Chiropractic Adjustment versus Physical Therapy Mobilization

July 28th, 2010

“At Richetto Chiropractic and Rehab, we adhere to the principles and peer reviewed researches which legitimize proper and reasonable treatments in the healthcare arena. RCR promotes and adheres to both Chiropractic AND Physical Therapy protocols, and believes that when combined, these philosophies are greater than the sum of their parts. In addition, we provide each patient a specific and personal blend of Chiropractic, Physical, and Manual modalities to get each patient symptom free more efficiently and effectively.” Dr. Drew Richetto, DC, CSCS

The immediate effect of Chiropractic manipulation versus Physical Therapy mobilization on pain and range of motion in the cervical spine: a randomized controlled trial.

http://www.ncbi.nlm.nih.gov/pubmed/1469341?dopt=Abstract&holding=f1000,f1000m,isrctn

The objective of this study was to compare how the patient’s pain and range of motion were affected immediately following a Chiropractic manipulation (CMT) verses Physical Therapy mobilization (“Mobs”) in neck pain patients. 100 patients were studied, suffering from a unilateral neck pain which referred into the trapezius muscle.

52 patients received chiropractic manipulation and 48 subjects were mobilized using Physical Therapy Mobs. 16 subjects reported having neck pain for less than 1 week (acute phase), 34 subjects stated having pain between 1 week and 6 months (subacute to chronic) and 50 patients reported having pain for more than 6 months (chronic). 78 subjects had a prior history of neck pain. 31 subjects had been involved in a  motor vehicle accident and 28 subjects had other types of minor trauma to the neck. Using the Pain Disability Index, there were no significant differences measured between the two treatment groups with respect to history of neck pain or level of disability.

The patients received either a single rotational manipulation (high-velocity, low-amplitude thrust) or received mobilization in the form of muscle energy technique. Cervical spine range of motion and pain intensity were recorded Prior to and immediately after the treatments. The results show that both treatments do increase active ranges of motion, however, manipulation had a significantly greater effect on decreasing the subjects’ pain intensity. 85% of the manipulated patients and 69% of the mobilized patients reported pain improvement immediately after treatment. However, the decrease in pain intensity was more than 1.5 times greater in the manipulated group. This study demonstrates that a single manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain. Both treatments do increase range of motion in the neck to a similar degree.

Posted in Neck Pain, Physical Therapy | No Comments »

Iliotibial band and low back pain

July 28th, 2010

The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain

http://www.chiroandosteo.com/content/18/1/1

As a patient suffering with pain down the side of your leg extending to the knee accompanied by low back pain, you may wonder if it is all related to your low back pain. Moreover, is this tightness down the lateral portion of your leg causing a decrease in muscle function of the related muscle group?

The following study took 300 subjects with and without low back pain between the ages of 20 and 60 and attempted to discover if there indeed is a correlation between tight Iliotibial symptoms associated with low back pain. The perceived theory has been that iliotibial tightness in individuals with LBP is a compensatory mechanism following hip abductor muscle weakness (specifically, gluteus medius and tensor fascia latae)

Hip Abduction is when starting in the anatomical position; the entire leg is lifted laterally (or away) from the body, maintaining a straight leg. The main muscle used for this action is the Gluteus medius. When the gluteus medius is injured or in a state of dysfunction, the tensor fascia latae compensates by taking on more responsibility that the gluteus cannot provide. Many speculate that this leads to the TFL being overworked, causing tightness pain and eventually weakness. It has been proposed that this TFL overuse in patients with low back pain causes weakness directly to the tensor fascia latae.

However, the results of this study, in contrast with the current perceived theory, revealed no significant difference in hip abductor strength/weakness between subjects with low back pain with or without Iliotibial band tightness.

Based on this research, if a patient presents to my Chiropractic office with low back pain, with or without IT band tightness, I would not prescribe a strengthening protocol for the tensor fascia latae in the patient’s rehabilitation treatment plan, as it would be medically unnecessary.

Posted in Physical Therapy | No Comments »

Neck Pain

May 10th, 2010

What is neck pain?

Neck pain can occur anywhere in the neck, from the top of the shoulder regions and up to the base of the skull. It can potentially move to your upper back and even radiate down the arms. It may decrease the ability to move your head and neck in normal positions such as flexion, extension, and bending.

Neck pain is a very common symptom, but by no means is it ever “normal.” The majority of sufferers are middle aged people 50 and older.

What are causes of neck pain?

A majority of all neck pain is created through daily activities that strain the neck. Poor posture such as slouching at your desk, painting a ceiling with your head locked in an extended position, or sleeping on your stomach with your neck rotated and twisted are some things that can cause neck pain. These, and many similar kinds of activities, can lead to neck a strain, even a spasm of the neck muscles, or swelling of the neck joints.

An injury can also cause neck pain. A slip and fall or whiplash from a car accident can cause neck pain. Some less common medical problems can also lead to neck pain, such as:

What are the symptoms?

You might feel a headache, stiffness, a knot, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may notice a decreased ability to move or turn your head in certain positions. If there is pressure on a spinal nerve root due to inflammation or direct compression, you experience radiating pain that shoots down your arms. You may also have numbness, tingling, or weakness or any combination thereof, in your arm.

If your neck pain lasts longer than a few months (chronic), you may have trouble coping with your activities of daily living. Common side effects of chronic pain include fatigue, depression, and anxiety.

How is neck pain diagnosed?

A diagnosis can only be obtained by a licensed profession Primary Care Provider such as a Medical Doctor (M.D./D.O.) or Chiropractor (D.C.). Healthcare professionals that CANNOT diagnose you include, Physical Therapist (PT), Athletic Trainer (ATC) Occupational Therapist (OT). The first thing your doctor will do is perform a physical exam while asking you questions about your symptoms.  Some of these questions may include any current or past injuries, illnesses, or activities that may be causing your neck pain.

During the physical exam, the doctor will perform a range of motion test to determine how well you can move your neck. The doctor will also palpate and exam your body to look for tenderness or numbness, tingling, or muscle weakness in your arms or hands.

If your pain started after an injury, or if it doesn’t improve after a few weeks, your doctor may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues. These tests may be done to check the neck vertebrae, spinal discs, spinal nerve roots, and spinal cord .

How is it treated?

The type of treatment will be determined once an accurate diagnosis has been established by your doctor. They will also consider whether your neck pain is caused from activities of daily living, from an injury, or from another medical condition, including side-effects of any current medication you are taking.

For neck pain that occurs suddenly:

  • Reduce pain or inflammation by putting an ice pack on the affected area
  • Avoid more injury to your neck by changing activities and habits, such as how you sit or sleep.
  • Try exercises or stretches to help move your head and neck more easily.

To treat chronic neck pain, your medical doctor might prescribe acetaminophen medicine for pain control or NSAIDs to relax your neck muscles. Your Chiropractic doctor may try medical massage and therapeutic exercises to relieve neck irritation.

Surgery is rarely performed to treat neck pain. But it may be considered as a last option if your pain is caused by a medical problem, such as pressure on the spinal nerve roots, a tumor, or narrowing of the spinal canal.

Can you prevent neck pain?

You can circumvent neck pain caused by stress or a muscle sprain/strain with lifestyle changes. Avoid long periods of time in positions that stress your neck such as flexion or lateral bending. This can include sitting at your computer, desk or couch for long periods of time. Try setting a timer for 20-30 minutes to remind you to change your posture and walk around a few minutes to reset your body.

If your neck pain is worse in the PM hours, think about how you sit during the day. Sit straight in your chair with your feet flat on the floor and knees facing forward. Take short breaks several times an hour.

If your neck pain is worse in the AM, check your mattress and pillow and the position you sleep. If you are a stomach sleeper, try to avoid this position by training your body by falling asleep on your back or side. Use a pillow that keeps your neck straight.

Learning about neck pain:
Being diagnosed:
Getting treatment:
Living with neck pain:

Posted in Neck Pain | No Comments »

Low Back Pain

May 10th, 2010

Low Back Pain

A majority of low back pain is triggered due to a mixture of muscle strain, overuse, and injury to ligaments, tendons, discs, and muscles which support the spine. Leading experts reveal that over time strain of the muscle will lead to a global imbalance in spinal structure. This further can lead to constant tension on ligaments, tendons, bones, muscles, and discs which make the back more vulnerable to injury or exacerbation of old injuries.

Causes of low back pain in the lumbosacral region, are likely to build upon one another. When injury occurs to a specific area in the back, the injured person tends to alter their gait or move in unnatural ways to avoid feeling pain. This may burden or overwork other auxiliary muscles that aren’t designed to compensate for the initially injured muscles. The newly recruited muscles are now working double duty, and will most likely become strained as well.
The most common causes of low back pain are:

  • Injury or overuse of muscles, tendons, facet joints, ligaments, and the sacroiliac joints.
  • Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by:
  • A herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.
  • Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.
  • Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.
  • Spinal stenosis, or narrowing of the spinal canal, which typically develops with age.
  • Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.
  • Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.
  • Compression fractures. Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

    Less common spinal conditions that can cause low back pain include:

    • Ankylosing spondylitis, which is a form of joint inflammation (arthritis) that most often affects the spine.
    • Bacterial infection. Bacteria are usually carried to the spine through the bloodstream from an infection somewhere else in the body or from IV drug use. But bacteria can enter the spine directly during surgery or injection treatments, or as the result of injury. Back pain may be the result of an infection in the bone (osteomyelitis), in the spinal discs, or in the spinal cord.
    • Spinal tumors, or growths that develop on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.
    • Paget’s disease, which causes abnormal bone growth most often affecting the pelvis, spine, skull, chest, and legs.
    • Scheuermann’s disease, in which one or more of the bones of the spine (vertebrae) develop wedge-shaped deformities. This causes curvature of the spine (rounding of the back, or kyphosis), most commonly in the chest region.

    Other medical conditions that can cause pain that may be similar to low back pain include:

    “I think, therefore I am…” When a doctor tells you, “your pain is all in your head,” they are actually scientifically correct, all joking aside. It is the brain that translates the signals your body sends to it via your nerves and spinal cord, which ultimately are interpreted by your brain as…pain. Your state of mind also has an effect on your level of pain and whether it becomes long-lasting (chronic). People who are depressed, under stress, unhappy in their work, or seeking money for an injury are more likely to have chronic back pain.

    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. A majority of this information is provided by WebMD.

    Posted in Low Back Pain | No Comments »

    Therapists’ Schedule

    September 8th, 2009

    Mon: 9am-1pm Lacey; 1-6pm Heidi

    Tues: 1-6pm Bobbi

    Wed: 9am-1pm Lacey; 1-6pm Heidi

    Thurs: 1-6pm Bobbi

    Fri: Lacey AND Bobbi 10-3pm

    Posted in Massage Therapy | No Comments »