Spinal Maintenance Care

:

Keeping You Moving Well so that You Can Age Well

Your body’s motion is controlled by the neuro-musculo-skeletal system. This motion system is broken down into three groups based upon the function of the various tissues within your body. The first group is known as the Active Subsystem which consists of the muscles that create motion. The second group is known as the Passive Subsystem which consists of the skeleton, ligaments, tendons, fascia, and other connective tissue that hold your body together. The third group is the Control Subsystem which consists of the brain, spinal cord, nerves, and mechanoreceptors that control the motion of your body.

These three subsystems must work together for normal, healthy motion. Even if you have strong healthy muscles you cannot maintain overall wellness if your Passive and Control subsystems are not as equally strong. Therefore if you are trying to lift something without integration of these subsystems you will unable to move any more weight than your muscles, joints, or nerves will allow.  Balanced and full motion allows joints and muscles to move smoothly and keep you moving well as you age.

The doctors at Life in Motion Chiropractic and Wellness approach treatment with three principles in mind. The first is motion; problems with this affect all three of the body’s subsystems. To effectively help a motion problem treatment solutions must address the mechanical and neurological issues involved and our doctor’s approach to this threefold:

- Chiropractic manipulative therapy unlocks, restores, and maintains joint motion. Joint mobilization reduces restrictions and other posture and motion distortions. In fact, freeing a compressed nerve or restoring motion can affect other parts of the body via the Control Subsystem.

- Myofascial therapy lengthens tight muscles and breaks up ligamentous and fascial adhesions. Other benefits of this form of therapy can be pain relief, which also affects the Control Subsystem, improved circulation, and general stress reduction.

- Therapeutic exercise, during which we teach you how to properly stretch tight/facilitated muscles and strengthen weak/inhibited muscles.

Secondly, we look for compensatory movement patterns in the body’s chain of motion. Your body type, injuries, and lifestyle habits train you, over time, to involuntarily and without thinking move your body in a unique pattern of motion using your stronger muscles. Your joints and ligaments stretch in the direction they are used and subsequently adhesions form along unused paths of motion. Therefore, you begin to move along the path of least resistance, just as a piece of paper bends along a crease the tissues of the body literally groove and fold in the way they are being used. As these mechanically inefficient patterns of poor posture and unbalanced motion progress, a “pain cycle” is created, the result of which is a continuous loop of increased body stress, joint degeneration, chronic pain, and recurring injury.

The solution, which is the third principle of treatment at Life in Motion Chiropractic and Wellness, is the implementation of “the motion cycle” through the use of postural retraining which helps to form new “life habits” and trains the body to move with conscious, full range of motion. Free, balanced motion reduces joint stress, relieves pain, and restores flexibility subsequently breaking the “pain cycle”.

The goal of treatment at Life in Motion Chiropractic and Wellness is to restore balance, flexibility, and control which instills self-efficacy and helps to keep your body moving naturally, feeling good, and aging well.

Optimal Wellness Through Massage - VIDEO

Healthcare Fee Schedules

Our office continues to receive shocked and, on occasion, agitated feedback from prospective patients who call our office that are either under-insured or have a policy with a company we don’t participate with when we inform them of our cash rate fee schedule. These folks feel that our rate(s) for care are high or, on occasion, exorbitant and state that they will seek care elsewhere. The fact is that our fee schedule is simply something we have no control over.

For ANY healthcare provider that participates with insurance company reimbursement for services rendered they are required by federal law (i.e. Health Insurance Portability and Accountability Act) to adopt a cash rate fee schedule that is comparable to the reimbursement rates of the insurers they participate with. To do so otherwise (i.e. discount their fees for cash paying patients) is known as a “dual fee schedule”. This unfortunately is illegal and to do so would open any healthcare provider up to litigation from the insurance company(s) for insurance fraud.

The doctors at Life in Motion Chiropractic and Wellness are also everyday consumers and we would relish the opportunity to provide those individuals who are under-insured or possess policies we don’t participate with a discounted rate(s) for care but due to federal statutes our hands are tied. The only way we would legally be able to provide any discount is to simply stop our participation with health insurance companies and we entertained this idea at the end of 2016. The feedback we received from most of our current insured patients was not favorable and therefore we decided to maintain our involvement with third-party payers (i.e. BC/BS, UHC, UPMC).

In closing, we encourage everyone to petition their local government representatives with your thoughts about the healthcare conundrum in the United States and request that they begin to allow healthcare providers more latitude with their billing practices so that we can truly make healthcare affordable for everyone!

Here is the LINK to our current fee schedule.

NOTE: The one service that we do offer in our office that is not covered by health insurance and therefore allows us to set our own fee is myofascial therapy (i.e. massage). If you feel that your particular problem is related to muscular tension/pain our rates for strictly myofascial therapy is $1/minute with a 15 minute minimum however you can schedule appointments for up to one hour.

Here is the LINK for more information on this service.

Optimal Wellness Through Massage

An extensive amount of research has been conducted on the effects of massage therapy. Research data has shown that massage produces measurable biological effects and may have an effect on the immune system.[1] While some of this scientific evidence is preliminary it has shown that massage can also help with back pain, neck pain, headaches, extremity pain and may improve quality of life for people with depression, cancer, HIV/AIDS and when utilized appropriately and provided by a trained professional, massage therapy appears to have few risks.[2]

Massage therapy focuses on the muscle and other superficial soft tissues of the body to help alleviate tension, inflammation, and pain via the application of manual hands-on techniques. The goal of massage is to establish and maintain good physical condition and health by normalizing and improving muscle tone, promoting relaxation, stimulating circulation, and producing therapeutic effects on the respiratory and nervous systems.[3]

So what is massage therapy?

Swedish massage utilizes long strokes, kneading, deep circular movements, vibration, and tapping.

Deep tissue massage focuses on certain painful, stiff "trouble spots" in your body and utilizes slow, deliberate strokes that focus pressure the muscles, tendons, or other tissues deep under your skin and provides relief from chronic patterns of tension and injuries such as back sprain.[4]

Structural massage, also known as myofascial release, manipulates the soft tissues within the body using different angles and degrees of physical pressure to stretch and guide fascia to a place of easier movement.[5] Research has shown that this style of massage produces positive effects on pain, anxiety, depression, fatigue, and stiffness in those suffering with fibromyalgia.[6]

Myofascial trigger point therapy is most effectively utilized in the treatment of chronic and acute pain. Postural holding patterns, emotional stresses and work-related muscular usage all contribute to areas of contracted muscle that develop firm nodules or taut bands know as trigger points which most of the time we aren’t even aware of. When pressed, trigger points are painful and are associated with pain elsewhere in the body and without direct intervention to eliminate them will not go away on their own.[7]

So what exactly does medical research say about massage?

Since 2008, the National Center for Complementary and Integrative Health (NCCIH) a division of the U.S. Department of Health & Human Services has taken an active role in not only reviewing the available literature but has also funded clinical trials on massage therapy. This is what they have discovered:

- Massage therapy helped reduce pain, improve function, and decrease the use of anti-inflammatory medication more effectively than usual medical care[8] in people with chronic low-back pain.[9]

- Massage therapy led to statistically significant improvements in neck pain severity, pain-related disability and function, and in one study participants reported a 14% decrease in the use of pain medication.[10] [11]

- A 2012 study found that a 60 minute massage once per week exhibited significant improvements in pain, function, and global response compared with those receiving usual care medical care for osteoarthritis of the knee.[12]

Aside from the research conducted by the NCCIH there have been other studies that have found myofascial therapy to also be an effective form of treatment for conditions such as tension type headache [13] [14] [15] [16], temporomandibular joint (a.k.a. TMJ) pain[17], and chronic shoulder pain.[18]

Chronic muscular restriction can inhibit essential physiologic processes such as blood flow, lymphatic drainage, nerve conduction, and cellular metabolism which can, over time, affect our overall health. The primary reason for the therapeutic effects of massage therapy is that it increases blood flow in small vessels that has been impeded due to muscle tension and that leads to better and faster recovery around the muscle tissue which in turn improves the range of motion, reduces swelling, and has pain-reducing properties.[19] [20]

Dr.Sean Konrad at Life in Motion Chiropractic and Wellness applies a collection of skills when performing therapeutic myofascial treatment, however the type of therapy performed will depend on your needs and physical condition.

Dr. Konrad provides treatment via chair massage, during which myofascial therapy is performed over the clothing in a forward seated position as seen here,

Chair Massage

or on a flexion-distraction therapy table for cases in which a more deep tissue approach is warranted. 

Aside from this he can also apply a range of modalities to supplement this hands-on therapy which include:

Heat or Ice Application

Muscle Stimulation

Hot Stone Massage

Instrument Assisted Soft Tissue Manipulation

Kinesio Tape Application

Here a short summary of Dr. Konrad’s formal training in myofascial techniques:

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[1] Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. (http://www.ncbi.nlm.nih.gov/pubmed/20809811) The Journal of Alternative and Complementary Medicine. 2010; 16(10):1–10.

[2] Field, Tiffany, PhD, Andrea Furlan, MD, Karen Sherman, PhD, Partap Khalsa, DC, and John Killen, MD. "Massage Therapy for Health Purposes." National Center for Complementary and Integrative Health. U.S. National Library of Medicine, 06 Sept. 2016. Web. 21 Sept. 2016.

[3] Fritz, Sandy. "Chapter 2." Mosby's Fundamentals of Therapeutic Massage. 4th ed. St. Louis, MO: Mosby/Elsevier, 2009. 30-33. Print.

[4] Keifer, David, MD. "Massage Therapy Styles and Health Benefits." WebMD. WebMD, 01 Aug. 2016. Web. 21 Sept. 2016.

[5] Konopelky, Karin. "Structural Integration." Massage Therapy 101. Tsavo Media Canada Inc., n.d. Web. 22 Sept. 2016.

[6] Yuan SL, Matsutani LA, Marques, AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Man Ther. 2015;(2):257-264

[7] Finando, Donna. "What Is the Difference Between an Acupoint and a Trigger Point? Part 1." MASSAGE Magazine. Massage Magazine, 08 Dec. 2008. Web. 01 Mar. 2017.

[8] Usual care for low-back pain may include medication, other forms of physical therapy, back exercises, and education.

[9] Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low-back pain: a randomized, controlled trial. (http://www.annals.org/content/155/1/1.abstract?aimhp) Annals of Internal Medicine. 2011;

155(1):1–9.

[10] Sherman KJ, Cherkin DC, Hawkes RJ, et al. Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain. 2009; 25(3):233–238.

[11] Sherman KJ, Cook AJ, Wellman RD, et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. (http://www.ncbi.nlm.nih.gov/pubmed/24615306) Annals of Family Medicine. 2014;12(2):112–120.

[12] Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose finding trial. PLoS One. 2012; 7(2):e30248.

[13] Doraisamy, Magesh Anand, Charles Prem Kumar & Anshul, and Chandran Gnanamuthu. "Chronic Tension Type Headache and the Impact of Myofascial Trigger Point Release in the Short Term Relief of Headache." GJHS Global Journal of Health Science 2.2 (2010): 239-44. Web.

[14] Fernández-De-Las-Peñas, César, and Carol A. Courtney. "Clinical Reasoning for Manual Therapy Management of Tension Type and Cervicogenic Headache." Journal of Manual & Manipulative Therapy 22.1 (2013): 45-51. Web.

[15] Quinn, Christopher, Clint Chandler, and Albert Moraska. "Massage Therapy and Frequency of Chronic Tension Headaches." American Journal of Public Health 92.10 (2002): 1657-661. Print.

[16] Ferna´ndez-de-las-Pen˜ as, Cesar, Maria L. Cuadrado, and Juan A. Pareja. "Myofascial Trigger Points, Neck Mobility, and Forward Head Posture in Episodic Tension-Type Headache." Headache 47 (2007): 662-72. Print.

[17] Miernik, Marta, Mieszko Więckiewicz, Anna Paradowska, and Włodzimierz Więckiewicz. "Massage Therapy in Myofascial TMD Pain Management." Advances in Clinical and Experimental Medicine 21.5 (2012): 681-85. Print.

[18] Bron, Carel, Arthur De Gast, Jan Dommerholt, Boudewijn Stegenga, Michel Wensing, and Rob Oostendorp. "Treatment of Myofascial Trigger Points in Patients with Chronic Shoulder Pain: A Randomized, Controlled Trial." BMC Medicine. BioMed Central Ltd., 24 Jan. 2011. Web. 30 Jan. 2017.

[19] Goats GC: Massage – the scientific basis of an ancient art: part 2. Physiological and therapeutic effects. Br J Sp Med 1994, 28(3), 153–156.

[20] Smith AR Jr.: Manual Therapy: The Historical, Current, and Future Role in the Treatment of Pain. Sci World J 2007, 7, 109–120.

Optimal Wellness Through Chiropractic Care

#ThinkChiropractic

Your spinal column, which consists of 24 bones known as vertebrae and the interlaying discs, protect your most delicate and important system, your central nervous system, and impingements within the joints of your spinal column can contribute to a number of health problems and ailments.

The spinal cord is the first relay site in the transmission of information to the brain regarding a peripheral stimulus that causes pain. Sensory signals are transmitted from the periphery by primary nerve fibers into the dorsal horn of the spinal cord where wide dynamic range neurons are housed. Wide dynamic range neurons are responsive to thermal, chemical, and mechanical sensory input as well as a broad range of intensity of stimulation from the peripheral nerves. They steadily increase their firing rate as the stimulus intensity rises into the very unpleasant range. Therefore adverse stimulation of wide dynamic range neurons can lead to altered body image[1] such as:

• Feeling like your back or neck is “swollen”

• Feeling of “stiffness” despite normal range of motion

• Alteration of the body’s natural ability to maintain good posture in relation to the surrounding environment at rest and during motion

• Headache pain[2]

An effective solution to maintaining optimal wellness is chiropractic care. Chiropractic is like brushing your teeth, it's something you need, just like regular dental hygiene, to maintain the life of your spine, because regular activities, poor posture, chronic sitting, and improper ergonomics can contribute to your spine functioning less than optimally.

Research published in a June 2004[3] and subsequent May 2007[4] edition of the  Journal of Manipulative and Physiological Therapeutics examined the integration of allopathic[5], osteopathic, chiropractic and various forms of alternative and complementary medicine versus conventional strategies alone at a health maintenance organization (HMO) in metropolitan Chicago. The data complied was based on 70,274 member-months[6] over a seven-year period and they found that the integrative care model resulted in:

• 60.2% decrease in-hospital admissions

• 59% decrease in hospital days[7]

• 62% decrease in outpatient surgeries

• 85% decrease in pharmaceutical costs

Subsequently, a National Health Interview Survey was conducted in 2012 which provides the most comprehensive information on the use of complementary health approaches in the United States. National estimates were derived via data collected from 34,525 adults aged 18 and over regarding wellness-related reasons for consumer’s utilization of supplementation, yoga, and spinal manipulation. The results of this survey were published on November 4, 2015 by the  National Center for Complementary and Integrative Health (NCCIH) and they found that:

• Over 50% reported using spinal manipulative therapy (SMT) for wellness

• While over 65% reported using spinal manipulation for treating a specific health condition

Wellness Related Use of CAM

However, the most common responses from those using SMT for general wellness or disease prevention was:

• It improved overall health

• Spinal manipulation “made them feel better.”​

In fact, approximately 40% of those who reported utilizing chiropractic care stated that they experienced reduced stress, better sleep, and/or an easier time coping with health problems after receiving spinal manipulative therapy.

Chiropractic Care Makes People Feel Better

This data substantiates the fact that the traditional medical model of healthcare is beginning to wane. Today’s healthcare consumer is now more focused on the effects that physical and psychological stress has on our bodies and the therapeutic interventions that address the mind-body connection are beginning to receive some much deserved attention as well as implementation. Chiropractors clearly have a greater role in your health and wellness than just treating sore backs. Chiropractic care should be considered an invaluable tool to assist you in not only feeling well, but to also help you maintain an optimal level of wellness.

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[1] Nijs J, et al. “Nociception affects motor output: a review on sensory-motor interaction with focus on clinical implications.” Clin J Pain. 2012;28(2):175-81

[2] Jull, et al. “Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches.” Cephalalgia 2007; 27:793-802

[3] Sarnat, Richard, and James Winterstein. "Clinical and Cost Outcomes of an Integrative Medicine IPA." Journal of Manipulative and Physiological Therapeutics. U.S. National Library of Medicine, June 2004. Web. 08 Feb. 2017.

[4] Sarnat, Richard, James Winterstein, and JA Cambron. "Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update." Journal of Manipulative and Physiological Therapeutics. U.S. National Library of Medicine, May 2007. Web. 08 Feb. 2017.

[5] This is the principle of mainstream medical practice, as opposed to that of homeopathy.

[6] The number of individuals participating in an insurance plan each month. Member month is calculated by taking the number of individuals enrolled in a plan and multiplying that sum by the number of months in the policy.

[7] The total number of days a patient stays in a hospital after admission to the hospital for a sickness that requires 24-hour nursing care and medication.

Effective Conservative Spine Care

#ThinkChiropractic

Low back pain (LBP) is a recurrent disorder that can occur anytime in a person’s life and 50% of people who experience LBP seek health care during an episode.[1] [2] At least 85% of those who do seek care are diagnosed as experiencing nonspecific/non-pathological LBP.[3] Effective management of LBP in the United States is challenging and therefore it is difficult to determine the best approach for each patient given the vast number of recommended conservative treatment options within our complex health care system.[4]

Researchers from Optum Health Care Solutions[5] in collaboration with researchers from the Jefferson School of Population Health[6] published an article in a 2013 edition of Population Health Management[7] titled, “Conservative Spine Care: Opportunities to Improve the Quality and Value of Care” that suggests the utilization of a “classification-based” model for the management of LBP which, in a clinical trial published September 29, 2011 in The Lancet, demonstrated practical potential for improving clinical outcomes and addressing incongruous utilization of services.[8] The STarT Back Screening Tool (SBST)[9] can be administered prior to initiating treatment and provides the portal of entry provider the opportunity to incorporate evidence-informed decision criteria and guidance regarding an appropriate conservative low back care pathway in which to place the patient.

The SBST approach changes the pattern of provider management and referral of LBP to coincide with primary care data that suggests approximately 55% of patients are at low risk of poor outcome (i.e. irrespective of treatment), 33% are at medium risk, and 12% are at high risk.[10] Using the SBST approach, low risk individuals usually benefit most from receiving reassurance and advice while treatment options for medium risk individuals are typically physiotherapy approaches to addressing pain and disability. However, providers who are skilled at cognitive-behavioral approaches in addition to physiotherapy interventions are best suited to render care to high risk individuals.[11]

When compared to current best practice, use of the SBST tool along with targeted treatments increased efficiency, improved clinical outcomes, and reduced health care costs. [4]

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[1] Dagenais S, Haldeman S. Evidence-Based Management of Low Back Pain. St Louis, MO: Mosby, Inc. (Elsevier); 2012:1–2.

[2] Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat. 2005;13:13.

[3]Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.

[4] Kosloff, Thomas M., David Elton, Stephanie A. Shulman, Janice L. Clarke, Alexis Skoufalos, and Amanda Solis. "Conservative Spine Care: Opportunities toImprove the Quality and Value of Care." Population Health Management. Mary Ann Liebert, Inc., 01 Dec. 2013. Web. 01 Feb. 2017.

[5] A health services and innovation company whose mission is to help make the health system work better for everyone.

[6] A college whose mission is to prepare leaders with global vision to examine the social determinants of health and to evaluate, develop and implement health policies and systems that will improve the health of populations and thereby enhance the quality of life.

[7] A journal that provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices.

[8] Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary caremanagement for low back pain with current best practice (STarT Back): A randomisedcontrolled trial. Lancet. 2011;378(9802):1560–1571. https://www.youtube.com/watch?v=yVu6w_01p9k

[9] Developed by researchers at Keele University (United Kingdom) with funding from Arthritis Research UK

[10] Hill JC, Dunn KM, Lewis M, et al. A primary care back pain screening tool: Identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59:632–641.

[11] Sowden G, Hill JC, Konstantinou K, et al. Targeted treatment in primary care for lowback pain: the treatment system and clinical training programmes used in theIMPaCT Back study (ISRCTN 55174281). Fam Pract. 2012;29:50–62.