Category Archives: Chiropractic

Spinal Decompression or Chiropractic?

drx9000 in san francisco
Spinal Decompression Therapy with DRX9000

We have been providing chiropractic treatment for herniated discs in San Francisco for over 20 years now. About 8 years ago we began to incorporate nonsurgical spinal decompression with the DRX9000 into our treatment protocols. The results have been outstanding.

So, how do we know if a herniated disc patient needs spinal decompression therapy or chiropractic care? Well…sometimes we don’t…yet!

Often times, a patient with severe low back pain and/or sciatica will present to our clinic and not have had either spinal decompression treatments or chiropractic care. Sometimes they have an MRI and sometimes they don’t.

We need an MRI to know where to apply spinal decompression, but since they are very expensive we don’t want to order one unless we really need it. And we always want to try chiropractic first if possible because chiropractic is much less expensive than spinal decompression and is covered by most insurance…decompression therapy is not.

Here’s a case history of a recent chiropractic, then spinal decompression patient we have been working with:

A 45 year old female presented to our clinic with severe low back pain and sciatica. She has a previous 15 history off on and off low back pain and sciatica but the symptoms have never been this bad. She had also had chiropractic in the past which helped. We decided together to try a month of chiropractic to see if it would help…and it did…a lot…at least for the low back pain…not the sciatica.

At this point we ordered a lumbar MRI which was covered by insurance. And we also satisfied the conservative care first requirements most carriers want to see before a chiropractor orders an MRI.

The MRI revealed a large extruded disc (disc herniation) at L5-S1 on the right which is contacting the nerve roots…OUCH! We are starting a 20 session spinal decompression treatment program today. We are excited because we have had great success with the DRX9000 with cases just like this. The patient is excited as well.

Now, if the low back pain and sciatica would have both resolved with chiropractic care than we would not have ordered the MRI. This happens frequently…more often than not. But if it doesn’t, than we need to go to the next step…which thankfully is not back surgery, it’s spinal decompression with the DRX9000.

So, whether we recommend chiropractic or decompression therapy for a lumbar disc herniation just depends…it depends on all of the above. There are also some patients who have such severe low back pain that we are unable to do chiropractic, but the patient can handle decompression….because it is very gentle…in these instances we order an MRI and move forward with spinal decompression.

The best thing to do if you feel you may have a herniated disc or if you already know, and want to find out if chiropractic or spinal decompression make sense, is to contact a spinal decompression doctor right away…most are chiropractors.

If you need help finding a doctor in your area with a DRX9000 I recommend doing a Google search like this “DRX9000 _________(your area)”. For example: DRX9000 San Francisco.  Let us know if you need help.

If you live or work in the SF Bay Area you can contact our San Francisco Spinal Decompression Center at 415-392-2225. Ask for a complimentary consultation. We validate parking at the Embarcadero Center.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Is Neck Pain from a Herniated Disc or Something Else?

neck pain san francisco
Neck Pain Treatment

Neck pain can arise from many different sources, and the patient’s clinical presentation can be quite similar making it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome, or TOS. Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.

            TOS can arise from either blood vessel compression, nerve compression or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle) and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm and hand (usually affecting the 4th & 5th fingers). It’s our job to run different tests to figure out where the primary pinch or pinches are located so we can treat the right area.

            The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle and so on can also result in pinching of the nerves and/or blood vessels.

            Purses, backpacks, carrying golf clubs, a mailbag and the like can also cause a pinch. A seat belt injury in a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.

            Our posture alone (without trauma), such as a slouchy, slumped posture where the shoulders roll forwards can cause TOS and, large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as waitresses, carpenters, electricians, increase TOS risk.

            You can depend on us to identify, locate and treat the areas that need attending as chiropractic includes many effective TOS treatment methods. The surgical outcomes are less than impressive so do EVERYTHING else first (a good surgeon will tell you that).

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment for neck pain treatment in San Francisco call 415-392-2225.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Low Back Pain and The Way You Sleep

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Low Back Pain

We have been providing low back pain and sciatica relief in San Francisco for over 20 years now in the Financial District.

Low back pain (LBP) and sciatica can arise from a lot of causes, most commonly from bending, lifting, pulling, pushing, and twisting. However, there are other possible causes, including sleep. This not only includes sleeping in a crooked or faulty position, such as falling asleep on a couch, in a chair or while riding in a car, but also from the lack of sleep. So the question is, how much sleep is needed to feel restored and how much sleep is needed to avoid low back pain?

            It’s been shown that the lack of sleep, or chronic sleep loss, can lead to serious diseases including (but not limited to): heart disease, heart attack, heart failure, irregular heartbeat, high blood pressure, stroke and diabetes. Sleepiness can also result in a disaster; as was the case in the 1979 nuclear accident at Three Mile Island, the oil spill from the Exxon Valdez, as well as the 1986 nuclear disaster at Chernobyl. With sleep deprivation, our reaction time is slowed down, and hence, driving safety is a major issue. The National Highway Traffic Safety Administration estimates that fatigue causes more than 100,000 crashes per year with 1500 annual crash-related deaths in the US alone. This problem is greatest in people under 25 years old. Job related injuries are also reportedly more frequently, especially repeat injuries in workers complaining of daytime sleepiness which resulted in more sick days. It’s also well published that sleep plays a crucial role in thinking and learning. Lack of sleep impairs concentration, attention, alertness, reasoning, and general cognitive function. In essence, it makes it more difficult to learn efficiently. Also, getting into a deep sleep cycle plays a critical role in “consolidating memories” in the brain, so if you don’t get to a deep sleep stage (about 4 hours of uninterrupted sleep), it’s more difficult to remember what you’ve learned. An interesting study (U. of Pennsylvania) reported that people who slept less than 5 hours/night for 7 nights felt stressed, angry, sad, and mentally exhausted. As shown in another study of 10,000 people, over time, insomnia (the lack of sleep) increases the chances by 5-fold for developing clinical depression. Other clinical studies have published many other negative effects of sleep deprivation, of which some include aging of the skin, forgetfulness, weight gain, and more.

            Regarding low back pain, what comes first? Does LBP cause sleep interference or does sleep deprivation cause the LBP (or both)? It’s been shown that sleep loss can lower your pain threshold and pain tolerance, making any existing pain feel worse, so it works both ways. Specific to LBP, in a 28-year, 902 metal industry worker study, sleep disturbances (insomnia and/or nightmares) predicted a 2.1-fold increase in back pain hospitalizations with one and a 2.4-fold increase with both sleep disturbance causes (insomnia and nightmares). Other studies have shown patients with chronic LBP had less restful sleep and more “alpha EEG” sleep compared to controls. Similar sleep pattern differences using EEG (electroencephalogram – measures brain waves) have been shown when comparing chronic LBP patients with vs. without depression compared to controls (non-LBP, non-depressed subjects).

            So the BOTTOM LINE, talk to us about how chiropractic helps reduce LBP, stress and facilitates sleep. There are also nutritional benefits from Melatonin, valarian root, and others that we can discuss. Now, go to bed and get a good night’s sleep!

It IS possible to break this low back pain, sleep deprivation cycle with chiropractic adjustments and/or nonsurgical spinal decompression with the DRX9000.

            We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment for low back pain relief in San Francisco call 415-392-2225. Mention this article for a complimentary consultation.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Neck Pain, Arthritis and Smoking

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Neck Pain

There is a lot of convincing peer reviewed literature (research) that supports chiropractic as one of the first and best courses of care to consider when choosing a treatment option for neck pain and headaches. This is because there is low risk, few rare side-effects, and most importantly, IT REALLY WORKS!  But, there are other considerations in the management of neck and headache pain that perhaps we haven’t thought about. One is smoking.

            There are several convincing studies that have looked at the exposure to tobacco smoke and smoking in terms of its effect on neck pain. Let’s look at some statistics. One study reported that as many as 213 per 1000 people reported neck pain. The 12-month prevalence of neck pain ranged between 30-50% of which activity-limiting pain was reportedly as high as 11.5%. Women were found to be more at risk than men which peaks in middle age. Risk factors for neck pain include genetics, poor psychological health, and EXPOSURE TO TOBACCO. Interestingly, smoking / exposure to tobacco is listed as a risk factors but disk degeneration is not! Researchers also pointed out that the use of equipment made to prevent injury to the head/neck such as helmets and face shields was NOT associated with increased risk for neck injury in bicycling, hockey or skiing as some have suggested that wearing protective head gear increases vulnerability to injury. THIS IS NOT THE CASE, so wear your helmet! This study concluded that there are some things we can’t modify regarding increased risk of developing neck pain (such as gender, genetics, and age); however, the modifiable risk factors of smoking, exposure to tobacco, and psychological health CAN be helped so that’s the LEAST WE SHOULD DO!

            Two new studies show that smoking is directly tied to neck / back pain and the development of arthritis. Interestingly, the Harvard study reported that the risk of developing psoriatic arthritis was twice as high for current vs. past smokers, and both current and past smokers were at greater risk when compared to those who had never smoked. The 2nd study (Paris, France) found that smokers had an earlier onset of inflammatory back / neck pain and a worse course of the disease than non-smokers. Taking these two studies together, the interactions between environmental factors and the onset, the degree of severity and the ultimate outcomes of rheumatic diseases, “…it’s becoming increasingly clear how detrimental the influence of smoking is on most of these diseases.” The worst scenario was found in those who smoked >25 years and, >20 “pack years” (>1 pack/day for 20+ years).  The “bottom line” is that smoking and exposure to smoke have significant negative health affects, not only for present health, but also for future pain, suffering and quality of life. Thankfully, it’s been shown that if you quit smoking, the likelihood of improved health affects is high so of course, QUIT NOW and you’ll be ahead of the curve.

            In fact, a conscientious surgeon recommending a spinal fusion may say, “…you must quit smoking or else I will not perform the surgery that you need.” The reason for this insistence is because the risk of fusion failure goes up 500% in smokers (fusions are needed in certain types of back and neck surgeries).

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment for neck pain treatment in San Francisco call 415-392-2225. Mention this blog post for a complimentary consultation.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Spinal Decompression or Chiropractic for a Disc Herniation?

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Spinal Decompression Therapy with DRX9000

We have been providing chiropractic in San Francisco for over 20 years now. About 8 years ago we began to incorporate spinal decompression with the DRX9000 into the mix.

In general, we always want to rule out chiropractic as a first choice for herniated discs in the neck or low back. Spinal decompression is more expensive and time consuming and is not covered by insurance.  Actually, most insurance will cover re-exams, exercises, ice, muscle stimulation, and some of the ancillary services we provide to decompression patients.

If a patient presents with a new condition, even though it appears to be a herniated disc (it’s not hard to tell)…we still want to try conservative chiropractic care first if the patient can tolerate it…and most can because we start out very gentle and easy.

On the other hand…if a patient comes to us and has already tried chiropractic without much success, or we treat them ourselves without any change, say after a few weeks, then we consider decompression therapy and will usually order an MRI.

A few weeks ago we had a 28 year old male present with severe back and leg pain with no apparent cause. He was listing to one side (antalgia) which is common with a lumbar disc herniation, and had all the positive disc findings…another-words chances are he has a herniated disc…we would need MRI to confirm.

Our game plan was to treat with conservative chiropractic for a few weeks and see if we could stabilize him and get him back on track. He really wanted to avoid an MRI and the  time and expense of spinal decompression.

The treatment started out slow with not much change…then after 4 chiropractic adjustments he started to come around, sleep better, stand straighter, feel better, and have hope that chiropractic can help.

As it stands he had to go on a work trip and will be back at the end of the week. This is not ideal so we will see.

I guess the point is this…We always want to try the more conservative, less expensive chiropractic adjustments first when it comes to treating bulging and herniated cervical and lumbar discs. But we have a Plan B if we need it, Nonsurgical spinal decompression with the DRX9000 or DRX9000c (cervical decompression system).

To find out if you are a candidate for spinal decompression in San Francisco, call 415-392-2225. Mention this blog post for a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Cervical Decompression with the DRX9000c

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DRX9000c Cervical Decompression

We have been providing treatment in San Francisco for herniated discs in the neck for over 20 years now. About 8 years ago we began to incorporate nonsurgical cervical decompression with the DRX9000c into the mix.

Since then, cervical decompression has become the gold standard for the nonsurgical treatment of neurovascular compression syndromes such as bulging and herniated cervical discs, cervical stenosis, disc degeneration, and facet syndrome.

Often times,  patients are scheduled for risky neck surgery when they decide to try the DRX9000c first at the recommendation of their medical doctor. Other times, we discover the cervical disc herniation when we send an unresponsive chiropractic patient out for an MRI. Some patients find us while conducting their own research for nonsurgical drug-less options for neck pain, which may or may not be radiating into the arms and hands.

Neck pain that radiates into the upper extremities can also lead to weakness up grip strength and disability. It’s best to seek treatment right away before it gets worse.

We have seen miracles at our spinal decompression clinic with the DRX9000c. Most recently,  a dentists that was having to use a wheel chair and could not work, is now walking on his own and reports a 70% recovery at about the half way point.

While cervical decompression is not a Magic Bullet…it is the most advanced technology in the marketplace today for herniated and bulging discs.

Not all patients qualify medically for the DRX9000c. The best thing to do if you feel you are a candidate is to find a spinal decompression doctor near you.

If you live or work near downtown San Francisco you can visit us at our San Francisco Spinal Decompression Center. Simply call 415-392-2225 and ask for a complimentary consultation and demonstration of the DRX9000c.  

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Neck Pain: Manipulation vs. Mobilization – What’s Better?

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Neck and Upper Back Manipulation

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

             Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint using various methods such as figure 8, side to side, front to back and /or combinations of any of these movements. In the neck, gentle to firm manual traction or pulling, when applied to the cervical spine, stretches the joint and disk spaces and can be included during MOB. Some consider nonsurgical spinal decompression to be a form of Mobilization. In my opinion decompression therapy is it’s own category.

             Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide). Some joints “cavitate” or “crack” while others are less likely to release the gas. This is what a chiropractic adjustment does and is what we do at our San Francisco Chiropractic Clinic.

Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of gas release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.  As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.  Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic,  as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

            Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function! So, the next time you ask the question, “….do you have to crack my neck?,” the answer should be “yes, if you want to achieve the quickest response.” However, if there is sharp pain during the “set-up” of the manipulation or adjustment, modifications in the technique are appropriate or, a different method should be considered.

            We realize that you have a choice in where you choose your health-care services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Special Note: When SMT fails to deliver results, spinal decompression therapy should be considered as a treatment option for back and neck pain secondary to herniated and bulging discs.

To schedule an appointment with one of our Back and Neck Pain Experts in San Francisco, call 415-392-2225.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Is it Low Back or Hip Pain?

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Back Pain

When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.

When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or, to the foot if more severe) but the next time, with only groin pain. When pain radiates down a leg, the almost automatic impression by both the patient and the health care provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?

During our history, we often ask the question, “…what activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip related diagnosis is favored but, it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” that’s getting more hip pain specific as hip rotation is frequently lost before the forward flexion motion. When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90˚, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or, applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip. Though challenging sometimes, we are well trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate. This is the case more often than not.

            We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment with one of our San Francisco Chiropractors call 415-392-2225. Mention this blog post for a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Is Maintenance Chiropractic for Chronic Low Back Pain Effective?

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Back Pain

When people think of chiropractic, they immediately think of low back pain and are often surprised to find out that chiropractic can benefit many conditions such as carpal tunnel syndrome, tennis elbow, rotator cuff tears, as well as hip, knee, and ankle conditions.  There is also research support for manipulation (a key component of chiropractic) and its role in managing “somatovisceral” related conditions such as pneumonia, dizziness, stage 1 hypertension, PMS, asthma, colic, and bed wetting.

Research clearly shows that chiropractic manipulation out performs other forms of treatment for acute, subacute and chronic low back pain. But, the question remains, can “maintenance chiropractic” PREVENT problems down the road? Ironically, two medical doctors in August of 2011 published an article in a leading medical journal (SPINE) entitled, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” The study’s objective was to determine if treating chronic low back pain patients (pain >6 months) after a course of 12 treatments in the first month would do better, the same or worse if treatments were continued at 2-week intervals for an additional 9 months. They compared 3 groups of patients: 1.) 12 treatments of “sham” (placebo) manipulation over a 1-month period. 2.) 12 treatment of “real” spinal manipulative therapy (SMT) for 1 month but no treatments for the subsequent 9 months. 3.) The same as #2 but with treatments every 2 weeks over the next 9 months. To determine the differences between these 3 groups, the authors measured pain and disability scores (using questionnaires), generic health status (questionnaire), and back-specific patient satisfaction (questionnaire) at 1, 4, 7 and 10-month intervals.

The results showed that groups 2 (SMT for 1 month only) and 3 (SMT for 1 month + every 2 weeks for 9 months) had significantly lower pain and disability scores than the 1st group (sham/placebo group) at the end of the 1st month or, 12 visits. However, only group 3 (treatments were continued for 9 months at 2 week intervals) showed more improvement in pain and disability scores at 10 months. Equally important, the scores for the non-maintained group 2 patients returned to near their pre-treatment levels by month 10!

The authors concluded that not only is spinal manipulative therapy effective for chronic low back pain, but more importantly, REGULAR ADJUSTMENTS EVERY 2 WEEKS after the initial course of concentrated care (3x/week for 4 weeks) was needed, “…to obtain long-term benefit,” suggesting that, “…maintenance SM after the initial intensive manipulative therapy,” is appropriate care to obtain long-term results.

This study FINALLY supports the recommendations made by chiropractors for many years –regular adjustments are beneficial to obtain a higher quality of life, less pain and less disability!

            We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment with one of our San Francisco Chiropractors, call 415-392-2225. Mention this low back pain article for a complimentary consultation and office tour.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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The Neck and Shoulder Pain Relationship

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Neck and Shoulder Pain Connection

Given the close anatomical proximity between the neck and shoulder, it’s no wonder the two are intimately related. In our hectic lifestyles of driving, hunching over computers, talking on the phone, not to mention stress arising from multiple sources, the muscles in the neck, upper back and shoulders seem to tighten up and hurt at the same time. The question is, between the neck and the shoulder, which one is the “chicken” and which is the “egg?”

The neck gives rise to the nerves that innervate the head (C1-3 nerve roots), the shoulders (C4-5), and the arms (C5-T2). Hence, there are 8 sets of nerves in the neck, 12 sets in the thoracic (middle back region), and 6 sets in the lumbar or low back region and 5 sets in the sacrum, all of which travel to a specific destination allowing us to move our muscles and to feel hot, cold, sharp, dull, vibration and position sense. When these nerves get pinched or irritated, they lose their function and the ability to feel, making it challenging to button a shirt, thread a needle, or pick up small objects.  It can also make it difficult to unscrew jars, squeeze a spray bottle, or lift a milk container from the refrigerator. Hence, the nerves arising from the neck, when pinched, can have a dramatic effect on our ability to carry out our desired activities in which the shoulder, arm and hand use is required.

On the other hand, when the shoulder is injured (such as a rotator cuff tear), this can also result in neck problems. There are several ways pain from the neck affects the shoulder and vice versa. When the shoulder is injured, pain “information” is relayed to the brain starting at the nerve endings located in the area of the shoulder injury, transmitting impulses between the shoulder and the neck, and finally from the neck to the sensory cortex of the brain. That information is processed and communication to the motor cortex prompts nerve signals to be sent back to the shoulder through the neck and to the injured area (in this case, the shoulder). A reflex muscle spasm often occurs as a result, serving as kind of an “internal cast” as the muscle spasm tries to protect the injured shoulder. This can become a “vicious cycle” or never-ending “loop” until the reflex is interrupted (perhaps by a chiropractic adjustment). Another means by which both areas become injured has to do with modifications in function. We tend to change the way we go about our daily chores when an injury occurs to the shoulder, such as putting on a coat differently by leaning over to the opposite side. These functional changes can also give rise to neck pain. Because of this reflex cycle, as well as the close anatomic relationship between the neck and shoulder, not to mention the “domino effect” of soft-tissue injuries which seem to change the function at the next joint level, it’s not surprising that both the neck AND the shoulder require simultaneous treatment for optimal treatment benefit. However, the good news is, regardless which one is the “chicken or the egg,” chiropractic treatments of shoulder injuries will almost always include the neck and vice-versa.

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 To schedule an appointment with one of our chiropractors in San Francisco call 415-392-2225. Mention this neck and shoulder pain article and receive a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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