therapy

Treating Whiplash-Associated Disorders with Intramuscular Stimulation

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Trauma to the neck can cause acute pain. Chronic pain and dysfunction from such injury is called “whiplash-associated disorder” (WAD). WAD is a very common complication to people who were involved in a Motor Vehicle Collision. The Quebec Task Force [QTF] classified WAD severity. The key points of QTF are as follows:

• Whiplash is the most common injury associated with motor vehicle accidents and a major cause of disability and litigation.

• Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms from Grade 0 to 4.

• Patients usually complain of neck pain and stiffness in the acute phase, with the majority recovering within 3 months.

• Depression, anxiety, and mood disorders are common in patients with chronic whiplash.

• Reassurance, early mobilization, simple analgesic, and physiotherapy are recommended in acute whiplash (WAD I–III).

• In chronic WAD, multidisciplinary pain clinic referral followed by cognitive behavioural therapy and cervical radiofrequency neurotomy plays an important role.

Although there are many treatment approaches to a whiplash injury, one study was able to specifically demonstrate the efficacy of treatment using intramuscular stimulation therapy.

In this study Forty-three (43) people accepted intramuscular stimulation therapy. They had pain and abnormal physical signs such as allodynia, trophedema, muscle knots, and limited range of motion. With treatment, twenty-nine achieved long-term improvement.

In an IMS treatment, when the needle enters, the muscle will ‘grab’ the needle and a deep, cramping sensation is felt. Once the muscle grabs it then typically will ‘reset’ itself and begin to relax. When the tight muscle relaxes, a decrease in pain typically follows. IMS is now being recognized and used by physiotherapists and doctors around the world to treat chronic pain of musculoskeletal origin.

Conclusion

The whiplash disorder symptoms were due to abnormal function of the central nervous system. Most subjects improved subjectively and their abnormal physical signs resolved. Such direct clinical evidence of benefit is clearly meaningful.

Acupuncture for Jaw Pain Relief

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During the past twenty years, a multidisciplinary approach to the management of jaw pain disorders has been advocated by many pain practitioners including physicians, dentists, physical therapists, chiropractors, and acupuncturists.

One technique often overlooked in the treatment of temporomandibular (jaw) disorders and the resultant painful symptoms is acupuncture. Acupuncture and acupressure have long been utilized by the Chinese and Japanese for the relief of pain in the temporomandibular regions.

Although acupuncture initially was used for disease management, its use has evolved as a pain control modality. Late in 1997, the National Institute of Health (NIH) released a consensus statement supporting the use of acupuncture as part of a comprehensive treatment plan for some conditions. Some researchers specifically recommended acupuncture for the facial pain of trigeminal neuralgia (tic doloreux) and of TemporoMandibular Joint (TMJ) dysfunction. This modality is most successful when the cause of the pain is neuromuscular rather than due to joint damage. The NIH panel pointed out that acupuncture is associated with a lower risk of adverse events than those associated with drugs or other medical intervention.

Possible Mechanisms

The stimulation of specific sites on the body surface exerts a marked inhibitory influence on pain. The acupoints have been known to the Chinese for many years. Their validity in pain control has been verified by numerous researchers.

One experimentally well-documented mechanism for pain relief by acupuncture is the modulation of endorphin levels. Myofascial pain is relieved primarily by inactivating the source of pain. According to one research article, acupuncture alleviates the awareness of pain.

Additionaly, multiple studies of acupuncture verses splint therapy have been reported in the literature. These studies show the comparative effectiveness of acupuncture in the treatment of temporomandibular disorders.

In the study by Johansson, et al, forty-five individuals with long-standing facial pain or headache of muscular jaw origin were randomly allocated into three groups. The first group was treated with acupuncture, the second group received an occlusal splint, and the third group served as controls. Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs. No differences between these two groups were found with regard to treatment effects. It was concluded that acupuncture is a great alternative method for individuals with craniomandibular (jaw) disorders of muscular origin.

In a different study by Raustia and Pohjola, acupuncture seemed to be a useful early form of therapy in patients with TMJ disorders. Acupuncture could well be complimentary to stomatognathic treatment — either preceding or following — to achieve full neuromuscular rehabilitation, to ease the treatment, or to eliminate other possible contributing factors.

Additionally, Rosted wrote an article to review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on pre-defined methodological criteria. Acupuncture, in 11 out of 15 studies, proved effective in the treatment of TemporoMandibular Dysfunction (TMD) and as analgesia. Rosted concluded that the use of acupuncture in treating TMD and facial pain seems real and that acupuncture could be a valuable alternative to orthodox treatment.

More Solutions to Chronic Pain

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Chronic pain is a debilitating condition that affects people all over the world. In the North America, the prevalence of chronic pain is estimated at 30.7%, and spine and musculoskeletal disorders account for nearly 70 million physician office visits annually and 130 million outpatient, hospital, and emergency room visits. For persons under the age of 45, low back pain is the leading cause of disability. Back-related disabilities are also the most prevalent cause of disability in the military. To reduce treatment costs, as well as disability and absenteeism from work, acute pain cases (less than 6 weeks in duration) must be prevented from becoming chronic pain cases (more than 3 months in duration).

To address this challenge, the functional restoration treatment approach was developed in the 1980s in the United States. Economic aspects of chronic pain care were consequently addressed by a few studies. Gatchel et al clearly demonstrated the cost effectiveness of an early multidisciplinary intervention in acute low back pain patients who were identified as having a high risk for chronicity. Schweikert et al found that the cost of adding cognitive behavioral treatment to standard therapy was largely offset by lower indirect costs.

Evidence-based, novel, and cost-effective care pathways can be used to quickly and effectively triage the target-patient population at a central entry point. Treatment plans focus on a cross-disciplinary and multimodal approach to pain control utilizing evidence-based medical therapy, as well as on functional restoration and multidisciplinary pain rehabilitation programs that have been proven effective. Given the large population of patients affected by chronic back pain and the high and rapidly rising cost of treatment, comprehensive and multimodality delivery models are imperative for efficient triage, functional restoration, and pain rehabilitation.

One of the main goals of a Chronic Pain Rehabilitation Program is to wean patients off opiates so they avoid the short- and long-term side effects of chronic opioid management. The well-known side effects of opioids are nausea, sedation, euphoria or dysphoria, constipation, and itching. With chronic use of opioids, most side effects subside, as patient tolerance to side effects seems to be greater than tolerance to analgesic effects.

Sources Cited:
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010 Nov;11(11):1230–1239.
Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003 Mar;13(1):1–9.
Schweikert B, Jacobi E, Seitz R, et al. Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain. J Rheumatol. 2006 Dec;33(12):2519–2526.

Acupuncture and seasonal allergies

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Symptoms of running nose, sneezing, and watery itchy eyes that recur during specific parts of the year are a cause of much suffering of a large segment of the Canadian and U.S. population. Millions of dollars are spent on medications and the allergy shots for the treatment of seasonal allergies.

Western medicine views seasonal allergies as a form of immediate hypersensitivity reaction which occurs when anti-bodies produced by lymphocytes interact with airborne particles such as pollen. Western medicine describes the locations of lymphocytes in addition to being in the blood stream as also in Peyer’s patches in the gastrointestinal tract, spleen, lymph nodes, and bone marrow.

Interestingly in practice of acupuncture the Spleen, Stomach, and Large Intestine meridians are utilized to treat seasonal allergies a great deal. One can clearly see an overlap of Western and Chinese medical thought. Also, Chinese medical thought views sweets as being harmful to the Spleen function. Sweets are often a major factor in the persistence and intensity of seasonal allergy symptoms.

There is often a quick response when treating seasonal allergies with acupuncture. Often patients get some relief during the first visit while lying on the exam table with their acupuncture needles in place. Patients are asked to score their nose stuffiness on a zero to ten scale. Zero meaning no stuffiness at all and 10 being the worst possible stuffiness for the patient. A score may be determined before and after the acupuncture treatment. Patients can also determine the effectiveness of acupuncture treatment by tracking the number of sneezes per day and the number of itching episodes around their eyes. After an initial series of treatments, patients come in for further treatments on an as needed basis. Some patients come back in once or twice a year for a booster while others may come more often. In general, patients do better if they avoid sugar and milk in their diets. They have better and longer lasting responses. A lot of patients who failed medication and allergy shots respond to acupuncture. Patients continue with whatever standard treatments they are currently undergoing while getting acupuncture treatments. Most patients end up significantly reducing or eliminating their dependence on allergy medications.

There are many different ways of performing acupuncture, for example Traditional Chinese Medicine, Japanese, Korean, French Energetics, Worsley 5 Elements, etc. In choosing an acupuncturist the specific style a practitioner uses is not as important as the success rate a practitioner obtains with whatever style they use. Prospective patients should speak with the acupuncturist and inquire about past experience in treating seasonal allergies and their success rate.

Chiropractic for Fibromyalgia

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Fibromyalgia (FM) is a chronic disorder involving widespread pain and sensitivity in the entire musculoskeletal system. To be diagnosed with FM, a patient will typically possess a minimum of 11 out of 18 specific tender points on the body. In addition to pain, patients will also report long-term fatigue, and/or disturbed sleep and mood. Other disorders commonly associated with FM may include: irritable bowel syndrome, TMJ pain and dysfunction, psychological conditions and some autoimmune diseases.

What Causes Fibromyalgia?
Medical science is yet to discover the cause for this condition. Because there are so many different symptoms associated with fibromyalgia, there are just as many theories for what causes it. Since those with FM often experience an altered mood, such as depression, many medical experts focus on the psychological aspect of the disease. Others feel that FM is more a physiological entity, and has its origins in physical trauma or chronic postural alterations. Some suggest that FM is a central nervous system disorder, with imbalances in neurochemicals, since those with FM are hypersensitive to even the slightest stimuli. They often have a pain response to normally non-painful pressure or activity. It’s not out of the question that a combination of psychological and physical triggers can result in the onset of many of FM symptoms.

Chiropractors often offer their skills to FM patients, hoping to relieve some of their symptoms. In fact, evidence suggests that those with FM consult with chiropractors quite regularly. According to a study conducted at a tertiary Mayo Clinic, 37% of the 300+ FM patients surveyed had visited a chiropractor in the previous 6 months.

But does chiropractic work for them? Some recent studies indicate it does. In one example, chiropractors surveyed FM patients before, during and after a series of treatments to see if they responded favorably to chiropractic adjustments combined with a specific soft tissue technique known as ischemic compression. In this preliminary study, 60% of the subjects who were treated with this protocol experienced a significant improvement with respect to pain reduction, improved sleep and decreased fatigue. What was especially encouraging was the improvements were reported to be maintained in a 1-month follow up. Chiropractors are trained as neuromusculoskeletal specialists, and one of the main focuses of chiropractic care is the positive effects it can have on a person’s nervous system. Since all information from the outside world is collected and analyzed by the nervous system, it’s logical to assume that if a person with FM is sensitive to a stimulus that others are not, there may be something wrong with this system.

More studies are needed to show the positive effects that chiropractors can have with FM patients. However, some studies already indicate that having chiropractic care alongside other traditional treatment methods including exercise, massage techniques and cognitive behavioral therapy is likely to give these patients a better chance for recovery.

It is also important to note that not all chiropractors are the same and treatment can be quite varied. This is the same with medical doctors to some extent. To put it in the proper context, if you tried one medical doctor and you didn’t like them or what they did would you never go back to another medical doctor again? Most would say no to that. However, many people try chiropractic, not chiropractors. So, if you have gone to only one or a few chiropractors and he or she didn’t help you, consider trying PRI Clinic. This is especially true with Fibromyalgia.

I have done extensive research with Fibromyalgia and one of the main things to consider in treating a patient is their capacity to accept treatment. If you do too much with a Fibromyalgia patient, either later that day or the next day they will feel like they have been run over by a truck. However, if you treat them within their capacity they will show continual improvement. Often I will have a patient come back in after their first treatment stating that they slept extremely well the night after their treatment. This is exciting to the patient because they are finally getting the rest they need and it is exciting to me because I know that their body is finally beginning to heal. At PRI clinic, we have chiropractors, massage therapists and psychologists that are specifically trained to offer you the techniques that will help your fibromyalgia condition that is individually tailored to your needs.

Massage Therapy and Thyroid Health

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January is National Thyroid Awareness Month. In this article, we talk about how massage therapy can assist some thyroid conditions.

Hypothyroidism
The term hypothyroidism encompasses any condition witnessing the thyroid gland’s inability to produce adequate levels of hormones known as T3 and T4. Hashimoto’s thyroiditis, an autoimmune inflammatory condition that destroys the thyroid gland, is the leading cause of hypothyroidism. The other major cause indicates a broad medical treatment term that includes surgical procedures to remove all or a portion of the thyroid. Removal of cancerous tissue in thyroid cancer patients is a prime example of this cause.

Major signs and symptoms of hypothyroidism include fatigue; muscle weakness; fluctuations in weight without an obvious reason; dry, thinning hair; rough skin patching; cold intolerance; depression; abnormal menses; decreased libido; and cognitive challenges.

A patient may be difficult to diagnose by her physician due to not manifesting many of these symptoms initially. Insidious changes occur slowly, leaving a patient wondering why he feels off-balance. Most people will not think to consider their thyroid as the culprit, resulting in symptoms worsening slowly over time. Serious complications can occur, including heart failure, coma and severe depression.
Goiters, or enlarged thyroids, may be witnessed in hypothyroid patients. These result from an overproduction of thyroid-stimulating hormone (TSH) from the pituitary gland. The constant stimulation from TSH will cause the thyroid tissues to swell. If the thyroid gland still cannot produce adequate T3 and T4 hormones, the patient will be considered to have goitrous hypothyroidism.

It is important to note that the presence of a goiter does not always equate to hypothyroidism. Other conditions featuring the development of a goiter include dietary iodine deficiency, the patient taking lithium carbonate, infectious disease, postpartum complications or a rare fibrosis condition called Riedel’s thyroiditis.

Massage for Thyroid Patient Health
Massage therapy and related bodywork can benefit the hypothyroid patient in many profound ways. First, a significant reduction in the patient’s symptoms can be witnessed with the usage of acupressure. This benefit was demonstrated by a research study in Russia conducted in 2011. Reflexology and Gua Sha technique were also utilized in this study involving Chinese medicine theory in addressing hypothyroidism.

A second benefit of massage therapy for the hypothyroid patient is aiding improved blood and lymphatic circulation. Since proper blood and lymphatic flow is vital for all endocrine organs, the thyroid could benefit from improved circulation.

Reduced inflammation is a third benefit derived from massage therapy and related bodywork. Research through the Buck Institute for Research on Aging in Novato, California, and McMaster University in Ontario, Canada, indicates that massage therapy may create a result similar to anti-inflammatory medications at a cellular level. This benefit will aid the hypothyroid patient with Hashimoto’s thyroiditis or similar inflammatory concerns.

A fourth benefit of massage treatment is reduced stress within the body. This benefit can decrease cortisol and other stress hormones to help manage weight healthily.

Finally, increasing muscle strength will combat the fatigue and weakness often felt by the hypothyroid patient. A Swedish massage including a large percentage of petrissage strokes can enhance the size, strength and stamina of muscle tissue.
Please note that the information presented here is not intended to replace advice from a medical professional. If you are affected by hypothyroidism, please consult an MD.

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