Optimal Wellness Through Chiropractic Care

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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

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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.

Chiropractic Wellness Care

The 2012 National Health Interview Survey 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

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

Chiropractic Care

The Dr. Oz Segment, Can Your Chiropractor Kill You? Which Aired, 11/16/16

The Details

On Tuesday, November 15, 2016, The Dr. Oz Show filmed two segments addressing the death of Ms. Katie May. The first segment involved the family of Ms. May who believe Ms. May’s death was a result of the care she received from a chiropractor. The second segment involved Dr. Oz, Dr. Carolyn Brockington, a neurovascular surgeon, Mt. Sinai Hospital in New York (http://www.mountsinai.org/profiles/carolyn-d-brockington) and Dr. Steven Shoshany, a practicing chiropractor from New York (www.drshoshany.com).

While the consideration of any adverse outcome associated with our care is unflattering, the manner in which this situation was addressed by all three panelists was fair, constructive and informative for the public. There was no condemnation of chiropractic, and there was no statement, in this segment, that the chiropractor caused this problem. To the contrary, there was a thorough discussion of vertebral artery dissection, including its rarity in association with chiropractic care, its ability to present in seemingly healthy middle-aged persons, discussion that most dissections do not evolve into a stroke and finally that death from arterial dissection is extremely uncommon.

Three questions were posed to Dr. Shoshany in the six-and-a-half-minute segment including:

- Did cervical manipulation play a role in the circumstances of Katie May?

- How important is a patient's history in helping to understand this problem?

- What are chiropractors doing to address these situations?

Dr. Shoshany expressed condolences to the family of Ms. May and went on to explain that the best science available suggests that this was a dissection in progress that occurred during the photo-shoot involving Ms. May. He used a Bow-Hunter’s Stroke as an example of the mechanism of causation—that is the strain of maintaining a stressed position for a period yielded the injury.

He related how rare these events are in chiropractic.

The discussion moved to comments from Dr. Brockington, the neurovascular surgeon. She was asked point blank by Dr. Oz, “Do you think manipulation caused the dissection?”

- She did not say the chiropractor caused this stroke.

- She did not raise undue concern about cervical spine adjusting.

In response, she related that she, as a stroke specialist, sees strokes every day. Some of the strokes she sees have known causes and many don’t. She related that she recently saw a gentleman who developed an arterial dissection while painting. She noted that these conditions can occur in seemingly healthy persons in their 30-50s with no prior history. She reviewed an angiogram to show what a dissection looked like on imaging and to explain how it was related to blood flow and oxygenation of the brain.

She discussed that most dissections don’t lead to stroke, but cervical artery dissection did account for 1 in 5 strokes in middle-aged persons.

The conversation moved to the second question about the value of a patient history.

Dr. Shoshany related that, as a clinician, Dr. Oz appreciated that the patient history was the most valuable tool we have to work with. He related the importance of knowing about a history of stroke, aneurysm, dissection, collagen disorders, etc. Dr. Oz then walked the audience through the 5 Ds, the 3 Ns and the A associated with cervical artery dissection:

- Diplopia [a.k.a. double vision]

- Dysphagia: difficulty in swallowing

- Dysarthria: difficulty in speech articulation

- Drop Attacks: a tendency to fall without warning and without losing consciousness, or a fall of this kind

- Dizziness

- Nausea

- Numbness

- Nystagmus: an involuntary rhythmic movement of the eyes, usually from side to side, caused by some illnesses that affect the nerves and muscle behind the eyeball

- Ataxia: the inability to coordinate the movements of muscles

The advice given was that one should think of their neurologist OR visiting the emergency room rather than chiropractor when one has neck pain with these additional symptoms.

The third question about what the profession is doing about this problem allowed Dr. Shoshany to explain that the profession has been addressing this situation for decades. He also added that he has delivered more than 200,000 cervical adjustments in his 20+ years of practice in Manhattan without a single occurrence of this problem. He added that Life University, the largest single campus chiropractic program in the world, has provided an estimated 4.5 million cervical adjustments during the past 25 years without any incident of this nature. Finally, he added that among the 17 chiropractic educational programs in the United States, there has not been a single incident, to his knowledge, of this nature in the past 20 years.

Dr. Oz read a statement from the American Chiropractic Association (ACA) commenting on how DCs are educated and trained in differential diagnosis based on history, examination, etc., and that they are trained to refer when necessary for further evaluation or emergency intervention.

Dr. Shoshany again emphasized the safety of chiropractic and offered the view that when you consider our safety record in light of 45 people dying every day of opioid use and abuse, chiropractic care is even safer than first thought.

The segment ended with Dr. Oz offering the following comments:

- Cervical artery dissections happen; this doesn’t mean you need to avoid going to your chiropractor.

- This doesn’t mean it was caused by the chiropractor.

- It does mean anyone with neck pain needs to fully advise their chiropractor of any other symptoms or problems they are having with the neck pain.  

The Take-Aways

1. The family of Ms. May are naturally upset about the loss of a loved one. They are entitled to their emotional grief, and even if the data doesn't support the argument, they may choose to direct it toward the chiropractic profession. 

2. The DATA cited on The Dr. Oz Show from chiropractic education about this type of issue is as follows:

- Life University, 25 years, 4.5 million cervical adjustments—no dissection related issues have been reported

- Among all 17 chiropractic educational institutions, 20 years, millions of cervical adjustments—no dissection related issues have been reported

- The 25-year window at LIFE and the 20-year window across chiropractic education should not imply something happened 26 or 21 years ago, respectively. The data isn’t available for the period before those dates.

3. The 5 Ds, 3 Ns and the A the telltale signs of a health history

- Dysphagia, dysarthria, diplopia, drop attacks and nystagmus are important symptoms that, by themselves in the presence of neck pain, strongly suggest a level of care that DOES NOT include chiropractic.

- Dizziness, nausea, numbness and ataxia are not as strongly associated by themselves with dissection and stroke, but you should look for the development of these symptoms in a constellation as a guide to increasing your index of suspicion.

- When you experience neck pain is “unlike any pain I ever had before in my life” or “the most unusual pain I have ever had” or “the worst pain I have ever had,” THINK about the possibility of a dissection in progress and handle accordingly.

4. Chiropractic care is very safe. When it is viewed in a comparative sense with pharmaceuticals or surgery for similar types of problems, it is remarkably safe. Life has risks. There are fewer risks under chiropractic care than under medical or surgical care.

5. This wasn’t discussed on The Dr. Oz Show, but it is something you should be aware of: The Coroner’s Report in the case of Ms. May noted: “Bilateral vertebral artery dissection is a rare complication of neck manipulation in one per 100,000 to one in 2 million manipulations. (South Med J. 2007 Feb; 100(2):201-3)”

* The literature cited is misquoted as follows:

- The article states “Serious complications are infrequent, with a reported incidence between one per 100,000 and one per 2 million manipulations.”

1. This does not refer exclusively to vertebral artery complications.

2. This does not refer to bilateral vertebral artery dissection.

- The literature cited did not identify an arterial dissection-unilateral or bilateral on imaging or during autopsy.

- The literature cited was the weakest class of evidence, a single case study, and neglected the opportunity to refer to two more recent case-control and case-crossover studies (Cassidy, 2008) and Kosloff (2015). He also chose not to refer to a recent meta-analysis on this subject conducted by neurosurgeons at Penn State Hershey Medical Center (Church, 2016).

Bilateral cervical artery dissection is more commonly associated with a disease of the arteries (arteriopathy) than with other causes.​

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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.

How to Improve Your Posture - Doctors of Chiropractic

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