Teaching Activity Modification Requires Constant Reinforcement

Humans are largely creatures of habit. It can be difficult to influence people to change the way they do things, particularly when they have years of a under their belts.

Chiropractors often experience this challenge with patients who require activity modification to prevent pain and amplify healing due to an injury or chronic condition. Enforcing non-damaging movements in patients outside the chiropractic office can be difficult.

This is why the team at Ideal Spine suggests chiropractors practice constant reinforcement when it comes to activity modification – particularly for patients with chronic problems in which harmful motions may cause lasting damage.

What is activity modification?

Activity modification represents a temporary change in the way everyday activities are performed. This is usually necessary to prevent future or further injury of the spine and nervous system following the identification of an injury or weakness.

Teaching patients about activity modification also helps them continue moving, in spite of fear of pain. It is an important aspect of at-home care. Patients should learn which movements to avoid, as they can put additional stress on the injured area, and ways to accomplish similar tasks without the added stress or pain.

Activity modification will not cure the patient’s ailments, but it may result in a reduction of symptoms – sometimes this reduction can be significant enough that the patient feels like their condition is gone. The goal is to help the patient to live as free of pain as possible and allow the body to heal.

During activity medication, patients should stay active to maintain adequate function and range of motion. Activity modification does not require complete rest or inactivity. In fact, too little activity may result in a worsened condition or the development of another problem, such as muscled degradation.

However, slight changes in movements to accommodate for symptoms may help the body heal from its injury and naturally ease symptoms over time – particularly inflammation.

Reinforcing modification methods to patients

Activity modification is usually only recommended for short periods of time – it is not a necessary life-long adjustment. However, this short timespan can work against patients who forget to make the modifications and instead continue to engage in potentially painful or damaging movements.

For patients with chronic problems, such as osteoarthritis, activity modification may need to be a more long-term care strategy.

Because activity modification is largely an at-home treatment method, chiropractors must work with their patients to reinforce the modifications during their appointments. The use of in-office demonstrations, pamphlets, videos, and discussions may help influence patients to use the modifications in their day to day lives.

It may help to provide patients with an approved list of motions and exercises they should focus on to maintain mobility. Emphasizing routine completion of the correct motions may overshadow the warnings against improper ones and successfully influence the activity modification.

Without the adequate completion and reinforcement of activity modification, patients may continue to do actions that worsen their injuries and prevent the body from healing completely.

Of course, activity modification is just one aspect of a much larger treatment plan for a variety of musculoskeletal problems. The team at Ideal Spine helps chiropractors implement the holistic treatments of Chiropractic BioPhysics (CBP) in their practices for a more comprehensive approach to patient wellness.

Chiropractic BioPhysics® corrective care trained Chiropractors are located throughout the United States and in several international locations. CBP providers have helped thousands of people throughout the world realign their spine back to health, and eliminate a source of chronic back pain, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. The exam and consultation are often FREE. See www.CBPpatient.com for providers in your area.

Testing for Range of Motion Diminished by Ankylosing Spondylitis

Back pain is a common complaint of chiropractic patients today, but certain conditions cause more unique symptoms that give professionals a better idea of what they are dealing with. In the case of ankylosing spondylitis, a very limited range of motion in the back and pelvis after persistent pain is sometimes enough to clue chiropractors in to the specific condition.

Limited range of motion can be damaging to patients. At Ideal Spine, we encourage chiropractors to become skilled at identifying range of motion loss as well as in treating it through varied methods to improve each patient’s quality of life. In order to do this effectively, thorough testing is required.

How ankylosing spondylitis affects range of motion

Ankylosing spondylitis is a type of arthritis largely affecting the spine. It can cause significant inflammation along the spine, resulting in stiffness in the back, as well as potentially in the knees, hips, and shoulders.

Persistent inflammation from ankylosing spondylitis often causes the joints and vertebrae to actually fuse together over time. This is due to the body’s healing response as it grows new bone and scar tissue at the inflamed areas of the spine. These fusions are usually weak but can cause rigidity in the spine, preventing flexible movement. Not all patients will experience this severe form of the condition, but many do.

Both the inflammation and the fusion can have a negative impact on the patient’s range of motion, prohibiting complete movement in one or multiple directions.

Identifying poor range of motion in your practice

When a patient is suspected to suffer from ankylosing spondylitis, it’s important to begin by testing their current range of motion capabilities. This provides a baseline before you create a treatment plan to potentially improve the conditions in the spine.

By evaluating the degree of mobility in different segments of the body – including the trunk, shoulders, hips, and knees – you may be able to tell almost immediately where the patient experiences symptoms of the condition the most.

Have the patient walk, sit, squat, and bend forward and backward as part of this testing, since many patients experience pain and stiffness around the sacroiliac (SI) joints. The areas of pain and those with limited movement will be the ones that should be targeted, in particular – particularly if the range of motion loss interferes with daily life.

Additional scans may be necessary to truly determine where new bone growth and fusion may be significantly hindering range of motion, versus where inflammation is merely causing stiffness.

Treatments for addressing ankylosing spondylitis mobility problems

There is no cure for ankylosing spondylitis, so a treatment plan using Chiropractic BioPhysics (CBP) methods is generally the best possible response. The earlier the condition is discovered, the more easily treatment may be able to stall symptoms. It can be difficult to ease more severe symptoms brought on by years of fusion and stiffness from the chronic inflammation.

Most chiropractic ankylosing spondylitis treatment plans include routine exercises and stretches to help stabilize the spine, strengthen muscles to support the spine and joints, and increase flexibility.

Rotating and moving certain body parts may be tough for people with ankylosing spondylitis, particularly in the hips and pelvic region. Slow but persistent stretching may help improve the range of motions in these and other areas, potentially alleviating discomfort while the patient moves.

By implementing Ideal Spine’s holistic approached to chiropractic testing and treatment, you may be able to significantly increase your ankylosing spondylitis patients’ mobility and comfort.

Chiropractic BioPhysics® corrective care trained Chiropractors are located throughout the United States and in several international locations. CBP providers have helped thousands of people throughout the world realign their spine back to health, and eliminate a source of chronic back pain, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. The exam and consultation are often FREE. See www.CBPpatient.com for providers in your area.

Linking Signs of Depression with Poor Spine Health

Even though depression is a disease rooted in the chemical makeup of the brain, it has close connections with the physical health of the rest of the body – including the back. Things like chronic pain and poor spine health can take a toll on mental health, potentially causing depression.

But what many people don’t realize is that the reverse can also be true. Depression may be able to create problems within the body.

The chiropractic experts at Ideal Spine teach the treatment methods of Chiropractic BioPhysics (CBP), a holistic approach to patient care. Part of this holistic course of treatment involves considering more than the physical when it comes to the spine – looking for signs of mental illness that may impact the health and healing process of patients with spinal conditions.

Chronic pain and depression

People who suffer from chronic conditions of the spine and nervous system may be more likely to develop depression. Suffering from chronic pain can be extremely isolating, which is also linked to depression. Additionally, living in consistent pain can create feelings of worthlessness and misery, as well as persistent irritability.

Chiropractors should be aware of this when speaking with their patients and creating treatment plans. Part of a holistic treatment plan may include therapy for the mind as well as the body.

Depression leading to back pain

Studies have also indicated people with existing depression may be up to four times as likely to develop back and neck pain as people without. It is not completely known why this occurs. There are many causes of depression, as well as many causes of back pain, and the combination of multiple factors may heighten feelings of pain over time.

Some signs of depression may contribute to or perpetuate back pain. One is lethargy or fatigue, which may lead to a decrease in physical activity and stretching. This can weaken the muscles surrounding the spine, potentially leading to subluxations or misalignments. It may also result in stiffness and tension in the muscles and joints of the spine, causing pain.

The link between the brain and body may also result in heightened sensations of pain due to inflammation. When the brain does not feel good, the body is unlikely to, as well, possibly worsening pain symptoms and causing depression patients to complain of back problems.

Helping patients with back pain and depression

Although chiropractors are not trained in the inner workings of the mind, they may be able to provide help to patients who display signs of combined back pain and depression.

Patients with chronic musculoskeletal pain may be interested in learning more about the link between chronic pain and depression. Consider providing resources for therapy or support groups to help your patients cope with their conditions outside of your office.

Discussions and questionnaires may also help you identify an existing link between depression and back pain in patients.

A combination treatment plan can potentially improve your patient’s quality of life and may even put them on a more likely path toward healing. For more information regarding holistic treatment of depression and poor spine health, contact Ideal Spine and learn from our spinal experts.

Chiropractic BioPhysics® corrective care trained Chiropractors are located throughout the United States and in several international locations. CBP providers have helped thousands of people throughout the world realign their spine back to health, and eliminate a source of chronic back pain, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. The exam and consultation are often FREE. See www.CBPpatient.com for providers in your area.

Distance Runners and Endurance Athletes Need to Keep a Standing Chiropractic Appointment

In the same way endurance athletes and runners should regularly visit an athletic trainer or a physical therapist to maintain good athletic performance, chiropractors should also urge their athletic clients to make routine visits for chiropractic adjustments and care.

Chiropractic has a lot to offer endurance athletes, from potential improved mobility to possibly relieving aches and pains due to consistent bodily stress. At Ideal Spine, we encourage chiropractors training in Chiropractic BioPhysics (CBP) methods to actively engage athletic patients and teach them how much chiropractic may be able to do for their performance and health.

Sustained periods of activity take a major toll on the body. Without a well-functioning nervous system and a properly aligned spine, the muscles, joints, and ligaments are less likely to perform their proper roles. This increases the risk of injury and may reduce overall performance.

Although the body is able to make up for tension or weakness by compensating during short periods of activity, long-term compensation of this kind may lead to more severe injury. It is much safer to resolve these problems and allow the body to function optimally prior to engaging in long periods of exercise as endurance runners, cyclists, and swimmers do.

Chiropractic benefits for endurance athletes

When discussing chiropractic care with patients who regularly engage in endurance activities, emphasize the potential benefits of routine visits.

  • Improve range of motion: A misaligned spine has the potential to significantly limit an athlete’s mobility and range of motion, whether in the shoulders, hips, or back. Pelvic misalignments are particularly common in runners and cyclists and can drastically alter the way they move. Routine chiropractic adjustments may resolve these misalignments, allowing the body to move more freely.
  • Reduce injury risk: By properly aligning the spine, chiropractic has the potential to ease mechanical loads on the body. In turn, this may reduce the risk of injury by alleviating the need for other body parts to compensate for tightness or weakness.
  • Relieve pain: If the athlete is experiencing pain in a particular area of the body that is the result of a misalignment or compensation, chiropractic may help alleviate pain and pave the way for healthier and pain-free movement as the patient continues to train.
  • Improve performance: Chiropractic adjustments may improve blood flow and lymphatic flow throughout the body, providing ample nutrients and oxygen to the muscles working hard during exercise. Combined with increased range of motion and reduced compensation, this improved flow may help improve the athlete’s overall performance.

Ways to help your athletic patients

Chiropractors have a range of tools in their arsenal to help endurance athletes feel better while training.

The most important method of care may be the chiropractic adjustment to correct misalignments and subluxations and restore optimal bodily positioning. This may require repeat treatment, due to the natural shifting of the spine after athletic activity.

Targeted massage may also be beneficial or even necessary to loosen tight muscles and allow the body to resume a natural position. Finally, chiropractors can use education, teaching their patients warmups and stretches they can do to ensure proper bodily alignment and preparedness before exercise.

Of course, a single chiropractic appointment is likely not enough to correct routine stress caused by endurance sports. To learn more about how to treat athletic patients in your practice, contact Ideal Spine.

Chiropractic BioPhysics® corrective care trained Chiropractors are located throughout the United States and in several international locations. CBP providers have helped thousands of people throughout the world realign their spine back to health, and eliminate a source of chronic back pain, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. The exam and consultation are often FREE. See www.CBPpatient.com for providers in your area.

Sagittal Cervical Alignment Outcomes Are Linked to Pain, Disability, and Neurophysiological Improvements

By: Deed E. Harrison, DC

Chronic cervical spine disorders is one of the leading causes of disability across nations and cultures.1 There exists an opinion in the spinal health literature that the presence and extent of the cervical sagittal plane curve is unrelated to spine pain conditions and patient health.2 However, in this author’s opinion, the number and quality of studies is weighted on the positive side of the equation; in other words, there is a correlation between neck pain and related disorders and the cervical curvature.3-6

Background Data Indicates That Cervical Spine Lordotic Curve Correlates to Neck Pain and Disability

Villavicencio et al,3 in their prospective, randomized, double-blind clinical study, enrolled 122 patients who were followed an average of 37.5 months. They3 identified that maintaining a consistent segmental sagittal alignment and increasing cervical lordosis was related to a higher degree of improvement in clinical outcomes as measured with the short-form 36 questionnaire and the neck disability index. Similar findings were identified in the study by Gum et al.4

Figure 1 demonstrates the normal state of the cervical lordotic curvature on the reading left, this person would be expected to have little to no neck related disorders. Then, the sequential loss of the cervical lordotic curve is shown in the consecutive images where progressive development of spinal arthritis and disc disease in different patients over time is shown (Levels 1-4).7

Figure 1. Image © Copyright CBP Seminars and Deed Harrison, LLC. Reprinted with Permission. All rights reserved.

Studies by CBP® Researchers Demonstrate Relationship to Chronic Pain

In two separate cervical spine investigations, McAviney and colleagues5 and Harrison et al.,6 compared the cervical lordosis in chronic neck pain populations to that in healthy participants without a history of neck pain or cervical spine trauma.

  • Statistically, persons whose cervical spine curves were below 20° were twice as likely to be in the chronic neck pain group. This finding was not age or gender dependent strengthening these findings.5,6
  • Participants with a straightened or reversed cervical curvatures were 18 TIMES more likely to be in the chronic neck pain group as compared to the non-pain group.5
  • Thus, a cervical lordosis less than 20° can be considered a type of cervical spine subluxation.

Randomized Trials Indicating Improved Pain, Disability, Neurophysiology

Recently, CBP researchers, lead by Professor Ibrahim Moustafa (Sharjah University, UAE) and Dr. Deed Harrison (CBP NonProfit-Idaho, USA) have completed a series of randomized clinical trials (RCT’s).8-11 These RCT’s were designed to test the hypothesis that structural correction of the cervical sagittal alignment will improve pain, disability, and neurophysiology measurements. Importantly, in two of the RCT’s it was found that restoration of the cervical lordosis towards the 20° magnitude concomitantly improved dermatomal somato-sensory evoked potentials (DSSEP’s)8 and the H-reflex9 in patients with both cervical spine and lumbo-sacral radiculopathy and chronic pain.

In two of the most recent RCT’s by this team of investigators,10-11 the effect of sagittal rehabilitation of the cervical spine on central nervous system latency (velocity) and amplitude was assessed. Correction of the cervical sagittal lordosis and head posture was found to statistically correlate to improvement central conduction time (spinal cord velocity) as measured with the N13-N20 potential. These two break-through RCT’s are the first studies to identify a statistically significant increase in the central nervous system’s conduction velocity resulting from correction of the subluxated cervical spine. Noteworthy, is the fact that traditional conservative interventions did not improve sagittal alignment and did not improve neurophysiology even though they were associated with temporary pain and disability improvements. Only the group receiving CBP extension traction methods were found to have statistically significant improvement in spine alignment, neurophysiology, and long-term pain and disability outcomes.8-11

References

  1. Noormohammadpour P. Prevalence of Chronic Neck Pain, Low Back Pain and Knee Pain and their Related Factors in Community-dwelling Adults in Iran: A Population-based National Study. Clin J Pain 2016 Jun 1.
  2. Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):690-714. doi: 10.1016/j.jmpt.2008.10.004.
  3. Villavicencio AT, etal. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 2011 May;68(5):1309-16; discussion 1316.DOI:10.1227/NEU.0b013e31820b51f3.
  4. Gum JL, et al. Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion. Am J Orthop (Belle Mead NJ) 2012 Jun;41(6):E81-4.
  5. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005 Mar-Apr;28(3):187-93.
  6. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.
  7. Harrison DE, Harrison DD, Janik TJ, Jones WE, Cailliet R, Normand M. Comparison of axial and flexural stresses in lordosis and three buckled modes of the cervical spine. Clin Biomech 2001; 16(4): 276-284.
  8. Moustafa IM, Diab AM, Ahmed A, Harrison DE. The efficacy of cervical lordosis rehabilitation for nerve root function, pain, and segmental motion in cervical spondylotic radiculopathy. PhysioTherapy 2011; 97 Supplement: 846-847. (Link)
  9. Moustafa IM, Diab AA, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of lumbosacral radiculopathy: A randomized controlled trial Proceedings of the 13th World Federation of Chiropractic Biennial Congress / ECU Convention, Athens, Greece, May 13-16, 2015. Paper #184 Mediterranean Region Award Winning Paper.
  10. Moustafa IM, Diab AA, Taha S, Harrison DE. Addition of a Sagittal Cervical Posture Corrective Orthotic Device to a Multimodal Rehabilitation Program Improves Short- and Long-Term Outcomes in Patients with Discogenic Cervical Radiculopathy. Arch Phys Med Rehabil, 2016, 97: 2034-2044.
  11. Moustafa IM, Diab AAM, Taha S, Harrison DE. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial. Proceedings of the 14th biennial congress of the World Federation of Chiropractic, March 15-18, 2017.