Workers' Comp and Chiropractic

This is a great article about the cost effectiveness of chiropractic in the worker's comp arena versus traditional medical care care for back pain.  There has been numerous studies showing the effectiveness and reduced cost of chiropractic. 

Bottom line is if you want to feel better faster with less expense and greater satisfaction as a patient, use chiropractic.

Here is list of some of the studies analyzed and their findings.

Research Suggesting Effectiveness And Reduced Costs Attributable To Chiropractic Care For Spinal-Related Injuries And Conditions

Study / Source Summary of Findings

Utah Workers' Compensation Board Study:  Total treatment costs for back-related injuries averaged $775.30 per case when treated by a chiropractor; $1,665.43 when injured workers received standard medical treatment.

North Carolina Workers' Compensation Patients:  Average medical care cost for lumbosacral sprain was $3,425, but only $634 when treated with chiropractic.

Ministry of Health, Ontario, Canada:   "Injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."

American Journal of Managed Care:   Health care costs for back and neck pain were substantially lower for chiropractic patients than patients receiving medical care ($539 versus $774, respectively)..

Medical Care Journal:  1. Mean total payments were lower for chiropractic care ($518) versus medical care ($1,020).  2. Favorable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending.

University of Ottawa:  1. Chiropractic treatment was significantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Significantly fewer patients needed to return for further treatments at the end of the first and second years when receiving chiropractic care vs. medical care (17 percent vs. 24 percent).  2. Highly signifi cant cost savings could be achieved if more management of low-back pain was transferred from physicians to chiropractors.

Oakland University Study:  Health insurance claims for 395,641 chiropractic and medical care patients indicated that patients who received chiropractic care, solely or in conjunction with medical care, experienced signifi cantly lower health care costs compared with those who received only medical care. Total insurance payments were 30 percent higher for those who elected medical care only.

Medical College of Virginia:  By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.

Florida Workers' Compensation Board:  Of 10,652 back-related injuries occurring while on the job, individuals who received chiropractic care compared with standard medical care experienced a (1) 51.3 percent shorter temporary total disability duration; 2) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case); and 3) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

Australian Workers' Compensation Study: Individuals who received chiropractic care for their back pain returned to work four times faster (6.26 days vs. 25.56 days) and had treatment that cost four times less ($392 vs. $1,569) than those who received treatments from medical doctors.

VU Medical Center Extramural Medicine: Total costs of manual therapy (447 Euro) were around one third of the costs of physiotherapy (1,297 Euro) and general practitioner care (1,379 Euro) for neck pain.

Journal of Manipulative and Physiological Therapeutics: For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.



CBS and Consumer Reviews Pick Chiropractic

Check out this video.  I has some good stuff.  80% of people surveyed picked chiropractic.

Fosamax and Increased Fracture Risk

I recently read an article about the long term use of Bisphosphonate (Fosamax) and increased fracture risk.  Typically Fosamax is typically given to postmenopausal women with osteopenia (osteoporosis) to slow bone loss and to prevent fractures due to osteoporosis.  It is noted that several studies have reported a the occurrence of specific and rare types of femur fractures in individuals (mostly women) who have been taking bisphosphonates (Fosamax) for approximately 4-8 years.  It should be noted that the fractures occurred with no apparent trauma.  These fractures were not from falls.  In fact, in most cases, individuals were performing low energy exercise, sometimes just walking down a flight of stairs.

To give some background and technical info, bisphosphonates work by supressing osteoclasts (the cells that break down and recycle bone).  The theory is that if you inhibit bone turn-over you will be left with more bone and less net bone loss. However, bisphosphonates accumulate in the bone tissue and stay active for up to 10 years after their consumption is stopped.  What you are left with is increased bone density, but the quality of the bone is not not good.  When the osteoclast are suppressed the osteoblasts (cell used that form new bone)  are also affected.  Bone remodeling and turnover is a natural part of maintaining bone health and when bone resorption is decreased, bone formation is also decreased.  The microdamage that occurs regularly in bones and is normally repaired accumulates over time and is apparently not repaired because the normal process of bone resorption and formation has been altered by treatment with bisphosphonates.  After long term use, the quality of bone is not maintained. 

Present conclusion are that during long term alendronate (generic name for Fosamax) therapy, severe suppression of bone turnover may occur, resulting in increased susceptability of nonspinal fractures along with delayed healing.  Current evidence suggests that bisphosphonates should be stopped after 5 years.  In otherwise healthy perimenopausal women who merely have osteopenia, the best therapeutic option is probably not bisphosphonates. 

Weight-bearing exercise is essential for the prevention and treatment of osteoporosis and unfortunately, it is often overlooked and underutilized.  Muscle strength is an accurate predictor of bone strength weight-bearing exercise has been shown the most effective way to strengthen bone and thus protect against osteoporosis-related fractures.

Once again, medication is not the best way to prevent osteoporosis: nutrition and exercise are key for bone health (and overall health).

On a side note, in 2008, bisphonphonates sales exceeded $3.5 billion according to data from IMS Health.

Chiropractic and High Blood Pressure

This is a very good video about a CBS News piece depicting chiropractic and reducing  high blood pressure.  Chiropractors have been saying for years that chiropractic care is good for much, much more than just back pain.  It is very refreshing to see some formal studies being done by the government and researchers.  Just think of all the money that could be saved if the reliance on hypertension medication could be reduced, not to mention the savings in indirect costs by not having to pay for the consequences of the side effects caused by the medication. 

The basic premise of chiropractic is that chiropractors help remove the interference on the nervous system which then allows the body to better regulate itself. 

If you don't have facebook, you can also look at this video on youtube which is very simular.

Try Chiropractic First - Avoid Costly, Risky Surgery

I read an article in last Wednesday’s San Jose Mercury News that spinal surgery is on the rise for Medicare patients. This was based on a Medicare study that showed spinal fusion surgeries are on the rise and they are often done unnecessary. The main reason state for the operation is for arthritis and aging or just plain old back pain. The focus of the article is that more spinal fusions are being done rather than simple decompression surgeries as in the past. The difference is that decompression costs about $20,000.00 and the fusion costs $80,000.00 plus it is riskier and more challenging leading to more complications, longer hospital stays and even death, the article goes on to say.
The really interesting thing is that the spinal fusion surgery is no more effective than the less costly surgery, and there is “no good evidence that the expensive one is being used appropriately in the majority of cases.” The study goes on to say that the cost to Medicare, just for the hospital charges for the three kinds of back surgery reviewed, is about $1.65 billion per year. The study analyzed 32,000 Medicare patients who had one of the three kinds of surgery in 2007.
When talking about complications the article stated that about 5 in 100 patients who had simple or complex fusions suffered major complications such as stroke compared to 2 in 100 with decompressions. The risk of death within 30 days after surgery was 6 in 1000 for complex fusions, 5 in 1000 for simple fusions and 3 in 1000 for decompressions.
The article also says that patients should ask their doctor about alternatives such as steroid injections or physical therapy.  No mention of chiropractic!!
What bothers me most about this article is that nowhere chiropractic is mentioned! This is outrageous since it has been shown over and over that chiropractic is the safest and most effective treatment for back pain and has the highest levels of patient satisfaction and has the least complications and is the most cost effective of conventional treatments. Additionally, the risk of death is between 3-6/1000 and 2-5/100 for serious complications such as a stroke. The most common complication is from chiropractic is occasionally some temporary soreness. How would like to go to your doctor and have him tell you that you had a 2-5% chance of having a stroke from this procedure and a 0.5% chance of dying!!! Would you not opt to try chiropractic first?

Let’s hope everyone reads this article and uses chiropractic as first choice rather than a last resort.

Expanding Chiropractic in Medicare

I just read an interesting article in Dynamic Chiropractic about expanding the role of chiropractic in Medicare.

The final report for the chiropractic demonstration project by the federal government has finally been released. The purpose of the study was to determine whether it was feasible to expanding chiropractic coverage in the Medicare program. The project was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Medicare patients gave chiropractors high marks when rating their satisfaction with care. In a report from Centers for Medicare & Medicaid Services from 2005 through 2007, 87% of patients surveyed gave their chiropractor a score of 8 or higher when asked to rate their satisfaction with care (1-10 scale), and 56% percent rated their chiropractor a perfect 10. Moreover, healthcare costs did not increase significantly with the addition of chiropractic services.

Other key findings in the report included:

· The most frequent reason for care favorable earlier experiences (59%) and insufficient relief of symptoms (39%).

· Clinical problems included back pain 78%, neck pain 50%, hip problems 38% and shoulder problems 32%.

· 60% of respondents indicated that they received “complete” relief of their symptoms or “a lot of relief of symptoms from chiropractic treatments.”

The conclusions are that Medicare is cost-effective and has a high patient satisfaction level and chiropractic benefits should be increased in the Medicare system. Hopefully, chiropractic will play a prominent role in the upcoming healthcare reforms just passed!!

The entire report can been reviewed at www.acatoday.org/pdf/demo_report.pdf

Golf Injuries and How to Prevent Them

Now that spring is here many of us will be hitting the links again, trying to improve our game.  In order to enjoy the game to the fullest, it should be enjoyed pain free.  Unfortunately, injuries are common.  For the amateur golfer the most common injuries involve the lower back, followed by the elbow, wrist, shoulder and knee.  That is a lot of potential injuries from an activity that doesn't even involve contact with the other players - at least it shouldn't!! 

We can break down the golf swing to develop some key exercises in each phase to the swing to prevent injury. In Phase I (take-away) concentrate on the muscles of the wrist, hand and forearm. Wrist exercises include using a 5 lb dumbell and doing flexion/extension exercises and ulnar/radial deviation exercises.

In Phase 2 (impact) which consists of the downswing and impact with the ball - most injuries are caused by stress on the back knee and compression forces acting on the wrists.  Stretching of the legs is essential and exercises involving leg curls and extensions and abduction/adduction exercises.  Massage is also very helpful.  Exercising and strengthening the triceps with stabilize the elbow and help prevent injury. 

In Phase 3 (follow through) of the swing, there is abdominal torque which can cause injury to the lower back.  The best exercises for this phase of the swing is to do core exercises which will stabilize your trunk. 

Warming up with stretches and brisk walk before your round will also help injuries.  Cool down exercises after the round can also reduce injuries. 

The average amateur has no warm up or stretching protocols for golf.  They are swinging the club with violent, intermittent effort - grip it and rip it golf swing - add this to varied amounts of pre-existing postural dysfunction and poor flexibility  it is no wonder so many become injured.

On a brighter note, my future mother in law just got her first hole in one at the age of 71 after only taking up golf 2 years ago!!!

You can read the full article at http://www.toyourhealth.com/.  Also log on to my website for complete videos of exercises.

20 Minute Workout for Conditioning and Fat-loss

I just read this article in the March issue of To Your Health Magazine.  It is a good prgram that you can do at home.  All you need is a stability ball, dumbbells or kettle ball, a step up platform, resistance band and a chin up bar if you want.  All of this stuff is very inexpensive and can be purchased at any sporting goods store - or ordered through my office. 

What I like is that the program focuses on the core which is essential for back health and stability - especially in the lower back.  The article also give you 8 exercise routines to chose from so that you don't get bored. 

The great thing about exercise balls, kettle balls, and restiance bands is that you can develop entire exercise regimens from just those few things.  Check out my website for an entire list of exercises with videos and demonstrations at http://www.doctormacaulay.com/

Pillows and Neck Pain

Neck pain and pillow issues go hand in hand for many patients. Unfortunately, little research is available on this popular topic. However, a recent study in Manual Therapy was just published, comparing the following pillow types: 1. Polyester synthetic fibre filled, 2. Foam regular shape (from high density foam), 3. Foam contour shape (high density foam), 4. Latex rubber, and 5. Feather.
The feather pillow was significantly proven as the worst pillow. The best results were found with a Dunlopillo latex rubber pillow (115mm in depth [height]). Pillow shape did not affect pain levels and contoured pillows were actually found to be more uncomforable than regularly shaped pillows.

Remember, we are all shaped differently; perhaps you are comfortable sleeping on your feather pillow? As long as you are not sleeping on a pillow that jacks your head up into flexion and you are comfortable on the pillow you currently own, keep on sleeping well.

If you are a stomach sleeper… become a back sleeper now! If you are a side sleeper, try to get on to your back too as many individuals who sleep only on one side will encounter shoulder and rib injuries over time.

Gordon SJ, et al., Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy 2009; 14: 671-678.




I prefer water based pillows over the foam pillows.  I have found that the foam pillows break down over time and lose their elasticity and their shape.  Water pillows do not have this problem.  You can also adjust the firmness of a water based pillow to your personal preference.
 
There has been significant research into water based pillows.

DID YOU KNOW? On average, there are 12 major body shifts and 50 movements in head and neck position during sleep. With the Mediflow Water Pillow, as you roll from back to side, the water instantly adjusts to constantly maintain correct head and neck support and provide outstanding comfort.


RESEARCH -


In a medical school conducted study, on adults with chronic neck pain, it was found that the Mediflow ® Waterbase ® pillow was associated with reduced morning pain intensity, increased pain relief and improved quality of sleep.
Use of a Mediflow ® Waterbase ® pillow in conjunction with chiropractic care resulted in a reduction in neck pain and disability, and improved quality of sleep in subjects with chronic neck pain. ²
Based on a survey of students, faculty and staff at a chiropractic college, over 68% said their quality of sleep improved after using the Mediflow Waterbase ®. Over 84% rated the Mediflow ® Waterbase ® pillow 8 or better (on a point scale from 1 to 10, with 10 being the highest level of satisfaction). ³

CONCLUSION: Proper selection of a pillow can significantly reduce pain and improve quality of sleep.


¹Cervical Pain: A Comparison of Three Pillows, Lavin RA. Research conducted at Johns Hopkins University School of Medicine. Published in Archives of Physical Medicine and Rehabilitation February 1997. original article

²Chronic Neck Pain Findings, Logan College of Chiropractic. Presented at the International Conference on Spinal Manipulation. October 1996 Bournemouth, England.

³Quality of Sleep Findings, Logan College of Chiropractic. Poster presentation at the Conference of Chiropractic Research and Education, June 1996 San Diego, USA.


Sleep tight and sweet dreams!

FDA Admits that Tylenol is the Number One Cause of Liver Failure in the US

In this article the FDA finally admitted that acetominophen is the leading cause of liver failure in the United States!!  Annually it is reponsible for 456 deaths and 56,000 emergency room visits. 

I also found it interesting that in the nineteen years since data collection began on the harmfulness of acetaminophen, it can be extrapolated that over a million emergency room visits and 8,000 deaths have stemmed directly from the use of this drug. For those who are keeping track, over two and a half times as many people were killed from this drug as were killed on that fateful day in September, 2001. And unfortunately, acetaminophen is but one drug, of many drugs, that cause significant harm to the population - all with the stamp of the FDA.

Read the entire article it is very interesting. 

Remember it is always wiser to try safe and effective chiropractic first.  Even over the counter medications can have very serious side effects even when taken properly.

Stevia as an Artificial Sweetener

The Truth About Stevia Based Sweetners



In 2007 the FDA banned the use of Stevia as a food additive (or sweetener); yet new Stevia-based “sweetener” products continue to pop up on grocery store shelves nationwide. How can this be?

The most likely answer—the FDA is caving into pressure from artificial sweetener manufacturers who fear they will lose their empire in the wake of a new “natural” sweetener hitting the market. So instead of approving the Stevia plant for use as a natural sweetener the FDA decided to only approve one of Stevia’s active ingredients: rebaudoside.

Rebaudoside is the agent that provides most of the sweet taste found in Stevia. The problem is this: when used as a whole plant Stevia offers zero calorie sweetness with other health benefits. But by extracting just one element of the Stevia plant for use as a sweetener, this element loses its group synergy and will most likely perform differently when consumed. In a nutshell, the new Stevia based sweeteners now on grocery store shelves may not affect your body the same way as the Stevia plant—Stevia based sweeteners may deliver adverse health affects.
Here’s what we know for sure. The plant Stevia has been used as a natural sweetener for over 1,500 years. Besides being a zero calorie natural sweetener, studies have found many other health benefits associated with Stevia including a reduction in blood glucose, triglycerides and triiodothhyronine (Dec 2008 Journal of Animal Psychology and Animal Nutrition). Stevia is also a great source of antioxidants (Journal of agricultural and Food Chemistry, 2007).

All of this information paves a clear path of action for us as consumers: avoid artificial sweeteners at all costs including Stevia based sweeteners (the ones that use only Rebaudoside). Instead, opt for using natural, untampered with, regular old sugar as your sweetener of choice.

Uncover the health hazards of using artificial sweeteners and refined sugar; order your copy of Dr. John Madeira's book 'Setting Things Straight' available at www.SettingThingsStraight.com.

Chiropractic for primary care

I just read an interesting article about children and adverse drug events.  It comes from a study published in Pediatrics, in October 2009 and basically it was an 11-year study of adverse drug events in the outpatient setting from clinics and hospitals across the nation.  Here are a few of the things that I found interesting from the study.

•    600,000 children per year had to go to the doctor’s office or the emergency room for treatment of adverse drug reactions to prescription medications that were administered and taken properly.

•    Children 0-4 years of age had the highest incidence of ADE (adverse drug reactions) visits, accounting for 43.2% of visits.

•    The medication classes most frequently implicated in an ADE were antimicrobial agents (27.5%), central nervous system agents (6.5%) and hormones (6.1%)

•    Among the adverse reactions to antimicrobial agents, more than half were a result of a penicillin (40%) or cephalosporin (15%).

•    About 70% of children seen by medical personnel in an ambulatory setting are given drugs – translation: when you take your child to a clinic he will be given drugs 70% of the time

•    4.7% of all hospitalizations are the result of adverse drug events.

•    6.5% of inpatients will suffer adverse drug events during their hospitalization.

•    16% of all outpatient prescriptions are associated with adverse drug reactions – translation:  almost 1/5 of the drugs taken are to counteract or to fix the damage from the drugs taken previously – what is wrong with that picture!!

•    Among children 12-18 the increase in the number of adverse drug reactions related to central nervous system agents and hormones and synthetic substitutes.  The rise in visits related to central nervous system agents likely reflects the increase in medication therapy for depression and other emotional and behavioral disorders during adolescent years.

Bottom line in all of this is that for all non life-threatening medical treatments, you are better off trying safe and natural chiropractic care first rather than taking drugs.  Have faith in your chiropractor that he will refer to a medical doctor if he finds a condition that he cannot treat or one that requires medical care beyond chiropractic.

reference article:
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e744-e750 (doi:10.1542/peds.2008-3505) Pediatric Adverse Drug Events in the Outpatient Setting: An 11-Year National Analysis Florence T. Bourgeois, MD, MPHa,b, Kenneth D. Mandl, MD, MPHa,b,c, Clarissa Valim, MD, ScDd,e, Michael W. Shannon, MD, MPHa

Besides the back...what else is Chiropractic care good for?

Chiropractic is very effective with ear infections, both in children and adults. The cervical spine (neck) is out of alignment, lymphatic fluid can build build up and stagnate in the middle ear. This can lead to, or prolong, ear infections (otitis media). Chiropractic can help this by increasing the motion of the neck, increasing and promoting lymphatic drainage, thereby reducing and/or preventing ear infections