the patients at the above stated intervals.

The medical patients showed more severe baseline pain and disability when entering treatment, greater prevalence of pain radiating below the knee, and poorer general health status, than in patients treated by chiropractors. These differences were more pronounced in the chronic patients than in the acute patients.

A modest advantage was seen for DC care when compared with MD care in pain relief for the first 12 months. This difference was very small for acute LBP, but was greater for those with chronic LBP during the first year of treatment. There were no differences for patients cared for between 12 and 24 months. Trends in disability were similar to the pain trends, but were of smaller magnitude.

There was an advantage chiropractic care in chronic patients with pain radiating below the knee, and some small advantages were also seen in the acute patient group. Differences were also seen in chronic patients with no leg pain during the first 3 months of care. There were no differences in the 2 groups and the 2 types of medical care for pain radiating above the knee.

All patient groups saw clinically significant improvement in pain and disability over the course of treatment. Acute patients saw greater improvement, with many obtaining near complete relief of their symptoms. Most achieved symptom relief by 3 months, followed by a plateau through 12 months. This was followed by significant, clinical aggravation of pain at 12 to 24 months, with another plateau until 4 years. Little increase in disability was seen between 12 and 48 months.

Of note, at 3 years into the study, 45% to 75% of patients noted at least 30 days of pain during the previous year, even in those who had gained significant pain and disability relief through early intervention. 19% to 27% of chronic LBP patients noted daily pain during the previous year.

  • Early interevention reduces chronic pain. Those who received early intervention for acute lower back pain, at 3 years after the initial injury, reported fewer days of back pain than those who waited longer for intervention. This would support providing early intervention for patients with acute back pain, since outcomes were better than in those who delayed treatment.
  • Chiropractic is beneficial for certain kinds of pain. Chiropractic care was more effective than standard medical care in certain situations: during the first 12 months in patients with chronic lower back pain, and for the treatment of LBP with pain radiating below the knee. The majority of the relief was obtained during the first 3 months of treatment, and was sustained throughout the first year.

Haas M, Goldberg B, Aickin M, Ganger B, Attwood M. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27(3):160-169.

Knee and Leg Pain

Every year, around 100,000 Americans have surgery to relieve knee pain. But studies suggest that many people can avoid surgery through natural, conservative treatments.Chiropractic adjustments, exercise therapy, and weight loss have all been shown to reduce symptoms of knee pain in patients osteoarthritis.

Chiropractic can also ease leg pain associated with sciatic nerve damage and sports injuries.

Articles on Knee and Leg Pain

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Non-surgical Treatment for Osteoarthritic Knee Pain

Weight Loss Reduces Knee Pain

Knee replacements may not be as reliable as previously thought

Back Pain: How Chiropractic Can Help

Back pain is the leading reason people seek out the assistance of a chiropractor. A chiropractor as can help both with both pain management, and by improving the alignment of the back, they can help prevent future episodes of pain.  When you first go to see a chiropractor, he or she will take a medical history and most likely ask you questions to find out what may have triggered the pain. The chiropractor will also feel around your back to determine where the pain is coming from.

Chiropractors treat many types of back pain using spinal manipulation.  The chiropractor will have you lie down on a special table and put your arms and/or legs in certain positions.  Then he or she will apply pressure to make your bones and joints return to their proper places.  Most people feel great relief when they have this done, although some people are a little sore the next day.

Arthritis Articles

Arthritis is a common source of pain. Browse our articles to learn more about arthritis, and different methods of treatment.

Arthritis Treatments

Back Pain

Carpal Tunnel Syndrome

Chiropractic Care for Seniors

TMJ, TMD, and Jaw Pain

 

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