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Response to the Media Inquiries Regarding the Unfortunate Death of Model Katie May

According to the various media reports, Katie May, a well-known model dubbed “The Queen of Snapchat,” suffered a trauma to her neck to which she sought care from a chiropractor. According to news sources, her father has made remarks that suggest that her chiropractic care played a role in her untimely death.

Here are some facts for your consideration:

- Arterial dissection of the cervical (neck) arteries is a very rare condition occurring in 2-3 persons per 100,000 population per year. As this condition often produces neck pain and headaches, many times individuals will consult with their health care providers for advice or treatment in response to the discomfort.​​

- Whether a person consults a medical doctor or doctor of chiropractic, stroke can follow at an equal rate regardless of the type of provider. Epidemiologic studies over many years with millions of patients do not reveal any greater association of stroke for persons under chiropractic care compared with persons under medical care.

- In February 2016, a team of neurosurgeons at the University of Pennsylvania Hershey Medical Center published research concluding, “There is no convincing evidence to support a causal link between chiropractic manipulation and cervical artery dissection (CAD).”

- Chiropractic manipulation has shown to be safe, effective treatment for neck, mid back and lower back pain. A comprehensive review of scientific evidence noted that there is as much evidence supporting chiropractic care as for other treatments such as prescription and non-prescription drugs and surgery.

The doctors at Life in Motion Chiropractic and Wellness recognize that this is a sensitive subject and we are presenting this information to you with the utmost respect for Ms. May and her family.

Got Pain?

#ThinkChiropractic

TRY CHIROPRACTIC FIRST!

Here’s why:

Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study.

Spine (Phila Pa 1976). 2013 Apr 15;38(8):627-34.

Conclusion: The results of this trial suggest that chiropractic manipulative therapy (CMT) in conjunction with standard medical care (SMC) offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute low back pain (LBP).

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Spine J. 2010 Dec;10(12):1055-64.

Conclusion: This is the first reported randomized controlled trial comparing full clinical practice guidelines-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed usual care (UC) in the treatment of patients with acute mechanical low back pain (AM-LBP). Compared to family physician-directed UC, full clinical practice guidelines-based treatment including chiropractic spinal manipulative therapy is associated with significantly greater improvement in condition-specific functioning.

Pain, disability, and satisfaction outcomes and predictors of outcomes: A practice-based study of chronic low back pain patients attending primary care and chiropractic physicians.

JMPT. 2001 Sep; Vol. 24, Issue 7, Pg. 433–439

Conclusion: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.

Primary Spine Practitioner

Chiropractic Care: A Safe, Effective Treatment for Neck, Mid-back and Lower Back Pain

#ThinkChiropractic

Better Functional Improvement Outcomes and Higher Satisfaction with 

Doctor of Chiropractic (DC) Care

-  Back Pain 

-  Neck Pain

-  Headache Pain

Excellence in Hands-On Care

Americans' Perceptions of Chiropractic

#ThinkChiropractic 

The second "Gallup-Palmer College of Chiropractic Annual Report: Americans'Perceptions of Chiropractic," validates chiropractic as a valuable option for neck and back pain. 

Conditions Treated by a Chiropractor Near Me

Neck Pain – Management Strategies: Vol 15 Iss 5 The In Good Hands Newsletter from Chiro-Trust.org

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

More ABC US news | ABC World News

When you make an appointment for a chiropractic evaluation for your neck pain, your doctor of chiropractic will provide both in-office procedures as well as teach you many self-help approaches so that as a “team”, together WE can manage your neck pain or headache complaint to a satisfying end-point. So, what are some of these procedures? Let’s take a look!

In the office, you can expect to receive a thorough history, examination, x-ray (if warranted), and a discussion about what chiropractic care can be done for you and your condition. Your doctor will map out a treatment plan and discuss commonly shared goals of:

• Pain reduction

• Posture/alignment restoration

• Prevention of future episodes.

Pain reduction approaches include (but are not limited to):

  - joint mobilization and/or manipulation

  - muscle/ligament stretching techniques

  - inflammation control by the use of physical therapy modalities (such as electrical stimulation), ice, and possibly anti-inflammatory vitamin / herbal therapies. 

Your chiropractor will also teach you proper body mechanics for bending, lifting, pulling, pushing and help you avoid positions or situations where you might re-injure the area. 

Posture/alignment restoration can include methods such as wall stand and/or stork exercises, respiratory "re-training", spinal stabilization exercises, and/or foot orthotic inserts. 

The third goal of future episode prevention is often a combination ongoing treatments in the office and strategies you can employ at home. This includes (but is not limited to):

• Whether you should use ice, heat, or both at times of acute exacerbation

• Avoiding positions or movements that create sharp/lancinating pain

• DOING THE EXERCISES that you've been taught ON A REGULAR BASIS

• Eating and an “anti-inflammatory” diet (lean meats & lots of fresh fruits/veggies).

Let’s talk exercise! Your doctor of chiropractic will teach you exercises that are designed to increase range of motion (ROM), re-educate a flat or reversed curve in the neck, and strengthen / stabilize the muscles in the neck. Studies show that the deep neck flexor muscles – those that are located deep, next to the spine in the front of the neck – are frequently weak in patients with neck pain. These muscles are NOT voluntary so you have to “trick” them into contracting with very specific exercises. Your doctor will also teach you exercises that you can do EVERY HOUR of your work day (for 10-15 seconds) that are designed to prevent neck pain from gradually worsening so you aren't miserable by the end of work. 

Along these lines, he/she will discuss the set-up of your work station and how you might improve it – whether it’s a chair, desk, computer position, a table/work station height issue, or a reaching problem; using proper “ergonomics” can REALLY HELP! 

Posture & Ergonomics Training

Your doctor will also advise you not to talk on the phone pinching the receiver between your head and shoulder, to face the person you are talking to (avoiding prolonged head rotation), to tuck in your chin as a posture training exercise, and more. 

Chiro-Trust.org

ChiroTrust™ members are a group of Doctors of Chiropractic worldwide who have taken “The ChiroTrust Pledge” and are dedicated to providing conservative, mainstream chiropractic care to patients without sales pressure, long-term recommendations, unnecessary therapies or excessive costs.

Efficient Spine Care in the United States

Back and/or neck pain are a prevalent issue in society today and it is estimated that 149 million work days are lost every year in the United States at a cost of $100-200 billion [i.e. lost wages and decreased productivity] due to low back pain alone.[1]^{,[2], [3]} The World Health Organization reports that currently the primary treatment for low back pain is analgesic medication and that the causes for its provocation are rarely addressed.[4] This ineffectual treatment protocol isn't necessarily the fault of the rendering primary care physician due to their “inadequate preparation for practice in the real world” with regards to musculoskeletal medicine.[5] In November 2014, DiGiovann, et al reported that North American medical schools have limited time devoted to musculoskeletal education and cite that only 30% to 40% of schools have required instruction in the musculoskeletal system.[6]^,[7],[8] This is unfathomable when the average total health expenditure per person with back and/or neck pain in the United States is 73% greater than for individuals in other countries.[9]^,[10] The time has come for a truly unbiased and integrative approach to the treatment of low back and neck pain a fact that has been evident within the medical community since 1999.[11]

In July 2011, Murphy et al published a commentary expressing the need for the implementation of a primary spine practitioner (PSP) to effectively triage patients experiencing spine related disorders (SRDs), conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. They state that the PSP “would function as the first contact for patients with SRDs, i.e. the first practitioner that a patient consults when he or she develops a spine problem and could also function as a resource for traditional PCPs (family practice physicians, general internal medicine physicians, pediatric, obstetrical/ gynecological physicians, primary care nurse practitioners or physician’s assistants) to refer patients who present with SRDs”. This implementation exhibits potential benefits to SRD patients (i.e. faster recovery, cost savings, iatrogenic[12] disability avoidance, increased productivity, decreased likelihood of becoming a chronic pain sufferer, high patient satisfaction, focus on prevention), our society ( i.e. knowledgeable care coordinator, SRDs as a public health initiative, improved worker productivity, less long term disability), and the overall healthcare system (i.e. controlling costs, unburdening traditional PCPs, more strategic specialist referrals, disruptive innovation, standardization of care, new evidence and technologies). [13]

Candidates for the role of PSP within our current system would be currently licensed healthcare providers (i.e. chiropractor, physician, physical therapist, nurse practitioner) who would receive additional training based on a spine care pathway which has already been implemented in hospital systems, accountable care organizations, patient centered medical homes,  and privately operated PCP and specialty groups.

The effectiveness of integrative care for SRDs has not only been clinically demonstrated but has been mandated by a renowned medical center’s health plan:

- A 2013 study of Washington state workers who had recently filed worker’s compensation claims due to back injury found a 41.2 percent decrease in lumbar spine surgeries when the claimant consulted a chiropractor first.[14]

- Priority Health a major health plan in Western Michigan found that when they required spine patients who were heading for a non-urgent surgical consultation to first consult a physiatrist, surgical referrals decreased 48 percent, spine surgeries decreased 25 percent, and surgical costs dropped 25.1 percent.[15]

- University of Pittsburgh Medical Center Health Plan requires that patients with chronic back pain undergo a minimum of three months of chiropractic and/or physical therapy before any spine surgery is approved.[16]

So why am I so adamant about this subject? In September 2013, Spine Care Partners in conjunction with Lifetime Health Medical Group and Excellus BlueCross BlueShield commenced the inaugural spine care pathway training which was conducted at Excellus’ corporate headquarters in Rochester, NY. Dr. Fralick and I had the honor of being part of that inaugural class and have experienced first-hand the benefits this evidence based and patient centered program exhibits. Everything the Murphy et al commentary envisioned, at least in regard to SRD patient benefits, has become a reality for the patients who have sought care in our office.

The desire for this integration on a community level became evident to us upon receiving a letter from Excellus Blue Cross/Blue Shield of Rochester dated 29 December 2014. In this letter they outlined a “Waived Copayment Pilot Program” whose purpose is to “help drive care to spine pathway trained practitioners so that the program’s value can be measured and compared to other modalities of treatment for back and neck pain”. This program will extend until 31 December 2015 and only include Excellus employees and their covered family members but underlines the fact that a major health insurer believes PSPs are credible portal of entry providers for patients who present with musculoskeletal conditions.

So I urge all of you who are reading this to share this information with your healthcare providers and encourage them to seek out these practitioners in your community and integrate them into their treatment plans for spine related disorders.   

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[1] Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health, 1999, 89(7):1029-1035.

[2] Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006, 88(suppl 2):21-24.

[3] Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin, 2007, 25(2):353-371

[4] Duthey, Beatrice, PhD. "Background Paper 6.24 - Low Back Pain." Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.13 to 6.24 (part 2). World Health Organization, 15 Mar. 2013. Web. 11 Mar. 2015. <http://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf>.

[5] Association of American Medical Colleges. Medical School Objectives Project. Contemporary issues in medicine: musculoskeletal medicine education. Report VII. 2005.

[6] DiGiovann, Benedict F., , MD, Richard D. Southgate, , MD, Christopher J. Mooney, , MA, MPH, Jennifer Y. Chu, , MD, David R. Lambert, , MD, and Regis J. O’Keefe, , MD, PhD. "Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students."The Journal of Bone and Joint Surgery E185 96.21 (2014): n. pag. The Journal of Bone and Joint Surgery, Inc. The Journal of Bone and Joint Surgery, Inc.; STRIATUS Orthopaedic Communications, 05 Nov. 2014. Web. 17 Jan. 2015. <http://jbjs.org/content/96/21/e185>.

[7] DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003 Mar;85(3):565-7.FREE Full Text

[8] Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001 Sep;83(9):1317-20. Abstract/FREE Full Text

[9] Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingsworth W, Sullivan SD. Expenditures and

health status among adults with back and neck problems. JAMA, 2008;299(6):656-664.

[10] Rosner, Anthony. "Going About Spine Care the Wrong Way - Spine Care "bass-ackwards."" Dynamic

Chiropractic - News, Articles, Research & Information for Chiropractors. MPA Media, 01 Jan. 2014. Web.

10 June 2014. <http://www.lifeinmotionchiro.com/Educational%20Brochures/Going-About-Spine-Care-the-Wrong-Way.pdf>. Vol. 32, Issue 01

[11] Andersson GB, et al. A comparison of osteopathic spinal manipulation with standard carefor patients with low back pain. N Engl J Med 1999;341: 1426-1431

[12] of or relating to illness caused by medical examination or treatment.

[13] Murphy et al. The establishment of a primary spine care practitioner and its benefits to health care reform

in the United States. Chiropractic & Manual Therapies 2011, 19:17 http://chiromt.com/content/19/1/17

[14] Keeney B, Fulton-Kehoe D, Turner J. Wickizer TM, Chan KC, Franklin GM. Early predictors of spine

surgery after occupational back injury: results from a prospective study of workers in Washington

State. Spine, 2013;38(11):953-964.

[15] Fox J, Haig AJ, Todey B, Challa S.. The effect of required physiatrist consultation on surgery rates for back

pain. Spine, 2013;38(3):e178-e184.

[16] "DC Receives Federal Grant to Study Nonsurgical Alternatives to Surgery for Spinal Stenosis: Interview

With Michael Schneider, DC, PhD." Health Insights Today, March 2013.

Safety of Chiropractic Care - Neck Manipulation

The efficacy of spinal manipulative therapy (SMT) has been a topic of research for more than 20 years now and has subsequently been recognized as such in at least four countries which has led to increased integration of chiropractors into mainstream healthcare.[1] This greater predominance has led to questions regarding the possibility of complications due to SMT, especially with respect to manipulation of the cervical spine (neck).

This was never more prevalent than after two tragic events following chiropractic care in Canada in the 1990s which spurred rabid media attention and an adamant stance by the neurology community to avoid cervical manipulation as a treatment for neck pain.[2] These events have no less been the provocative factor for the publication of several case reports in which chiropractors have been incorrectly identified as the practitioner responsible for injuries related to SMT.[3] This fact is inescapable when reviewing two articles published in the Journal of Neurology where the authors cite 46 cases involving stroke and/or vertebral artery dissection due to “chiropractic manipulation”. Truth be told only FOUR (4) of the cases involved chiropractors the remaining 42 cases (91%) of injury due to cervical manipulation were induced by 25 -orthopedists, 6 -physical therapists, 1 -neurologist, 2 -Primary Care Physicians, 1 -homeopath, 2 -“health practitioners”, and the rest “remained unreported”.[4][5][6] Admittedly there is inherent risk, albeit minimal, associated with neck manipulation but all forms of therapeutic intervention come with risk and some are far greater than SMT.

 Take for instance the most common “quick fix” for musculoskeletal pain, non-steroidal anti-inflammatories [NSAIDs] (i.e. Advil, Aleve, Motrin, Tylenol). Medical studies published during the 1990s found that hospitalizations due to gastrointestinal complications from NSAIDs range from 32,000 - 103,000 while NSAID related deaths average out at 9,850 ANNUALLY in the United States alone![7][8][9] In fact the Food and Drug Administration reports that the largest cause of drug overdose in the United States is acetaminophen (Tylenol) which by itself is responsible for 56,000 emergency room visits, 2,600 hospitalizations, and 458 deaths due to acute liver failure EVERY YEAR![10] The one-year risks of experiencing complications due to prolonged NSAID use are simply staggering: [11]

Severe gastrointestinal bleeding:

            - Adults younger than 45 = 1 in 2,100

            - Adults older than 75 = 1 in 110

Death:

            - Adults younger than 45 = 1 in 12,353

            - Adults older than 75 = 1 in 647

These non-prescription pain relievers have become an accepted form of musculoskeletal pain relief yet their catastrophic effects have never been as scrutinized as spinal manipulative therapy which has been scientifically proven to be more effective in relieving neck pain and headache[12] with statistically infinitesimal risk of serious adverse reaction.

A population based study published in Neurology in 2006 discovered that over a 16 year period (1987-2003) the incidence rate of  strokes due to arterial dissection (ICAD and VAD) affected only 0.97 - 1.72 residents per 100,000 annually within the defined community (Olmsted County, MN).[13] These findings regarded the population in general since reliable epidemiological data was not available. A subsequent population-based case control and case-crossover study conducted by members of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders was published in SPINE in 2008 which investigated the association between chiropractic care and stroke due to arterial dissection and compared it to primary care physician (PCP) treatment for the same issue.[14] This study examined ALL residents of Ontario (109,020,875 person years), Canada’s most populous province over a nine (9) year period (1993-2002). The researchers found only 818 cases of stroke due to arterial dissection that met the study’s inclusion/exclusion criteria. Overall, 4.4% (n=36) of the cases had visited a chiropractor and 51.0% (417) had only visited a PCP 30 days prior to hospital admission for stroke related to arterial dissection. It should be noted  though that of the 36 cases noted above, only 16 cases (2.0%) were exclusively chiropractic visits 20 (2.4%) had visited both a chiropractor and PCP with the remaining 365 cases having consulted no one for care prior to hospitalization due to stroke. In the end the researchers came to the following conclusions:

            - Stroke due to arterial dissection within the population is a RARE EVENT.

- Of the 453 cases that did consult either a chiropractor or PCP prior to hospitalization, the chief complaint upon presentation was neck pain and headache. The researchers concluded that this similarity was due to an arterial dissection IN PROGRESS which led these patients to seek relief of their pain.

- There is an association between chiropractic care and arterial dissection-related stroke within residents under the age of 45 but chiropractic care DOES NOT exhibit any excess risk of eliciting a stroke.

- There is an association in PCP care and arterial dissection-related stroke in ALL AGE GROUPS.

- Currently there exists no valid screening procedure to identify the risk of stroke in a person presenting with neck pain and/or headache.

The substantive nature of this data is enlightening but in no way exhausts the need for further investigation into this rare yet life altering event. A collaborative effort between chiropractors and neurologists during future research is needed in order to derive a feasible screening method and eliminate the confusing and conflicting information currently being given to patients regarding the treatment of neck pain and headache.

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[1] Haldeman, Scott, Paul Carey, Murray Townsend, and Costa Papadopoulos. "Arterial Dissections following Cervical Manipulation the Chiropractic Experience." Canadian Medical Association Journal 165.7 (2001): 905-06. Print.

[2] Cassidy, David, Eleanor Boyle, Pierre Cote, Helen He, Sheilah Hogg-Johnson, Frank L. Silver, and Susan J. Bondy. "Risk of Vertebrobasilar Stroke and Chiropractic Care." Spine 33.4S (2008): 000. Print.

[3] Terrett, AG. "Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury." Journal of Manipulative and Physiological Therapeutics 18.4 (1995): 203-10. Print.

[4] Murphy, Donald. “Primary Spine Practitioner Training Session III: Putting it all Together.” Community Spine Pathway Training. Burgundy Basin Inn, Rochester. 3&4 May 2014. Lecture.

[5] Hufnagel, A., Alexander Hammers, Paul-Walter Schonle, Klaus-Dieter Bohm, and Georg Leonhardt. "Stroke following Chiropractic Manipulation of the Cervical Spine." Journal of Neurology 246(8) (1999): 683-88. Print.

[6] Reuter, U., M. Hamling, I. Kavuk, K. M. Einhaupl, and E. Schielke. "Vertebral Artery Dissections after Chiropractic Neck Manipulation in Germany over Three Years." Journal of Neurology 253(6) (2006): 724-30. Print.

[7] Risser, Amanda, Deirdre Donovan, John Heintzman, and Tanya Page. "NSAID Prescribing Precautions." American Family Physician 80.12 (2009): 1371-378. American Academy of Family Physicians. American Family Physician, 15 Dec. 2009. Web. 08 May 2014. <http://www.aafp.org/afp/2009/1215/p1371.html#afp20091215p1371-b13>.

[8] Wolfe, Micheal, David Lichtenstein, and Gurkirpal Singh. "Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs." New England Journal of Medicine 340;24 (1999): 1888-899. Print.

[9] Tarone RE, Blot WJ, McLaughlin JK. Nonselective non-aspirin nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding. Am J Ther. 2004;11(1):17–25.

[10] June 29-30, 2009: Joint Meeting of the Drug Safety and Risk Management Advisory Committee with the Anesthetic and Life Support Drugs Advisory Committee and the Nonprescription Drugs Advisory Committee: Meeting Announcement http://www.fda.gov/AdvisoryCommittees/Calendar/ucm143083.htm).

[11] Blower AL, Brooks A, Fenn GC, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharm Ther. 1997;11(2):283–291.

[12] Association, American Chiropractic. "Benefits and Risks of Neck Pain Treatments." Acatoday.org. American Chiropractic Association, n.d. Web. 13 May 2014. <http://www.acatoday.org/pdf/Benefits_Risks_Neck_Pain_Treatments.pdf>.

[13] Lee, VH, Brown RD Jr, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67: 1809-12

[14]Cassidy, David, Eleanor Boyle, Pierre Cote, Helen He, Sheilah Hogg-Johnson, Frank L. Silver, and Susan J. Bondy. "Risk of Vertebrobasilar Stroke and Chiropractic Care." Spine 33.4S (2008): 000. Print.