Tuesday, April 28, 2015

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


Tuesday, April 21, 2015

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

Friday, April 17, 2015

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

Tuesday, April 7, 2015

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

Friday, April 3, 2015

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'

Wednesday, April 1, 2015

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