Dynamic Chiropractic

The BMJ, formerly the British Medical Journal, has issued a strong recommendation against several commonly used interventional procedures for non-cancer chronic spine pain. This "Rapid Recommendation" advises against joint radiofrequency ablation, epidural injections, joint-targeted injections, and intramuscular injections for chronic axial spine pain, as well as dorsal root ganglion radiofrequency and epidural injections for chronic radicular spine pain. The recommendation, based on a clinical practice guideline developed by an international expert panel, suggests that "all or nearly all well-informed people would likely not want such interventions" and that they should primarily be offered within clinical trials. This expert panel, comprised of patients, clinicians, and methodologists, based their guideline on systematic reviews and meta-analyses of existing research. An accompanying article in the BMJ highlights the significant cost burden of these often ineffective treatments, citing an estimated $9 billion spent annually on epidural injections in the U.S.. While these injections might offer relief for acute and subacute pain, they are often problematic for chronic pain. This new guideline signals a potential shift in how chronic spine pain is managed, emphasizing the need to reconsider the widespread use of these interventional procedures.

Treating children of divorced parents presents unique legal and ethical challenges for chiropractors, as highlighted in this Dynamic Chiropractic article. The primary concern revolves around parental consent, especially in joint custody situations where both parents typically need to provide written consent for treatment unless a court order states otherwise. The article recounts a case where a chiropractor faced legal repercussions for assuming one parent had sole authority. To mitigate these malpractice risks, the author strongly advises chiropractors to obtain written consent from both parents, establish clear office policies addressing divorced or separated families, and ensure parents understand these policies during intake. Maintaining neutrality in parental conflicts and clearly defining financial responsibilities are also crucial. The article underscores the importance of training staff to identify potential red flags during patient intake and emphasizes that proactive documentation and clear communication are essential to protect the practice and focus on providing quality care. Recognizing when escalating parental conflict necessitates discontinuing treatment is also a key consideration.

Tired of the same old back pain advice? This Dynamic Chiropractic article dives deep into lumbar spine stability, revealing it's far more nuanced than just planks and crunches. The key lies in the balance between superficial prime movers and deeper stabilizer muscles. Often, dominant prime movers become stronger while stabilizers lag, leading to an imbalance called synergistic dominance, a common culprit in low back pain. True spinal stability, the ability to resist buckling and control movement, relies on the coordinated action of the multifidus, transverse abdominus (TA), internal oblique, pelvic floor, and diaphragm. The article highlights the importance of targeting stabilizers specifically through corrective exercises, moving beyond generic exercises. It emphasizes techniques to improve motor control and TA activation. Notably, the diaphragm and pelvic floor are often overlooked but crucial for resisting compressive loads. Individualized care, focusing on achieving segmental and regional stability for daily activities, is essential for long-term low back pain management.

Ever wonder how your feet impact your back? This fascinating study in Dynamic Chiropractic uncovers the significant link between foot pronation and pelvic alignment. The authors reveal that when the **calcaneus (heel bone)Ever wonder how your feet impact your back? This fascinating study in Dynamic Chiropractic uncovers the significant link between foot pronation and pelvic alignment. The authors reveal that when the **calcaneus (heel bone)Ever wonder how your feet impact your back? This fascinating study in Dynamic Chiropractic uncovers the significant link between foot pronation and pelvic alignment. The authors reveal that when the calcaneus (heel bone)everts (pronates) under the talus, the talus shifts, causing internal rotation of the tibia and femur. This chain reaction culminates in anterior rotation of the os coxa (pelvic bone). The study, involving healthy subjects, demonstrated a significant positive correlation between induced foot pronation (using a heel lift) and this anterior pelvic tilt. This highlights that assessing and addressing foot pronation is crucial when evaluating anterior pelvic rotation. The researchers suggest future studies could explore if correcting foot posture can restore neutral pelvic alignment. This article underscores the foot's fundamental role as the foundation of posture, impacting structures all the way up the kinetic chain.

Get ready for a leadership transition at Life Chiropractic College West! After an impactful tenure since 2017, Dr. Ron Oberstein, the college's third president, will retire on June 30, 2025. He describes his time as president as "one of the most meaningful and transformative experiences" of his life. Dr. Oberstein highlights several key achievements under his leadership, including the opening of Life West Nebraska, the introduction of the Clinically Inspired Curriculum, and the establishment of Life West Service Trips. Other notable milestones include enhanced educational opportunities like the Early Clinic Entrance and Last-Year Preceptor Program, the creation of the Nexus Brain Center and Technology Training Center, and significant upgrades to classroom technology. Perhaps the most significant achievement he notes is nearing the completion of Life West India, the first chiropractic college in India. As the Board of Regents begins the search for his successor, Dr. Oberstein will remain available to ensure a smooth transition by offering guidance and sharing his extensive institutional knowledge. Prior to becoming president, Dr. Oberstein served on the Life West Board of Regents for 25 years, including two as chair, and held leadership positions in prominent chiropractic organizations like the Association of Chiropractic Colleges and the International Chiropractors Association.

Are your patients, especially older adults, taking a cocktail of medications? This Dynamic Chiropractic article shines a light on "deprescribing" – a planned and supervised process of reducing or stopping medications that may no longer be necessary or could be causing harm. The article points out that many individuals, particularly seniors, continue taking drugs without regular review, leading to polypharmacy, which is associated with poor health outcomes. It's alarming that the term "deprescribing" was only coined in 2003, highlighting a historically prescription-focused medical model. Encouragingly, research indicates benefits from deprescribing certain medications like antihypertensives, potentially lessening cognitive decline in dementia patients. While chiropractic doesn't involve prescribing drugs, the article empowers chiropractors to play a vital role by simply asking patients about medication reviews with their medical providers. This simple question can encourage patients and their doctors to reconsider the necessity of their current drug regimens, potentially leading to improved health and well-being.

This insightful article in Dynamic Chiropractic delves into the crucial distinction between chronic pain and high-impact chronic pain, a diagnosis that significantly limits daily life and work activities. Drawing on experience with underserved patients, the author highlights that chiropractors may underdiagnose chronic pain due to insurance limitations. The article emphasizes the growing prevalence of both chronic and high-impact chronic pain. It further explores a potential yet often overlooked cause of chronic pain: statin myopathy, characterized by muscle pain and weakness, particularly in large muscle groups. A compelling case example illustrates a patient experiencing long-term low back and leg pain potentially linked to statin medication, showcasing the diagnostic considerations and the use of a SOAP note. The article underscores the importance for chiropractors to accurately identify and manage high-impact chronic pain and to consider statin intolerance as a contributing factor, even suggesting communication with the prescribing physician.

This Dynamic Chiropractic article presents two crucial legal updates impacting chiropractors. In New Jersey, a landmark fraud and RICO case initiated by no-fault insurance carriers against doctors, including chiropractors, is under review by the Supreme Court. The case revolves around whether such claims should be pursued in court or through mandatory no-fault arbitration. A Superior Court initially ruled in favor of arbitration for all claims, including IFPA, a decision later reversed by the appellate court, creating a conflict with a Third Circuit ruling. The NJ Supreme Court's final decision will significantly impact how these insurance fraud allegations are handled. Separately, in British Columbia, a notable change in registrant status has occurred, with chiropractic doctors now registered under the College of Complementary Health Care Professionals, moving away from the College of Chiropractors of BC established in 1934. This shift could potentially foreshadow broader legislative changes in healthcare regulation in other jurisdictions.

Suffering from persistent low back pain? This article from Dynamic Chiropractic highlights a promising addition to traditional core stabilization exercises: diaphragmatic breathing. With a staggering 82% of people experiencing back pain and 10% developing chronic issues, finding effective management strategies is crucial. The article explains how the core trunk musculature, including the diaphragm, plays a vital role in lumbar spine stability. Research indicates that the diaphragm is often fatigued in individuals with recurrent LBP, compromising spinal support. A spotlighted study demonstrated that incorporating specific diaphragmatic breathing exercises alongside core stabilization exercises led to significant improvements in pain levels, muscle activation, disability, sleep quality, and chest expansion in chronic LBP patients. These exercises, focusing on belly breathing while keeping the chest still, help reduce stress, improve breathing mechanics, and enhance core stability. By strengthening the diaphragm and its connection to the transversus abdominis and lumbar multifidus, this simple technique can be a valuable and safe addition to chiropractic care for managing chronic low back pain.

In part two of his article, Dr. Jeffrey Tucker urges chiropractors to actively engage in their patients' cardiovascular health beyond musculoskeletal concerns. He emphasizes the importance of personalized protein intake based on lean body mass and dietary preferences, noting that meat, poultry, and seafood provide coenzyme Q10 which can help preserve nitric oxide. Dr. Tucker strongly advocates for an anti-inflammatory, plant-based forward diet to combat various conditions linked to inflammation, including vascular issues. He highlights the crucial role of deep sleep in cardiovascular restoration. Regarding fats, he favors olive oil (especially extra virgin) for its nitric oxide-boosting polyphenols and cardiovascular benefits, while expressing concerns about the processing and high omega-6 content of many seed oils. Other recommendations include limiting sugar and processed foods, promoting nasal breathing, and considering water filtration and specific supplements like red ginseng and red sage to enhance nitric oxide production. Ultimately, Dr. Tucker stresses that lifestyle factors significantly impact heart disease risk and that chiropractors have a vital role in educating patients about prevention.