I spend a considerable amount of time explaining the research based imaging guidelines to my patients and that advanced imaging such as MRI is grossly overutilized. 
The Choosing Wisely campaign was launched by the American Board of Internal Medicine Foundation about three years ago. It initially had only 9 medical societies involved and in three years that number has risen to 70 medical societies.
Notice on their list of overused tests that about 3/4 are advanced imaging tests. These tests have a very high rate of false positive findings leading to much dangerous and costly further testing and treatments, not to mention anxiety for many patients.
Anyone had any recent experience with advanced imaging testing?

Do you really need that MRI?

 

A new study in the American Pain Society's Journal of Pain showed physical therapy as effective as surgery for carpal tunnel syndrome. The non surgery group was doing better at 1 and 3 month follow-up and similar at one year followup, and with no down time.
I am board certified in chiropractic rehabilitation and treat many patient's with CTS using using physical medicine procedures, joint manipulation, and bracing. I have kept many patients from surgery for this condition.

Physical Therapy Just as Effective as Surgery for Carpal Tunnel Syndrome

Chiropractic Safer than Medical Care for Elderly

Seniors that received chiropractic care had a 76% lower rate of injury within seven days of treatment when compared to the subjects that met with their primary medical physician as a result of a neuromusculoskeletal complaint. This is from a new study in Spine Journal and is the latest of numerous studies showing chiropractic care to be safer than  medical care.

Chiropractic Safer than Medical Care for Elderly

6 Things Chiropractors Can Help With—And What They Can't

Very good article from Prevention Magazine. These six disorders of low back pain, neck pain, headache, back pain during pregnancy, digestive disorders, and high blood pressure are among the most common ailments in medicine. I am board certified in chiropractic rehabilitation and also treat many non spinal joint and muscle problems.
As stated in the article, MD's are better at treating acute emergencies, infections, chronic diseases, fractures, injuries that require surgeries, tumors, and broken bones


6 Things Chiropractors Can Help With—And What They Can't

Chiropractic care give better patient satisfaction rates at lower cost

Higher patient satisfaction rates and lower cost for chiropractic care compared to medical care  according to a new study in the journal JMPT. This was done while giving comparable results.


Three Reasons to Choose Chiropractic Care?

Maybe less aggressive medical treatment for seniors

The US medical profession is very good at providing acute and emergency care, but is much less effective at treating chronic conditions, which are becoming more common with our aging population. 
Aggressive treatment is also very common in our medical system and many times does more harm than good.

Are Seniors Getting Too Much Medical Treatment?

Key words to help identify the quality of media articles on medical research

Unfortunately media articles on research can vary dramatically in quality. There are excellent articles and then there are articles in which it is clear that the author does not even understand basic science or is trying to sensationalize the research findings.
Below are 2 short (75 second) videos explaining some core concepts and keywords to help you evaluate the quality of these articles.

75-second videos capture some of our concepts

JAMA has recently published a double-blind randomized controlled trial suggesting that a muscle relaxant and a narcotic drug are no more effective than naproxen for relieving acute low back pain. There have been many previous studies that have shown that the narcotic drugs are no more effective for treating low back pain. Naproxen is an anti-inflammatory medication and much safer than the narcotic drugs.
Prescription Naproxen as Good as Narcotic Painkillers for Low Back Pain: Study

The effects of sitting can be reversed with a short walk

I continually encourage my patients to be active as there are so many beneficial effects including promoting the healing of soft tissue injuries including back and neck injuries. This new study showed a reversal of the diminished blood flow to the legs due to 6 hours of sitting reversed with a 10 minute walk.

Short Walks Can Reverse Effects of Sitting

Study asks: Does taking opioids for back pain delay return to work?

There have been many studies showing that patients with worker's compensation injuries return to work faster after chiropractic treatment than after medical treatment ( many showed they returned in about half the time). 
The prescribing of opioid (narcotic) drugs may be one of the reasons. Here is another study, this one from from McMaster University and published in the British Medical Journal that shows an association with narcotic drug prescription and a longer return to work time. 
Most of the patients I treat for worker's compensation injuries who I have to take off work get back to work in a very short amount of time. Has anyone had chiropractic treatment for a work injury?

Study asks: Does taking opioids for back pain delay return to work?

American's Perception of Chiropractic

Below is a link to the first national survey concerning perceptions of chiropractic care which was jointly produced by the Gallup organization. The good news is that the use of chiropractic care has risen significantly in recent years and most Americans think that the profession is effective at treating back and neck disorders.
I was very surprised at a few of the findings such as 25% of people think chiropractic care is dangerous and almost 20% think we have less than 2 years of education! The truth is chiropractic care is much safer than many medical and drug treatments including over the counter pain meds, and DC's have 7- 9 years of advanced education.
Any chiropractic experiences or perceptions you would like to share?

Americans' Perception of Chiropractic

Your heart is probably much older than you think, the CDC warns

The Centers for Disease Control have released a new report using data from the famous Framingham Heart Study. The CDC developed a calculator to give a "heart age". The report unfortunately shows that American men have heart ages 8 years older and American women 5 years older than chronological ages. A clinical study showed that use of the heart age made it much more likely that people would make positive changes for their heart.

Your heart is probably much older than you think, the CDC warns

How to Fix Your Worst Posture Mistakes

I frequently walk into treatment rooms and see patients sitting with their spines and necks severely bent forward looking at a smart phone in their lap.
Here are some good tips on posture from Yahoo site. 
Any questions on this info?
How to Fix Your Worst Posture Mistakes

WHO Guidelines on Basic Training and Safety in Chiropractic

So many misconceptions about chiropractic care! I have had patients told by medical providers that they cannot continue with chiropractic treatment because they have osteoporosis. These providers probably mean well, but unfortunately most medical providers are very uninformed concerning chiropractic care. The reality is that this condition is not an absolute contraindication to chiropractic care. We just modify or use different techniques on patients with osteoporosis.
I have attached a link to a document by the World Health Organization on chiropractic training and safety. Here is a statement from the document. "When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems."
Does this surprise anyone?
WHO Guidelines on Basic Training and Safety in Chiropractic

Joliet octogenarian cycles, skis and does overseas mission work with Morris-based group

I have been a lifelong athlete and member of the Joliet Bicycle Club for over 20 years. I feel that staying fit has brought much benefit to my life. Here is an inspirational article on another long time member of the JBC who is now 85 years old and continues to stay fit!
Recent research has revealed that much smaller amounts of exercise than previously thought can yield large health benefits. Many current guidelines recommend at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week, and for added benefit moderate to vigorous muscle strengthening exercises 2 days a week. 
Any comments on how exercise has benefited your life?
Joliet octogenarian cycles, skis and does overseas mission work with Morris-based group

FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs

You probably have seen articles on the new FDA enhanced warnings for NSAID's ( anti-inflammatory drugs). We have known for over a decade that they can increase the risk of heart attack and stroke if taken long term, but new research shows that these risk factors can occur in a little as a few weeks for some people. 
This is even more reason to use non drug treatments such as spinal manipulation and physical medicine procedures such as exercise therapy.
Here is a link to information on the FDA website. Any questions of these new warnings?

FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs

Low Back Pain: Spinal Manipulation vs. Prescribed Medications

New study from the prestigious medical journal Spine showing high velocity low amplitude (also known as thrust) manipulation to be significantly more effective for acute and sub acute low back pain than usual medical care including prescribed medications. 
94% of the manipulation group vs. only 56% of the medical care group had more than 30% reduction of pain at 4 weeks.

Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial.

Time to Address the Global Impact of Pain

Back pain remains the No. 1 cause of years lived with disability worldwide; neck pain is also a common contributor to years lived with disability. The burden of musculoskeletal disorders (disorders of joints, muscles, and bones) is much larger than previously appreciated,"
These are findings of the latest Global Burden of Disease (GBD) study. Led by the Institute for Health Metrics and Evaluation and funded by the Bill and Melinda Gates Foundation, GBD 2013 represents a massive analysis of global disability data, with 35,000 data sources spanning 188 countries.
Have any of you been disabled by back or joint disorders?
Time to Address the Global Impact of Pain

Why America Can’t Kick Its Painkiller Problem

This is the American Chiropractic Association's response to a recent Time magazine cover story entitiled: Why America Can't Kick Its Painkiller Problem. Medical associations are recognizing the problem and looking for strategies to deal with the disproportionate prescription and use of opioids (narcotic drugs) in the United States. 
Would it not be rational to try chiropractic and other conservative treatments first and keep the dangerous drugs as a last resort?

Letter to TIME on Painkillers

Many Migraine Sufferers Given Narcotic Painkillers, Barbiturates

Two more studies showing very high rate of prescriptions for narcotic drugs given to migraine sufferers. One study found an over 50% rate for adults and the other study found a 16% rate for children. Narcotics are considered last-resort, "rescue" drugs for migraines that won't subside. Narcotics are potentially addictive, can cause withdrawal symptoms, and may make migraines worse in the long run. Dr. Lawrence Newman, president of the American Headache Society was quoted as saying "These findings are upsetting".
This is upsetting to me. Is it upsetting to you?
Many Migraine Sufferers Given Narcotic Painkillers, Barbiturates

Back and Joint Disorders Continue to be Major Cause of Worldwide Illness

A new study published in the medical journal Lancet finds that low back disorders continue to be the number one worldwide cause of ill health. Musculoskeletal disorders (mainly conditions such as low back pain, neck pain and arthritis) make up a large percentage of lost years to illness.
I know it is easy to not take back and joint problems seriously if you have never had a severe case, but the statistics show that they are a major cause of disability.
Has anyone experienced any disability related to back or musculoskeletal disorders?
World's Population Is Getting Sicker, Study Shows

These researches conclude that the very small possible benefit from surgery for knee arthritis is not worth the risks of the surgery which include deep venous thrombosis, pulmonary embolism, infection, and death. This is from a new systematic review of 9 previous studies published in the British Medical Journal. 
We are finding that many spine and joint surgeries give less benefit than previously thought.
Do you think it might be more rational to start out with more conservative procedures such as chiropractic or physical therapy?

Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms

Chiropractic Care Better than Medical Care in Keeping Seniors with Back Pain More Active

Back pain can be a significant challenge for those seniors looking to maintain their activities of daily living. One study found that chiropractic care for uncomplicated back pain can actually keep seniors more active longer. “The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.”
Regular chiropractic care can be very beneficial for seniors who wish to stay active as well as everyone with a spine.
Do you know that doctors of chiropractic treat millions of Medicare patients and seniors?
The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

What to Expect at the First Chiropractic Consultation

Many times new patients will ask my staff what happens on the first chiropractic visit. Here is a good description from the Spine-health website. Just like any other physician a history is taken, an examination is performed, and further testing is performed or ordered if necessary. This site also has a link to common manipulations/adjustments for various parts of the body demonstrated by Dr. Matt Kowalski from my previous posting.
What to Expect at the First Chiropractic Consultation

Chiropractic Adjustment of the Thoracic Spine (Upper Back) Video

Many people unfamiliar with chiropractic and spinal manipulation think that manipulation is an aggressive type of treatment. If performed correctly it is not aggressive and it is much safer than many common medical treatments.
Here is a video showing a few common types of thoracic or mid back manipulations (adjustments). This is by a doctor that was in my chiropractic class graduating in 1990. He is now board certified in orthopedics and a staff chiropractor for Brigham and Women’s Hospital.

Chiropractic Adjustment of the Thoracic Spine (Upper Back) Video

Oral Steroids Provide Little Help for Patients with Sciatica

New study from JAMA shows that Oral Steroids (Prednisone) for sciatica ( pinched nerve in low back causing leg symptoms) does not help pain, does not decrease need for surgery, and gives just a slight increase of functioning.
I am just amazed at how many common medical procedures and drugs for back pain and sciatica have now been shown to give no or little benefit! These cost us billions of dollars a year and have a risk of harm to patients. 
Why do we continue with all these unscientific dangerous practices for back and joint disorders?

Oral Steroids Provide Little Help for Patients with Sciatica

OSHA Computer Workstations eTool

This eTool website from OSHA can help you create a safe and comfortable computer workstation. This is the checklist page to get you started. Any no responses will send you to a page to analyze and control the problem.

Computer Workstations eTool

Overkill An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

It seems to be common sense that more medical care equals better health, but like anything else too much of anything can be bad. Here is a very good article by a surgeon arguing that we are now getting too much medical testing and treatment and in some cases it is doing more harm than good, and it is also costing us a lot of money. 
It is a rather long article but I encourage you to read it...at least the first 2/3 where he talks about the possible harms from over testing and over screening.
Do you understand how over testing can be harmful?

Overkill An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? BY ATUL GAWANDE

Tylenol Acetaminophen A Poor Choice for Relieving Your Low Back Pain

I recently reported on a new meta-analysis from the British Medical Journal concluding that acetaminophen/Tylenol is ineffective in the treatment of low back pain. Unfortunately it can also cause significant harm including death. 
In fact, improper use, coupled with the drug's narrow safety margin, means "a large fraction of users [are] close to a toxic dose in the ordinary course of use," according to the Food and Drug Administration. Also the FDA has mandated that all acetaminophen-containing prescription products feature a "black box" warning (the administration's strongest safety statement) noting an overdose can cause liver failure and even death; and have been urged to place similar language on OTC acetaminophen products.
So it definitely is a poor choice for back pain treatment.

A Poor Choice for Relieving Your Low Back Pain

Ice to decrease inflammation has been a mantra in medicine for decades. Below is a recent article by Dr. Gabe Mirkin who coined the term RICE (rest, ice, compression, elevation) back in 1978. Because studies have failed to show better healing with ice therapy and that it may even delay healing, many practitioners are now no longer recommending it to decease inflammation. Dr. Mirkin still advocates very short term use of ice for pain relief, but not with the goal to decrease inflammation.
Did you know that inflammation is an integral part of the healing process and has many beneficial effects?

Why Ice Delays Recovery

Here's What Really Happens When You Crack Your Knuckles

Interesting new study from the University of Alberta. Researchers used a motion MRI to visualize a finger joint while traction of the finger caused it to cavitate (commonly called cracking). This study disproved previous thought that the sound was caused by a gas bubble collapsing and showed that it was from the creation of the gas bubble. This is a natural phenomenon that also creates the sound when opening a can of soda pop or popping packing bubbles.
Studies have shown that this does not cause arthritis. In fact the most recent study showed that "knuckle crackers" had slight less finger arthritis than controls. 
Did anyone previously think this was harmful?

Here's What Really Happens When You Crack Your Knuckles

Physical Therapy as effective as spinal surgery for spinal stenosis Annals of Internal Medicine

Spinal stenosis can cause pinching of the nerve roots and/or spinal cord and can cause low back and leg pain, numbness, weakness, and incoordination of the legs and is a common reason for spinal surgery with and without spinal fusions. 
It is a condition I commonly treat at my clinic. 
Below is a new comparison study from the Annals of Internal Medicine performed over 7 years showing no difference in functioning outcome at 24 months between surgical and physical therapy treated patients.

Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial

Dr. Greg Rose of the Titleist Performance Insitute

I recently attended the national symposium of the American Chiropractic Rehabilitation Council as part of my board certification continuing education. The keynote speaker was Dr. Greg Rose who is a chiropractic physician and engineer who founded and heads the Titleist Performance Institute. They have trained and certified thousands of medical and fitness professions around the world to work with golf swing, strength and conditioning, and medical conditions.
This info will help me treat the many golfers I see at my clinic.
Titleist Performance Institute

Acetaminophen 'does not work for lower back pain or osteoarthritis'

This is the conclusion from a new systematic review and meta-analysis of 13 previous studies and published in the British Medical Journal. Acetaminophen, most commonly known in the US by the brand name Tylenol is worldwide the most widely used over-the-counter medicine for musculoskeletal conditions. A study published last year in the Lancet had similar conclusions. Also this drug is associated with higher risk of liver toxicity in patients and is included in many narcotic drug combinations such as Vicodin, Tylenol 3, Narco, and many others.
Why does this continue to be such a widely prescribed and recommended drug?

Acetaminophen 'does not work for lower back pain or osteoarthritis'

Oh, my aching wallet: MRI instead of physical therapy for low back pain leads to $4,793 higher price

This article from the Washington Post describes a recent study on low back pain showing a much higher cost to patients who were first referred for an MRI as compared to first referred to physical therapy. 
I have frequently wrote about the high amount of false positives (insignificant findings) of advanced imaging MRI and CT scans.
This very commonly leads to unnecessary further testing and treatment increasing the costs to the patient. The modern evidence based guidelines do not recommend early advanced imaging except with certain uncommon red flag signs or symptoms. Unfortunately many family doctors and specialists do not follow these guidelines.
Has anyone had any unnecessary testing or treatment for a low back disorder?

Oh, my aching wallet: MRI instead of physical therapy for low back pain leads to $4,793 higher price

Bad Science Dr. Ben Goldacre

I just finished reading this book and feel that it or a book like it should be must reading for just about everyone. Dr. Ben Goldacre's book is about all the 'bad science' we are constantly bombarded with in the media and in advertising,why this happens, and how to recognize it. 
He is a British MD who like Carl Sagan has a knack for explaining science principles in easy to understand language.

Bad Science

If Patients Only Knew How Often Treatments Could Harm Them

Most people would opt for less medical care if they were informed of the dangers of that care. This article discusses a systematic review study (combined from many previous studies) from JAMA, the Journal of the AMA. This gets back to those two very important statistical concepts I posted about recently, NNT (number needed to treat) and NNH ( number needed to harm). 
I know it is more fun to read about the latest medical or health fad or scare than statistics, but understanding these will benefit you to a much greater degree.

If Patients Only Knew How Often Treatments Could Harm Them

Too much texting can wear out your spine

Reading on a tablet, texting on a smartphone, leaning toward a computer screen, inching toward the steering wheel during traffic — can add up to more than 700 hours per year of excess stress on the cervical spine, according to research by Dr. Kenneth Hansraj, the chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine.
Neck disorders are the second most common problem treated by myself and the chiropractic profession.
Do you feel that computer/smart phone usage is over-stressing your neck?

Too much texting can wear out your spine

How the health care system is making pain patients worse

I and many others agree that for back and spinal disorders the medical system probably on average does more harm than good. Studies show that family doctors and orthopedists commonly do not follow evidence based guidelines...and surprisingly the orthopedists are worse! Here is an article from a medical blog written by a clinical professor of physical medicine and rehabilitation at the Medical College of Wisconsin. 
Any ideas why so many of these docs are resistant to following the research evidence?

How the health care system is making pain patients worse

Researchers found little or no evidence that long-term opioid (narcotic drug) therapy (therapy lasting more than three months) relieves chronic pain. These findings are from a study recently published in the Annals of Internal Medicine. This was a systematic review which looked at all relevant studies from 2008 thru August, 2014.
Opioid-related deaths have more than tripled and are estimated at 16,000 per year.
Please help me here...why are drugs that have no evidence of effectiveness for chronic conditions and kill so many people, so widely prescribed by doctors who are trained in drug usage?
Painkiller Abuses and Ignorance

Chiropractic for Daily Living

Chiropractic care has more of a protective effect than medical care for older adults against declines in activities of daily living. This is from a comparative study in the Journal of Manipulative and Physiological Therapeutics. 
Many do not realize that chiropractic care can help with increasing functioning along with decreasing pain thus indirectly helping with cardiac, pulmonary, and other body systems.
Do you see how this could be beneficial for older adults?

Chiropractic for Daily Living

Spinal manipulation plus home exercise shown to be more effective than home exercise alone for sciatica

New study from the Annals of Internal Medicine journal on a very disabling condition commonly called sciatica (leg pain from a pinced nerve in the low back). This comparitive study found that spinal manipulation (adjustment) plus home exercise and advise gave significantly better outcomes at 12 weeks than home exercise and advise alone.
I have had many patients over the years with severe sciatica tell me that the pain was so bad they wished someone would cut their leg off!
Even the narcotic drugs are mostly ineffective for more severe nerve pain.
Has anyone had experience with a severe pinched nerve?

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain

How to Measure a Medical Treatment’s Potential for Harm

Now for an article on the second metric called NNH (number needed to harm)...how many people would need to receive a particular treatment for one person to be harmed. 
Again I would highly encourage you to learn these two metrics as they could greatly help you with medical decisions and some day even help you make a life or death decision.

How to Measure a Medical Treatment’s Potential for Harm

Can This Treatment Help Me? There’s a Statistic for That

My next two posts will be articles reviewing two medical statistical metrics that I highly encourage you to learn and utilize. They can greatly help you make medical diagnostic and treatment decisions. These metrics are NNT (number needed to treat) and NNH (number needed to harm). They were developed in the 1980's and help determine the benefit versus risk of medical procedures.
Let me know if you were familiar with these or have any questions.

Can This Treatment Help Me? There’s a Statistic for That

One-fifth of spine surgery patients develop PTSD symptoms

Nearly 20 percent of people who underwent low back fusion surgery developed post-traumatic stress disorder symptoms associated with that surgery, according to a recent study.
This is the first study to evaluate for PTSD after an elective surgery. This was very eye opening to me as it was off my radar and the findings are rather dramatic.
I see on a daily basis how spinal disorders and surgery can effect people's life.
Has anyone had any similar issues after a surgery?

One-fifth of spine surgery patients develop PTSD symptoms

Study from Spine Journal on Medicare patients shows chiropractic care to be safer than family practitioner care for seniors

Surprising how some of these journal studies showing benefit of chiropractic care can have such negative titles. Don't hear it as often as in the past, but still have family doctors and medical specialists sometimes warning patients about chiropractic care in spite of the fact that our treatment methods are significantly safer than their methods.
Here is a new study from the prestigious Spine Journal using the Medicare database for a whole year showing that patients aged 66-99 with an office visit risk for a neuromusculoskeletal problem, risk of injury to the head, neck or trunk within 7 days was 76% lower among subjects with a chiropractic office visit as compared to those who saw a primary care physician!
So this is evidence that we are a significantly safer treatment for older patients. 
Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

Weight Still Top Risk Factor for Knee Arthritis, Pain

25% of cases of onset of knee pain could be attributed to being either overweight or obese." This is one of the conclusions in a new systematic review and meta-analysis (studies that combines many research papers) of 46 previous studies. 
We know that each extra pound puts an average of 4 pounds on the knee joint with each step. So ten pounds increase this to 48,000 pounds per mile.
Weight Still Top Risk Factor for Knee Arthritis, Pain