Feeling "Crabby" Blog

Are you getting the best care?

4/26/2023

I want to take the time to explain the difference between active and passive modalities in chiropractic care. Modalities is a term used that can be interchanged with the word “treatment”.

Passive modalities are those that do not require any participation from the patient. Common modalities that fit in this category are e-stim, therapeutic ultrasound, heating pads, acupuncture, dry needling, ADJUSTMENTS and soft tissue therapy.

Active modalities are those that require the patient to be physically active! Common modalities that fit in this category include stretching, rehab exercises, and strength training.

So why does it matter that patients understand the difference between these two things???

Because at some point during care, patients should be participating in ACTIVE MODALITIES. This is a vital part of care. Passive modalities only provide TEMPORARY relief of symptoms. While active modalities help to provide LONG-TERM relief.

Why is it that active modalities provide long-term relief?

Because active modalities require muscle recruitment. In many cases, patients are dealing with chronic pain because they do not possess the strength to handle the amount of STRESS they are applying to their bodies. A heating pad and an adjustment won’t make you stronger, they may give you a few days of relief, but for YEARS of relief, you have to build up your muscle tissue to handle what you're asking it to do.

You may be thinking, “Well I sit at a desk for 8+ hours a day for my job, I don’t have to be strong to sit in a chair” ...YES YOU DO! You are asking your back muscles to hold you erect in a chair for 8+ hours! That is an incredible task! Could you hold a dumbbell curl for 8 hours?

Takeaway: If your chiropractor has never discussed active care with you, then they have done you a disservice. If they signed you up for some outrageous treatment plan with an exorbitant number of visits that don’t include ACTIVE CARE, ask for your money back for your unused visits (FYI they legally have to refund you for any unused visits in the state of Texas) and find yourself someone better.

References
Jansen, Mariette J., et al. "Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review." Journal of physiotherapy 57.1 (2011): 11-20.

This article showed that mobilization with strengthening showed the best results.

Shipton, Edward A. "Physical therapy approaches in the treatment of low back pain." Pain and therapy 7 (2018): 127-137.

Promoted that a combination of active and passive care be used. Even saying manipulation w exercise showed positive outcomes.

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Debunking Chiropractic

4/19/2023

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Can Chiropractic be used to treat non-musculoskeletal disorders?

There have been several claims over the years that chiropractic adjustments can be used to treat conditions such as infantile colic, asthma, hypertension, dysmenorrhea, and migraines (Cote, 2021). With the origin of these conditions being non-musculoskeletal or idiopathic in nature.

A 2021 systematic review examined if there was enough evidence to support these claims.
(A systematic review collects primary research that fits within their specific criteria set forth by the study. It is considered the highest level of quality in research.)

It is important to note that when evaluating studies that involve chiropractic adjustments, it is very difficult to create a “placebo or sham” adjustment. Evaluations may even differ between providers.

Cote and colleagues concluded that there was no evidence to support that chiropractic adjustments help to manage infantile colic, asthma, hypertension, dysmenorrhea or migraines. In addition, they challenge the theory that treating spinal dysfunctions can affect organs and their functions.

This is a very important study for the chiropractic field because this was the primary theory taught in schools for years. I’m sure you have had a chiropractor tell you, “oh if I adjust you here it will help with your liver, etc”.

While adjustments do impact the nervous system, it is due to the stretch reflex (Clark). As a result, the muscles will relax and release endorphins, and temporarily increase joint range of motion (Potter). There is no direct physiological impact on the other organ systems. This is why there is not sufficient evidence to support the claims above.

Takeaway:
Chiropractic adjustments can be very beneficial and there are several accounts of anecdotal evidence when it comes to treating non-musculoskeletal conditions. However, at this time, there is no solid research to support these statements. When it comes to chiropractic care, your primary concern should be to treat musculoskeletal conditions. For internal health concerns, the patient should seek health and wellness counseling.

Reference:
Clark, Brian C., et al. "Neurophysiologic effects of spinal manipulation in patients with chronic low back pain." BMC musculoskeletal disorders 12.1 (2011): 1-10.

Côté, P., Hartvigsen, J., Axén, I. et al. The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature. Chiropr Man Therap 29, 8 (2021). https://doi.org/10.1186/s12998-021-00362-9

Potter, Louise, C. H. R. I. S. T. O. P. H. E. R. McCARTHY, and Jacqueline Oldham. "Physiological effects of spinal manipulation: a review of proposed theories." Physical therapy reviews 10.3 (2005): 163-170.

Skyba, D. A., et al. "Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord." Pain 106.1-2 (2003): 159-168.

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Do you have a Babinski's reflex?

4/12/2023

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A reflex is a response we cannot control. Typically, doctors will check the reflex at the elbow, knee and heel to see if it elicits a response. Without diving into the neurology of how a reflex works, it basically skips the “thinking” part of the process.

Let's look at an example:

Input: There is a nail sticking out of the ground, you take a step and FEEL the tip of the nail
Brain processing: Initiates reflex
Output: You shift your weight to the opposite leg and quickly pull your heel off the nail.

SOOO what is a “Babinski’s reflex”?

This is considered a PATHOLOGICAL reflex. It can be checked a few different ways, but the most common is running the end of a reflex hammer along the bottom of the foot.
In a normal response, for an adult patient, the toes should curl up (Acharya).
An “abnormal response” in an adult would be the toes flaring out.
- This is a sign of an upper motor neuron lesion. Meaning that the brain or spinal cord is affected. This is commonly seen in patients who have had a concussion, traumatic brain injury or neurodegenerative disease (Lance).
- Note: the toes flaring out is a NORMAL response in infants. The toes splay to help create more surface area to help the baby exit the womb. This reflex typically disappears within the first year of life (Modrell).

Takeaway:
Reflexes are designed as a protective mechanism. They can become dysfunctional when there is damage to the nervous system. It is important to note that a Babinski’s reflex should be assessed along with clinical findings to determine if further investigation is needed.

References:
Acharya, Aninda B., Radia T. Jamil, and Jeffrey J. Dewey. "Babinski reflex." StatPearls [Internet]. StatPearls Publishing, 2022.

Lance, J. "The Babinski sign." Journal of Neurology, Neurosurgery, and Psychiatry 73.4 (2002): 360.

Modrell, Alexa K., and Prasanna Tadi. "Primitive reflexes." StatPearls [Internet]. StatPearls Publishing, 2021.

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