Denver Chiropractic, LLC

On Februrary 8th, 2010 a survey was published in the Archives of Internal Medicine regarding the management of acute low back pain in general practice to see if low back pain guidelines were being followed.  In summary, the care being provided did not match evidence based care.  Primarily, too much imaging and incorrect pharmaceuticals used for acute low back pain.  The study catagorized spinal manipulation under a general therapy catagory, so it is unclear how often GP’s refer for spinal manipulation.  The following is the abstract, and full text of the article can be found here.

Low Back Pain and Best Practice Care

A Survey of General Practice Physicians

Christopher M. Williams, MAppSc; Christopher G. Maher, PhD; Mark J. Hancock, PhD; James H. McAuley, PhD; Andrew J. McLachlan, PhD; Helena Britt, PhD; Salma Fahridin, MHSc; Christopher Harrison, MSocHlth; Jane Latimer, PhD

Archives of Internal Medicine 2010;170(3):271-277.

Background  Acute low back pain (LBP) is primarily managed in general practice. We aimed to describe the usual care provided by general practitioners (GPs) and to compare this with recommendations of best practice in international evidence-based guidelines for the management of acute LBP.

Methods  Care provided in 3533 patient visits to GPs for a new episode of LBP was mapped to key recommendations in treatment guidelines. The proportion of patient encounters in which care arranged by a GP aligned with these key recommendations was determined for the period 2005 through 2008 and separately for the period before the release of the local guideline in 2004 (2001-2004).

Results  Although guidelines discourage the use of imaging, over one-quarter of patients were referred for imaging. Guidelines recommend that initial care should focus on advice and simple analgesics, yet only 20.5% and 17.7% of patients received these treatments, respectively. Instead, the analgesics provided were typically nonsteroidal anti-inflammatory drugs (37.4%) and opioids (19.6%). This pattern of care was the same in the periods before and after the release of the local guideline.

Conclusions  The usual care provided by GPs for LBP does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time. The unendorsed care may contribute to the high costs of managing LBP, and some aspects of the care provided carry a higher risk of adverse effects.

5 days after initial K tape application

I know people that have never completely recovered from their initial ankle sprain, because they never had the ankle looked at by a professional. Unfortunately for some, an ankle sprain will lead to fear avoidance behavior. Meaning, they are overly cautious how they use their ankle, because of fear that the same injury will occur. This is typically a person that has never saught care for their once injured ankle, and was never properly rehabilitated.

Ankle sprains are common, and they do not, and should not prevent you from returning to your sport or recreational activity. Mild and moderate sprains can be treated very successfully by the chiropractor. I’ve had great results with treating mild and moderate sprains. Any severe sprains, where there is absolute loss of any movement, should be referred to the orthopedist. Some sprains can also have underlying fractures, so it is imperative that a doctor of chiropractic, or any other specialist evaluate your ankle as soon as possible.

After a thorough evaluation, treatment could consist of any number of therapies. One therapy in particular, for ankle inversion / eversion sprains, is extremity joint manipulation. I find adjusting the ankle to be quite effective at helping to restore nomal function to an injured and dysfunctional area. When an injury occurs to a joint, the muscles surrounding the joint will splint and alter the motion of the joint. I have found that restoring the motion of the joints through joint manipulation, profoundly speeds up the healing time.

After getting the ankle joints and surrounding joints to a state where they are working better, I typically use kinesio tape to help with drainage of the inflammatory products. If the sprain happens during a sporting event where the athlete needs to participate, I will adjust and then use athletic tape and a local topical analgesic to get them back in play. So, timing and circumstances will also dictate the type of treatment given.

Other treatments in the early and late stages of the sprain include:

* Protect with athletic tape, removable air cast, loose lace up support
* Rest – possible use of crutches, but wean ASAP
* Ice – 20 min on, 1 hour intervals to control inflammation, this is most important for the first 24 hours
* Compression – elastic wrap or sleeve
* Elevate – helps control swelling
* Pain free active range of motion (can use slushy bucket), tilt your ankle up and down and side to side, the movement will help control swelling, will help prevent muscle splinting, and will help get blood to the area (we heal with what’s in our blood – so eat healthy!)
* Cold Laser – Speeds up Mitochondrial ATP production
* Pulsed ultra sound indirect in cold water
* Electrotherapy – helps with pain control and will also indirectly decrease muscle splinting
* Kinesio tape – help with inflammatory fluid drainage, will also help restore normal muscle tension, restore appropriate nervous system feedback to help improve proprioception (that is how your body knows where it is in space)
* Osseous Manipulation – Get adjusted! It is a very safe procedure, and it feels great – give it a shot! This will dramatically affect alignment of your joints, help allow correct muscle tension on the joints, and wil help restore normal muscle receptor feedback ( golgi tendons and muscle spindles ) to your brain.
* Anti – inflam nutrition – Vitamin C @ 1,000mg to 3,000mg per day, 1,500 mg to 3,000mg of EPA/DHA, Bromalain at 2,000mg per day.
* Alternate heat and ice after the first two days of injury
* Isometric exercises – contract the different muscle of the foot without moving your foot
* Continue weight bearing walking
* Running in swimming pool
* Ice after exercise
* Toe raises – flat ground – progress to step
* Balance drills – wobble board, rocker board, balance sandals ( this is a huge area and lots of different exercises can be done with theses tools ) doing these drills will help you regain your confidence that your ankle is back to normal.
* late rehab includes more balance and coordination drills

So, there is a ton of therapies that can be done to fix your once new ankle. This information is no substitute for a visit to the doctor. Go to a pro and get yourself looked at, you will be glad you did. Your return to the living will be much quicker. I gurantee it!

Dr. Trent Artichoker MS, DC
www.denvercoloradochiropractic.com

The American Chiropractic Association recently put out a press release regarding issues surrounding informed consent and the overall safety of cervical manipulation. In summary, a study expert validated that cervical manipulation is safe.

“The study, which analyzed nine years’ worth of data from a population of 110-million person years, concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke following a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician (PCP).”

The press release can be read here http://www.acatoday.org/press_css.cfm?CID=3769

Entire press release:

“Media Contacts:
Caitlin Lukacs: (703) 812-0218 | clukacs@acatoday.org

As a profession, doctors of chiropractic remain committed to expanding the research and clinical understanding of VBA injuries, because even one cerebral vascular incident that could have been prevented or detected early is one too many. ”

Dr. Trent Artichoker MS, DC
www.denvercoloradochiropractic.com

Denver Chiropractor, Dr. Artichoker explains the causes of back pain.

Chiropractic maintenance care is actually a great phrase for spinal hygiene. Just about everything in life needs care for continuation of optimal function. In regards to health, maintenance is an absolute, and not an option. I think health maintenance is a simplistic concept, and easy to understand, in that our health is a direct effect of how we treat our bodies.

The foundation of our bodies is the spine and everything it houses, and without proper function, your body is working sub optimally. Sub optimal function leads to increase stress and strain on the parts of the body that lead to fatigue, break down, and dysfunction.

As a denver chiropractor that deals with mechanically dysfunctional bodies, I recommend getting your spine adjusted at least once a month. Everyone is different, and so once a month might be to much, or for some, to less. It all depends on how you are taking care of your body. Are you exercising regularly? Are you eating healthy foods? Has your body had any past trauma? Do you have spinal conditions?

Those are some of the questions that are needed answered before maintenance care can be recommended. Another worthy question, how much do you want to spoil your self? Usually, once a person gets several adjustments and understands the feeling of being aligned. It is much easier for you to know how often your body needs adjusted, and when it is time to see the chiropractor.

So, there is no magical number about how often you should get adjusted. It is completely up to you on how you utilize chiropractic. I get adjusted once a month and feel that is a good time frame for my body to get aligned and worked on.

Treat your body, get adjusted.

Dr. Trent Artichoker MS, DC
http://www.denvercoloradochiropractic.com/

As you were comfortably snuggled in your bed, sleeping, after a long hard tiresome day, dreaming of an alternate world, something painful was about to happen to your body. Even though we can defy the laws of physics in our sleep, we cannot escape the real world and the consequences of sleeping wrong.

Sleeping wrong? I thought we just lay there and close our eyes, but it is much more than that. Who hasn’t slept in a strange bed and woke with soreness. Or, how about going camping, to find that your sleeping area is really just a sloped mountain side that is filled with rocks. Funny how we can be a little sore after sleeping on the ground, but when waking from our tripple density nasa foam mattress, with custom inflation, we can barely move our neck or back.

This has happened to me once, my neck was so stiff, I might as well had a neck brace on. The pain was horrendous, and the limitation of my movement made me disabled. It is a horrible feeling, to be fine one day, and unexplainably incapacitated the next day. I survived, and that was with out seeing a doctor, but if I knew then what I know now, I would have seen a chiropractor or another doctor in my area. As a chiropractor in Denver, I regularly see patients with the exact same presentation.

They usually have no explainable cause as to why their neck or low back is so stiff, and painful. They wake to find their neck or back completely different, painful, and with almost no normal motion. Plenty of conditions can mimic this situation, so it is wise to consult a doctor.

This lack of movement, and severe pain that develops overnight is most likely attributable to the derangement of the soft tissues that surround the joint, i.e. the joint capsule. Each joint in your body has a capsule that surrounds it holding the precious synovial fluid, akin to the oil in your car. Also in the joint, we have special folds of the capsule called Menscoids. It is the meniscoids in this situation that are not working correctly. They are little flaps of the capsule that can sometimes be misaligned and function incorrectly. It is like putting dirt in ball bearings. These meniscoids also have the ability to transmit pain, which they do very well.

The pain from the meniscoid triggers a spasm in the nearby muscles, which will leads to fatigue and a cycle of ischemia, inflammation, and more pain. While the spasms and inflammation can be targeted with pharmaceutical therapy, the drugs still do not address the underlying problem. The underlying problem of a joint that is locked up due to incorrectly working joint mechanics. So, no matter how many drugs you take, the alignment will not fix itself.

Every type of doctor has a niche, and the condition of the trapped meniscoid, is well suited to the Chiropractor. We perform approximately 95% of all the adjustments that occur in the United States. No other profession that dabbles in spinal manipulation gets as much training as a chiropractor. So, if you have never seen a chiropractor before, and have such a condition, I implore you to see your local chiropractor.

To Your Health,
Dr. Trent Artichoker MS, DC

http://www.denvercoloradochiropractic.com/

Every year you will have to reconsider your auto insurance policy as it expires on a yearly basis. If you have never been in an auto accident, or have not had to use your insurance, you might want to check your policy to know exactly what your insurance will cover.

There will be approximately 5,000 rear end type accidents in Denver alone this year. You do not wanna be caught off guard, and have to pay for damages to your car, medical care, and someone elses car because you had inadequate insurance coverage. Take an hour and check your policy, because that single hour of your life might just protect you in case you are in a car accident. Please feel free to call our office, (Denver Chiropractic, LLC) if you are wanting further explanation on auto insurance.

The following is from the Colorado Chiropractic Association:

􀂄 Bodily injury liability
coverage (BI) (MANDATORY):
$25,000 per person and $50,000 per accident in Colorado) covers injuries YOU cause to others if you are at-fault in an accident. These mandatory amounts have proven to be inadequate in other states AND
Colorado because 1) there is a greater incidence of liability claims under a tort system; 2) liability insurance will not go as far; 3) and there will be more competing interest to claim dollars from liability coverage. Many
insurers recommend carrying at least $250,000 per person and $500,000 per occurrence, plus $100,000 for property damage. You should consider what assets you have to protect when deciding how much to purchase. In addition, consider purchasing Uninsured/Underinsured Motorist Coverage (discussed later in this newsletter) for protection from people who may not purchase enough insurance or any at all.

􀂄 Property liability coverage
(MANDATORY: $15,000 in Colorado) covers damages YOU cause to someone else’s property. Usually it’s someone else’s car, but it could apply to buildings, utility poles, garage doors, etc. As previously mentioned,
many experts recommend at least $100,000 in property damage coverage.

􀂄 Collision coverage (optional) covers damage to your car from a collision with
another car or object such as a tree or brick wall. To minimize your premiums, select a deductible you can live with – $500 or $1,000.

􀂄 Comprehensive coverage (optional) is in case your car is stolen or damaged in ways
that don’t involve a collision, such as theft.

􀂄 Uninsured & UNDERinsured (UM/UIM) motoristcoverage (optional) is available in two forms – property damage coverage and medical coverage to pay your bills when a driver without insurance or with NOT ENOUGH insurance hits you. Since this is optional coverage, insurance agents may urge you to eliminate it to keep your premium down – BUT DON’T DECLINE THIS COVERAGE. Again, consider purchasing at least $250,000/$500,000 limits to protect you, your family, and your assets.

􀂄 Medical payments coverage (Med Pay) (optional), pays for reasonable expenses you and your passengers incur because of injury in a motor vehicle accident, regardless of fault. Be sure the Med Pay you purchase covers care you may need in the event of an accident, such as chiropractic treatment and massage therapy. Even if you have health insurance, there may be limitations on what types of health care are covered and various exclusions. Your health insurance may not cover resident relatives and will definitely not protect other passengers or people who borrow your car. MedPay is a necessity if you consider these factors. Ask about the monetary levels offered by your insurance carrier and select mid-to-high levels of $5,000 to $25,000 or more. If your auto insurance carrier DOES NOT offer Med Pay or the limits are too low, choose another insurance company that offers what you need
to protect yourself.

􀂄 Essential services and rehabilitation (optional): These coverages will be eliminated under the Tort law. These types of losses will be included in BI or UM/UIM, but not available to other injured parties. Some insurers may sell extra coverage in this area, but are not require to do so.

􀂄 Umbrella policies (optional): It is expected that many people will purchase only the state’s minimum coverage, so it will be more important than ever to protect yourself by purchasing adequate coverage. Ask your insurance agent about purchasing an Umbrella Policy that includes UM/UIM coverage.

For more information, check with your auto insurance agent or visit the Colorado Division of Insurance web
site at www.dora.state.co.us/insurance. 􀂄

As you can see, many benefits under an insurance policy are optional. Declining these options might save you a small amount of monely immediately, but in case of an accident, these benifits could save you a tremendous amount of money and time.

Dr. Trent Artichoker MS, DC
http://www.denvercoloradochiropractic.com/