Chiropractic for scoliosis

September 22, 2012 By

DEAR DR. GOTT: I was diagnosed with scoliosis at age 2. I am now 37. In 1976 the surgery techniques were still primitive so my parents decided to put me in a brace. I lived with that brace for many years and never saw improvement. In college I decided to look into physical therapy for pain and discovered a lot of relief, proving you can live a normal health life with scoliosis and without surgery.

There are chiropractors who specifically work with scoliosis and physical therapists who can help. Surgery and back braces do nothing to help a condition that is mainly muscular. I am living proof that you can be normal with a curve that most people would consider disabling. I swim for relief of back pain. I lift weights. I have never not done something because of my back. I even carried three children to full term. For those of you out there with scoliosis, consider finding a good chiropractor.
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So You Have a Disc Problem Part 2: The Bulging Disc

May 10, 2011 By

In the first part of the disc series I covered the degenerated disc. In this column I will address the bulging disc. Please refer back to my earlier column for normal disc anatomy.

In a normal disc the gel-like center, the nucleus, is contained within the tough fibrous rings that make up the annulus. As the fibrous rings become unhealthy due to trauma or even normal wear, they can tear, allowing the inner gel material to go out into the tear. If the tear is big enough it can cause the remaining intact outer ring of the disc to pouch outward or bulge due to the amount of pressure the gel is under (as it is bearing the weight of your body above it). The gel can then put pressure on the sensitive outer ring which has nerve endings that can cause you to feel pain. Thus, a bulging disc can cause you to have back pain. Also, these nerve endings have attachments to the exiting spinal nerves that can cause you to feel pain into your arm or leg. This would be a referred pain into the extremity rather than a radiating or pinched nerve pain.

The typical age for someone to experience a disc bulge is 20 to 50 and most often occurs at the lowest level of the spine, L5/S1. Although, it can occur at pretty much any age and at different spinal levels. An acute disc bulge usually occurs suddenly and is usually without any provocation at that moment, although it is essentially the end result of prior wear and tear or traumas. You may be just bending over to pick something up or sneeze or twist- the straw that broke the camel’s back. It is among the most painful and debilitating of the spinal disorders. The pain can be sudden and severe and may cause you to become “crooked” or unable to stand up straight. Many patients have related going to their knees due to the intensity of the pain. Other common symptoms are difficulty bending forward, difficulty on arising from sitting or especially on getting out of bed in the morning. Prolonged sitting or standing gives increased pain. Sneezing or coughing can be very painful. You may also have pain going into the arms or legs and/or tingling or numbness.

The only way to image a bulging disc is through a MRI. You cannot see the disc on plain x-rays as the disc is soft tissue and will not show up. An interesting phenomenon with disc bulges is that they may show up on the MRI but not be symptomatic or you may have all the symptoms of an acute disc bulge and it will not show up on the MRI. You don’t treat from the image however; you treat from the patient’s history and symptoms.

One of the first things I recommend my patient’s to do to treat a disc bulge is to use ice. A good rule of thumb is 20 minutes on/ 2 hours off as much as possible. I also may put a lumbar brace on the patient which can be quite comforting. I am hesitant to do this if the patient has pain into the leg as I have found the brace can increase the pain in the extremity. You also want to avoid prolonged sitting and lying especially in the initial onset phase as to get up from such can be quite difficult. You want to have some degree of movement for the spine; walking is good if you can tolerate it. You especially want to avoid sneezing or coughing, good luck with that, as that can send you to your knees. Disc bulges respond well to chiropractic care. It is somewhat amazing to see the patient barely able to walk into the office for their initial visit and with time and treatment they become pain free again. In my office I treat disc bulges with manipulation primarily in the form of flexion/distraction for which I use a specific table for such. My job is to reduce the disc bulge by inducing the gel material to go back towards the center of the disc and to keep it their while the torn rings undergo healing around it. Even though this can occur and the patient gradually becomes more functional and in less and less pain the tissue healing that occurs is with scar tissue and it is never quite as strong as the original. When I see someone with an apparent acute disc bulge I will ask them if they have ever had this happen before. Many of them will answer yes as it is a problem that will tend to recur over the years of time. If they answer no, then I inform them that unfortunately it will tend to recur periodically and usually without any provocation. Once you have it once you will probably have it again. The typical disc bulge patient can do about anything they want in terms of physical activity without any problem then one day on bending over to pick up a penny off the floor their back will “go out”.

My advice to a recovered disc bulge patient is to get into a Yoga program or a stretching class. Back strengthening exercises are also in order as well as to keep their weight down. One of my best suggestions to help prevent recurrence is to not do anything “stupid”. By that I mean that on most occasions when I have a returning disc bulge patient they relate to me that they had done something “stupid”. They were in a hurry, should have gotten some help or should have known better than to do the activity in the first place. Some commonsense can go a long way.

My next column will be on disc herniations or ruptures.

Dr. David D. Godwin
Chiropractic Physician
Salisbury Chiropractic
Salisbury, NC 704-633-9335
www.salisburychiropractic.us

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Avoiding whiplash and how to treat it

October 26, 2010 By

Last week I almost hit three deer on two different occasions while driving to work. I have also driven through torrential rain and witnessed a van hitting and cracking a telephone pole.

Accidents happen all the time and while modern cars can often withstand quite a bit of “injury”, the human body often can not.

Your head weighs 8 to 10 pounds; if your seat belt is fastened, the force of a collision can cause your head to whip forward and back or side to side. Accidents are at times unavoidable, but there are things you can do to decrease the chance of sustaining a whiplash injury.

  • Always fasten your seat belt.
  • Position your head rest to “catch” your head, which means it should be right in the center of your head. Positioning it too high or too low can actually cause or worsen a whiplash injury.
  • Position your seat properly. You should be sitting up straight and the seat should be as close to your head as possible to lessen the distance between your head and the seat upon impact.
  • Be aware of your surroundings — which means no calling, texting, eating, putting on makeup, etc.

If you do sustain a whiplash injury, get checked out by a medical professional. Some of the symptoms of whiplash: blurred vision, dizziness, jaw, shoulder or neck pain, headaches, vertigo, memory loss, irritability, sleeplessness, fatigue.

Most pain associated with whiplash is caused by tense muscles. When the neck is forced back and forth in a jarring motion, such as the type caused by a car accident, muscles and ligaments in the area are stretched beyond their normal limits. In severe instances, the supportive muscles of the spine are torn. Muscles in the surrounding area then tighten to try and support the injured tissues. This limits range of motion and causes strain on those muscles which are not being used to bearing the extra load. This causes more pain.

Muscle pain is your chiropractor’s specialty, so get checked out. And be careful out there.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

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No pain, better game

August 17, 2010 By

My father has become an avid golfer. He plays every Tuesday — and then comes to see me, suffering from back and joint pain.

When I ask him if he warmed up before playing, he demonstrates his stretching routine by whipping his upper body back and forth. Clearly, this routine isn’t working.

Golfers exert a huge amount of effort, repetitively pounding on specific joints (usually on one side of the body). Among other ailments, this can lead to “golfer’s elbow.”

Warming up your joints is essential. Slow stretching lubricates the joints and warms the muscles surrounding them, to prevent tearing of ligaments, tendons, and other soft tissues.

To prevent injury, golfers should do exercises to strengthen the muscles supporting the joints used in golfing. That means they should do exercises to strengthen their shoulders, arms, wrists, legs, knees, ankles, abdominals and low back.

Many of our clients are golfers who compete in weekend tournaments without any preparation — and then wonder why, at the end of two grueling days, they are so sore they can barely move.

Golfers should straighten up, too. Good posture is key to achieving a great golf swing, and it is important to spinal health.

Golf also requires spinal flexibility, so try some yoga. You might be surprised at the improvements they bring to your game.

And if you still have pain after you play, visit a chiropractor. Chiropractors have extensive training in the biomechanics of human movement, so if after playing you feel pain in specific joints or muscles, you probably need those joints adjusted.

People don’t normally think of chiropractic for elbows and knees, but chiropractic is very effective in mobilizing smaller joints and relieving pain.

Your chiropractor can not only treat those repetitive stress injuries but can possibly redirect your swing pattern, improving your game while getting you out of pain.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
Monica Nowak, DC and Peter Markowicz, DC
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

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FIBROMYALGIA and CHIROPRACTIC

August 2, 2010 By

Over the past 25 years that I have been in practice there has been a slow but steady increase in the number of patients that upon entering my office relate that they have fibromyalgia also known as fibromyalgia syndrome or FMS. Some of these patients have been diagnosed by a healthcare professional and some have relied on self-diagnosis, which can be dangerous as I will discuss below. There has been a lot of controversy over FMS from is it a real entity, what exactly is wrong, how to diagnose it and to how to treat it. As a chiropractic physician the question put to me is “how can chiropractic help me with my fibromyalgia?”

Let’s first discuss a bit about what FMS is considered to be. FMS was first recognized by the American Medical Association as a diagnosis in 1987 even though it has been around for much longer than that. The name “fibromyalgia” implies pain and inflammation of the muscles and connective tissues of the body but this is an inaccurate label because there aren’t any actual problems in these particular structures, they just happen to be where the patient “feels” the pain and discomfort. On biopsy of these tissues in a patient considered to have FMS they do not show any inflammatory changes. Also, FMS symptoms do not respond well to anti-inflammatories e.g. prednisone as again these structures are themselves not inflamed. Much like having a pinched nerve in the neck or lower back that sends the pain down the arm or leg; the pain is only felt there, the problem is in the spine itself. The “problem” in FMS appears to be in the central nervous system. The problem in the central nervous system is in the area that controls the bodies sensitivity to pain. The ability to filter or dampen the nerve impulses for pain is impaired and thus stimuli that would not normally be interpreted by the body as painful are. No one knows for sure why this breakdown occurs but it is thought that this part of the central nervous system becomes “burned out” from the body dealing with significant stressful situations. This can be in the form of physical and/or emotional stress. Physical traumas such as auto accidents, which have seemingly been the trigger for some of my patients, or having to deal with stressful family or personal situations over a long period of time can be the underlying cause of this “burn out” situation in the central nervous system. Thus, FMS can be considered to be a post traumatic stress disorder or PTSD.

Patients that have FMS usually have a wide range of symptoms the most common of which are- hurt all over, insomnia, fatigue, depression and anxiety. Many also complain of difficulties with concentration and memory and may experience what many refer to as “fibrofog”. The list of symptoms that have been associated with FMS can be quite lengthy and can almost seem like any symptom you have can be attributed to FMS. Herein lies the biggest problem with a fibromyalgia diagnosis. Because that list of symptoms is so wide ranging someone who has been labeled as having FMS will just assume that any symptom they have is due to it. This can be dangerous as those symptoms may well be from some other underlying illness that is now going to be ignored as the patient assumes that they already know the reason for it. Even the more common symptoms associated with FMS may well be from some other illness or condition. Thus a diagnosis of FMS is usually arrived at through the process of elimination of all other possible causes of the patient’s problems. Other conditions that could give similar symptoms include- hypothyroidism, anemia, Lyme disease, rheumatoid arthritis, hormonal imbalances, allergies as well as numerous other illnesses. That is why it is extremely important to rule out other conditions first as they may be treatable and would therefore go untreated ultimately leading to other health problems if it is just lumped in as a “fibro” symptom. Thus, the person who self diagnoses as having FMS, is doing the worst injustice to themselves as they may have some other treatable condition that is just going to worsen over time. Once all other possible causes are eliminated then a diagnosis of FMS can be considered. The standard accepted criteria for diagnosing FMS, after the elimination process, is having widespread pain in all four quadrants of the body for a minimum of three months and must also have pain in at least 11 of 18 tender points in specific body locations on the application of pressure.

Now, lets get back to the original question, “how can chiropractic help me with my fibromyalgia?” First of all, as stated above, a patient should not just assume that any symptom they have is due to FMS. I have many patients say “there is nothing you can do for me my pain is from fibromyalgia”. Even though you may have FMS you are still entitled to good old-fashioned neck and back pain that may be from sprain/strains, disc related problems or even arthritis. All of which have nothing to do with FMS and can most certainly be treated in my office. They may also have an underlying carpal tunnel syndrome, tennis elbow, bursitis, and many other pain producing conditions not related to FMS that also respond well to chiropractic care. If it is determined that the problems with which the patient presents are indeed related to fibromyalgia and not from other causes then here is what I can do to help them. First of all, as a chiropractor, my number one form of treatment is spinal or extremity manipulation. Manipulations help to restore mobility to joints that may have been lost or reduced due to the tightness of the surrounding muscles as a response to the underlying pain feelings that the patient has. All joints are designed to move and to lose even some of that mobility can cause them to experience discomfort which just adds to that experienced from FMS. I usually also recommend 5-Hydroxytryptophan to help with sleep. Loss of sleep from FMS is the proverbial chicken or the egg scenario. It’s not really known if the lack of good sleep is a trigger for FMS or if having FMS affects the patient’s sleep. Regardless of which comes first to help the patient to have improved restorative sleep is certainly a plus. Also, along the lines of nutrition I recommend taking Magnesium and Malic acid as well as Omega-3 fatty acids all of which has shown some promise for relieving FMS symptoms. Further, a change in diet shifting from processed foods to eating whole foods and preferably organic (without additives, pesticides, hormones or antibiotics) is helpful not only for FMS but for your general overall health. Exercise is also important. Typically, a lot of physical exercise can be aggravating to a FMS patient so I usually recommend low impact type exercises e.g. water exercises, Pilates or especially Yoga which is very good for helping the joints of the body to keep mobile.

In summary, you always want to make sure that you have eliminated all other possible causes of your symptoms before accepting a diagnosis of FMS. Then, once it is established that you have true fibromyalgia, then it would behoove you to seek out natural treatment alternatives such as chiropractic. All you really have to lose is your pain.

David D. Godwin, D.C.
Salisbury Chiropractic
www.salisburychiropractic.us
Salisbury, NC
704-633-9335

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Back Talk

July 27, 2010 By

Summer fun is here and so is summer yard work. Be kind to your spine and take the proper precautions when working hard in your back yard.

First, hydrate. Your body is 70% water and your nervous system is 90% water. Water feeds your body, discs, ligaments and joints.

Position yourself properly. Being bent over, kneeling for long periods of time or lifting and hauling heavy objects can put a strain on your back, shoulders and neck. Bend your knees when lifting; use a kneeling board or stool; and get help with the big stuff.

Rest. Take breaks. Stretch before any strenuous activity and in-between doing them. Warming up your muscles can significantly reduce your chance of injuring yourself. The job may take you a little longer, but your back will thank you in the lung run.

And, finally — get adjusted. Visit your local chiropractor to realign your spine and get that much-needed muscle work done to balance out all that summer “fun”.

People too often put more care and attention into their cars and homes than their own bodies. We only have one and if you take care of yours, it will take care of you.

Monica S. Nowak, DC
Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748
www.PeterMarkowiczDC.com

Above article reprinted with permission from Monica S. Nowak, DC

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Octogenarian wants to dance again

July 16, 2010 By

DEAR DR. GOTT: I am an active 80-year-old female in good health. I’m writing about an injury to my left knee that occurred in December 2007 while dancing. In the same month, I fell down while bowling, injuring both my knee and back. The doctors diagnosed me with spinal stenosis and damaged cartilage of the knee.

I’ve since had chiropractic treatments and massage therapy but am unable to continue due to financial difficulties. I saw an orthopedic surgeon but to my dismay, he didn’t refer me for any treatment. Instead, he administered a cortisone shot and asked that I return for a follow-up visit in three months. Follow-up visits were disappointing as he did not even try to refer me for therapy or anything beneficial to my injury.
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The “Risk” of Chiropractic Manipulation put into Perspective

April 5, 2010 By

As with all health care providers I have to have “informed consent” from my patients before I treat them. This means that their condition and the benefits and risks of treatment are explained to them. They are also advised as to what their treatment alternatives might be and the risks of their condition going untreated before they “consent” to care. As a chiropractic physician this means that I have to explain the benefits and risks of spinal manipulation. Actually, the risks associated with spinal manipulation are extremely rare.

Many studies over the years have touted the benefits of spinal manipulation. Those studies have shown manipulation to be not only highly effective for treating spinal conditions but also to be beneficial to returning people back to work quicker and at less cost. The crux of this article however is to discuss “risks”.

The most common injury associated with spinal manipulation, particularly in the cervical spine, is stroke. Even though there has been much concern placed on this of late the truth of the matter is that studies have not shown a direct causal relationship between chiropractic spinal manipulation and stroke. Unfortunately, a patient who may be getting ready to have a stroke, could be experiencing symptoms that would be similar to a cervical musculoskeletal complaint- which is a common problem that someone would present to a chiropractor for treatment. Chiropractors are trained to screen patients who may be at risk of stroke. They will take a careful history and will perform tests and procedures to determine if a particular patient is at risk. They would then make the judgement as to whether spinal manipulation would be appropriate for that patient and their condition. Per a recent Canadian study there was no more risk of stroke from a visit to a chiropractor’s office than there was to a family physician’s. The actual risk of stroke is so low that a patient would be more likely to suffer serious injuries in an auto accident driving to the office if they lived over one mile away.

A very common medical treatment for neck and spine pain is the use of NSAID’s or non-steroidal anti-inflammatory drugs. Advil (Ibuprophen), Alleve (Naproxen) and Indocine commonly prescribed NSAID’s. They are considered generally safe and are amongst the most prescribed drugs in this country but the risks associated with them are more than 100X greater at 400 in 1 million risk than those associated with chiropractic spinal manipulation. The most common and serious adverse effects from NSAID’s are gastrointestinal ulcerations, hemorrhage and perforations. A recent study in The New England Journal of Medicine estimated that greater than 103,000 patients per year were hospitalized in the US for serious gastrointestinal complications due to the use of NSAID’s with an estimated 16,500 deaths occurring annually. This would rank them as the 15th most common cause of death in this country. Further putting the risk into perspective lets look at other healthcare risks- overall mortality rate for spinal surgery 7 in 10,000 with a death rate from cervical spine surgery 4-10 in 10,000. Risk of death associated with non-healthcare activities are- soccer/ football 1 in 25,000, motorcycling 1 in 50 and skiing 1 in 430,000.

The low risk of injury from chiropractic spinal manipulation is also reflected in malpractice rates. Malpractice rates are determined by the number of claims made against a particular group of healthcare providers by patients. The average rate for chiropractors across the United States is $1500.00 with rates for general practitioners ranging from $10,000 to $20,000 per year.

Thus, taking into account all of the above information, chiropractic spinal manipulation is not only an effective treatment for spinal pain but is also one of the safest. Should you have any concerns in regards to the safety and efficacy of chiropractic please ask your chiropractor to take some time to discuss them with you.

Dr. David D. Godwin
Chiropractic Physician
2907 South Main St.
Salisbury, NC 28147
704-633-9335

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Chiropractic Education

February 22, 2010 By

Having been in practice now for over twenty five years I have been asked innumerable times “How much education does a chiropractor have?” My usual answer is a lot. A typical entering chiropractic student has four years of premedical undergraduate studies in chemistry, biology, physics and psychology, much the same as an entering medical student. I, myself, did graduate work in Biochemistry prior to entering chiropractic school.

The prospective student has a choice of many chiropractic colleges located throughout the United States and in numerous countries around the world.

Once enrolled he or she begins a four to five academic year program of professional study that encompasses a minimum of 4200 hours of classroom, laboratory and clinical experience that includes a minimum of a one-year clinical-based program dealing with actual patient care. In some areas, such as anatomy, physiology, and rehabilitation, they receive more intensive education than most medical doctors or physical therapists. Whereas in medical schools there is a focus of concentration on pharmacology; chiropractic schools have a focus on specific adjusting techniques and therapeutic modalities for the spine and the extremities.

After the successful completion of the above the graduating student is awarded the professional degree of ‘Doctor of Chiropractic’ or D.C.

Before entering practice, doctors of chiropractic must pass four national board examinations as well as individual state board examinations. Chiropractors are licensed as primary care providers (meaning patients have direct access without a referral needed) in all fifty states and many nations throughout the world. They are trained in diagnosis and treatment and have the knowledge to make appropriate referrals when necessary.

To maintain their license the individual states have yearly requirements for post-graduate continuing education. Many chiropractors choose to pursue advanced training in diagnosis, neurology, orthopedics, nutrition and rehabilitation. Thus my answer of “a lot” would be most appropriate.

David D. Godwin, D.C.
Chiropractic Physician
Salisbury Chiropractic
Salisbury, NC
704-633-9335

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