Offering chiropractic care at on-site health facilities could decrease employee medical costs associated with musculoskeletal injuries and headache, suggests the results of a recent study.
Musculoskeletal injuries are the most common cause of worker disability in the US, resulting in significant clinical and economic burden. Every year, Americans spend between $84-624.8 billion on treating back pain alone. Efforts to increase access to effective treatments could reduce health-care costs while improving productivity.
Employee Health-care Utilization Study
Executives at Cerner Corporation, a health IT company, were recently interested in seeing whether chiropractic care could reduce health-care utilization in their employees. (Lower health-care utilization means less visits to the doctor and fewer expensive tests or procedures). They hired a team of researchers to conduct an analysis of employee health records in workers who received chiropractic care for back pain, neck pain, and headache. The analysis included 309 associates treated at an on-site company health facility and 858 associates treated at off-site community clinics.
Employees treated by a chiropractor, whether on-site or off-site, had significantly reduced disability scores on tests that evaluated headache, neck pain, and back pain. On average, chiropractic patients had 19% reduction in headache disability scores, a 14.6% reduction in neck pain disability scores, and a 14.5% reduction in back pain disability scores.
Although off-site chiropractic patients were just as likely to have reduced pain, the employees who received on-site care had fewer doctor's visits and reduced health-care utilization. Employees treated off-site were more likely to have outpatient visits, although the average number of outpatient visits were similar in both groups.
In one year of treatment in employees who received off-site care, the average physical therapy patient had 13.6 visits compared to 8.9 visits for chiropractic patients, and 23 visits for physician patients. (The physician's visits could have been elevated due to the fact that the data included visits non-related to musculoskeletal conditions). For those treated with on-site care, the average patient was less likely to receive physical therapy and more likely to be treated by chiropractor.
Impact on Employee Health-care Costs
The researchers concluded that on-site chiropractic care reduced health-care utilization while improving employee functional status related to musculoskeletal condition. They suggested that on-site facilities offer more opportunities for coordination and integration among different health services.
"The improved functional status indicates potential for reduced indirect costs, including absenteeism, presenteeism and productivity losses, with on-site chiropractic services," Kat Gorman, MPH, research scientist with Cerner Corporation wrote with colleagues in the executive summary of the study. "Additionally, direct cost savings may result through lower rates of health-care utilization." Gorman and her colleagues concluded that more research is needed to assess the potential for indirect and direct cost savings of on-site chiropractic care.
Earlier research has suggested that chiropractic patients have lower medical costs compared to patients under a physician's care for back pain, and a recent study found that chiropractic patients missed fewer work days.
Krause CA, et al. Value of chiropractic services at an off-site health center. Journal of Occupational and Environmental Medicine 2012; 54(8):917-21. doi: 10.1097/JOM.0b013e31825a3507.
Dagenais S, et al. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine Journal 2008; 8 (1): 8-20.
How Vitamin D Can Help
Vitamin D supplements could prevent brittle bones but many older adults lack sufficient levels of the vitamin. In a recent survey of older adults who sustained fractures, 64% had deficient vitamin D levels and 90% had insufficient calcium levels.
High doses of vitamin D could be an important preventative measures for older adults, a new study suggests. In the study, high doses of vitamin D reduced the risk of hip fractures in older adults by 30% and lowered the risk non-vertebral fractures by 14%. The meta-analysis differed from previous studies because researchers examined the actual amount of vitamin D participants consumed rather than the amount they were assigned to take. Of the 31,022 adults surveyed, those who took at least 800 IU of vitamin D had the largest reduction in fractures.
Taking vitamin D supplements could improve bone and spinal health, regardless of age. Consult with a doctor to determine whether vitamin D supplementation make sense for you.
Bischoff-Ferrari H, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J of Med 2012; 367:40-49.
Photo by Bradley J via Creative Commons.
Beyond Treating Pain
Chiropractic treatments have long been known to alleviate musculoskeletal pain. Now, researchers are beginning to examine additional ways that chiropractic care may improve overall health. A new study suggests that chiropractic adjustments can improve immune system function, even in patients who are not experiencing pain.
Studying Chiropractic Treatment's Effects on Immune System
Researchers at the Canadian Memorial Chiropractic College examined chiropractic treatments' effect on interleukin-2, a protein involved in immune response. The study involved 74 participants with no current symptoms of pain. The participants were split into three treatment groups, including one control group and two groups receiving different kinds of chiropractic adjustments. All participants received treatment on the same day, with blood samples collected before the treatment, 20 minutes afterwards, and two hours following the treatment.
The researchers compared before-and-after blood samples to determine whether the treatment correlated with an increase in the levels of certain antibodies, including induced immunoglobulin G (IgG) and immunoglobulin M (IgM). These antibodies occur as a response to infection, and are key parts of the immune system.
The researchers found that participants who underwent chiropractic treatments had increased levels of IgG and IgM measured 20 minutes following treatment. After two hours, these patients still had elevated IgM levels. The researchers suggested that chiropractic treatments could prepare the body's immune system for faster response to new infections. This "priming" effect, they conclude, shows that chiropractic adjustments may alter the functioning of the immune system, improving overall health.
Teodorczyk-Injeyan JA, McGregor M, Ruegg R, Injeyan HS. Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropractic & Osteopathy 2010; 18:26.
A recent study has demonstrated the effectiveness of a multi-modal, drug-free intervention program in treating children with Attention Deficit Hyperactivity Disorder.
Researchers recruited children diagnosed with ADHD who displayed inattention, hyperactivity, impulsivity, and problems with academics and/ or behavior. Some participants served as a control group, while the rest completed a 12-week program at Brain Balance Achievement Centers. The intervention involved sensory motor exercises, cognitive exercises, and nutritional counseling. Professionals involved in the program were focused on achieving physiologic balance and temporal coherence in the brain, in addition to improving skills that would more closely match each child's age and grade level.
The 122 children in the experimental group attended the multi-modal program for three hour-long sessions each week, for a total of 36 hours of treatment. After the 12-week study, 81% of the kids who participated in the program no longer fit the criteria for ADHD. They improved in the areas of attention, focus, impulsivity, and behavior problems. In addition, 60% of the experimental group achieved an academic increase of at least two grade levels, and half of these achieved an increase of four grade levels.
As a controlled study, researchers compared the group who did not participate in the intervention program, and they found that these children experienced very little change academically and that their behavioral symptoms worsened slightly.
"The groundbreaking study proves that medication is not the only option to help eliminate the symptoms associated with ADHD, and it validates what we have been practicing at Brain Balance for 10 years," said Dr. Robert Melillo, founder of Brain Balance. "Drug-free, multi-modal programs, like the one offered at Brain Balance Achievement Centers, are ultimately more effective when it comes to achieving long-term results and eliminating symptoms both academically and behaviorally. This study shows that our program actually addresses the primary problem in the brain that is the root cause of ADHD and learning difficulty, and that it actually improves brain function."
The study was published in the peer-reviewed Frontiers, a fast-growing publication dedicated to more transparent and democratic processes in science.
Leisman G, Mualem R, Machado C. The integration of the neurosciences, child public health, and education practice: hemisphere-specific remediation strategies as a discipline partnered rehabilitation tool in ADD/ ADHD. Frontiers Public Health 2013. doi: 10.3389/fpubh.2013.00022.
(2013, July 29). "New Control Study Finds Drug-Free Program is Successful for Eliminating ADHD Symptoms." The Sacramento Bee. Retrieved from http://www.sacbee.com/2013/07/29/5606019/new-control-study-finds-drug-free.html.
Dysfunction in the sacroiliac joint (SIJ), located in the pelvis, is thought to be a possible cause of sciatica, resulting in back pain that radiates down the leg and below the knee.
Scientists have questioned what the best treatment option is for patients with SIJ-related leg pain. In a recent study, researchers compared three treatment options: physical therapy, chiropractic manual therapy, and intra-articular injections of corticosteroids. Patients included 51 adults with leg pain associated with the sacroiliac joint. Researchers analyzed the effectiveness of each method after 6 weeks of selected treatments, and again after 12 weeks. The results for each patient was categorized as either a success or failure, based on relief or worsening of symptoms and average pain scores.
The study's findings revealed that manual therapy is the superior choice for treating leg pain associated with the SIJ. The success rate for chiropractic manual therapy was 72%, compared to just 20% for physiotherapy and 50% for corticosteroid injections. Researchers also found that neither physical therapy nor injections resulted in significant pain relief, whereas manual therapy resulted in a significant improvement on pain scores.
Due to the success rate and pain reduction of manual therapy, the study authors concluded that chiropractic should be the first treatment of choice in patients with SIJ-related leg pain. They hoped that their findings would be confirmed by further research with a larger sample size.
Additional research has highlighted the efficacy of chiropractic for sciatica, even after surgery has failed.
Visser L, Woudenberg N, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. European Spine Journal 2013 [online]. doi: 10.1007/s00586-013-2833-2.
A new study from Egypt reports that chiropractic care can be an effective treatment strategy for fibromyalgia.
The study involved 120 people between the ages of 40 and 65 who had suffered with severe fibromyalgia for four years or more. Each person rated their pain as a 4 or higher on a pain scale and also had limited movement in their cervical (neck area) spine, specifically in their C1-C2 area.
All of the individuals participating in this study engaged in 12 weeks of therapy which included:
- An education program (one two-hour session per week) designed to provide the participant with more information about fibromyalgia and available treatment options;
- Cognitive behavioral therapy (one two-hour session per week) which involved discussion regarding pain management via relaxation exercises, challenging treatment-prohibitive beliefs about fibromyalgia, and positive reinforcement about what types of actions can be taken to ease fibromyalgia symptoms; and
- An exercise program (three one-hour sessions per week plus 20-minute session twice daily at home) which included relaxation techniques, as well as active and passive stretches.
One-half of the individuals were also randomly assigned to a treatment group, which meant that they also engaged in upper cervical chiropractic adjustments. This involved a high-velocity, low-amplitude thrust to the C1-2 motion segment three times per week for the first month. This was then reduced to once a week sessions for the remaining eight weeks.
At the beginning of the study, the conclusion of the study, and at one year post-study, each participant was asked to complete various questionnaires to help the researchers determine what effect, if any, the chiropractic had on easing fibromyalgia symptoms and reducing its impact on their lifestyle. Specifically, questions were asked regarding physical function abilities, work days missed due to fibromyalgia symptoms, sleep disturbances, level of pain, fatigue, depression, and anxiety.
The individuals who participated in the cervical chiropractic care group showed more improvement and better results than the control group who had no chiropractic intervention. This was validated by questionnaire scores that improved by 15 or more percent. The researchers concluded that adding chiropractic to your current fibromyalgia treatment regimen may offer even more benefits when it comes to getting to the root off the problem.
Moustafa IM, Diab AA. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatology International 2015;35(7):1163-1174.
Trigger point therapy reduced cervicogenic headache pain by 71% for patients in a new study. The patients also experienced a 59% reduction in neck pain symptoms, as well as improved range of motion and muscle function.
Trigger point therapy is a treatment commonly used by chiropractors to relieve trigger points (TrPs), or hyperirritable spots of pain located in taut bands of skeletal muscles. Earlier research has shown that chiropractic spinal adjustments are effective for cervicogenic headache, but few studies have tested the efficacy of trigger point therapy for the condition.
In a new preliminary study, researchers tested the effects of trigger point therapy for the treatment of cervicogenic headache. Twenty patients were randomly assigned to receive either trigger point therapy (TrP therapy) or a sham treatment for three sessions during a one week period. The treatments were applied to active trigger points located in the neck.
Patients receiving TrP therapy experienced markedly better outcomes than the sham group. TrP therapy patients had significantly improved neck range of motion and increased functioning of the deep cervical flexor muscles. They also had substantially reduced pain sensitivity, neck pain, and headache. On average, patients' headache pain scores dropped from a 7.6 out of 10 to a 2.2, or about a 71.1% reduction. Their neck pain scores also decreased from a 7.4 to a 3.0 after treatment, or about a 59.5% reduction.
More research is needed to understand why TrP manual therapy lead to these improvements. It has been hypothesized that trigger points play a role in the development of headache, since earlier studies have reported trigger points present in patients with tension headache, cluster headache, and migraine. However this is one of the first studies to confirm the presence of trigger points in people with cervicogenic headache, and to suggest that trigger point therapy can help.
Chiropractors frequently use trigger point therapy in conjunction with spinal adjustments, spinal mobilization, and exercise rehabilitation. This study adds further evidence of the efficacy of chiropractic care for cervicogenic headache.
Bodes-Pardo G, et al. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2013; doi 10.1016/j.jmpt.2013.05.022.
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Fortunately, a recent study offers hope to sciatica patients: chiropractic care can speed the recovery from sciatica flare ups and allow patients to return to work sooner (2).
The study evaluated 44 Norwegian workers after they came to the hospital with severe sciatica pain. Most of those patients had been experiencing pain for three or more weeks prior to their hospital visit.
The hospital chiropractor examined each patient to evaluate his/her posture and gait, range of motion, and palpation of the lumbar spine.
The chiropractic then performed various joint adjustments to the spine and other limbs that had been injured through patients compensating for pain. Ice treatment was also used to relieve soft tissue soreness.Patients were treated daily in the hospital and later three times a week for the first two weeks. Some patients needed additional follow-up treatment but typically did not exceed 14 treatments.
In matter of 21 days, 91% of patients returned to work full-time. Two patients returned to work part time. Researchers concluded this study demonstrates the potent benefits of collaboration between chiropractors and orthopedic surgeons. Chiropractic care can put an end to your sciatica pain so you can begin living your life fully again.
Posted in chiropractic, Chiropractic News, Sciatica, sciatica treatment, Understanding Sciatica
- Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
- Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.