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.

Common Back Pain Myths

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

80% of all Canadians will suffer from at least one significant episode of back pain in their lives.  Below are some of the common myths surrounding back pain and what modern science has to say about them.

 

Myth 1:  If you’ve injured a disc (i.e. herniation, rupture), you must have surgery.

Truth:  Surgery to relieve back pain should only be used as a last resort.  Even if specific testing reveals a damaged disc, recovery often results without surgery.  An injured disc in the back may become inflamed and put pressure on nerves and surrounding pain sensitive structures.  Non-surgical treatment aims at minimizing pain and discomfort from joint irritation and muscle spasm, and prescribing specific exercises to help with recovery.

 

Myth 2:  Most back pain is caused by injuries or heavy lifting.

Truth:  Injuries caused by heavy lifting do not account for all back pain.  In up to 85% of cases, individuals can’t recall a specific incident that brought on their back pain.  Back pain can result from a single exposure to a bending or twisting incident or it can be small cumulative loads placed on the spine over time.  Scientific research also links the following risk factors to back pain: smoking, being overweight, poor posture, poor physical fitness, and stressful life events.

 

Myth 3:  X-ray images, CT and MRI scans can always identify the cause of pain.

Truth:  Even the best imaging tests cannot identify a muscle spasm or ligament sprain that may be the cause of pain.  Imaging is usually reserved for special cases such as those suffering trauma in a fall or accident, surgical candidates, unresolved cases of severe chronic back pain, and suspicion of underlying tumor, infection or other serious disease.

 

Myth 4:  If your back hurts, you should take it easy until the pain goes away.  Bed rest is the mainstay of therapy.

Truth:  Clinical data indicates that individuals who remain active do better than those who try bed rest.  Remaining active means continuing with daily activities as tolerated and easing back into a regular routine.  Activities may have to be modified while recovery occurs, but movement is important for recovery provided it does not put the individual at risk for further injury.

 

Myth 5:  Diagnosing back pain is simple and straightforward.

Truth:  The causes of back pain can be complex and difficult to diagnose.  There are many biological tissues that can generate pain in the back.  These may include muscles, ligaments, bones, nerves, and joints.  Quite often it is a combination of several or all of these structures that can manifest into back pain, and potentially radiating pain into the buttock or leg regions.  Sometimes stress and depression can also contribute to back pain.  A licensed health practitioner who deals with back pain is best trained to diagnose the source(s) of your problem and prescribe appropriate therapy when required.  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.

Low Back Pain: Facts And Fiction

By Dr. Greg Lusk, DC

As you can imagine conversations around low back pain are quite common in the office of a chiropractor.  While we are trained to diagnose and treat muscle and joint related conditions throughout the entire body, pain in the low back area is the most frequent complaint bringing patients through the door.  In addition to any therapy we can provide, education plays an integral role in helping clients understand what may have contributed to their pain, what structure(s) may be causing it, what needs to be done to resolve it, and finally what should be kept in mind as they aim to prevent a recurrence.  That being said, patients often have some misinformed beliefs about low back pain that need to be addressed as these beliefs can have a real influence on how they feel and how easily they may recover.

 

Belief #1

It’s important to know exactly what tissue is causing the low back pain.  There’s no arguing the fact that this would be nice to know but research does not support our ability to determine this in the majority of cases.  Once serious causes have been ruled out, which can largely be done with a good patient history, the many tests we have to stress different structures in the back are not good at isolating the cause.  Even when there is imaging (i.e. x-ray, MRI) that shows an abnormality it’s often not definitive what the source of pain is.  Instead, we have to take all clinical information into account, decide a course of action, and evaluate the outcome of that trial.  As a result, "Mechanical Low Back Pain" is often the best diagnosis available, in all its vagueness.

 

Belief #2

Imaging, such as x-ray or MRI, is needed early for proper diagnosis and treatment.  There are definite indications for imaging, such as suspicion of fracture or cancer, but serious causes of low back pain account for less than 5% of all cases.  Also, if low back pain is accompanied by progressive neurological changes in the legs or is not responding to an appropriate trial of care, imaging becomes warranted.  However, most low back pain does not present this way.  Unfortunately, getting imaging done early can have a negative effect by identifying and attributing value to abnormalities that are not clinically relevant.  In extreme cases, this may result in unnecessary surgery but the far more common negative effect is the patient’s belief that the finding is important and “bad”.  Research repeatedly shows that a high percentage of healthy, pain free individuals have abnormal low back findings with imaging so it’s vital to make sure they’re clinically relevant, not just present.

 

Belief #3

The severity of back pain correlates to the amount of tissue damage present or the degree of injury.  With respect to back pain this simply is not the case.  Pain is a very complicated phenomenon that is affected by many things including, but not limited to, tissue damage, previous injury history, perception of threat to daily activities (i.e. fear), and ideas of what may have occurred.  It is not uncommon to see a client in severe pain be remarkably improved in a few days, which far exceeds the rate of normal tissue healing.  Therefore, tissue injury cannot be the only factor at play.

 

Being an informed patient not only assists recovery but may also help prevent the undesired development of chronic pain.  This article is for general information purposes only and is not to be taken as professional medical advice

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 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.