Monday, 11 April 2016
WHAT IS CHIROPRACTIC?(from Wikipedia)
Chiropractic is a form of alternative medicine concerned with the diagnosis and treatment of mechanical disorders of themusculoskeletal system, especially the spine, under the belief that these disorders affect general health via the nervous system. It is the largest alternative medical profession, and chiropractors often aspire to become primary care providers, though they lack the medical and diagnostic skills necessary to fulfil this role. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling. The "specific focus of chiropractic practice" is chiropractic subluxation. Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence. Some chiropractors fear that if that do not separate themselves from the traditional vitalistic concept of innate intelligence their profession will continue to be seen as fringe.
There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain. Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.
There is a wide range of ways to measure treatment outcomes. Chiropractic care, like all medical treatment, benefits from the placebo response. It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. The efficacy of maintenance care in chiropractic is unknown.
Available evidence covers the following conditions:
- Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain. The same review found that SMT appears to be no better than other recommended therapies. A 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain. A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain. A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain. A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. Specific guidelines concerning the treatment of nonspecific (i.e. unknown cause) low back pain are inconsistent between countries.
- Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered. There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathyand acute lumbar disc herniation with associated radiculopathy. There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.
- Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain. A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement. A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain. A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak. A 2010 Cochrane review found low quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction. A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.
- Headache. A 2011 systematic review found evidence that suggests that chiropractic SMT might be as effective as propranolol or topiramate in the prevention of migraine headaches. A 2011 systematic review found evidence that does not support the use of SM for the treatment of migraine headaches. A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2004 Cochrane review found evidence that suggests SM may be effective for migraine, tension headache and cervicogenic headache.
- Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive. A 2008 systematic review found that the addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) resulted in significantly better pain relief and functional improvements in both the short and long-term. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions.
- Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension. A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness. There is very weak evidence for chiropractic care for adultscoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions. Other reviews have found no evidence of significant benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, gastrointestinal disorders, kinetic imbalance due tosuboccipital strain (KISS) in infants, menstrual cramps, or pelvic and back pain during pregnancy.
Chiropractic for Headache/Migraine
Migraines and Chiropractic Treatment
Signs and Symptoms:
Causes of Migraine
How will Chiropractor be assessed for Migraine?
Tuesday, 5 April 2016
In general, the severity of the scoliosis depends on the degree of the curvature and whether it threatens vital organs, specifically the lungs and heart.
- Mild Scoliosis (less than 20 degrees). Mild scoliosis is not serious and requires no treatment other than monitoring.
- Moderate Scoliosis (between 25 and 70 degrees). It is still not clear whether untreated moderate scoliosis causes significant health problems later on.
- Severe Scoliosis (over 70 degrees). If the curvature exceeds 70 degrees, the severe twisting of the spine that occurs in structural scoliosis can cause the ribs to press against the lungs, restrict breathing, and reduce oxygen levels. The distortions may also cause dangerous changes in the heart.
- Very Severe Scoliosis (Over 100 degrees). Eventually, if the curve reaches over 100 degrees, both the lungs and heart can be injured. Patients with this degree of severity are susceptible to lung infections and pneumonia. Curves greater than 100 degrees increase mortality rates, but this problem is very uncommon in America.
Some experts argue that simply measuring the degree of the curve may not identify patients in the moderate and severe groups who are at greatest risk for lung problems. Other factors (spinal flexibility, the extent of asymmetry between the ribs and the vertebrae) may be more important in predicting severity in this group.
EFFECTS ON BONES
Scoliosis is associated with osteopenia, a condition characterized by loss of bone mass. Many adolescent girls who have scoliosis also have osteopenia. Some experts recommend measuring bone mineral density when a patient is diagnosed with scoliosis. The amount of bone loss may help predict how severely the spine will curve. Preventing and treating osteopenia may help limit further curve progression.
If not treated, osteopenia can later develop into osteoporosis. Osteoporosis is a more serious loss of bone density that is common among postmenopausal women. Adolescents who have scoliosis are at increased risk of developing osteoporosis later in life.
Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density.
SPINE PROBLEMS IN PREVIOUSLY TREATED SCOLIOSIS PATIENTS
After 20 years or more, scoliosis patients who were previously treated with surgery experience small but significant physical impairments (mainly mild back problems), compared to their peers without scoliosis. More people with a history of scoliosis report having to take days off from work, compared to people who never had the condition. In general, however, most patients experienced a similar quality of life to peers who never had the condition.
The following are some possible causes of later back problems in people with a history of treated scoliosis:
- Spinal fusion disease. Patients who are surgically treated with fusion techniques lose flexibility and may experience weakness in back muscles due to injuries during surgery.
- Disk degeneration and low back pain. With disk degeneration, the disks between the vertebrae may become weakened and rupture. In some patients, particularly those treated with the first generation of the Harrington rods, years after the original surgeries the weight of the instrumentation can cause disk and joint degeneration severe enough to require surgery. Treatment may involve removal of the old rods and extension of the fusion into the lower back. Still, most patients do not experience significant back pain from these problems.
- Height loss. Fusion of the spine may inhibit growth somewhat. However, much of the growth takes place in long bones, which are not affected.
- Lumbar flatback. This condition is most often the result of a scoliosis surgical procedure called the Harrington technique, which eliminated lordosis (the inward curve in the lower back). Adult patients with flatback syndrome tend to stoop forward. They may experience fatigue and back and even neck pain.
- Rotational trunk shift (uneven shoulders and hips).
Evidence suggests that previous treatment with braces may also cause mild back pain and more days off, but problems appear to be less than with surgery. In one study, dysfunction was comparable to people without a history of scoliosis.
PROBLEMS IN ADULT-ONSET OR UNTREATED CHILDHOOD SCOLIOSIS
Pain in adult-onset or untreated childhood scoliosis often develops because of posture problems that cause uneven stresses on the back, hips, shoulders, necks, and legs.
Many individuals with untreated scoliosis will develop spondylosis, an arthritic condition in the spine. The joints become inflamed, the cartilage that cushions the disks may thin, and bone spurs may develop. If the disk degenerates or the curvature progresses to the point that the spinal vertebrae begin pressing on the nerves, pain can be very severe and may require surgery. Even surgically treated patients are at risk for spondylosis if inflammation occurs in vertebrae around the fusion site.
LONG-TERM EMOTIONAL IMPACT OF SCOLIOSIS AND ITS TREATMENTS
Emotional Impact in Childhood. The emotional impact of scoliosis, particularly on young girls or boys during their most vulnerable years, should not be underestimated. Adults who have had scoliosis and its treatments often recall significant social isolation and physical pain. Follow-up studies of children who had faced scoliosis without having strong family and professional support often report significant behavioral problems. Fortunately, current treatments are solving many of the problems that previous generations had to deal with, including unsightly bracing and extremely painful surgeries with little pain control.
Emotional Effects in Adults. Of some concern are the growing numbers of adults with scoliosis. This group experiences considerable problems in general health, social functioning, emotional and mental health, and pain.
Older people with a history of treated scoliosis may carry negative emotional events into adulthood that have their roots in their early experiences with scoliosis. Patients who were treated for scoliosis may often have limited social activities, a poorer body image, and slight negative effect on their sexual life. Pain appears to be only a minor reason for such limitation.
EFFECTS ON PREGNANCIES AND REPRODUCTION
Women who have been successfully treated for scoliosis have only minor or no additional risks at all for complications during pregnancy and delivery. A history of scoliosis does not endanger the child. Pregnancy itself, even multiple pregnancies, does not increase the risk for curve progression. Women who have severe scoliosis that restricts the lungs, however, should be monitored closely.
Patients with severe deformities, particularly those with underlying neuromuscular disorders, may develop what is called restrictive thoracic disease. This term refers to problems in breathing and, at times, trouble obtaining enough oxygen due to a smaller chest cavity. This smaller chest cavity results from the deformities or surgery. The restricted chest cavity is also less able to expand when breathing.
RISKS OF CANCER FROM MULTIPLE X-RAYS
Some evidence suggests a slightly higher risk for breast cancer and leukemia in patients who had multiple x-rays. Risks are highest in patients who had the largest radiation exposure, such as those who had been surgically treated.
Patients who simply received x-rays for untreated idiopathic scoliosis, or scoliosis caused by uneven length of the legs or hip abnormalities have a very low risk for future complications.