Degenerative Disc Disease

Degenerative Disc Disease and Chiropractic Care

Whether they first see the phrase in print or hear it for the first time in a doctor’s office, “degenerative disc disease” is a term that many chronic back pain sufferers will encounter. It’s part of a brand new vocabulary that many patients learn as they try to understand their condition and navigate healthcare choices. But what does it really mean?

Degenerative disc disease is not actually a disease at all. Rather, it refers to normal changes in your spinal discs that tend to occur naturally as your body ages. Spinal discs are the soft “separators” between your vertebrae that cushion the individual bones and give your spine its flexibility. Healthy ones are thick and soft. Unhealthy ones are thinner and more brittle.

Over the years, these discs may gradually become less effective as the amount of fluid inside is reduced or cumulative wear and tear damages the discs and raises the risk of bulging, rupture or disintegration. The truth is that by the time we reach middle age, most of us already have degenerating discs, whether we’re experiencing any pain or not. And even with our best imaging technology, it can be very difficult to tell whether this degeneration is actually the source of a patient’s problems.         

So from a patient’s point of view, this bit of language—degenerative disc disease—can be both confusing and frustrating since it suggests a diagnosis but doesn’t usually come with a clear set of treatment options attached.  In some ways, it may actually seem like a “catch-all diagnosis” or “un-diagnosis”.

Can I Benefit From Chiropractic Care if I Have Degenerative Disc Disease?

Sometimes patients who’ve been told they have degenerative disc disease wonder if chiropractic adjustments can still help them or if they’re safe.

The answer to these questions depends on the patient’s individual circumstances, including whether the damaged discs are herniated or ruptured (bulging or broken) or have caused other conditions, such as osteoarthritis (a breakdown of the tissue that protects joints) or spinal stenosis (a narrowing of the channel within the spine that holds the spinal cord).  

Chiropractic physicians are specially trained to diagnose the underlying causes of back pain and to recognize when specific types of treatment may be either ineffective or harmful in situations where patients have degenerative disc disease. Since they are often skilled in a wide range of conservative, non-surgical therapies, most chiropractors will recommend low-force, non-thrusting techniques in situations involving disc degeneration and related complications. They may also employ traditional spinal adjustments based upon the results of a careful evaluation of the patient.

Chiropractic care generally focuses on addressing back pain at its source as well as improving the spine’s stability and mobility. While there is no cure for degenerative disc disease, an effective treatment plan will usually combine manual therapies (such as manipulation or massage) with supervised exercise and/or nutritional programs and lifestyle changes designed to minimize its impact.

If you’re wondering what chiropractic care could do for you or someone you care about, please call Dr. Wintermute at (949) 559-7999 today to schedule a consultation.

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Bibliography
 
Degenerative Disc Disease - Topic Overview. (2011, July 21). Retrieved September 2011, from WebMD: http://www.webmd.com/back-pain/tc/degenerative-disc-disease-topic-overview
 
Arn Strasser, D. (n.d.). How a Chiropractor Treats Degenerative Disc Disease. Retrieved September 2011, from spineuniverse.com: http://www.spineuniverse.com/experts/how-chiropractor-treats-degenerative-disc-disease
 
New York Times Back Pain In-Depth Report. (n.d.). Retrieved September 2011, from nytimes.com: http://health.nytimes.com/health/guides/symptoms/back-pain-low/print.html
 
Peter F. Ullrich JR, M. (n.d.). Degenerative Disc Disease. Retrieved September 2011, from spine-health.com: http://www.spine-health.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease

What is the Atlas Orthogonal (AO) Technique?

The Atlas Orthogonal chiropractic technique, often abbreviated AO, is a specialty within the field of chiropractic that focuses of the upper cervical region. Even more specifically, practitioners of the Atlas Orthogonal technique concentrate on the Atlas vertebrae – the very first bone in the neck. Their goal is to make the Atlas bone orthogonal (or exactly perpendicular) to the skull. This is where the approach gets its name.

The premise behind AO is that the first bone – the atlas – is central to the alignment of the remainder of the column. Imagine a marching band where the first member is out of position. All the other band members position themselves relative to the first member. When the first member is out of place, the entire band is out of formation. This is a crude analogy to explain the critical role played by the atlas in directing the alignment of the other vertebrae.

And, it’s not hard to imagine how the atlas may be out of alignment. The rather light atlas (it weighs about 2 ounces) supports the weight of the human head (which weighs about 9 to 17 pounds).

Imagine the head as a golf ball and the atlas as the top of a golf tee. The small tee is best able to support the weight of the golf ball on top when it is straight up and down.

The atlas can become misaligned as a result of chronic poor standing or sitting posture, an awkward sleeping position or improper lifting. These are all examples of gradual processes. The atlas can also be jarred out of alignment by an auto accident, bad fall, or a blow to the head.

When the atlas is out-of-alignment (non-orthogonal), the body will compensate in other ways to keep the heavy head centered over your feet. The other spinal vertebrae and the muscles in your neck, torso and lower back will alter their normal position and function in response (just like the marching band reacting to the position of the first member). Now you’ve created a situation where there may be excessive pressure on certain nerves, muscle spasms and tissue inflammation which can cause pain and dysfunction in other areas of the body.

Hopefully you are starting to see why the Atlas Orthogonalist focuses so intently on the atlas. A problem with the atlas alignment can manifest in many other distant places and cause a multitude of problems.

So how does the AO chiropractor restore the proper position of the atlas? By carefully evaluating each patient’s precise atlas position and then programming an instrument to deliver a precise percussive wave to reposition the atlas.

First, an AO-trained chiropractor will take very detailed x-rays that can map the exact position of your atlas. The tilt and rotation of your atlas are as unique to you as your own fingerprints.

Second, an instrument programmed with your exact settings will deliver a painless vibration to the affected area. There is no twisting or cracking.

Since the adjustment is custom-programmed for you it can be simultaneously very gentle and very effective. Some patients that have had traditional chiropractic will often walk away from their first AO treatment thinking that nothing has be accomplished because an AO adjustment is barely felt by the patient.

This article is just a brief introduction to the Atlas Orthogonal technique. When you visit our office, you’ll be able to get answers to all your questions. And after an exam, we’ll be able to talk with you in detail about whether you can benefit from atlas adjustment the same way that tens of thousands of your peers have.
 

Bibliography
 
(n.d.). Retrieved 8 29, 2011, from GlobalAO.com - The Official Site of the Atlas Orthogonal Program: http://globalao.com/
 
(n.d.). Retrieved 08 29, 2011, from Sweat Institute for Atlas Orthogonal Chiropractic: http://www.sweatinstitute.com/content/home.php

Straight Talk About Foot Orthotics

Good spinal health is built from the ground up, starting with the feet.

For years medical researchers and healthcare providers have recognized that problems there can cause posture changes that eventually trigger a variety of musculoskeletal issues in other parts of the body (particularly the ankle, knee, hip and back).

Studies have also shown that even slight foot problems can negatively affect athletes’ performance and predispose them to a broad range of sports-related injuries.

What Are Orthotics and How Can They Help?

Orthotics are shoe inserts that are specially designed and manufactured to correct an abnormal or irregular walking pattern by promoting proper alignment and balance.  They’ve improved the quality of life for millions of people, and it’s become very common for physicians to recommend them to address many different patient needs:

• Reducing pain and/or fatigue
• Providing targeted foot support
• Relieving pressure or stress on an injured or sensitive area
• Preventing or limiting deformity
• Improving foot positioning and function
• Restoring balance

Reinforcing or supplementing other therapies (particularly chiropractic adjustments)

Foot orthotics are medical devices that can significantly change the way a person stands, walks and runs (and therefore the way his or her body absorbs and distributes related forces). For this reason, it’s important that the person wearing them clearly understand their benefits, risks and limitations.  It’s also important that the person use them correctly.

What Every Patient Should Know About Orthotics

There is no “one-size-fits-all” answer when it comes to orthotics. What works for another family member or neighbor will probably not work for you!

Getting the right prescription for your particular needs is all about working effectively with your healthcare provider to define your own goals and develop a complete understanding of your foot’s unique structure and function.

For instance, orthotics can be very sport-specific—the performance requirements of a hiker will not be the same as those of a skier or a football player.
 
 
Not all orthotics are created equal, and the differences matter. The prefabricated orthotics that can be purchased at shoe stores, pharmacies and sporting goods stores are not the same as the custom orthotics prescribed by a healthcare provider. Do not confuse them!

Mass-produced products are tailored for the “typical” foot and are unlikely to address problems specific to any one individual’s foot.

In some situations, such products can actually make a medical condition worse, cause new problems or increase the risk of injury. So while they’re usually less expensive than custom orthotics, they may not actually solve your particular problem.
     
Orthotics don’t actually correct foot or ankle problems. They are intended to realign the structures of the foot to improve function, reduce pain and decrease the risk of injury.
 
Needs can change over time and your orthotics should too. The structure and function of the foot can change as people age. So too can people’s lifestyle and priorities. Your healthcare provider can work with you to ensure that your prescription is still the right one for you.

Long-term use of orthotics may pose its own risks. Any time that you provide outside help to the structures normally responsible for supporting and moving parts of your body (casts or braces are good examples), you are essentially asking them to do less. And if you provide that help over a sufficiently extended period, you run the risk that your bones, muscles and connective tissues may become weaker as a result. The unintended consequence is that you may actually become less capable and more reliant on your devices to do the work your body used to do.

Your healthcare provider will talk with you about how to use your orthotics correctly and manage any long-term risk that he or she believes may exist.
      

Prescribing orthotics is arguably as much an art as a science. Don’t underestimate the role of professional judgment in prescribing orthotics. Experts acknowledge that there are few widely-accepted standards and that we can’t always predict successfully how an individual will respond to a particular prescription.

In fact, recent research has demonstrated that individuals with the same condition can respond very differently to identical orthotic therapy.

There’s even evidence that the same patient can respond to a prescription inconsistently or can respond just as favorably to two entirely different (even contrary) prescriptions. This means that some trial and error may be necessary to get the results both you and your healthcare provider are looking for and that good communication is critical. Without accurate and timely feedback from you about how well your orthotics are doing their job, it’s impossible for your healthcare provider to make the adjustments that will eventually lead to success.


How Your Chiropractor Can Help

There’s a close relationship between the way your feet work and the way the rest of your musculoskeletal system supports your body. So even if your feet themselves don’t actually hurt, they could be contributing to other health problems that you’re experiencing.

After your chiropractor has examined you carefully and talked with you about your situation, he or she can help you decide whether foot orthotics should be part of your broader treatment plan. Call Dr. Wintermute at our office today to learn more - (949) 559-7999.

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References and Resources
 
Gina Kolata, Close Look at Orthotics Raises a Welter of Doubts.  Orthotic Shoe Inserts May Work, but It’s Not Clear Why.  New York Times Fitness and Nutrition.  January 17, 2011.  Accessed August 2011.
http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all

Nigg, BM et. al., Effect of Shoe Inserts on Kinematics, Center of Pressure, and Leg Joint Movements During Running.  Medicine & Science in Sports & Exercise.  February 2003.  Accessed August 2011.
http://journals.lww.com/acsm-msse/Abstract/2003/02000/Effect_of_Shoe_Inserts_on_Kinematics,_Center_of.21.aspx

Best Foot Forward with Chiropractic.  Journal of the American Chiropractic Association.  January 2001.  Accessed August 2011.
http://www.acatoday.org/pdf/focus_january2001.pdf

Back Pain during Pregnancy

Does Chiropractic Help Back Pain Associated with Pregnancy?

If you are pregnant and suffering from low back pain, a neighbor or a friend has probably suggested you visit a chiropractor because a chiropractor was able to help them during their pregnancy.

The discussion probably left you curious, is that good advice or just a single success story?

Additionally, you may be wondering whether chiropractic is safe during pregnancy and how much low back pain improvement the average pregnant woman can expect to get.

After looking at several scientific publications on these exact topics, the appropriate conclusion seems to be that “chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.” (Borggren, 2007)

So basically the answers are:

• Yes, chiropractic is safe during pregnancy.
• Yes, chiropractic helps common musculoskelatal probelms during pregnancy  (including back pain).
• Your friends experience isn’t just one woman’s story. Many women are finding relief and the results are being sporadically published in medical journals too.
• More research under more controlled conditions is needed for the purposes of educating primary care physicians and obstetricians about chiropractic care during pregnancy.

Here are a few additional details about the prevalence of low back pain during pregnancy and the number of women being referred for treatment.

• 57 – 69% of women complain of low back pain during pregnancy
• Only about 32% of women report these symptoms to their primary doctor
• Only about 25% of primary doctors recommend seeking treatment for the pain.

Clearly this is a big problem with 2 in 3 having pregnancy-related back pain. Also a big problem is that they are generally not talking to their obstetricians and primary care physicians about it and that these professionals are not referring them to effective treatment options.

Chiropractic treatments can be quite effective for pregnancy-related back pain with just a few visits for the majority of women seeking help. In a small study of 17 women:

• Sixteen of 17 (94%) saw clinically important improvements in low back pain with chiropractic care.
• The average pain rating went down from 5.9 to 1.5 (on a scale of 0 to 10).
• It took an average of 1.8 visits and 4.5 days to get clinically important pain relief.

We hope this article gave you hope that many pregnant women do get significant, rapid relief from low back pain.

If you are currently pregnant with low back pain, you probably have many questions not answered by this article. Perhaps you’ve never had chiropractic care before or you want to know how we adjust our techniques to work with pregnant patients.

The best way to get answers to your questions is with an initial consultation. The only way for us to know whether you are a good candidate is for you to come see us, so call Dr. Wintermute at (949) 559-7999 for an initial appointment today.

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Bibliography
 
Borggren, C. L. (2007, Spring). Pregnancy and chiropractic: a narrative review of the literature. J Chiropr Med, 6(2), 70-74.

Khorsan, R., Hawk, C., Lisi, A., & Kizhakkeveettil, A. (2009, Jun). Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv, 64(6), 416-27.

Lisi, A. (2006, Jan-Feb). Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health, 51(1), 7-10.

Stuber, K., & Smith, D. (2008, ul-Aug). Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther., 31(6), 447-54.

Shortening the Road to Recovery After an Automobile Injury

Your Chiropractor Can Help

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It's a great success story that most of us probably haven't heard very much about.  America's roads have become far safer across the past 20 years.

By just about any measure, travelers are much less likely to be injured or killed in a motor vehicle accident than they were in the late 1980s and early 1990s.

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Fast Facts:  Motor Vehicle Accidents by the Numbers

Vehicle Miles Driven:  Americans traveled 2,172 billion miles in 1991 and 2,979 billion miles in 2009. That's a 37% increase.

Motor Vehicle Accidents:  During the same 1991-2009 period, the number of accidents on U.S. roads actually decreased by 10%, dropping from 6,117,000 to 5,505,000.  So even though we're traveling more miles, we're having fewer accidents.

Occupant Fatalities:  The number of motor vehicle occupants killed in accidents during 1991 was 31,934. That number declined by 23% to 24,474 in 2009. The fatality rate per 1,000 accidents dropped from 5.2 to 4.4 persons. That means that when we do have an accident, it's become less likely that someone traveling in the vehicle will be killed.    

Occupant Injuries: The statistics show an even more positive trend with respect to injuries. The number of occupants injured in accidents fell 29% from 2,850,000 in 1991 to 2,011,000 in 2009. The injury rate per 1,000 accidents declined from 465.9 persons to 365.3. Simply put, our motor vehicle accidents seem to be injuring fewer drivers and passengers when they do occur.
It's likely that this general trend toward safer roads is being driven by a combination of factors. It could be the way we're driving that's producing fewer, less serious crashes. It could be the way our roads are designed, maintained or policed. It could also be the active and passive safety features now included in many of our vehicles. But whatever the reasons, we can all agree that this is good (if under-reported) news for our nation's travelers.  
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But What if I'm One of the Two Million Unlucky Ones this Year?

As encouraging as this trend is, it obviously means little to you if you or someone you care about is actually injured in a car accident. Even in cases where drivers and passengers walk away from a wreck believing they're 'uninjured', accidents can have profound, long-lasting health consequences for those involved. It's not uncommon for some types of symptoms to appear only gradually days or weeks after the event itself, delaying effective diagnosis and treatment. Symptoms may also come and go intermittently, making it more difficult to associate them with the accident.
        
Fortunately, there are things you can do to safeguard your health and improve your chances of a more rapid, complete recovery following an auto accident. Clinical studies have demonstrated that chiropractic care can shorten recovery time and decrease the amount of permanent physical damage sustained in a collision.

Take Care of First Things First 

Always address any life-threatening injuries first. If you experience (or have reason to suspect) significant bleeding or bruising, broken bones, internal pain, difficulty breathing, loss of consciousness, or shock, you should seek immediate help from healthcare professionals who specialize in treating trauma injuries.

Recognize Signs that You May Be at Increased Risk of Developing Chronic Problems
 
Be sure to tell your doctor if any of the following warning signs apply:

• A prior history of back, neck or shoulder problems (including previous injury).
• Distinct numbness, tingling or pain immediately following an accident.
• Increased muscle tension or reduced range of motion after the crash.
• You were involved in a rear-end collision.
• Your head was turned at the moment of impact.
• You have symptoms that don't resolve or that become generalized.

Visit your Chiropractor as Soon as Possible After an Accident 

Do this even if you don't think you've been hurt very badly.

Research has shown that early intervention in the form of chiropractic adjustment, massage and supervised exercise and stretching programs can make a big difference in longer-term function.

Stay Active 

Activity encourages blood flow to the injured area and promotes healing. It also helps prevent or reduce scar tissue formation and maintain range of motion.

Strengthen the Affected Area(s) as Directed by your Chiropractor

Exercise and stretching programs are designed to help prevent future injuries and are an important part of a balanced treatment plan.

An auto accident can affect your health (and your lifestyle) for years if you don't receive the proper treatment. So if you or someone you care about has been injured in a collision, please call our office and make an appointment today. Chiropractic care can help put your recovery in the fast lane!

Contact Dr. Wintermute at Health-XL now at: 949-559-7999 


References and Resources
A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System.  Traffic Safety Facts 2009 Early Edition. U.S. Department of Transportation National Highway Traffic Safety Administration.  Accessed August 2011. http://www-nrd.nhtsa.dot.gov/Pubs/811402EE.pdf
 
Mayo Clinic Comprehensive Guide to Diseases and Conditions: Whiplash and Alternative Medicine.  Accessed August 2011.
http://www.mayoclinic.com/health/whiplash/DS01037/DSECTION=alternative-medicine

Berglund A, et. al., The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. December 2006.

Jull G, et. al.,  Does the Presence of Sensory Hypersensitivity Influence Outcomes of Physical Rehabilitation for Chronic Pain? A preliminary RCT. Pain. May 2007.
 
Karnezis IA, et. al., Factors Affecting the Timing of Recovery from Whiplash Neck Injuries:  Study of a Cohort of 134 Patients Pursuing Litigation. Archives of Orthopedic and Trauma Surgery. October 2007.

Peolsson M, et. al., Generalized Pain is Associated with More Negative Consequences than Local or Regional Pain:  A Study of Chronic Whiplash-Associated Disorder. Journal of Rehabilitation Medicine. April 2007.

Rosenfeld M., et. al., Active Intervention in Patients with Whiplash-Associated Disorders Improves Long-Term Prognosis. Spine. November 2003.

Sterling M., et. al., Physical and Psychological Factors Maintain Long-Term Predictive Capacity Post-Whiplash Injury. Pain. May 2006.

Common Causes of Back Pain

Understanding the cause of your back pain is the key to proper treatment.

There are many different underlying conditions that cause back pain. The more common causes of back pain are described below. Don’t try to make your own diagnosis. A trained chiropractor that deals with back pain complaints on a daily basis will know what to look for and what questions to ask you to determine the underlying cause.

1.    Muscle strains and muscle spasms are the most common cause of low back pain.  Patients may or may not remember the initial event that triggered their muscle spasm. Back pain from muscle spasms can be incredibly painful and feel like nerve pain when the muscle tighten and twitch around a key nerve such as the sciatic nerve.

2.    A ruptured intervertebral disc, also called a herniated disc, is another common cause of back pain. The terms ruptured, herniated, slipped and bulging disc don’t really have precise definitions to distinguish one from another and are often used somewhat interchangeably to describe protruding disc material. It is important to note that a large percent of the population is walking around with bulging discs that cause no symptoms, so not every herniated disc warrants treatment or intervention.

3.    Discogenic back pain is the result of damage to the intervertabral disc, but without disc herniation. Diagnosis of discogenic back pain may require the use of a discogram.

4.    Spinal stenosis causes a lot of back pain in the elderly. As we age, the spinal canal can become constricted from arthritis and other conditions.  If the spinal canal becomes too tight, back pain can be the result.

5.    Arthritis most commonly affects joints such as the knees and fingers. However, arthritis can affect any joint in the body, including the small joints of the spine. Arthritis of the spine can cause back pain with movement.

6.    Spondylolisthesis causes back pain because adjacent vertebra become unstable and begin to "slip."  The most common cause of spondylolisthesis are degenerative changes causing loss of the normal stabilizing structures of the spinal column. 

As stated earlier, backaches are hard to self-diagnose. The causes listed above are just a few of more common possibilities. If you suffer from acute or chronic backaches, consult a qualified chiropractor for a complete exam.