Articles
Chiropractic Spinal Manipulation and Back Surgery – What Are The Risks?
While most people seeking medical care for back or neck pain recognize that they may have treatment options (often including chiropractic care and surgery), many do not understand the potential benefits and risks associated with those choices. Patients who ask family, friends or coworkers for advice all too often hear secondhand stories about healthcare “miracles” or “nightmares” experienced by a friend’s uncle, a wife’s boss or a father’s golfing buddy. The clinical facts—on the other hand—are often less accessible to the average person and tend to leave a smaller impression. However, for those who want a broader perspective on their treatment options, there are several high-quality research resources available. The American Journal of Medicine and Spine (among others) have featured information on the risks involved with surgery and spinal manipulation.
Both Back Surgery and Spinal Manipulation Present Risks
Patients who are suffering with neck pain and considering both surgery and chiropractic treatment should be aware of the risks and discuss them openly with their healthcare providers.
In the case of any surgery, there may be serious complications from anesthesia, excessive bleeding, blood clots that lead to pulmonary embolism and infection. These general risks are added to the more specific risks of surgery on the spine. These may include a dural tear (the dura surrounds the spinal cord and a tear can cause leaking of cerebrospinal fluid), spinal cord injury and persistent or increased pain from an unsuccessful procedure.
Spinal manipulation may also cause dangerous complications. Spinal manipulation has been associated with disc herniation, cauda equina syndrome (pain, weakness or loss of bladder and bowel function) and vertebrobasilar accident (a tear in a major artery of the neck). These complications can be just as serious as the complications associated with surgery.
If similarly severe complications may result from either course of treatment, how can a patient weigh the risk of each option? Managing risk isn’t just about understanding “worst-case”-type scenarios, it’s also about understanding how likely these and other complications are to occur. This is where some additional research findings can help.
How Frequently Do Serious Complications Actually Occur?
In April 2010, the journal Spine (published by Lippincott Williams & Wilkins) included an article that summarized the incidence of adverse events in spinal surgery based on the authors’ review and analysis of the existing literature. They found complication rates for spinal surgery ranging from 5% to 19%. Similarly, the American Journal of Medicine in 2002 published the results of a study that examined the incidence of serious adverse events for spinal manipulation. By comparison, researchers involved in that work reported complication rates ranging from one out of every 400,000 manipulations to one out of every two million.
So now we can see that the risk of a serious adverse event from spinal manipulation is extremely low relative to the risk posed by surgery. That’s one reason that the Mayo Clinic and many other reliable healthcare organizations around the world consider spinal manipulation very safe when performed by someone trained and licensed to provide this type of chiropractic care.
Whenever we talk about risk, it’s always important to remember that almost everything we do can be ‘associated’ with some type of adverse event. Driving a car, handling scissors, and even eating dinner can all lead to serious complications. The best way to handle these risks, including the risks of spinal manipulation, is to understand them and keep them in perspective. Healthcare providers are uniquely qualified to help you do that. If you or someone you care about is interested in chiropractic care—including its potential benefits and risks—please call our Concord chiropractic office at (925) 681-0801; Pleasant Hill chiropractic office at (925) 676-8200; and Brentwood chiropractic office at (925) 308-7575 to make an appointment.
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References:
Dekutoski, MD, M. B., Norvell, PhD, D. C., Dettori, PhD, J. R., Fehlings, MD, PhD, FRCSC, FACS, M.G., & Chapman, MD, J. R. (2010).
Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S). Retrieved August 31, 2011.
Staff, M. C. (n.d.). Chiropractic adjustment: Risks – MayoClinic.com. Mayo Clinic. Retrieved August 31, 2011.
Stevinson, MS, C., & Ernst, MD, PhD, E. (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571. Retrieved August 31, 2011.
Understanding B Complex Vitamins
What Exactly Are the B Complex Vitamins?
The B group of vitamins is probably the most commonly misunderstood of the vitamins, simply because the B vitamins are several distinct vitamins lumped together. Additionally, the fact that the vitamins in this group are known by both letter, number and name is confusing to many people. Here is a quick list of the B vitamins found in the Vitamin B complex group.
- B1 is also thiamin
- B2 is also riboflavin
- B3 is also niacin
- B5 is also pantothenic acid
- B6 is also pyridoxine
- B7 is also biotin
- B9 is also folic acid
- B12 is also cobalamin
You should note that there are four additional substances in the B complex group, though they are not known as vitamins. They are choline, lipoic acid, PABA and inositol. When you purchase B complex vitamins, these four will not be included. Furthermore, one or two of the recognized B vitamins may also be omitted. B5 and B7 are so widely available in food that most people get plenty of these vitamins even if they aren’t eating a healthy diet.
There are gaps in the numbers of the B vitamins because our understanding of them has evolved over time. Initially there was only a single B vitamin. Later it was recognized that what had been referred to as a single vitamin, actually had many components. These component parts where numbered 1,2,3,4, etc… Even later it was determine that some of these components (such as B4) did not meet the criteria of being a vitamin and they were dropped. That’s how we ended up with 8 B-vitamins with non-sequential numbers.
One thing that all the B vitamins share is that they are water soluble. Any excess vitamin B is not stored, but rather is excreted in the urine. That means that all the B vitamins need to be constantly replenished from our diets.
B vitamins are found in whole unprocessed foods including grains, meats and vegetables. In general, the more processed that food is, the lower the content of all the B vitamins. A daily multi-vitamin is a great way to ensure that you are getting all the B complex Vitamins your body needs on a daily basis.
One of the most commonly recognized uses of the B vitamins is an energy booster. Many popular energy drinks that claim a natural boost of energy without sugar or caffeine are high in B vitamin complex.
There are too many components in the Vitamin B complex to discuss the health benefits, deficiencies and Recommended Daily Allowance for the whole group in a single article. Look for future articles about each of these important nutrients.
If you have questions about your current nutrition and supplement plan, just ask. Our chiropractors from Concord, Brentwood and Pleasant Hill are here to help!
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Bibliography:
B Vitamins MedlinePlus. (n.d.). Retrieved 8 10, 2011, from National Institutes of Health.
Micronutrient Information Center. (n.d.). Retrieved 8 11, 2011, from Linus Pauling Institute at Oregon State University.
How to Get a Lasting Headache Relief
Headaches are a common source of pain for a large number of Americans. 95% of women and 90% of men have had at least one in the past 12 months. And for about 45 million of us, those headaches are chronic.
While a wide variety of over-the-counter and prescription medications have been developed to relieve this pain, they generally do little to address the underlying cause of the problem. In addition, many of these compounds can have unwanted side effects, particularly if they’re used often, over a prolonged period of time or in combination with other medicines. A growing awareness of both the limitations and risks of pharmaceuticals has led many headache sufferers to explore alternative approaches to managing them, including chiropractic.
Understanding Headaches
Headaches occur for many reasons and can vary greatly in their intensity and duration. They may arise on their own (these are termed “primary headaches” and account for about 90% of all headaches) or be triggered as a result of some other health condition (described as “secondary headaches”). Chiropractic physicians most commonly encounter three types of headaches in their work:
Tension headaches are primary headaches that are brought on by unrelieved muscular contractions in the head, neck and shoulders, usually as a result of stress that cannot find an outlet. These muscular contractions can themselves become the source of broader tension and stress throughout the body, setting in motion a feedback loop that eventually produces a headache.
Migraine headaches are also primary headaches. They are sometimes referred to as vascular headaches because they happen when blood vessels in the head suddenly expand, or “dilate”. However, we know that the nervous system and genetic factors are also leading contributors. Sufferers report a wide range of triggers and related symptoms. Research into the exact cause of migraines is ongoing, and the condition has stubbornly resisted efforts to find a pharmaceutical “silver bullet”.
Cervicogenic headaches are secondary headaches produced when pain begins in the neck or back of the head and is referred to the forehead or the area behind, in and around the eyes. Trauma, chronic tension and disease are some of the more common initial sources of neck pain that is referred to the head. Trigger points in the neck, shoulder blade and spine may also be sources of these headaches, though they can be much more difficult to identify.
How Martin Family Chiropractic Can Help
There is a large and growing body of medical research that suggests chiropractic care can be effective in preventing or reducing the frequency and severity of primary headaches. There is also some evidence that it may have benefits for cervicogenic headache sufferers.
Chiropractic manipulation of the spine and neck is used to improve the alignment of the spine and relieve muscle tension. It also reduces nerve irritation and improves vascular flow. Your chiropractic physician may also include massage and other therapies as part of a well-rounded treatment plan. He or she will likely suggest exercise, stretching and relaxation techniques as well as nutritional strategies designed to help prevent future headaches.
If you or someone you know is looking for lasting relief from chronic headaches, we encourage you to call our doctors of chiropractic today. The sooner you make the call, the sooner we can help you put an end to the suffering.
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References
Headaches and Chiropractic. American Chiropractic Association. Accessed August 2011.
Encyclopedia of Alternative Medicine. AltMD. Accessed August 2011.
Information for Patients. American Headache Society. Accessed August 2011
Research Spotlight: Study of Spinal Manipulative Therapy for Neck-Related Headaches Reports Findings on Dose and Efficacy. National Institutes of Health, National Center for Complementary and Alternative Medicine. Accessed August 2011.
National Institutes of Health MedlinePlus. Accessed August 2011.
Is Going Barefoot Really a Prescription for Fewer Running-Related Injuries?
The latest in performance footwear isn’t on display at America’s elite university track programs. Nor will you find it on the pitch at professional soccer games. You won’t see it on the baseball diamond, basketball court or football field either. Why not? Because the most recent innovation in athletic shoes (at least among a small but growing community of hardcore running enthusiasts) is… not wearing any at all!
The Reasons Behind the “Back to Basics” Movement
For a majority of runners either considering or actively experimenting with barefoot running, it’s not about trying to rediscover their inner caveman. Rather, these individuals are looking for ways to improve comfort, reduce wear and tear on their bodies and add years to their running lives. A 2009 bestselling book called “Born to Run”, written by Christopher McDougall, evangelizes barefoot running and ties many of our species’ running-related maladies to the use of shoes. But does running barefoot actually solve the problem? And do the obvious risks outweigh the potential benefits?
What Does Science Say About Running Barefoot?
The idea is controversial among medical researchers and healthcare providers as well as among runners themselves. At the center of the debate is our understanding of the musculoskeletal system and the biomechanics of running, and it’s fair to say that the evidence today doesn’t point clearly in one direction or the other. In fact, the leading researchers on the topic at Harvard University’s Skeletal Biology Lab are careful to point out that none of the information they present is meant to answer questions about how people should run and whether running barefoot or with shoes is any more likely to cause(or prevent) any particular type of injury. So if you’re thinking about adopting the barefoot running lifestyle yourself, it’s worth considering a handful of points about which there seems to be some general agreement:
1. We run much differently when we wear shoes. For example, long-time shoe wearers (that’s most Americans) tend to take longer strides and land further back on the foot, producing a harder heel strike that would be uncomfortable or painful without shoes. Shoe wearers also generally lean forward more. By contrast, experienced barefoot runners are far more likely to have a forefoot or midfoot strike and will tend to run in a more upright position.
2. The differences in running style mean that impacts and stresses are distributed and absorbed differently by the body. Research suggests that the hard heel strike creates a higher-frequency impact that tends to move upward through a runner’s bones, while the lower-frequency impact of landing on the forefoot travels through the muscles and soft tissue.
3. The fact that most Americans wear shoes from an early age means that our bodies adapt to it. And we probably adapt in a couple of different ways. Not only do we learn to move differently when we have shoes to absorb the impact and protect us from cuts and scrapes, we also strengthen (or weaken) different parts of our bodies in the process. If you’ve “grown up” running in modern athletic shoes (which enable long strides and hard heel strikes), it’s unlikely that your feet and calves have the same muscle strength as a those of an experienced barefoot runner. It’s also unlikely that you have the same sorts of calluses.
4. Just because we’ve walked and run in shoes for most of our lives doesn’t mean we can’t do something different, but it does mean that we should be smart about making a change. The last thing you want to do is to inadvertently increase the risk of some types of injury in the course of trying to prevent others (upping the odds of sprains, strains and tendonitis to reduce the likelihood of stress fractures, for instance). It takes time for a runner to adjust his or her form and for the body to make its own adjustments. For this reason, it’s important to make a gradual change and pay close attention to your running technique. Your own body will provide some feedback on your progress, but education and common sense should play a central role in helping you set appropriate goals and expectations.
5. Whether you choose to run in shoes or to run barefoot, good form matters. And it matters a lot. Countless coaches and trainers have gone on the record saying that bad form contributes to more running-related injuries than any other single factor. Dr. Daniel Lieberman recently provided a wonderful quote to Gretchen Reynolds of the New York Times:
“Humans may have been built to run barefoot, but we did not evolve to run barefoot with bad form.”
If you’re a runner looking for a healthier approach–especially if you are experiencing pain or have a history of injury, your Martin Family chiropractic physician can help! As experts in diagnosing, treating (and, even better, preventing) muscular and skeletal problems, our chiropractors use a variety of proven techniques to relieve pain, promote healing and improve performance. Best of all, they can help keep you running at your best! Call our office today to make an appointment.
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References & Resources:
- Lieberman, D., et. al., Biomechanics of Foot Strikes & Applications to Running Barefoot or in Minimal Footwear. Harvard University Skeletal Biology Lab. Accessed August 2011.
- McDougall, Christopher, “Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen” 2009.
- Reynolds, Gretchen, “Are We Built to Run Barefoot?”. The New York Times. June 8, 2011. Accessed August 2011.
Some Surprising Statistics About Back Pain
Back pain relief is just one component of chiropractic care, but it is often a patient’s first introduction. Back pain is horribly debilitating affecting all aspects of work and personal life. If you are suffering from back pain, you are not alone. Here are a few facts about back pain that may (or may not) surprise you.
• Back pain is the number one disability for those under age 45.
• In the United States of America alone, there is an expected 31 million people with lower back pain at any given time.
• Back pain runs second, after only the common cold, as the top reason for visiting a healthcare provider in the United States.
• Experts place the likelihood of any person to experience some type of back problem in their lifetime at about 80%. That’s four out of every five people!
• Over 50 billion dollars are spent per year in the pursuit of clearing up cases of back pain.
• Around 30 to 40 percent of all workplace absences are due to back pain.
• Approximately one quarter of U.S. adults reported having low back pain lasting at least one whole day in the past three months, and 7.6 percent reported at least one episode of severe acute low back pain within a one-year period.
• One-half of all working Americans admit to having back pain symptoms each year.
• Approximately 2 percent of the U.S. work force is compensated for back injuries each year
• Lower back pain accounts for two thirds of all back pain-related cases.
• More than two-thirds of back strains are caused by lifting and other exertions like pulling and pushing.
• Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
The key to proper treatment of back pain is to understand the cause. Remember, pain is always a sign that something else is wrong and if continually ignored may lead to more serious harm. Chiropractors are experts in assessing the root cause of your back pain and putting you on the right course to recovery.
