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

Chiropractics vs Back Surgery

Comparing the Risks: Spinal Manipulation versus Back Surgery 

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.

Headline:  Both Surgery and 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 Dr. Wintermute at (949) 559-7999 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, from http://www.medscape.com/viewarticle/721611

Staff, M. C. (n.d.). Chiropractic adjustment: Risks - MayoClinic.com. Mayo Clinic. Retrieved August 31, 2011, from http://www.mayoclinic.com/health/chiropractic-adjustment/MY01107/DSECTION=risks

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, from http://www.sciencedirect.com/science/article/pii/S0002934302010689 

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

Reliable Information on Nutritional Supplements

Great Source for Reliable Information on Nutritional Supplements

Have you ever found yourself tuning out information about nutritional supplements because it all seems confusing and contradictory? If yes, you are not alone.

One headline says 'get more X' the next headline says 'be careful about too much X' and another says 'X supplementation not necessary at all'. Headlines are meant to sell newspaper and magazines.

They report on what's new not necessarily what is backed by the most evidence. And, the stories are often selected based on findings that are contrarian or against conventional wisdom. After all, who is going to buy a magazine with the headline, "No change in guidelines – eating more plant-based foods is still good for you."

Consumers really need a reliable source of evidence-based recommendations for nutritional supplements. Since these are not regulated by the FDA, there isn't a government run website that you can count on to be unbiased. There are several private companies, non-profits and even individuals that claim to offer comprehensive unbiased information on nutritional supplements, but who has the time to sift through all of these to figure out whose information is the best?

At the risk of offending a number of other great sources, this article is a plug for the Linus Pauling Micronutrient Information Center at Oregon State University at http://lpi.oregonstate.edu/infocenter. Chances are this is a source you've never heard of or looked at, but you should.

The website describes the Linus Pauling Institute as a “source for scientifically accurate information regarding the roles of vitamins, minerals, other nutrients, dietary phytochemicals and some foods in preventing disease and promoting health”.

As you can see from the description, their mission extends beyond nutritional supplements to also include whole foods. This is critically important because sometimes nutrients are more potent together (as in a food) than they are separately.

When you visit the website, you'll have a chance to subscribe to the newsletter near the top of the page. Do it. This isn't another email newsletter but rather a printed, bound newsletter sent to your house containing all of the Institute's latest research.

The folks at OSU are doing excellent work to bring us all trustworthy, evidence based recommendations on the tens of thousands of nutrients in our foods. Take some time to look at their website, bookmark it and share it with others. If there are concepts or terms you don't understand, feel free to ask us during your next appointment or send us an email.