Archive for year: 2016

The Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness-A Randomized Controlled Trial.

Spine (Phila Pa 1976). 2016 Nov 18.

Berglund L1, Aasa B, Michaelson P, Aasa U.

STUDY DESIGN:

The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects are affected by mechanical LBP.

SUMMARY:

There is evidence that patients with low back pain may have a decreased size of the (LM) muscles with an asymmetry between sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.

CONCLUSIONS:

There was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

The study investigated a relationship between the presence of chronic health conditions outside the bowel and the contribution of a family of protiens found in wheat called amylase-trypsin inhibitors(ATI’s). ATI’s make up about 4% of wheat protiens.
Past studies focused on Gluten and its effects on digestive health this research casts a light on the effects ATIs may play in chronic health conditions such as RS, MS, asthma and others.
The type of “gut inflammation” seen in non-celiac chronic gluten sensitivity differs from that of celiac disease and they don’t believe its triggered by gluten protiens. “We demonstrated that ATI’s from wheat, that are also contaminating commercial gluten, activate specific types of immune cells in the gut and other tissues, potentially worsening the symptoms of pre-existing inflammatory illnesses”.

Maybe there is something to the sedulous chatter regarding: “I feel so much better not eating wheat…but my doctor tells me its all in my head because I don’t have celiac disease”…..

Boucher P, Robidoux S. J Forensic Legal Med. Feb. 2014.

This interesting review of (6) Canadian court cases where Chiropractors were sued for allegedly causing a lumbar disc herniation after spinal manipulation. The highlights of the cases were:
1. Informed consent is an ongoing process and can’t be entirely delegated to office personnel.
2. When patient history reveals risk factors for lumbar herniation the DC has a duty to rule out disc pathology as an etiology for the symptoms before beginning anything but palliative treatments.
3. Lumbar disc herniation may be triggered by spinal manipulation on vertebral segments distant from the involved disc…such as the thoracic spine.

Jung-Seok, L et al. J Exerc Rehab Oct. 2016.

The benefits of strength exercise plus walking was found to be more effective for overweight cLBP patients vs. just strength training. The exercise was performed twice a week, 50 mins per session for 12 weeks. All variables were improved but the fat-loss and pain levels were more improved by the addition of strength-training plus walking.
This study further supports the suggestion that if we are using rehab in our clinics, 2-4 months of 2-3x per week sessions is both reasonable and clinically expedient for all of the variables which constitute successful outcomes.

The expression “I’d rather be rich than famous” rings far truer to those over 40 and self-employed than other populations. Most of us strive to build wealth using our vocation and a network of people who can facilitate that end….as such “fame & notoriety” tend to go, at least partly, hand-in-hand with wealth. As Zig Ziegler pointed out ‘the only way you get what you want is by helping enough other people to get what they want’…..we do this with spinal care.

People want health, wellness and pain-relief….and they want it (typically) quick and as inexpensively as possible. So, long-term “profit-based” care can only persist IF effective (a.k.a evidenced/science-based) care is the format of the practice. 

The beauty of most people is their ‘amiability‘ and willingness to give the benefit of the doubt to those they trust….IF you try your best most people tend to stick with you. There may be some itinerant patients however most tend to stick with a doctor once they’ve built a relationship of trust and that trust is from confidence and faith the doctor knows best, and has their best interest at heart.

There is no shortage of ways to take advantage of patients using gimmicks, high-priced junk science and lies. However you are far less likely to see good retention, referrals or longevity.

Protocol/evidenced-based Decompression, ‘intense’ heat modalities (Class IV high-power Laser) exercise and ergonomic-bio-mechanical education (McGill) are reasonable, science-based treatment regiments ANY doctor should be confident & proud to deliver and ANY patient to receive. We’ve spent a combined 50 years developing our protocols and equipment to create both science/evidenced-based care as well as profit–based care. These procedures can stand up to patient scrutiny and have a long track record of “making money“.

I believe the vast majority of DCs never want to fool, misguide or rip-off patients. We feel the exact same. We all have to get up and go to bed with ourself & our deeds playing in our head. Pride, confidence and faith in the treatments you deliver and the equipment you deliver them with have to be both scientific-evidenced based and profitable…..Otherwise why bother?