What's the best treatment for neck pain?

By ANAHAD O'CONNOR
Tony Cenicola/The New York Times, January 3, 2012,


What’s the best treatment for neck pain?
Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.
The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.
But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.
“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”
Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.
“There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.
To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.
One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day. (A demonstration of the exercises can be found at www.annals.org).
After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.
A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.
Dr. Bronfort said it was a “big surprise” to see that the home exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”
In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”
He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.”

Should I see a Massage Therapist or a Chiropractor?

“How do I know if I need to see a Massage Therapist or a Chiropractor?” I am asked this question from time-to-time by prospective patients. It is a good question, and worth taking some time to look at a number of considerations.

Massage Therapists (MT) in Georgia are licensed professionals who graduate from a 9 month course of study. Prerequisites include a High School diploma or equivalent.
Massage is a system of structured touch, pressure, movement or holding of the soft tissues of the body, which has the primary intent to enhance or restore health and well-being.

Doctors of Chiropractic (DC) are licensed healthcare professionals who graduate from a 4-year course of study, and pass 4 National Board Exams. Prerequisites include an undergraduate degree or equivalent. DC’s may examine, use x-rays and other diagnostic testing, diagnosis and prescribe a course of treatment or refer.
DC’s may utilize spinal and extra-spinal adjustments, physiotherapy, therapeutic exercises, nutritional/dietary supplements and lifestyle modification.

It is very common for health insurance plans, motor vehicle accident insurance and Medicare to cover Chiropractic exams, x-rays and treatment. It is less common for insurance to cover Massage Therapy, but when it does, their must be a diagnosis and examination by a DC, MD or other doctorate level healthcare provider.

A typical first-time Massage Therapy client will have mild stiffness and stress in the neck or back, and they are looking for temporary relief and relaxation. The client comes back to the MT when they want more temporary relief.

A typical first-time Chiropractic patient will have more intense symptoms that interfere with some aspect of their daily life (sleep, work, mood, recreation, chores). They are looking for an understanding of their condition, relief from their pain or other symptoms and how to avoid future problems without drugs or surgery.
The patient follows a recommended schedule of care to get a desired result.

Over the years I have had new patients come to my practice who were told by a Massage Therapist that they needed a Chiropractor, and I have told patients that they needed to get massage more than they needed to be adjusted. Many of our patients who are under my care see our MT as well as me because the two working together is of more benefit than each alone.

What are your thoughts on when to see a Massage Therapist or a Chiropractor?

Best of the Best

Dr. James Cox, founder and developer of the Cox Technic system for spine pain, is one the most outstanding Doctors of Chiropractic in the world. I attended the Cox Symposium for Certified Cox Practitioners this weekend in Nashville, TN, receiving my re-certification status for another two years. I have been certified since 1994, and am one of the few DC's, out of 3,000 licensed chiropractors in Georgia, who carries the Cox certification. The Symposium keeps us up-to-date with the latest information and research documentation that we can apply to help patients who suffer from spine-related pain. The Cox Technic allows me to offer evidence-based non-surgical chiropractic protocols for the relief of spine pain due to disc herniations, stenosis and related conditions causing neck, upper back, shoulder, arm, low back and leg pain. The Cox Technic flexion-distraction protocols have been scrutinized in federally funded research projects. Flexion-distraction biomechanical effects have been documented- drop in intradiscal pressures, increase in spinal canal area and discal height-and clinical outcomes have been published- superior in pain relief for radiculopathy, better for relief of chronic low back pain, and more effective in reducing the need for healthcare visits for spinal pain in the year after treatment. I am proud to provide this specialized non-surgical solution for back pain relief in my Roswell practice. For additional information on Cox Technic, visit www.coxtechnic.com or our practice website www.leadingedgeatlanta.com.

Roswell Proclaims October National Chiropractic Health Month

Mayor Jere Wood of Roswell, Georgia has made an Official Proclamation declaring October 2011 National Chiropractic Health Month. Mayor Wood is joining other elected officials across the USA in recognizing the contribution that Doctors of Chiropractic make to the welfare of their patients and the public health. Through an initiative of the American Chiropractic Association (ACA) National Chiropractic Health Month 2011 will focus on the importance of being "TechnoHealthy" by using technology safely and making time to rest, exercise and engage in other wellness-enhancing activities.

Roswell Chiropractor, Dr. James E. Schantz, a long standing member of the ACA, is leading the initiative in North Fulton. Dr. Schantz remarks, "Repetitive stress injuries from texting and computer use are increasing and cause about 28% of the workforce to miss time from work. Inactivity and poor posture can cause stress on the neck and back which can lead to headaches, neck pain, carpal tunnel syndrome and numbness, pain and weakness in other parts of the body. Chiropractic Doctors focus on the whole person and have particular expertise in ergonomics and care of musculo-skeletal injuries.

If you think that you may be at risk for pain or injuries as a result of overuse or misuse of technology, then check back with our Blog during the month of October for advice.

Back to School doesn't have to mean a Bad Back in School

Backpack Misuse Leads to Chronic Back Pain, Doctors of Chiropractic Say
Back pain is pervasive among American adults, but a new and disturbing trend is emerging. Young children are suffering from back pain much earlier than previous generations, and the use of overweight backpacks is a contributing factor, according to the American Chiropractic Association (ACA). In fact, the U.S. Consumer Product Safety Commission reports that backpack-related injuries sent more than 7,000 people to the emergency room in 2001 alone.

"In my own practice, I have noticed a marked increase in the number of young children who are complaining about back, neck and shoulder pain," said Dr. Scott Bautch, a member of the ACA's Council on Occupational Health. "The first question I ask these patients is, 'Do you carry a backpack to school?' Almost always, the answer is 'yes.'"

This new back pain trend among youngsters isn't surprising when you consider the disproportionate amounts of weight they carry in their backpacks - often slung over just one shoulder. According to Dr. Bautch, a recent study conducted in Italy found that the average child carries a backpack that would be the equivalent of a 39-pound burden for a 176-pound man, or a 29-pound load for a 132-pound woman. Of those children carrying heavy backpacks to school, 60 percent had experienced back pain as a result.

According to Dr. Bautch, preliminary results of studies being conducted in France show that the longer a child wears a backpack, the longer it takes for a curvature or deformity of the spine to correct itself. "The question that needs to be addressed next is, 'Does it ever return to normal?'" Dr. Bautch added.

The results of these types of studies are especially important as more and more school districts - many of them in urban areas - remove lockers from the premises, forcing students to carry their books with them all day long.

The problem has become so widespread, in fact, that the California State Assembly passed legislation that would force school districts to develop ways of reducing the weight of students' backpacks. Similar legislation is being considered in New Jersey as well. The ACA believes that limiting the backpack's weight to no more than 10 percent of the child's body weight and urging the use of ergonomically correct backpacks are possible solutions.

What Can You Do?
The ACA offers the following tips to help prevent the needless pain that backpack misuse could cause the students in your household.
•Make sure your child's backpack weighs no more than 5 to 10 percent of his or her body weight. A heavier backpack will cause your child to bend forward in an attempt to support the weight on his or her back, rather than on the shoulders, by the straps.
•The backpack should never hang more than four inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking.
•A backpack with individualized compartments helps in positioning the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child's back.
•Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry-and the heavier the backpack will be.
•Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
•Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child's shoulders.
•The shoulder straps should be adjustable so the backpack can be fitted to your child's body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain.
•If the backpack is still too heavy, talk to your child's teacher. Ask if your child could leave the heaviest books at school, and bring home only lighter hand-out materials or workbooks.
•Although the use of rollerpacks - or backpacks on wheels - has become popular in recent years, the ACA is now recommending that they be used cautiously and on a limited basis by only those students who are not physically able to carry a backpack. Some school districts have begun banning the use of rollerpacks because they clutter hallways, resulting in dangerous trips and falls.
Chiropractic Care Can Help...
If you or your child experiences any pain or discomfort resulting from backpack use, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages and will use a gentler type of treatment for children. In addition, doctors of chiropractic can also prescribe exercises designed to help children develop strong muscles, along with instruction in good nutrition, posture and sleeping habits

Chiropractic Storm Relief

It was a gorgeous Sunday afternoon, quite different from the day that tornadoes stormed through Georgia and Alabama.
Massage therapist Theresia Greer and I exchanged chiropractic and massage services (along with homemade cookies and Jana water) for donations to the American Red Cross Storm Relief. We had a booth at the Roswell Cycling Festival on Canton Street where we worked on necks, backs, legs, knees and feet of cyclists, vendors and spectators. We raised over $100 and spread the good will of chiropractic across the land. If you didn't have an opportunity to participate in the Mayor's Ride, test out the mountain bike trails or watch the Criterion Races, make sure you put the first Sunday in May on your calendar for next year.

Pull Weeds, Not Your Back

Pull Your Weeds, Not Your Back, When Gardening
As springtime approaches, weather warms up and leaves turn green, many people will spend more time outside planting bulbs, mowing the lawn and pulling weeds. Gardening can provide a great workout, but with all the bending, twisting, reaching and pulling, your body may not be ready for exercise of the garden variety.

Gardening can be enjoyable, but it is important to stretch your muscles before reaching for your gardening tools. The back, upper legs, shoulders, and wrists are all major muscle groups affected when using your green thumb.

A warm-up and cool-down period is as important in gardening as it is for any other physical activity," said Dr. Scott Bautch of the American Chiropractic Association's (ACA) Council on Occupational Health. "Performing simple stretches during these periods will help alleviate injuries, pain and stiffness."

To make gardening as fun and enjoyable as possible, it is important to prepare your body for this type of physical activity. The following stretches will help to alleviate muscle pain after a day spent in your garden.

Garden Fitness Stretches
Before stretching for any activity, breathe in and out, slowly and rythmically; do not bounce or jerk your body, and stretch as far and as comfortably as you can. Do not follow the no pain, no gain rule. Stretching should not be painful. o While sitting, prop your heel on a stool or step, keeping the knees straight. Lean forward until you feel a stretch in the back of the thigh, or the hamstring muscle. Hold this position for 15 seconds. Do this once more and repeat with the other leg.
Stand up, balance yourself, and grab the front of your ankle from behind. Pull your heel towards your buttocks and hold the position for 15 seconds. Do this again and repeat with the other leg.
While standing, weave your fingers together above your head with the palms up. Lean to one side for 10 seconds, then to the other. Repeat this stretch three times.
Do the "Hug your best friend." Wrap your arms around yourself and rotate to one side, stretching as far as you can comfortably go. Hold for 10 seconds and reverse. Repeat two or three times.
Finally, be aware of your body technique, body form and correct posture while gardening. Kneel, don't bend, and alternate your stance and movements as often as possible to keep the muscles and body balanced.

When the Bulbs Are Planted...
If you already feel muscle aches and pains and did not complete the warm-up and cool-down stretches, there are ways to alleviate the discomfort. Apply a cold pack on the area of pain for the first 48 hours or apply a heat pack after 48 hours, and consider chiropractic care.

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Top Athletes Benefit from Chiropractic Care

ACA Today News- Recent news stories about Washington Redskins wide receiver Santana Moss and professional golfer Michelle Wie have mentioned chiropractic care as an important part of helping both athletes stay competitive. Moss told The Washington Post that he sees a DC (Doctor of Chiropractic) twice a week to help his aging body cope with the rigors of playing professional football. NBC Sports recently ran a story on its Website stating that Wie is seeing a DC to recover from back problems in time for next season.

Here we have two athletes, two different genders, two different age groups, playing two very different sports- yet both are using chiropractic care to help them stay in their game. Are you letting pain, stiffness or lack of stamina prevent you from staying in your game? You don't have to be a professional athlete to receive the benefits of chiropractic care. You may be a softball player on the company team, an ALTA player for your subdivision team or the parent of a varsity lacrosse player. Chiropractic care is a safe and effective approach to enhancing sports performance, avoid injury and treating pain, strains and sprains.

Dr. Schantz is a Certified Golf Conditioning Specialist and a member of the American Chiropractic Association Council on Fitness and Sport Injuries.

Roswell Bicycle Festival Chiropractic Booth

Our chiropractic intern, Barney Roca and I spent the day on Sunday providing check-ups and muscle work for participants of the Roswell Bicycle Festival, along with their family members and festival goers. Sunday was a gorgeous day after the torrential downpour on Saturday.

The most common physical complaints from bicycle riding are neck pain (from drop-down handle bars), pain and numbness in the wrist (from leaning on your wrist), low back pain (from keeping your spine flexed too long) and numbness in one foot (from having a short leg).
Chiropractic care is a safe and effective method to detect and help correct these disorders, and keep bicycle enthusiasts in the saddle.

Roswell Day of Hope

What an amazing day! Close to 500 needy people with backaches, neck pain, pinched nerves, bum knees and ankles getting chiropractic care... all for free! Seven local chiropractic doctors, along with our chiropractic intern, volunteered our services as part of the health care team for Roswell Day of Hope. This huge charity event provided health care services, haircuts, groceries, entertainment and Christian spiritual guidance for thousands of underprivileged men, women and children in North Fulton county, Georgia.

What can chiropractic do to help spinal stenosis?

Spinal stenosis is a degenerative condition that affects as many as a half million Americans over the age of fifty, and it is rapidly becoming more common as the average age of Americans increases. Stenosis refers to thickening and hardening of the ligaments of the spine, along with decay in the disks. This causes narrowing of the spinal canal and/or opennings that allow the spinal nerves to travel to the pelvis and legs. The sad thing is that there is no good way to predict who will become affected by this disorder. The symptoms are characterized by nagging pain and stiffness in the lower back. It may be accompanied by pain that radiates into either or both legs, especially when walking for any distance. The classic sign of this condition is that the leg pains subside quickly with sitting or bending forward at the waist. So what can chiropractic do to help spinal stenosis? One of the most promising treatments is the Cox Decompression and Manipulation Method which helps to stretch the ligaments of the lower spine. By stretching the ligaments, their diameter becomes thinner, and they do not crowd the spinal nerves. The Cox Method also helps to increase the intradiscal space ( the area between the vertebrae) helping to alleviate disk degeneration. To find a chiropractor who is a Certified Cox Doctor in your area visit www.coxtechnic.com and click on Cox Physicians.