Chiropractic case studies

In response to:Can chiropractic help with sciatica?

Mon, 02 Nov 2009 16:02:05 +0100

The Truth:

The causes of sciatica must be treated on a patient by patient basis. Because of the many conditions that can compress nerve roots and cause sciatica, one patient’s treatment options may be very different than those of another.

A combination of treatment options is often the most effective course, and many patients will try some combination of the following treatment options:

 Physical therapy treatments such as Chiropractic can help relieve pressure on the sciatic nerve.

 Alternating heat therapy and ice massage therapy can help to relieve acute pain from sciatica.

 Anti-inflammatory medications like non-steroidal anti-inflammatory drugs (NSAIDs, i.e. ibuprofen, naproxen or cox-2 inhibitors) or oral steroids may be used to help relieve inflammation.

 Epidural steroid injections can reduce inflammation around the nerve root and the associated low back pain.

 To help control the low back pain and leg pain while undergoing other conservative treatments, patients may take pain medications.

 Surgery may also be considered as a treatment option, usually (but not always) following a course of conservative treatments.

It is important to note that what works for one patient may not work for another, even if they have the same back problems.

For example, a patient who has sciatica from a herniated disc may not find relief from conservative treatments and then will choose to undergo lumbar surgery. Another patient with sciatica from a similar type of herniated disc may find sufficient low back pain and leg pain relief through conservative treatments, including physical therapy, heat and ice therapy, injections and/or medications.

In response to:Can Chiropractic help with low-back pain with leg pain or sciatica?

Mon, 02 Nov 2009 15:46:36 +0100

Posted by Rupert Clements of C1 Chiropractic Health Centre.
Sciatica needs chiropractic care, and possibly some other options, to reduce pain in your back and legs.

Right, that’s it, I don’t want to hear the cry of: “I have sciatica” ever again unless it has been diagnosed by someone who as a clue. I’m fed up with having to disabuse patients of this rotten diagnosis – it’s not far off “I have lumbago”. As a chiropractor here in Bristol, we often have patients coming in for treatment with low-back pain (LBP) with pain running down the back of their legs. Quite often this has nothing to do with the sciatic nerve and is still called sciatica.

The anatomy: The sciatic nerve is the longest and widest single nerve in your body. It branches off at the base of the spine and runs down each side of your pelvic area, supplying nerve impulses to your gluteal region (butt), legs and feet.

The pain: If you've ever experienced sciatica, you know how debilitating this pain can be. I've seen patients, who could barely walk, couldn't bend over or even stand. With good care you will be back to your normal self within 2-3 weeks.

The solution: Chiropractic

oh, and try: massage therapy. I have patients who I see in my clinic that need gentle massage for their sciatic pain. We use various forms of massage to relax patient's muscles, improve blood flow, and most important, the release of endorphins in the body that act as natural pain relievers.

Last but not least, a highly effective technique for treatment that is being used more and more is acupuncture. A qualified and trained acupuncturist such as our great Zak can provide relief from back pain by simply using thin needles inserted in the area where you feel discomfort

There is no guarantee that this or any other combination of treatments will totally eliminate sciatica from reoccurring but if you follow the advice of your chiropractor and seek help early, you should prevent this from happening again in the future.

For more information on treatments and alternatives to protect your back, go to www.c1healthcentre.co.uk or contact me personally.

Rupert

In response to:Leg-length inequality - what's going on and can chiropractic help

Thu, 29 Oct 2009 16:49:14 +0100

Augusto, that will be you then? Good to see you are on the site. Does it make some sense to you?

In response to:Leg-length inequality - what's going on and can chiropractic help

Thu, 29 Oct 2009 16:11:27 +0100

hpp://digilander.libero.it/manganielloaugusto/

In response to:Leg length inequality -

Sun, 25 Oct 2009 12:05:29 +0100

The pathologies (scoliosis,low back pain, spondylolysis)
connected with leg length inequality are above all affected
by the load distribution at the lumbosacral level
(hpp://digilander.iol.it/manganielloaugusto).
On scoliosis, it emerges that often the greater the inequality,the lesser the scoliosis and vice versa. So that,
during growth, with inequality greater than 20 mm, since in
such cases at the lubosacral level the load is usually greater on the side of the longer limb,the curve is reduced;
while with inequality even of the order of just a few mm and overload on the side of the shorter limb,the curve is
subject to progression.If,however,at the lumbosacral level
the load distribution is symmetric, in the absence of
structural changes, the curve will almost be mild and
stationary.
Augusto manganiello

In response to:Solid study demonstrates the cost effectiveness of chiropractic care

Thu, 22 Oct 2009 02:18:41 +0200

This article/research confirms what we have been preaching to patients about for years. Good article, I am amazed at how many people think chiropractic care is expensive until you start showing them the alternatives. I usually tell people that they can spend their money to get an MRI or CT scan just to get a picture of their bodies or they can pay for chiropractic treatment that will address the cause of the pain and usually resolve the problem for close to the same price.

In response to:Solid study demonstrates the cost effectiveness of chiropractic care

Wed, 21 Oct 2009 11:02:09 +0200

Charming.

In response to:Solid study demonstrates the cost effectiveness of chiropractic care

Wed, 21 Oct 2009 10:37:58 +0200

Not Odobenus rosmarus but swine!

In response to:Solid study demonstrates the cost effectiveness of chiropractic care

Wed, 21 Oct 2009 09:42:10 +0200

Interestingly, the only other place I have seen the word modalities has been in Nigerian scams. :)

In response to:Sports massage therapy - can it help the athlete prepare for an event?

Tue, 20 Oct 2009 07:05:41 +0200

Therapeutic massage helps the body recover from the stresses of strenuous exercise, and facilitates the rebuilding phase of conditioning. The physiological benefits of massage include improved blood and lymph circulation, muscle relaxation, and general relaxation.

In response to:Chiropractic in Parliament - good thing too!

Fri, 16 Oct 2009 12:20:06 +0200

Walrus, good to see you back.
I think this has, at last, focused research on turning case studies (and loads of them) into RCTs and, as an example, I think there is a colic study being run in Denmark that started in August which may prove what has been experienced by many to be good care.

I wrote about paediatric care, with a reply by Simon Perry who's been great at holding the profession up to the light:

http://chiropractor.blog.co.uk/2009/09/17/can-chiropractic-help-with-paediatric-conditions-6985108/

The real problem for chiros is that this colic stuff is fringe activity and it is difficult, finacially and with patients, to arrange RCTs (imagine if you went to your Chiro with a cervicogenic headache and were enrolled on to a study where you were in the control group and then, to add insult to lack of care, you were asked to pay!).

What I think we need is for the Universities to direct their research projects into specific, descrete fields and then publish, accepting that the self-employed chiro is going to stuggle to find adequate numbers of patients and the time to carry out any form of RCT.

In response to:Chiropractic in Parliament - good thing too!

Thu, 15 Oct 2009 14:48:02 +0200

It's not too surprising, as some chiropractors (by no means all of them, I'm sure) were claiming to be able to fix all sorts of things like colic, as an example I can remember.

In response to:Gouveia rubbishes chiropractic, poor science though

Thu, 15 Oct 2009 12:59:07 +0200

I finally decided to write a comment on your blog. Its very informative.

In response to:What exercises can I do to help disc herniation?

Wed, 14 Oct 2009 12:45:09 +0200

Nutrition,
thanks for the comment and thanks for adding to the debate.

Im a great fan of crunches and hate sit-ups which will blow a disc in quick time. I'd suggest that the crunch has its place in rehab but perhaps later on as if you get it wrong you are exactly in the wrong position for the disc - forward flexed under load. It could really hurt.

If you've had success with this then let us know and we'll see what others think.

Rupert

In response to:What exercises can I do to help disc herniation?

Wed, 14 Oct 2009 10:48:44 +0200

One such exorcises requires you to simply lie back on the ball with your feet flat on the floor, and your arms crossed on your chest. Crunch up slowly from your waist and lie back. This exercise will help you to stabilize your spine and take pressure off of any painful areas or the herniated disc.

In response to:Are GPs good at diagnosing and handling low-back pain or are chiropractors a better bet?

Wed, 14 Oct 2009 10:46:22 +0200

I finally decided to write a comment on your blog. I just wanted to say good job. Its interesting. Thanks for sharing. I'll be visiting.

In response to:Clinical Hypnotherapy and the Treatment of Insomnia

Tue, 06 Oct 2009 10:18:04 +0200

Kab, I'm sorry but I don't quite get what you are suggesting. Can you add a bit of clarity to this one, please?

In response to:Clinical Hypnotherapy and the Treatment of Insomnia

Mon, 05 Oct 2009 18:32:47 +0200

great while you at it ooer can u be vaccinated via a phonograph needle

In response to:Can Chiropractic help asthma? - yes and no!

Tue, 29 Sep 2009 14:12:52 +0200

People who have asthma realize all too well the unpleasant and at times terrifying sensations accompanying the helplessness to inhale which happens when the airways become narrowed and result in acute breathing difficulties. It is very important research. I am going to use it in my final project. Thank you very much for giving a very useful article. I will visit this site in future also.

In response to:Preventing low-back pain at work - THE answer

Fri, 25 Sep 2009 14:18:20 +0200

Back pain is a real problem in our world today. It can be a seriously debilitating condition, and it’s not always easy to treat.
One survey said that Smokers appear to have a higher risk of back pain than non-smokers. This may be related to the fact that smoking reduces blood circulation. In addition, smokers tend to take longer to heal than non-smokers, which could mean that back pain lasts longer for them. Good article.!

In response to:Can Chiropractic help with paediatric conditions?

Tue, 22 Sep 2009 09:11:18 +0200

Larry, this is our conundrum isn’t it? We’ve all had, or know a sensible, methodical and caring chiro who’s had, the same success. And much of this is documented as case studies – some of the 171 case studies I mention.

What we can’t do is change these case studies into RCTs and I think this is because we just can’t afford to in terms of time and patient numbers.

What do you think?

In response to:Can Chiropractic help with paediatric conditions?

Mon, 21 Sep 2009 22:10:16 +0200

This is interesting as I have had positive results with several cases with infantile colic symptoms. (RCT or not) I know several chiropractors that have had the same results.

In response to:Can Chiropractic help with paediatric conditions?

Fri, 18 Sep 2009 10:51:44 +0200

Simon,
The evidence is in the 171 case studies which report successful treatment of a variety of paediatric heath conditions. Now, you have to agree that is exactly what I said and exactly what the words mean. I freely admit these are not gold –plated, copper-bottomed benchmark RCTs but they are evidence all the same.

As a point, here is a list of evidence quality I lifted from another systemic review to give a feel for the range of evidence a good review would consider:

“The Scale of Evidence in hierarchy employed by the three reviewers was systematic reviews, experimental studies (RCT), observational studies (quasi-experimental studies controlled but not randomized such as case-controlled studies or cohort studies), descriptive studies (non-controlled non-randomized studies such as case series, case reports, surveys, literature reviews, and expert opinion) and finally abstracts from conferences.”
You’ll notice that case studies and case series are seen as evidence but last on the hierarchical list. So, case studies typically report success but tell us little about effectiveness. But all the same, they are evidence.

The trial was this one:
Chiropractic management of primary nocturnal enuresis.
Reed WR, Beavers S, Reddy SK, Kern G.
Palmer Institute of Graduate Studies and Research, Davenport, IA 52803.
http://www.ncbi.nlm.nih.gov/pubmed/7884329?dopt=Abstract&holding=f1000,f1000m,isrctn

Now don’t get all shirty about this as I strongly advocate that there is a paucity of hard RCT gold-plated, copper-bottomed evidence at present and this must be addressed. So no coming back at me and saying the evidence is poor as that will be dull.

One of the things I wonder is why? I suspect that as this is fringe activity for a few motivated chiropractors they would find it hard to collect together a large enough group of patients to make a significant number, convince them all to take part in a trial which would see a proportion of them receive a sham treatment and at the same time the examiners make a living. Perhaps what we need is a govt funded research arm in one of our best universities – I’ve always liked Cambridge!

In response to:Can Chiropractic help with paediatric conditions?

Fri, 18 Sep 2009 08:22:57 +0200

Interesting. You start "Chiropractors successfully treat a wide variety of paediatric health condition" but then say the evidence is lacking. How do you justify this first sentence?

Also, you reference a trial that you say shows chiro to be effective. How about adding a link to the paper so we can read it?

In response to:Leg length inequality -

Thu, 17 Sep 2009 18:18:22 +0200

In my further searching I stumbled across this fascinating study:

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance
Gary A Knutson

Knutson, who I know about and is no slouch concluded:

“Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4").
Conclusion
Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.”

90%! – so that is every one in the world, you and I included in that. Now, no one told me that at University. But the key point it this – it doesn’t matter until it get too large. But then it really matters.

In response to:Posterior Facet Syndrome - what is it and can chiropractic help?

Tue, 15 Sep 2009 13:33:11 +0200

A recent study settled on an accurate description of acute, uncomplicated posterior facet syndrome in the low-back as:

“local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting.” They add that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture, so posture that reduces pain such as leaning to one side, and no aggravation of pain from sitting, flexion or coughing/sneezing.

The study is this one:
The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors

Lise Hestbaek, Alice Kongsted, Tue Secher Jensen and Charlotte Leboeuf-Yde
Nordic Institute of Chiropractic and Clinical Biomechanics, Forskerparken 10B, DK-5230 Odense M, Denmark

And is spot on.

In response to:Can Chiropractic help asthma? - yes and no!

Fri, 28 Aug 2009 14:23:56 +0200

Still, maybe it'd be worth a shot for some people at, let's see, £40 for a new patient work up and then a trial of 6 appointments, so £220, just to see if their symptoms improved suprisingly at the same time they are being treated. I think I'd consider it if I had the cash to flash as those drugs are far from fun and that inhaler thing a pain, possibly. Especailly if I wanted to feel that I was being engaged and active in tackling this problem.

I'd also suggest that if this was offered on the NHS by a physio, who do loads of treatment with no proven effectiveness, (see: Therapeutic ultrasound in physiotherapy. Bryant J, Milne R, Stein K; International Society of Technology Assessment in Health Care. Meeting.)

then it'd be one of the treatments offered to the asthma patient.

Still, I've never treated anyone for asthma so what do I know.

In response to:Can Chiropractic help asthma? - yes and no!

Fri, 28 Aug 2009 10:37:39 +0200

Then again, no evidence for effectiveness, and people tend to get better on their own quite often...

In response to:Singh v BCA and Chiropractic

Thu, 20 Aug 2009 19:21:20 +0200

Patrick, I quote:
“ - if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.”

Sings 'only objection' is far, far from the evidently unsubsantiated claims you suggest. Maybe you've been on the end of some Singh Spin?

In response to:Frozen shoulder - who can help

Wed, 19 Aug 2009 09:04:00 +0200

Zippy, I agree. However, I'd aslo like to suggest that it isn't physiotherapy that's the best treatment for it but it's what a physio does that's the best tratment for AC and these techniques are now widely used, even by a mere chiro like myself!