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.
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.
Expense of Chronic Back Pain
Lower back pain is incredibly common, and it can be very expensive to treat. According to one estimate, the direct and indirect costs of chronic back pain amount to $100 billion every year in the U.S. alone.
Low-Back Pain Is a Problem
The authors of a new study comment, “One factor explaining these enormous costs is the high rate of recurrence and chronic disability related to low-back disorders.” They estimate that ten percent of low-back pain patients account for more than 80 percent of the costs related to back pain.
Study Low-Back Pain Prevention
Because of the huge costs of treating low-back pain, many studies have focused on prevention. One recent study examined the role of chiropractic adjustments in treating chronic lower back pain. The study involved 30 participants whose back pain had lasted at least 6 months. The study began with one treatment-free month, enabling the researchers to observe a 'control period' of untreated back-pain symptoms.
Following this initial period, half of the patients underwent intensive chiropractic adjustments, including 12 treatments in one month, followed by no treatments for the next nine months. The other group received the same initially intensive treatment, along with maintenance chiropractic sessions every 3 weeks for a period of nine months. At the end of this period, researchers examined both groups.
The study authors found that:
- Both groups of patients experienced a reduction in pain. Even without follow-up visits, an intensive month of chiropractic treatments reduced pain levels.
- Disability levels showed a different response. Patients who received no continuing treatment found that disability levels returned to pre-treatment levels, while those who received maintenance treatments saw continued improvements in their disability scores over the nine-month study period.
The authors conclude that their research appears to confirm the idea that low-back pain and disability are reduced following chiropractic spinal adjustments. They added:
“It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment. Maintenance chiropractic care involving spinal manipulation combined with other treatment modalities (exercises, pain management program) should be investigated. Such combined interventions may have a critical influence on pain, disability, and return to work.”
Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics 2004;27:509-514.
Dr. Carlo sees many people weekly in our busy Largo chiropractic office who are looking for relief from the pain and distress they feel due to herniated discs. Our experience isn't unique; the scientific literature confirms that chiropractic care is a successful way to treat herniated disc problems.
One particular study involved 27 people, 8 male and 19 female, who had magnetic resonance imaging (MRI) confirming a disc herniation in either their neck or lower back. The people reported that they were experiencing pain, limited range of motion, and sensory problems bad enough to keep them off work.
Over the course of the research period, the participants were managed using one of two common chiropractic practices: traction for herniated discs in the cervical area or flexion distraction for the people who had herniation issues in the low back.
Each individual was seen four or five times per week for the first two weeks, then three times weekly, and then as needed for the rest of the study. Depending on the seriousness of the disc herniation, therapy ranged anywhere from six weeks to six months, with MRIs being conducted at a variety of stages to identify what impact, if any, the chiropractic care was having in regard to the disc herniation.
The researchers discovered that 80 percent of the patients experienced a "good clinical outcome," meaning reduced pain and a reduction in other issues, such as numbness. Furthermore, 77 percent of these men and women also showed MRI evidence that their disc herniation was either reduced or resolved completely. This resulted in 78 percent of the study participants being able to return to their place of work and led the researchers to conclude that chiropractic is both "safe and helpful" for disc herniations.
If you have a herniated disc and you're near Dr. Carlo in Largo, contact our office today to see what chiropractic can do for you!
BenEliyahu, DJ. Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal of Manipulative and Physiological Therapeutics 1996;19(9):597-606.
Back Pain Is Common During Pregnancy
Many women experience lower back pain while pregnant. In fact, studies show that more than half of pregnant women report back pain at some point during their pregnancy.
A recent study found that for many women, pregnancy is the first time they have experienced back pain. The authors state,
“The incidence of low back pain with an onset during pregnancy has been reported to be 61%. It has been shown that among women with low back pain of pregnancy, 75% reported no low back pain before pregnancy. In a study of women with chronic low back pain, up to 28% stated that their first episode of back pain occurred during a pregnancy.”
Studying Chiropractic Treatment for Back Pain
Chiropractic treatments may be beneficial for women who experience back pain during pregnancy. Researchers recently studied 17 pregnant women with lower back pain. The pain lasted an average of 21.7 days, and was rated an average of 5.9 on a scale of 1 to 10. The pain began an average of 20.6 weeks into the pregnancy. Each participant underwent chiropractic treatments individualized to their reported symptoms. The authors found that:
- About half of the women referred themselves for treatment, while the other half were referred by their obstetrician.
- It took an average of 4.5 days for the women to achieve clinically significant pain relief. The range was 0 to 13 days following the first treatment session.
- An average of 1.8 treatments were needed to reach clinically significant pain relief.
- Average pain levels decreased from 5.9 to 1.5 at the conclusion of the study.
- Patients received 3 to 15 treatments, with an average of 5.6.
- One participant of the 17 women involved did not experience clinically significant pain reduction during the study.
- None of the women reported negative reactions to the adjustments.
Lower back pain during pregnancy can detrimentally impact women's overall health. The study authors explain:
“In most instances, the average pain level is moderate, but severe pain has been reported in 15% of cases. Pain intensity often increases with duration and can result in significant disability. Sleep disturbances have been reported by 49% to 58% of women and impaired daily living by 57% in women with low back pain of pregnancy.”
However, many women do not report their back pain to their doctor, and it goes untreated. A previous study found that "just 32% of women reported their low back pain of pregnancy to their prenatal providers, and just 25% of these providers recommended a treatment.” Other research has found that "among women with low back pain of pregnancy, 80% thought that their providers had not offered treatment for their back pain.”
Chiropractic May Help You
If you're experiencing back pain as a pregnant woman, it's important to know you don't have to suffer through the pain. This research demonstrates that chiropractic care is an effective, safe way to reduce low-back pain during pregnancy.
Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. Journal of Midwifery & Women’s Health 2006;51:e7-e10.
Many athletes utilize chiropractic treatments following an injury or a strenuous workout. New research suggests that athletes could also boost their athletic performance through chiropractic adjustments.
The study involved 18 professional Brazilian judo athletes. Half received chiropractic adjustments to their cervical spine, located in the neck. The other half received a placebo treatment. Researchers examined the effect of the treatment by evaluating the athletes' grip strength, because judo relies heavily on muscle forces in the hands and arms.
The researchers measured grip strength before and after each cervical spinal manipulation. Following just three treatment sessions, the athletes in the chiropractic group had an overall improvement in grip strength of 10% on the left side and 16% on the right side, which is considered statistically significant. The placebo group did not experience significant improvements in grip strength. After analyzing the data, the researchers concluded that the chiropractic care enhanced grip strength in judo athletes.
Additional research is needed to fully understand the benefits of chiropractic care for athletes, though this study shows exciting results. In 2010, another study showed chiropractic sports interventions substantially reduces the risk of lower-limb injuries among football players. Chiropractic care offers a number of potential benefits for athletes, including injury prevention, enhanced recovery, and improved peak performance.
Botelho, Marcelo and Bruno Andrade. “Effect of Cervical Spine Manipulative Therapy on Judo Athletes’ Grip Strength. Journal of Manipulative and Physiological Therapies. 2011; 35(11): 38-44.
Hoskins W, Pollard H. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized control trial. BMC Musculoskeletal Disorders 2010;11:64.
Housework Riskier Than Sports?
Knee osteoarthritis appears to be linked to a lifetime of stress placed on the knees. The first study to estimate the cumulative effects of various activities on the knees has linked housework – but not recreational sports – to the painful condition.
The authors conclude that physical activity in the form of sports is safe, and does not increase the risk of developing knee arthritis. However, heavy-lifting housework could be partially to blame for the rising prevalence of knee arthritis. With new cases nearly doubling in the past two decades, researchers are eager to pinpoint the causes of knee arthritis.
The study involved a questionnaire asking patients about whether they had been diagnosed with knee arthritis, as well as their occupational and recreational history. While previous studies have examined the impact of manual labor occupations on the risk of knee arthritis, this study placed emphasis on the kneeling, lifting, stair climbing, and squatting actions common with housework.
Who Has Highest Risk?
Both men and women who scored in the highest category of total lifetime knee stress were significantly more likely than others to be diagnosed with knee osteoarthritis. However, estimated force on the knees due to sports activity was not seen as a significant factor. The authors conclude that encouraging physical activity does not create an unnecessarily risk for the knees.
Chiropractic May Help
Ratzlaff CR, et al. Is lifelong knee joint force from work, home, and sport related to knee osteoarthritis? International Journal of Rheumatology 2012;v.2012 ( 584193): doi: 10.1155/2012/584193.
There's the old lyrics, "Don't Worry, Be Happy."
Well, new research shows that worry actually speeds aging by degrading and modifying DNA.
Harvard researchers looked at 5,243 women and found that those with high phobic anxiety were more likely to have shorter telomeres.
The women with high anxiety had DNA damage similar to being six years older than their actual age!
"Many people wonder about whether—and how—stress can make us age faster," said Olivia Okereke, MD, MS, BWH Department of Psychiatry, study author. "So, this study is notable for showing a connection between a common form of psychological stress—phobic anxiety—and a plausible mechanism for premature aging. However, this type of study design cannot prove cause-and-effect or which problem came first—the anxiety or shorter telomeres."
In this age of mobile devices and smartphones, more and more patients are being diagnosed with neck pain associated with looking down at a screen. Studies have shown that young people are at increased risk of back and neck pain due to overuse of devices. Now, a new condition, dubbed "text neck," is being found in smartphone-users of all ages, resulting in serious stiffness, strain, and pain in the neck muscles and cervical spine.
Americans send an average of around 2.19 trillion text messages every year, meaning that text neck has the potential of afflicting millions of people.
The condition is relatively new, and as Forbes reports in their article, How Texting Can Give You a Permanent Pain in the Neck, "It takes time...for a new condition to spread throughout the medical community. Some doctors who have never heard of text neck don't think to ask patients with neck pain about their phone or computer habits."
However, investigators of worker's compensation claims are at the point that they look into the phone records of claimants with neck pain, and sometimes use their history of text messaging to get their compensation cases dismissed, attributing the neck pain to personal screen time rather than work.
There is no denying that a great number of people consider smartphones to be indispensable. And this overuse is causing what could be an epidemic of health problems into the future. A study published in the journal Applied Psychophysiology and Biofeedback found that an overwhelming majority of 83% of participants reported some hand and neck pain during texting. Researchers in this study also found that people sending texts displayed other classic signs of tension, such as increased heart rates and holding their breath. Even when they said they were relaxed, they had signs of tension.
If you text or play games on your smartphone, you know that it is easy to get into the habit of holding your head forward-and-down while typing on it. Another study conducted at the Center for Musculoskeletal Research found that 90% of people flexed their necks while texting, defined as bending the neck forward over 10 degrees past neutral alignment. In this study, it was discovered that the more texting that participants did, the worse their risk of neck or shoulder pain.
Especially susceptible to text neck are those of us who not only spend some of our leisure time on smartphones, but also spend much of our working time sitting at computers. All these hours spent in a flexed posture can add up to 30 pounds of extra weight on the upper vertebrae, straining the trapezius muscles and pulling the spine out of alignment over time.
Researchers are also finding that people over age 50 are more at risk of developing text neck. According to physical therapist Rob Worth, in an interview with Forbes, "People in their 50s and 60s have less tissue tolerance. Overuse injuries (like text neck) don't heal as quickly."
However, Worth said that young people are also at risk of permanent problems from text neck. He suggested that the stooped posture while typing on phones may freeze the position of the spine's alignment, and years down the road, we may see people who are permanently stooped because of it.
If you suspect you have text neck, talk to your health-care provider. Your chiropractor or physical therapist can help you determine if you're suffering from this ailment. These experts can also help design a treatment plan to relieve pain and regain range of motion, as well as advise you about preventing future injury. The following tips, summarized from the Forbes article, may help you avoid the risks of text neck:
- Hold your phone at a proper reading angle, rather than looking down. Your phone should be held directly in front of your mouth, a few inches across from your chin. Your eyes should look down rather than having to bend your neck down. Your shoulders should feel relaxed while you're typing.
- Use a text-dictation program if you have one. Hold the phone in front of your mouth.
- Set a timer and take breaks. Avoid prolonged phone use by taking regular breaks where you put your phone down and do something else.
- Build strength and range of motion. In your workout routine, include exercises and stretches that strengthen your neck, back extensors, rhomboids, and latissimus dorsi muscles. For some ideas, check out this blog post from researcher Dr. Erik Peper.
- Drink water and maintain hydration.
- Use other forms of communication. Try calling your family and friends or seeing them in person to chat.
Quilter D. How texting can give you a permanent pain in the neck. Forbes June 7, 2013. www.forbes.com.
Lin IM, Peper E. Psychophysicological patterns during cell phone text messaging: a preliminary study. Applied Psychophysiology and Biofeedback March 2009; 34(1): 53-57.
Gold JE, Griban JB, et al. Postures, typing strategies, and gender differences in mobile device usage: an observational study. Applied Ergonomics March 2012; 43(2): 408-412.
Peper E. Improve health with fun movements: practices you can do at home and at work. The Peper Perspective blog; February 2, 2013.
Study of Yoga and Total Knee Replacements
A recent study set out to determine whether yoga therapy can help alleviate pain in patients undergoing total knee-replacement surgery.
The study involved 51 patients undergoing total knee replacement (TKR) because of osteoarthritis. On the third day after surgery, baseline scores for pain and stiffness were taken. Half of the patients received conventional physiotherapy. The other half also received once-daily yoga asana treatment. Upon being discharged from the hospital, these patients were provided with photographs of the asanas and written instructions, and instructed to perform the movements 3 days per week.1
What Is an Asana?
Yoga asanas are functional postures involving slow stretching and movements of muscles and joints, and encourage different muscle groups to achieve stability and equilibrium. The purpose of the study was to determine whether yoga asanas have an added advantage for treating patients who have undergone total knee replacement.
Patients were evaluated at 6 weeks and 3 months after surgery to measure their perception of pain, stiffness, and function. The researchers found lower pain and stiffness reported by the group receiving yoga therapy than for patients receiving conventional therapy alone. They concluded that patients practicing yoga had better pain relief, reduced stiffness, and better function, suggesting that yoga asanas may be a valuable addition to conventional post-surgery treatments.
Other Ways to Reduce Knee Pain
Previous studies have recommended additional non-surgical approaches to reducing knee pain, particularly that resulting from osteoarthritis. Chiropractic adjustments have been shown to benefit patients with knee pain, who reported substantial drops in pain intensity and improvements in mobility, along with fewer clicking or grinding sensations within the knee.2 Weight loss has also been shown to alleviate chronic knee pain in obese patients.3 Consult with your doctor about relieving knee pain naturally.
- Bedekar N, Prabhu A, et al. Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty. International Journal of Yoga 2012; 5(2): 118-122.
- Pollard H, Ward G, Hoskins W, and Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association 2008; 52(4):229-42.
- Richette P, Poitou C, Garnero P, Vicaut E, Bouillot JL, Lacorte JM, Basdevant A, Clement K, Bardin T, Chevalier X. Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Annals of the Rheumatic Disease 2011;70(1):139-44.