The Chiropractic Patient Experience

By Dr. John A. Papa, DC, FCCPOR(C)

 

In last week’s article “An Introduction to Chiropractic Care”, we specifically focused on the training and education of chiropractors, regulation of chiropractic, and the scope of chiropractic care.  This article will focus on the chiropractic patient experience written specifically from the author’s perspective of what patients experience at his private practice.  Individual chiropractic experiences may vary in different chiropractic settings dependent on practitioner interests, experience, education, and training.

 

Chiropractors provide diagnosis, treatment and management of disorders arising from the musculoskeletal system (joints, muscles, tendons, nerves, and bones), such as back pain and neck pain.  Before any treatment is commenced on a prospective chiropractic patient, there are several steps that are taken to ensure the case is one that can be helped with chiropractic care.

 

First, a thorough Medical History is taken which documents an individual's specific complaint and may also include questions concerning past surgeries and illnesses, medication use, general and family health history.  Second, a Physical Examination is performed consisting of orthopedic, neurological, and range of motion testing.  X-rays may also be ordered to help determine the source of pain or dysfunction.  Third, a Diagnosis and Prognosis is provided to the patient to let them know if their complaint(s) can benefit from chiropractic care.  If the complaint will not benefit from chiropractic care, a referral is made to the appropriate health discipline.

 

For all complaints that may benefit from chiropractic care, a proposed treatment plan is communicated to the patient, including type of treatment and duration.  Factors taken into consideration when developing a treatment plan for a particular individual include age, sex, severity and duration of complaint, lifestyle and environmental factors, physical health and fitness, medication use, and any other relevant health conditions.  In addition, factors relating to patient concerns and preferences are also taken into account, because patients always have a choice as to the type of care they wish to receive.

 

Chiropractors are trained to offer multi-modal physical therapy incorporating the use of different techniques commonly employed in combination with each other to decrease pain, stimulate healing, and restore overall function.  Chiropractic adjustments and mobilizations are just one mode of therapy utilized by chiropractors (but not with every patient), to restore normal motion and functioning in joints.  Soft tissue therapy is used to alleviate muscle spasm, decrease scar tissue, and increase pain free ranges of motion.  Electrotherapy involves the application of relaxing therapeutic electrical current or sound waves to the area of injury, dysfunction, or pain (i.e. TENS, interferential current, ultrasound).  Acupuncture can be used to promote healing, decrease pain, and control inflammation.  Rehabilitative exercise prescription may also be used to improve balance, coordination, strength, flexibility, and posture.

 

Contemporary chiropractic care provides many options for prospective and current patients seeking effective and safe therapy for their musculoskeletal complaints.  Additional chiropractic resources can be found at:  (www.nhwc.ca), (www.chiropractic.on.ca), and (www.ccachiro.org).

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

 

An Introduction To Chiropractic Care

By Dr. John A. Papa, DC, FCCPOR(C)

Chiropractic is one of the largest primary contact health professions in Canada.  Approximately four and a half million Canadians use the services of a chiropractor each year.  Despite the professions growing popularity, there are still many in the public who don’t exactly know what services a chiropractor performs or what qualifications and training they possess.  This article is the first of a two part series introducing the chiropractic health discipline and the profession’s role in the health care system.

A large majority of patients who seek chiropractic care do so for complaints of the musculoskeletal system (joints, muscles, tendons, nerves and bones).  Chiropractors provide diagnosis, treatment and management of these complaints which may include but are not limited to:  back pain, neck pain, sciatica, whiplash, osteoarthritis, migraine and tension headaches, upper and lower extremity complaints, along with repetitive strain, sport, work and motor vehicle injuries.

Chiropractic practitioners undergo a rigorous course of study similar to that of other health professionals.  Training involves a minimum of three years undergraduate university education, followed by another four years of intensive academic and clinical education at an accredited chiropractic college.  Becoming licensed to practice chiropractic requires all eligible candidates to pass national and provincial examinations before applying to the Licensing Board.  Specialized post-graduate training enables the chiropractors of today to offer their patients additional treatment options.

Chiropractic in Canada is regulated by provincial statute in all provinces (The Chiropractic Act, 1991), created in accordance with the Regulated Health Professions Act (RHPA, 1991).  Chiropractors along with medical doctors, dentists, psychologists, and optometrists have the legislated right and obligation to communicate a diagnosis and to use the title doctor.  The College of Chiropractors of Ontario, like the colleges in each of the other provinces, is similar to the regulatory bodies for other health professions.  It is responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.

Chiropractic is well recognized within the health care system.  Chiropractic care is covered by the Workplace Safety and Insurance Board (WSIB) for occupational injuries, by automobile insurance in the event of a motor vehicle accident (MVA) injury, and by many Extended Health Care (EHC) plans.  A medical referral is not necessary to access chiropractic care.  Chiropractic adjustments are just one mode of therapy utilized by chiropractors today (but not with every patient).  Some chiropractors are also trained to employ other forms of physical therapy such as acupuncture, electrotherapy, soft tissue therapy, and rehabilitative exercises.  If your complaint is not something that would respond favorably to chiropractic care, a referral is made to the appropriate health professional.

Additional chiropractic resources can be found at: (www.nhwc.ca), (www.chiropractic.on.ca), and (www.ccachiro.org).  Join us next time for the second part of this series on chiropractic where you will learn about the chiropractic experience from a patient’s perspective.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

The Chiropractic Patient Experience

By Dr. John A. Papa, DC, FCCPOR(C)

In last week’s article “An Introduction to Chiropractic Care”, we specifically focused on the training and education of chiropractors, regulation of chiropractic, and the scope of chiropractic care. This article will focus on the chiropractic patient experience written specifically from the author’s perspective of what patients experience at his private practice. Individual chiropractic experiences may vary in different chiropractic settings dependent on practitioner interests, experience, education, and training.

Chiropractors provide diagnosis, treatment and management of disorders arising from the musculoskeletal system (joints, muscles, tendons, nerves, and bones), such as back pain and neck pain. Before any treatment is commenced on a prospective chiropractic patient, there are several steps that are taken to ensure the case is one that can be helped with chiropractic care.

First, a thorough Medical History is taken which documents an individual's specific

complaint and may also include questions concerning past surgeries and illnesses, medication use, general and family health history. Second, a Physical Examination is performed consisting of orthopedic, neurological, and range of motion testing. X-rays may also be ordered to help determine the source of pain or dysfunction. Third, a Diagnosis and Prognosis is provided to the patient to let them know if their complaint(s) can benefit from chiropractic care. If the complaint will not benefit from chiropractic care, a referral is made to the appropriate health discipline.

For all complaints that may benefit from chiropractic care, a proposed treatment plan is communicated to the patient, including type of treatment and duration. Factors taken into consideration when developing a treatment plan for a particular individual include age, sex, severity and duration of complaint, lifestyle and environmental factors, physical health and fitness, medication use, and any other relevant health conditions. In addition, factors relating to patient concerns and preferences are also taken into account, because patients always have a choice as to the type of care they wish to receive.

Chiropractors are trained to offer multi-modal physical therapy incorporating the use of

different techniques commonly employed in combination with each other to decrease pain, stimulate healing, and restore overall function. Chiropractic adjustments and mobilizations are just one mode of therapy utilized by chiropractors (but not with every patient), to restore normal motion and functioning in joints. Soft tissue therapy is used to alleviate muscle spasm, decrease scar tissue, and increase pain free ranges of motion. Electrotherapy involves the application of relaxing therapeutic electrical current or sound waves to the area of injury, dysfunction, or pain (i.e. TENS, interferential current, ultrasound). Acupuncture can be used to promote healing, decrease pain, and control inflammation. Rehabilitative exercise prescription may also be used to improve balance, coordination, strength, flexibility, and posture.

Contemporary chiropractic care provides many options for prospective and current patients seeking effective and safe therapy for their musculoskeletal complaints. Additional chiropractic resources can be found at: (www.nhwc.ca), (www.chiropractic.on.ca), and (www.ccachiro.org).

This article is a basic summary for educational purposes only. It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

 

Understanding Neck Pain

By Dr. John A. Papa, DC, FCCPOR(C)

 

Neck pain is a widespread experience among the general population, with 30-50% of adults reporting pain symptoms at any given time.  Once an episode of neck pain happens, most individuals will find it is a persistent or recurrent condition.  The purpose of this article is to outline our current scientific understanding of neck pain.

 

The cause of neck pain is usually multi-factorial, meaning that there is usually no single cause.  Factors such as overall physical and mental health, along with work and daily activities are just a few factors that can contribute to the development of neck pain.  Most causes are not the result of serious injury or disease.

 

 

Neck pain can affect people in different ways and is usually classified into the following categories:

 

GRADE 1: Neck pain with no signs or symptoms suggestive of major structural pathology, and little or no interference with daily activities.

 

GRADE 2:  Neck pain with no signs or symptoms suggestive of major structural pathology that limits daily activities.

 

GRADE 3:  Neck pain with no signs or symptoms suggestive of major structural pathology, with presence of neurologic signs of nerve compression (i.e. radiculopathy or "pinched nerve") and may include pain, weakness and/or numbness in the arm.

 

GRADE 4:  Neck pain with signs or symptoms suggestive of serious structural pathology (i.e. tumor, fracture, infection, systemic or visceral disease).

 

 

Evaluation of neck pain should include a proper medical history, along with a physical examination consisting of inspection, range of motion testing, and palpation for tenderness, along with strength, neurological, orthopaedic and functional testing.  Diagnostic tests such as x-rays, CT or MRI scans are only required in a minority of cases.

 

The majority of neck pain is classified as Grade 1 or 2.  There is scientific evidence to support the following treatments for Grades 1 and 2 neck pain: education, exercise, mobilization, manipulation, acupuncture, soft tissue therapy, and analgesics.  Conservative treatment of Grade 3 neck pain should proceed with caution.  The majority of Grade 4 neck pain will require specialty medical management.

 

Due to the persistent and recurring nature of neck pain, individuals need to have realistic expectations when addressing their symptoms as pain relief is often modest and short-lived. The scientific literature does not identify any “best” treatment that is effective for everyone.  Trying a variety of therapies or combination of therapies may be required to find relief and help manage neck pain.  It is important that individuals play an active role in managing their symptoms by participating in their usual daily activities as tolerated, exercising, and reducing mental stress.

 

Most people can expect to experience some neck pain in their lifetime that may or may  not limit daily activities.  For those with neck pain that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate conservative therapy, rehabilitation and self-management strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tennis Elbow...Minus the Tennis!

By Dr. Greg Lusk, DC

"Tennis Elbow" is the common term for lateral epicondylitis, which refers to an overuse muscle strain injury of the tendons that attach to the outside of the elbow.  This is in contrast to "golfer's elbow" where pain is experienced on the inside of the elbow.  Despite its name, most cases of tennis elbow are not related to tennis but to other causes of stress and strain to the elbow.  Repetitive gripping or leveraging activities are common culprits as muscles involved in these activities attach to the bony bump on the outer elbow.  Occupations or activities with repetitive hand use, such as carpentry, weight training, and even constant computer mouse use can contribute to development of this condition.

The symptoms of tennis elbow may include pain at the bony bump on the outside of the elbow and possibly down the back of the forearm to the wrist.  Pain is often experienced with gripping activities and even things as simple as holding a cup of water can become quite painful, requiring the assistance of the other hand to support the load.

 

Early on (i.e. within the first few weeks), self care efforts such as icing, avoiding aggravating activities, and the use of pain medications may be sufficient to ease the pain.  However, if the pain persists, which is quite common, it would be appropriate to seek treatment to help get things under control.  In fact, the longer this condition lasts the less likely the pain is due to inflammation in the soft tissues but rather to degenerative changes in the tendon.  This is true for all tendon injuries and at least in part explains why long term ice and anti-inflammatory medication use may not be effective beyond their "pain killing" benefits.

Management of a degenerated tendon is different than that of an inflamed tendon as the tendon structure has become disorganized and scar tissue is present, in the absence of inflammatory markers.  Healing and regeneration of the tendon must be facilitated and conservative treatment to assist this may involve the following techniques and strategies. 

·        Manual or tool-assisted soft tissue therapies are effective at breaking up scar tissue, improving blood and lymph movement in the tissues, decreasing tissue tension, and improving relative movement of one tissue across another.  Also, the micro trauma caused by the soft tissue treatment itself helps to restart the healing process with the end goal being a healthier, more properly organized tendon structure.

·        Eccentric exercises.  This refers to the part of an exercise movement where the muscle is lengthening while maintaining control of the weight.  Research shows this increases protein production in the tendon which is important for healing.

·        Other treatments, such as acupuncture or electrotherapies, may help at promoting healing and managing the associated pain.

·        Adequate rest is important to let the structural damage to the tendon heal.

·        Looking at the aggravating activities and modifying things to decrease the load imposed on the tendon.  In the case of tennis, there may be swing or footwork improvements that can be made which will decrease strain at the elbow.

 On a final note, if the above ideas or other treatments directed at the elbow are not yielding positive results after a fair trial period, it would be worth having your shoulder and neck assessed as anatomy located here can cause pain at the elbow and may be the ultimate source of stubborn elbow pain.

This article is for general information purposes only and is not to be taken as professional medical advice.

Plantar Fasciitis: A Common Source Of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)

Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.

 

Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.

 

Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.

 

Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.

 

Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.

 

Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapy, manual and soft tissue therapy, and specific rehabilitative exercises for the foot and lower leg.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.

 

It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding Neck Pain

 

By Dr. John A. Papa, DC, FCCPOR(C)

 

Neck pain is a widespread experience among the general population, with 30-50% of adults reporting pain symptoms at any given time.  Once an episode of neck pain happens, most individuals will find it is a persistent or recurrent condition.  The purpose of this article is to outline our current scientific understanding of neck pain.

 

The cause of neck pain is usually multi-factorial, meaning that there is usually no single cause.  Factors such as overall physical and mental health, along with work and daily activities are just a few factors that can contribute to the development of neck pain.  Most causes are not the result of serious injury or disease.

 

Neck pain can affect people in different ways and is usually classified into the following categories:

 

GRADE 1: Neck pain with no signs or symptoms suggestive of major structural pathology, and little or no interference with daily activities.

 

GRADE 2:  Neck pain with no signs or symptoms suggestive of major structural pathology that limits daily activities.

 

GRADE 3:  Neck pain with no signs or symptoms suggestive of major structural pathology, with presence of neurologic signs of nerve compression (i.e. radiculopathy or "pinched nerve") and may include pain, weakness and/or numbness in the arm.

 

GRADE 4:  Neck pain with signs or symptoms suggestive of serious structural pathology (i.e. tumor, fracture, infection, systemic or visceral disease).

 

Evaluation of neck pain should include a proper medical history, along with a physical examination consisting of inspection, range of motion testing, and palpation for tenderness, along with strength, neurological, orthopaedic and functional testing.  Diagnostic tests such as x-rays, CT or MRI scans are only required in a minority of cases.

 

The majority of neck pain is classified as Grade 1 or 2.  There is scientific evidence to support the following treatments for Grades 1 and 2 neck pain: education, exercise, mobilization, manipulation, acupuncture, soft tissue therapy, and analgesics.  Conservative treatment of Grade 3 neck pain should proceed with caution.  The majority of Grade 4 neck pain will require specialty medical management.

 

Due to the persistent and recurring nature of neck pain, individuals need to have realistic expectations hen addressing their symptoms as pain relief is often modest and short-lived.  The scientific literature does not identify any “best” treatment that is effective for everyone.  Trying a variety of therapies or combination of therapies may be required to find relief and help manage neck pain.  It is important that individuals play an active role in managing their symptoms by participating in their usual daily activities as tolerated, exercising, and reducing mental stress.

 

Most people can expect to experience some neck pain in their lifetime that may or may  not limit daily activities.  For those with neck pain that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate conservative therapy, rehabilitation and self-management strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

The Chirorpactic Patient Experience

By Dr. John A. Papa, DC, FCCPOR(C)

 

In last month’s article “An Introduction to Chiropractic Care”, we specifically focused on the training and education of chiropractors, regulation of chiropractic, and the scope of chiropractic care.  This article will focus on the chiropractic patient experience written specifically from the author’s perspective of what patients experience at his private practice.  Individual chiropractic experiences may vary in different chiropractic settings dependent on practitioner interests, experience, education, and training.

 

Chiropractors provide diagnosis, treatment and management of disorders arising from the musculoskeletal system (joints, muscles, tendons, nerves, and bones), such as back pain and neck pain.  Before any treatment is commenced on a prospective chiropractic patient, there are several steps that are taken to ensure the case is one that can be helped with chiropractic care.

 

First, a thorough Medical History is taken which documents an individual's specific complaint and may also include questions concerning past surgeries and illnesses, medication use, general and family health history.  Second, a Physical Examination is performed consisting of orthopedic, neurological, and range of motion testing.  X-rays may also be ordered to help determine the source of pain or dysfunction.  Third, a Diagnosis and Prognosis is provided to the patient to let them know if their complaint(s) can benefit from chiropractic care.  If the complaint will not benefit from chiropractic care, a referral is made to the appropriate health discipline.

 

For all complaints that may benefit from chiropractic care, a proposed treatment plan is communicated to the patient, including type of treatment and duration.  Factors taken into consideration when developing a treatment plan for a particular individual include age, sex, severity and duration of complaint, lifestyle and environmental factors, physical health and fitness, medication use, and any other relevant health conditions.  In addition, factors relating to patient concerns and preferences are also taken into account, because patients always have a choice as to the type of care they wish to receive.

 

Chiropractors are trained to offer multi-modal physical therapy incorporating the use of different techniques commonly employed in combination with each other to decrease pain, stimulate healing, and restore overall function.  Chiropractic adjustments and mobilizations are just one mode of therapy utilized by chiropractors (but not with every patient), to restore normal motion and functioning in joints.  Soft tissue therapy is used to alleviate muscle spasm, decrease scar tissue, and increase pain free ranges of motion.  Electrotherapy involves the application of relaxing therapeutic electrical current or sound waves to the area of injury, dysfunction, or pain (i.e. TENS, interferential current, ultrasound).  Acupuncture can be used to promote healing, decrease pain, and control inflammation.  Rehabilitative exercise prescription may also be used to improve balance, coordination, strength, flexibility, and posture.

 

Contemporary chiropractic care provides many options for prospective and current patients seeking effective and safe therapy for their musculoskeletal complaints.  Additional chiropractic resources can be found at:  (www.nhwc.ca), (www.chiropractic.on.ca), and (www.ccachiro.org).

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.