Recent Article in JAMA Highlights Spinal Manipulation for Low Back Pain
“Patients should stay active as tolerated and begin with nondrug treatments, including superficial heat, massage…and spinal manipulation.”
This JAMA patient page provides some great information for both acute and chronic sufferers of low back pain. It reiterates some things chiropractors have been saying for decades. However, it is always nice to see recommendations from the broader medical community. Such as highlighting the importance of conservative care before drugs or surgery. Spinal manipulation, also known as the chiropractic adjustment, is again touted. A great first line treatment option for both acute and chronic cases of low back pain. Combined with exercise and other non-drug treatment options, spinal manipulation is safe and effective.
There are many options to choose from when picking a treatment for your lower back pain. You can easily take a supermarket approach. But, you don’t need to waste your time and money down the aisle trying the latest fads, creams, lotions, potions, and miracle cures. The tried and true combination of time, early return to activity, exercise therapy, and chiropractic spinal manipulation remain at the forefront of first line intervention for lower back pain.
Dr. Erik Reich, Meriden chiropractor, and his son.
Dr. Erik Reich is a chiropractor in Meriden, CT. He practices at Omni Physical & Aquatic Therapy Center, Inc. located at 303 South Broad Street. Where he treats all types of patients from high school athletes, seniors, victims of trauma such as auto accidents, and desk jockeys. Dr. Reich enjoys staying active through a variety of sports, time at the gym, and finding new vegetarian food spots. Spending time with his wife and son, and their Boston terrier, is something Dr. Reich also enjoys.
What should you be looking for when choosing a chiropractor?
The chiropractic profession is varied, and there are many different styles of chiropractic treatment and practices out there. So how do you pick a chiropractor? I will list and discuss some key considerations when you are in search of a new chiropractor.
First, ask your family and friends for a recommendation, or even your primary doctor which chiropractors in the area they would see if they needed care. Friends, family, and your health care team will likely not recommend to you someone they don’t like and trust themselves.
Second, check online. You can do a quick internet search for the chiropractor’s name and the town or city they practice in and get an idea of their practice by looking at their website, checking reviews online, and even looking up their license to practice and check for irregularities. When you are choosing a chiropractor in your area, don’t neglect performing an online search.
Next, give their office a call. Did someone pick up right away or did you have to leave a message? If a receptionist, or even the doctor, answered, were they pleasant, easily understood, and helpful? Did you get a good first impression? These are important windows into the “feel” of the office.
Dr. Erik Reich practices in Meriden, CT at Omni Physical and Aquatic Therapy Center, Inc.
Things to consider when starting treatment.
Chiropractic treatment is varied, but there are certain considerations that you should be aware of when starting a treatment program. Many chiropractors utilize spinal adjustment or “manipulation” of the spine to alleviate neck or back pain. Adjustment of the extremities such as ankle or wrist may also be performed based on the presenting health issue.
As a patient, be extremely wary of any chiropractor who says they have a unique technique or treatment that only they can use or a new treatment which they discovered. Joint manipulation is practiced more frequently by chiropractors than other manual healthcare providers, but it is not exclusive or proprietary to chiropractors as a profession, and there are many different named adjusting techniques and styles but no one has a monopoly on getting someone better with an adjustment.
Furthermore, other treatment modalities practiced by any good chiropractic physician are not unique to the chiropractic profession. Education about your condition, an exercise program, stretching and other treatments of the muscles and tendons, and nutrition advise may be helpful and offered at a chiropractic visit, but none of these interventions are exclusive to the chiropractor. Be skeptical of any chiropractor who wants to sell you their own vitamins or supplements because they are the “best” or the only ones that work.
You should beware of excessive imaging. Years ago it was common for chiropractors to over-utilize x-rays for a variety of reasons. Be aware that current understanding and imaging guidelines do demonstrate their usefulness in ruling out fractures, dislocations, and other red flags. X-rays should not be taken in the absence of recent trauma or suspected disease, and x-rays are not indicated to monitor your progress as treatment progresses. If you are not in pain and the chiropractor wants to take x-rays, you should get a second opinion.
Avoid long term contracts, payment plans, and care which does not have a reasonable start and end point. When you see a chiropractor, you should start feeling better. Depending on the severity of the original injury or health issue, this may take 1 visit, 6 visits, or a month of visits, or even longer…but avoid any doctor who claims to know that you will need 3, 6, or 12 months of visits when they’ve only met you once or twice and want you to pre-pay for 6 months of care. Everyone responds and heals differently, but this can not be known that far in advance and especially not to the degree where you should pay up front.
What Makes a Good Chiropractor?
Choosing a chiropractor shouldn’t be difficult. However, because the market is so fractured with many different types of practices, and in America the healthcare system is so focused on profit and efficiency, patients need to be keenly aware of outdated and potentially harmful practices that are more focused on serving the doctor or benefiting the practice than providing benefit to you, the patient.
You need to look for a chiropractor who takes a patient centered approach, which uses best practices and current evidence to come up with an active treatment plan focusing on return to regular activity and eliminate or reduce pain.
A good chiropractor is therefore one who avoids gimmicky marketing tricks, reduces or eliminates unnecessary or wasteful imaging or other expensive tests, and works well with other members of your healthcare team including primary doctors, APRNs, orthopedists, neurologists, and specialists.
A good chiropractor takes a thorough health history and performs a detailed physical examination before working with you on a treatment plan that is individualized to your goals and preferences. Also, a good chiropractor will offer education, support, exercises, and lifestyle modification advice, to encourage active participation in the process of getting you well, and not rely solely on passive interventions such as heat, adjustments, ultrasound, etc.
American Academy of Orthopaedic Manual Physical Therapists Releases Position Statement Opposing Use of ‘Degenerative Disc Disease’ as Diagnostic Term
“Degenerative disc disease is a term which is neither accurate or helpful, it should be abandoned.” states Dr. Erik Reich, Meriden Chiropractor.
The position statement released recently by AAOMPT is spot on. Few things are as upsetting to me as a clinician as when a patient presents to my office having been scared by this garbage terminology. Degenerative disc disease (DDD) is not degenerative or a disease.
As Professor Stu McGill, a world renowned spine researcher is oft quoted as having said, “A degenerative disc disease diagnosis is the equivalent of telling your wrinkled mother-in-law that she has degenerative face disease.”
AAOMPT says patients often react to the label ‘degenerative disc disease’ by losing hope and seeking more invasive and higher-risk treatments. They avoid beneficial physical activity for fear that exercise and movement will worsen their condition, possibly leading to chronic pain. The majority of spinal pain is self-limiting and can be managed appropriately without the need for medications or risky procedures such as injections or surgery. For those individuals who do need care, AAOMPT supports and encourages early physical therapy instead of high-risk procedures and medication. AAOMPT strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease.
One of the key interventions a clinician can provide to a back pained patient is education about their condition. Telling someone who has had a diagnostic scan or imaging that they are suffering from a disease such as DDD, when in fact this process is a normal part of aging and not a disease at all, causes harm and creates a nocebo effect.
A nocebo in this case arises from a patient being told they have a disease where in fact no disease is present. This can lead to negative expectations of recovery, fear or avoidance of beneficial activities, and seeking more aggressive and invasive treatments when they are not indicated or necessary.
Unfortunately, use of this terminology is still prevalent. Hopefully that changes as more practitioners are made aware of the negative consequences to patients of using this type of poor diagnostic language.
“Chiropractic care may help reduce feelings of foot numbness, depending on the cause .” – Meriden Chiropractor Dr. Erik Reich
Sitting in a position that puts pressure on the blood vessels or nerves of the legs or feet can result in temporary foot numbness. This numbness or tingling is temporary and relieved by a change in position. You may experience longer lasting numbness with certain conditions, chronic numbness following surgery or with a metabolic disorder, or new numbness in the legs or feet following an injury such as a car accident.
What Causes Foot Numbness?
Foot numbness most people are familiar with involves sitting in an awkward position such as on the floor. Or with their legs crossed. This can restrict your circulation and/or compress nerves. Which then leads to loss of feeling in the toes and feet.
Longer term numbness in the feet is more likely caused by a medical condition. You may experience lasting numbness with lower back injuries such as a disc herniation. Metabolic disorders such as diabetes can cause numbness. Also, peripheral artery disease, autoimmune disease such as multiple sclerosis, tumor, and other conditions can lead to numb feet.
A proper history and evaluation is important to rule out red flags and come up with a diagnosis. A working theory as to why you are feeling numbness in the feet or legs is the first step. Because some of the underlying causes can be serious and even life threatening, even though less probable, prolonged or repeated bouts of loss of feeling in the lower extremities and feet should not be disregarded or ignored.
Treatment Options
Treatment is dependent on the underlying cause of the numbness. Symptoms stemming from posture or poor work ergonomics, sciatica, spinal disc or joint problems, lifestyle factors, and certain metabolic conditions can be well addressed in the chiropractors office through the taking of a careful history, examination, and any special tests such as imaging or blood work if warranted. Then, depending on the cause, an individual treatment plan can be discussed which may include education about the condition or conditions leading to the numbness, exercises or advice on lifestyle or diet modification, adjustments or joint manipulation to the spinal or extremity joints which may be affecting numbness in conditions such as lumbar facet syndrome or tarsal tunnel syndrome. Stretching and home exercise programs can be utilized to instill self reliance, independence, and confidence to try and overcome any flare-ups or recurrences of the condition you may experience.
Check the website and book an appointment. Call (203)235-0171 if you think your foot numbness should be evaluated by Dr. Erik Reich.
If you have ever suffered from lower back pain you are not alone. Prevalence of lower back pain is estimated to affect up to 80% or more of the population. However, there is no one cause of back discomfort. As a back pain sufferer there is a virtual supermarket of treatment options out there. You may even experience symptoms severe enough to see a doctor. Because there is this supermarket of options, you may be offered medication, physical therapy, patches, ointments, rest, ice, heat, exercise, chiropractic care, or something else entirely.
Chiropractic care is safe and effective without relying on invasive procedures or medications.
Patients report high levels of satisfaction with chiropractic care.
Is chiropractic care effective for lower back pain?
Studies have suggested the important and effective role chiropractic care can play in managing lower back pain for decades. In 2018 a series of papers in The Lancet focusing on low back pain as a significant driver of pain and disability across the world, specifically recommended non-invasive and non-drug interventions as first line treatment to address lower back pain. Chiropractic care, which often includes patient education, exercise, and of course, manipulative therapy (chiropractic adjustment of the spine or extremities) has been shown to effectively manage most cases of back pain with high rates of patient satisfaction reported.
High patient satisfaction with chiropractic care.
Patients love their chiropractors. You will not wait at your appointment for hours. A detailed history and examination will be taken and performed. Your treatment will be based on current research guidelines, the doctor’s experience, and your personal goals and preferences.
“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”
Hertzman-Miller et al (2002), American Journal of Public Health
Cost effectiveness of chiropractic care.
Another thing to consider is how much your treatment will cost when you are suffering from back pain. You will be presented with a multitude of treatment options including medicine, acupuncture, massage, physical therapy, and even surgery. Chiropractic care has been found to be one of the most cost effective means to address back injuries.
Findings from a study utilizing data from the North Carolina State Health Plan collected between 2000-2009 show that care by a doctor of chiropractic (DC) alone or DC care in conjunction with care by a medical doctor (MD) incurred “appreciably fewer charges” for uncomplicated lower back pain than MD care with or without care by a physical therapist.
Hurwitz et al. (2016), Journal of Manipulative and Physiological Therapeutics
What a patient needs to know when dealing with lower back pain.
Dr. Erik Reich in Meriden treats non-traumatic lower back pain and other muskuloskeletal conditions.
First and foremost, the human body is resilient and adaptable. Most cases of lower back pain resolve with little to no intervention. Taking a hot shower, a walk, and some light stretching is often enough to ease a hurting lower back after a day or two. If pain or symptoms persist, an evaluation and treatment may be a better course of action. However, many cases of lower back pain get better with a return to normal activity and time.
If your lower back pain does not resolve, or if trauma or overuse injury is involved (a fall, car accident, over zealous gardening or home improvement job, sports injury) then a visit to the office is a better idea.
At the office a thorough intake, history, and examination will be performed so that the cause of your lower back pain can be determined and a personalized plan of care will be recommended including education about your back pain, hot or cold compresses, physio-therapeutic modalities, stretching and exercises, and spinal manipulation (chiropractic adjustment of the spine).
You will be reassured to know that the vast majority of lower back pain episodes respond very well to this type of conservative care. Furthermore, despite a great deal of pain and worry, your lower back pain can be helped with gentle chiropractic care.
About Dr. Erik Reich
Dr. Erik Reich is a Chiropractic Physician in Meriden, CT. He practices at Omni Physical & Aquatic Therapy Center, Inc. . Where he treats all types of patients from high school athletes, seniors, and traumatic injuries such as work and car accidents. Spending time with his wife and son, and their Boston terrier, is something Dr. Reich also enjoys.
