See the MRI’s here? It’s an office worker on left and truck driver on right. Twin siblings 56 years old. They show high degrees of similarity in disc degeneration despite high differences in their lifetime physical exposure to loading.
The findings of the Twin Spine Study, an ongoing research program started in 1991, have led to a dramatic paradigm shift in the way disc degeneration is understood. In the past, the factors most commonly suspected of accelerating degenerative changes in the discs were various occupational physical loading conditions, such as handling of heavy materials, postural loading and vehicular vibration.
Drawing on information from 600 participants in the population-based Finnish Twin Cohort–147 pairs of identical and 153 pairs of fraternal male twins–the Twin Spine Study has turned around the “injury model” approach to disc degeneration.
Researchers from Canada, Finland, the United States and the United Kingdom compared identical twin siblings who differed greatly in their exposure to a suspected risk factor for back problems; for example, one of the twins had a sedentary job while the other had heavy occupational physical demands, or one routinely engaged in occupational driving while the other did not. The studies yielded startling results, suggesting that genetics play a much larger role in disc degeneration than we previously thought.
The findings indicated that while physical loading–handling heavy loads, bending, twisting and static work in awkward postures–appears to influence disc degeneration, the effects are very modest. The Twin Spine Study is far from over: having found evidence that genetics may play an overlooked role in disc degeneration, the team of North American and European is now working to identify the specific genes and biological mechanisms influencing disc degeneration and back pain problems; understanding how degeneration progresses over time; and differentiating normal, inconsequential changes from degenerative changes that lead to pain.
What’s the take home point here? I think it’s not that your life can be a physical loading free for all and the stressors you put on your spine don’t matter — they do. Trauma and repetitive strain can certainly have an effect on the degenerative process. However, family history is more likely than once thought to be a risk factor for spinal problems — or resistance to spinal problems. In other words, if you are among the 20% of the population who does not experience some form of low back pain in their lifetime, thank your genetics (and your parents).
Dr. Brett L. Kinsler is a chiropractor serving the greater Rochester NY area.
I am frequently asked by patients about the use of backbelts for spinal injury prevention. The short answer is that we’ve know for quite some time that these strappy supports rarely do anything to prevent low back injuries and a recently updated Cochrane review supports this practice.
To top things off (or wrap them up I suppose), the corset-like belts may actually allow back and abdominal muscles to weaken as they become dependent on the additional artificial external support.
We do occasionally recommend a support belt for patients in acute pain as a temporary pain relieving measure or for pregnant patients (a different kind of belt for them). We will also on occasion have patients wear a belt for short periods during tasks that may require additional support but long term, all day use should be avoided.
LOUISIANA – Having just finished a long weekend staying in the French Quarter of New Orleans, I was in for some surprises. This was my first trip to NOLA post-Katrina and I was expecting to see a lot of devastation still.
What I found was the entire French Quarter intact. Even the areas around downtown seemed just fine. Sure, there was some blight just a few blocks off Bourbon Street though there was always blight in New Orleans. There seems to be a lot of vacancy in both residential rental properties and commercial storefronts. I think this speaks more to the confidence level people have of the area more-so than anything else.
The restructuring and rebuilding of a city that spent days under 15 feet of water is well underway. Interestingly, the locals notice tourism and convention traffic is down but they think it’s because of the NOLA crime rate. They don’t realize the rest of the country pretty much thinks New Orleans consists of Bourbon Street surrounded by a vast wasteland of abandonded houses and buildings.
The question remains if something like Katrina can happen again. The experts seem to indicate that it will and unless the floodgates are rebuilt to higher standards, the future damage to the city built below sea-level will be worse than last time.
If you are considering whether or not to make a visit, I suggest you do not hesitate…although you may want to avoid hurricane season.
Every day I must ask patients how they rate their pain. It seems stupid and patients are frequently stumped.
ME: Where is your pain on a scale from zero to ten with ten being the worst pain you’ve ever experienced and zero being no pain.
THEM: It hurts.
ME: I know, but can you put it on that scale?
THEM: It freakin’ hurts a lot.
ME: So like an 8?
THEM: Whatever. Can you fix it?
A patient recently told me about the PAIN exhibit www.painexhibit.com The PAIN Exhibit is an educational, visual arts exhibit from artists with chronic pain with their art expressing some facet of the pain experience. The mission of the PAIN Exhibit is to educate healthcare providers and the public about chronic pain through art; and to give voice to the many who suffer in abject silence.
Some of the pieces on the website are awe-inspiring. Some truly disturbing. Most are poignent. Many are worth seeing.
Perhaps instead of pressing patients for a pain rating, we should hand some of them a box of crayons.
Dr. Brett Kinsler is a chiropractor in Rochester, NY
Auburn University researchers have found that wearing thong-style flip-flops can result in sore feet, ankles and legs. The research team presented its findings at the recent annual meeting of the American College of Sports Medicine in Indianapolis.
The study found that when people walk in flip-flops, they alter their gait, which can result in problems and pain from the foot up into the hips and lower back. Variations like this at the foot can result in changes up the kinetic chain, which in this case can extend upward in the wearer’s body.
Thirty-nine college-aged men and women were recruited for the study. Participants, wearing thong-style flip-flops and then traditional athletic shoes, walked a platform that measured vertical force as the walkers’ feet hit the ground. In addition, a video camcorder measured stride length and limb angles.
It turns out that flip-flop wearers take shorter steps and that their heels hit the ground with less vertical force than when the same walkers wore athletic shoes. When wearing flip-flops, the study participants did not bring their toes up as much during the leg’s swing phase, resulting in a larger ankle angle and shorter stride length, possibly because they tended to grip the flip-flops with their toes.
The research does not suggest that people should never wear flip-flops. They can be worn to provide short-term benefits such as helping beach-goers avoid sandy shoes or giving athletes post-game relief from their athletic shoes, but are not designed to properly support the foot and ankle during all-day wear. Improper foot and ankle support frequently leads to knee, hip and lower back problems as well.
Don’t let bad footwear cause you to have a painful summer.
It never ceases to amaze me that people will see something outrageous and their first instinct is to, well, actually believe it. Skepticism is dead in this country and I am certain it is the Internet, and probably YouTube, that killed it.
“But I saw it! I saw it!”
Yeah, you saw with your own two eyes the videos where people put a few cellphones together pointing at a few kernels of popcorn. They call the phones simultaneously and, POOF (or POP), the popcorn begins popping. Supposedly, it is the cell phone radiation causing the popcorn to cook. And imagine what it does to your brain?
Well, not much. Apparently, these videos of the cell phone popped corn were staged by Cardo Systems, the maker of bluetooth wireless headsets, as a publicity stunt. Cardo admits to that on their website posting that the popping of popcorn with a cell phone occurs only in the movies. The company also stated “The ‘cell phone and popcorn popping campaign’ is completely untrue and a joke. It has been seen by over 4.1 million users already and has become a sort of global urban legend as it continues to be tried throughout the world.”
Urban legend indeed. When I get one of these e-mails, my first stop is Snopes.com to check the validity. Sure enough, you can’t cook an egg between two cell phones on a 60 minute call and you can’t pop popcorn with cell phone RF.
Dr. Brett Kinsler is a skeptic and chiropractor who practices in Rochester, NY. His website is www.RochesterChiro.com
As in all branches of healthcare, the doctor-patient relationship is paramount to the practice of chiropractic, but is an extremely complex interpersonal exchange.The relationship must be strong and be based on good communication, openness and trust in order to facilitate a proper diagnosis and treatment.The patient must trust his chiropractor and have confidence in his training, competence and continuity.The chiropractor should be adept at making patients feel at ease and developing rapport.A sense of humor is important for making a patient feel comfortable and reducing tension.
The doctor-patient relationship is the cornerstone of medical ethics and goes well beyond the legal covenant of patient privilege.The doctor of chiropractic has numerous duties to the patient in their partnership, including:
Beneficence – assisting the patient in improving his or her health and conditions
Non-malfeasance – first, do no harm
Respect for patient autonomy, choice and individuality
Respect for patient dignity, privacy and right to confidentiality
The doctor’s role is to guide the patient in making treatment decisions in the patient’s best interest.
The chiropractor should be available to patients in an emergency situation, willing to return phone calls to answer reasonable questions and prompt in reporting test results to patients.
Patients can assist in the doctor-patient relationship by:
Being prepared with their questions and concerns in advance of a visit
Respecting the doctor’s time and professional boundaries
Ensuring their chiropractor has an up-to-date listing of their medications, surgeries, allergies and health conditions
Ensuring third-party payer arrangements and financial obligations are met
Having realistic expectations in their goals
Be willing to be an active participant in his or her treatment plan
Back pain is one of the most common reasons for patient visits to a doctor’s office and patients often wonder who they should see for back pain treatment. Below is a list of some of the most common types of doctors seen for back pain and what one might expect on a visit:
Family Physicians, General Practitioners, Internists
These are the most frequently visited physicians for low back pain. The medical doctor may be called upon to make an initial diagnosis. After taking the history, the medical doctor can review the systems of the body to determine the cause of pain and determine any risk factors. This group is experienced in the treatment of acute low back pain, they are able to rule out the serious problems such as organic disease, cancer and infection. In the absence of high risk factors listed above, this group of physicians may elect to treat low back pain with medications, ergonomic recommendations and chiropractic or physical therapy referral. If the patient’s symptoms fail to respond, they will often perform additional testing or imaging and/or refer the patient to a specialist.
Chiropractors, Chiropractic Physicians
Chiropractic is the largest non-surgical and drugless healing profession and is the third largest healthcare profession in the United States after medicine and dentistry. Many patients with low back pain obtain relief using chiropractic care. The Agency For Health Care Policy Reform says that chiropractic treatment and exercise is often the most beneficial form of treatment for acute low back pain. Chiropractors perform manipulative treatments or spinal adjustments and treatments which may also include passive modalities like cold laser therapy, electrical stimulation, ultrasound, stretching, exercise, rehabilitation and nutritional counseling. Chiropractors do not prescribe medications and do order special diagnostic testing when needed.
Physiatrists
This group of medical doctors specializes in the treatment of musculoskeletel injuries as low back pain. They are medical doctors who practice physical therapy, physical medicine and rehabilitation. The therapy they prescribe often includes exercise, therapeutic modalities and hot and cold packs. They prescribe medications and order other laboratory or diagnostic testing as indicated. They may also include physical therapists and occupational therapists as part of the treatment plan and sometimes have them as part of their staff. Some physiatrists work in pain management clinics (see below).
Neurologists
These physicians specialize in the treatment of disorders of the nervous system. They perform detailed neurological exams, and order tests to diagnosis causes of pain and weakness.
Pain Management Specialists
Pain Specialists and Anesthesiologists see patients who fail to improve under the more conservative approaches but for whom surgery is not an option. Their treatments may include medications and injections, nerve blocks, implantable pain devices or stimulators. Pain Psychologists are also included in this group for the evaluation and treatment of the psychological component of low back pain.
Neurosurgeons and Orthopedic Surgeons
These physicians concentrate in the surgical treatment of low back and lower extremity pain. Spinal attempts to maintain or enhance stability to the lumbar spine, while taking pressure off of the nerves to relieve pain and increase function.
Yesterday, a patient came to my office and told me her medical doctor sent her to me to see if I did spinal decompression. For those of you who don’t know, non-surgical spinal decompression uses a specialized type of chiropractic table that provides computer assisted traction in order to separate the spinal bones and promote disc and ligament healing. Devices are known as the DRX-9000, VAXD, Lordex, DRS and others. The problem is, there are too many problems.
Spinal decompression is a good procedure but has not been shown to be any better than techniques like Flexion-Distraction.
Providers of spinal decompression almost always claim superiority of their technique over others.
Spinal decompression devices are much, much, much more expensive than traditional flexion-distraction devices.
In order to pay for their expensive, computerized tables, many spinal decompression doctors resort to false or misleading advertising, pre-paid treatment plans and other unethical practices.
Decompression chiropractors frequently prescribe a 20 visit minimum treatment protocol (usually at about $200 per visit!!) for which there is no clinical rationale. Many of these patients would get better faster with other treatment methods.
I don’t have a problem with the DRX-9000 or other SD tables in and of themselves. The theory is pretty good and mirrors the excellent results we obtain with flexion-distraction for disc herniations and bulges. I have a major issue with the false and misleading practices, the high-pressure sales tactics, the false claims of superiority and the pre-paid treatment plans. I also don’t feel like paying an extra $60k to hook my table up to a computer.
I sent the MD who inquired about the technique a nice letter along with a copy of some of the articles naming lawsuits concerning the spinal decompression practices and some of the major insurance company positions on decompression (is it considered experimental and no better than currently available procedures). It would be nice to see this become a legitimate piece of equipment as a tool for chiropractors to use but as of now, there is too much controversy and too many unethical practices associated with it.
You will not find one in my office.
Dr. Brett Kinsler is a chiropractor in Rochester, NY. He gets excellent results with patients who have disc injuries and doesn’t use spinal decompression in his Rochester chiropractic offices. His website is www.RochesterChiro.com
The U.S. House of Representatives has approved a directive that orders the Pentagon to make chiropractic care a standard benefit for all active-duty military personnel. The legislation is contained in H.R. 5658, a bill authorizing defense programs in fiscal year 2009, and is based in part on recommendations from the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). The bill — passed by the Armed Services Committee on May 14 and the full House on May 22 — also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic.
In 2000, Congress passed and the president signed a similar authorization bill, which contained language calling on the secretary of defense to develop a plan to get the chiropractic benefit to all active-duty service members To date, chiropractors are at 49 military bases around the country; however, according to a 2005 Government Accountability Office (GAO) report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. This most recent legislation shelves the plan approach and simply states that chiropractic care is a standard healthcare benefit. According to ACA sources, the House Armed Services committee also expressed concern that there were no doctors of chiropractic stationed at overseas military facilities. The language contained within H.R. 5658 allows the Pentagon to conduct demonstration projects to implement chiropractic care at these sites.
Source: American Chiropractic Association, www.acatoday.com
