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Clinical Pearls from a Chiropractic Perspective

Pearson & Weary Pain Relief Clinic

Kelli Pearson DC DABCO Susan Barrett DC Dana Weary DC DABCO Daniel Osborne DC Beth Malizio BS - Rehab specialist Valley: N 1410 Mullan Downtown: E 505 3rd with Rockwood PT Gonzaga University, Athletic Training Room

Stenosis and manipulation

70% 60% 50% 40% 30% 20% 10% 0% Disability Imp at Self Rating worse pain Improvement

(2)

Mean Duration 16 months Tx: Distraction an Neural Mob

Primary Care Update 2008 - Do Not Reproduce without Author's Permission

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Radiculopathy and HNP

90 80 70 60 50 40 30 20 10 0 Disability Pn Intensity Fear Self rating Avoid

(3)

Improvement Mean Duration 55 weeks Mean visits 12

Flexion Distraction

Flexion therapy Williams and Cox Extension therapy Robin MacKenzie PT Decompression therapy Inversion tables

(4-8)

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Flexion distraction

10 Medically-diagnosed-as-needing-surgery cases successfully treated (4) Flexion Distraction successfully to help disc herniation patient (5) Cox Flexion distraction relieves L4-L5 disc herniations (6) L5-S1 herniation successfully cared for with distraction manipulation (7) L5-S1 disc herniation relieved by flexion distraction and side posture adjusting (8)

Chronic Neck Pain (9)

Strong evidence

Multi-modal approaches including: Stretching / Strengthening and Mobilization/Manipulation

Moderate evidence

Stretching and Strengthening alone IV Glucocorticoid for whiplash Epidural injections for pain reduction Low level laser therapy for pain - intermediate period Electrotherapy for immediate effect only

Limited evidence

Magnetic stimulation

Evidence of no benefit

Home exercises Hot pack Electromechanical stimulation Ultra sound Manip/mob alone for chronic pain Morphine added to epidurals Laser for myofascial lesions Iontophoresis Botulinum-A Magnetic Necklace Neck school Advice to rest

Related to Sub acute, Chronic, Acute neck pain, Headache and Radiculopathy

Traditional Chinese massage

Ref: Gross AR, Goldsmith C, Hoving JL et al. Cervical Overview Group. (9)

Orthopedic pillow

Key MND - Musculoskeletal Neck disorder, DNR Radiculopathy, DJD Degenerative Joint Disorder

Intermittent traction acupuncture for short term effect only (MND, DNR, DJD)

Botox injection

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Safety of Manipulation

Population based and case control and case cross over study To investigate association between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with PCP visits and VBA 818 strokes hospitalized in pop of 100 M people in Ontario between 1993 and 2002 CONCLUSION: VBA is a rare event. The increased risks associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. (10)

(10)

QuickTimeTM and a TIFF (Uncompressed) decompressor are needed to see this picture.

Clinical pearl

Low back pain has been diminished by teaching core stability of Transverse abdominus Shoulder pain is now being treated with scapular stabilization Standing retraction exercises make a difference

Primary Care Update 2008 - Do Not Reproduce without Author's Permission

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USA Today 4/28/08

AN OPTIMAL HEALTHCARE MODEL FOR THE 21st CENTURY Medical professional nationwide express confidence in chiropractic care. "Good medicine is about putting the patient first and chiropractors are an important part of the total health care team."

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