Famous Athletes See A Chiropractor
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Famous Athletes See A Chiropractor!

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TIGER WOODS

Tiger Woods, a professional golfer, has won multiple major tournaments, including the 1997 Masters Tournament, the 1999 PGA Championship, and the 2000 U.S. Open. He credits chiropractic therapy for a portion of his success. When his back became uncomfortable and he felt weak during a growth spurt, he began seeing a chiropractor. Tiger had an adjustment and was led through strengthening exercises by a chiropractor. He believes that chiropractic treatment aided him in improving his swing. We believe that if Tiger ever develops golfer’s shoulder, he’ll seek treatment from his neighborhood chiropractor.

EVANDER HOLYFIELD

Evander Holyfield is the only four-time heavyweight boxing champion in history. Despite the fact that a chiropractor was unable to help Holyfield after one of the most legendary boxing contests of all time against Mike Tyson, he does credit chiropractic care for a large part of his career. He once claimed that he always received a chiropractic adjustment before entering the ring for a fight and that going to the chiropractor three times a week helped him perform better. He believes in the value of chiropractic care and claims that the majority of boxers visit a chiropractor to gain an advantage.

TOM BRADY

Tom Brady is an American football quarterback for the New England Patriots of the National Football League. He is one of only two NFL players who have won five Super Bowls. He is the only player in NFL history to win all five Super Bowls with the same team. Tom holds chiropractic care in high regard as a treatment that keeps him on top of his game. After an adjustment, he feels three inches taller and every part of his body feels in place.

ARNOLD SCHWARZENEGGER

Chiropractic therapy is used by bodybuilders to stay in shape and improve their general health. Arnold Schwarzenegger has starred in films such as Jingle All the Way, Commando, and the Terminator trilogy, and has won three Mr. Universe competitions. Arnold dashed to the office of a friend, a bodybuilder-turned-chiropractor in Los Angeles, who gave him an adjustment whenever he had a problem with his body. He grasped the need of chiropractic care for sports injuries at this point. He also recognized how important a sports injuries chiropractor may be to his bodybuilding success.

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE
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How Much Does Chiropractor Cost Without Insurance?

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Chiropractic Care | We Care Chiropractic in Glendale Arizona

Have you lately been in a car accident? Perhaps you suffer lower back discomfort as a result of a home injury or repetitive strain at the gym. If you’re seeking to plan your first visit with your local chiropractor in any of these situations, you’re undoubtedly wondering if your health insurance covers chiropractic care. We’re here to help you understand all you need to know about chiropractic insurance coverage.

Is Chiropractic Care Covered by Health Insurance?

If you need to see a chiropractor, the first question on your mind is likely whether your insurance will cover the cost. “Yes,” is the quick answer. Chiropractic care is now covered by most health insurance providers, at least to some extent (about 87 percent of private policies). Most health insurance policies, including major medical plans, workers’ compensation, Medicare, a few Medicaid programs, and Blue Cross Blue Shield plans for federal employees, usually include it.

However, a number of factors influence whether your insurance plan covers chiropractic, including the services you want, your insurance policy (for example, PPO vs HMO), and your health insurance provider, among others.

Most plans, for example, will cover the initial and some rehabilitative care for acute diseases, but not maintenance or wellness therapies. Nonetheless, it’s worth looking over your policy and phoning your insurance company to learn more about your specific health benefits.

Additionally, more than 60 military sites and a similar number of VA medical facilities provide chiropractic therapy to members of the United States armed forces. Furthermore, Congress has ordered that certain chiropractic services be covered by anybody with Medicaid or Medicare in the United States. Chiropractic care is included in your insurance plan if you work for the federal government. Chiropractic care is also required for Workers Compensation claims in every state in the union.

If you have chiropractic coverage, the amount you pay and the amount your insurer pays will differ depending on the conditions of each plan, as well as other considerations like:

  • The chiropractic clinic’s location -The tests and services you require from the chiropractor -The sort of technology the clinic employs (the more cutting-edge technology the clinic employs, the more you’ll likely pay)
    An overview of any other insurance policies and/or wellness plans you may have, as well as how they interact with your current coverage.

So, before you make an appointment with your local chiropractor, check with your insurance company to see what type of chiropractic care (if any) is covered. Some points to discuss with them:

  • See if your chiropractic care team is on their list of approved providers for those services.
    Determine whether your insurance provider is an HMO (Healthcare Management Organization) or a PPO (Preferred Provider Organization) (Preferred provider organization). HMOs usually only cover practitioners on their approved list, whereas PPOs typically cover any chiropractic therapy, typically up to 80% of rates charged by doctors not on their preferred list.

If your insurance doesn’t cover your visits, talk to the staff at your local chiropractor’s clinic about other options for paying for them. Many chiropractors have unique financing options in place for their patients, as well as cash discounts.

What Does It Cost to See a Chiropractor With Insurance?

If you have a chiropractic insurance policy, you can anticipate your insurer to cover anywhere from 50% to 100% of the cost, depending on your specific policy benefits and the treatments you receive. You are responsible for the portion of the bill that the insurance does not cover. Your visit will be significantly more affordable if you have insurance.

How Much Will You Pay for a Chiropractic Visit Out of Pocket?

Chiropractic appointments are actually extremely affordable for many people, whether they have insurance or not. A free initial consultation may be offered, however new patients should anticipate to spend a little more on their first appointment because an overall health consultation is normally required (ex: X-rays, etc.) Again, the best way to get accurate pricing is to phone your local chiropractor.

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

Chiropractor Services

Here is a list of the many services offered by We Care Chiropractic:

  • Relieve pain caused by accidents and injuries.
  • Regular chiropractic care.
  • Corrective exercises.
  • Lifestyle advice.
  • Massage therapy.
  • Nutrition counseling.
  • Sports injuries.
  • Spinal screenings.

Read more about all the chiropractic services one can find in Glendale.

 

 

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE

CHIROPRACTIC CARE

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Want To Improve Your Golf – See A Chiropractor!

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Chiropractic Care | We Care Chiropractic in Glendale Arizona

We are sharing this article from the American Chiropractic Association including comments from medical professionals and Masters Winner, Jordan Speith as well as top PGA Tour player, Zach Johnson, whose Father happens to be a chiropractor! Read on to learn more!

AS MANY OF US KNOW, GOLF IS A CHALLENGING (AND OFTEN FRUSTRATING) SPORT. Many golfers feel the psychological component of golf is their greatest challenge and undervalue the biomechanics and conditioning that are required to play the game well. This is a mistake that eventually leads to poor play or injury. An extreme amount of compressive force – up to 10 times a person’s body weight – is exerted on the spine during the golf swing. Every joint involved in the swing is taken through its maximum range. If the body is not properly prepared to handle these forces, injury will eventually result.

“Formal golf instruction has been available to the general public for over 100 years, yet still most golfers, when they play strictly by the rules of golf, can’t break 100,” says Jeff Blanchard, DC, and golfer in Morro Bay, Calif., who trains chiropractic physicians on how to treat golf injuries. “In my experience, golf is not that difficult, but PGA instructors will confess that a student’s lack of fitness and conditioning is the primary barrier to improved performance.”

Dr. Blanchard indicates elbow pain is a common complaint among amateurs due to the lack of golf-specific flexibility. “Most amateurs bend their elbow during the backswing, then hyperextend the elbow during the downswing,” he states. “For tour pros, wrist injuries are prevalent, because on a professional level, players have to hit the ball where it lies, often out of deep, thick rough.”

Another common complaint is back pain, the result of an inefficient golf swing that creates too much stress on the back. According to Troy Van Biezen, DC, a Dallas-based chiropractic physician who works with professional golfers, four out of five golfers experience back pain as a result of repetitive swinging. “Regular chiropractic care helps alleviate back pain and greatly improves an athlete’s game,” says Dr. Van Biezen. “Neck, shoulder, elbow and hip pain are also frequent complaints among golfers of all ages. Chiropractic care is an effective non-pharmacologic solution for golfers who seek to rid themselves of pain and have a successful and enjoyable game.”

It Starts With the Swing

At age 45, Dr. Blanchard left private practice for 10 years to play professional golf. In his second year, a serratus anterior injury sidelined him for five months. “When I asked the PGA instructors what was happening in my golf swing to cause this injury, they had no idea what serratus anterior was,” he says. “When I asked the same question to the health care providers who were helping me during my recovery, they had no knowledge of golf-swing biomechanics.”

This led Dr. Blanchard to research and write the highly regarded Physicians’ Golf Injury Desk Reference. Today he works with amateur and professional golfers and also teaches a continuing education golf injury certification program (www.golfinjuryseminars.com) for doctors of chiropractic (DCs) based on his book.

All DCs who attend his seminars learn about the 14 areas of the body that are engaged during the golf swing. They are trained to evaluate each area for flexibility and/or strength. “If a patient fails any of the 14 exam points, correction protocols are taught and patients are given strengthening and stabilizing exercises to do at home, in conjunction with in-office treatment,” says Dr. Blanchard.

Dr. Van Biezen has traveled with the PGA Tour for 13 years. He was part of the PGA Tour medical staff for nine years, serving as the on-site chiropractor for about 145 players. “The golf swing is a unilateral movement that creates imbalances in the body, causing misalignments,” says Dr. Van Biezen. “These misalignments cause decentration of joints, resulting in undue stress and wear and tear.”

Today he travels with a number of PGA pros and works with high-level junior and college players at his Dallas office. His main goal is to be sure his clients are as symmetrical as possible in all planes of motion. This helps them get into positions for the golf swing that are efficient and repeatable. “I strongly believe chiropractic care is a must for all ages to play injury free, and for game improvement,” he says. “The game of golf is hard enough — why have your body working against you?”

Getting in Shape

Market research shows that most golfers believe better equipment will help them play better golf. However, statistical data, based on handicap averages over the past 30 years, prove otherwise.

“In short, the No. 1 barrier to improved performance on the golf course is the physical fitness and conditioning of the person swinging the club,” says Dr. Blanchard. “If you can improve your golf-specific flexibility and golf-specific stability, you can become a more powerful and more consistent golfer.”

If players are serious about golf, they must also get serious about conditioning. In his intermediate-and advanced-level training classes, Dr. Blanchard teaches fitness and conditioning protocols that are designed to help golfers improve their performance. Dr. Van Biezen has developed workout programs for his golf clients that vary from bodyweight stability exercises to simple isolation strength exercises using machines or more advanced functional-strength movements, such as Romanian deadlifts, Turkish get-ups, single-leg dead lifts or kettle-bell work. He also performs periodic health assessments on his clients.

“At the beginning of the year, blood work is performed to determine any nutritional depletions that may exist for micronutrients, hormones, antioxidants, etc.” says Dr. Van Biezen. “I also play the role of the nutritional consultant – for golfers to perform at a consistently high level. And, for the body to heal, repair and recover, nutritional supplementation and hydration are critical.”

Chiropractic physicians, of course, also treat golf-related injuries and imbalances when they occur. The most common problems are injuries to the neck, back, shoulder, hip, elbow and wrist. During the 2014 Masters Tournament, Dr. Van Biezen received a call in the morning from Zach Johnson, a player on the tour. Johnson had hurt his back, had difficulty standing and didn’t think he could play in that day’s round. Dr. Van Biezen met with him three hours before his tee time and took him through a modified functional screen. “I treated him accordingly, up to about an hour before his tee time,” he says. “Zach teed off that day and actually played well. I was very thankful to be able to help him, and the experience once again reassured me that chiropractic works.”

Becoming a Better DC

All athletes are looking for that edge that will improve their game, which is a “big reason why chiropractors are being more utilized in sports,” says Dr. Van Biezen. “I feel very strongly that players who regularly use chiropractors or travel with them full time stay healthier and don’t get injured as frequently as players who do not use chiropractic.”

Also, chiropractors don’t need to play golf to understand how to treat golf-related injuries. That said, DCs who don’t play golf can sometimes be dismissive of patients who do play golf. “Chiropractors who don’t play golf tend to underestimate the physicality and the injury potential of repetitive golf swings,” says Dr. Blanchard. “However, I make it very clear in my seminars that you do not have to play golf in order to become an excellent diagnostician and render treatment for golf-related injuries.”

He also points out that there is unrealized potential for generating new patients by forming an alliance with PGA instructors in your community.

“These instructors need your help, as they are trying to teach deconditioned students, many of whom become injured during the first months of lessons on how to play golf,” he adds. “The PGA instructor will work on the swing mechanics, while the chiropractor can focus on flexibility, joint mobility and postural stability. These cornerstones.” of chiropractic practice are the path to improve performance.”

JORDAN SPIETH Attributes Masters Win to Chiropractic

IN A RECENT ARTICLE (www.allamericanhealthcare.net/masters-winner-jordan-spieth-benefits-fromchiropractic), pro golfer Jordan Spieth calls golf a team sport – referring to the contributions made by his caddie, coach, trainer and manager and sports chiropractor Dr. Troy Van Biezen. So far this year, Spieth has won four PGA tournaments, including the Masters, earning more than $10 million.

Spieth has received chiropractic care since he was 14 to prevent injuries and optimize overall health and athletic performance. “Dr. Van Biezen is an important member of my team, and thanks to his care, my all-time dream of winning the Masters Tournament has become a reality,” Spieth says.

Dr. Van Biezen travels full time with Spieth, providing chiropractic care once or twice daily. “An individualized chiropractic care plan, including prevention and recovery-focused techniques, is essential for maintaining good health and gives Jordan a competitive edge,” notes Dr. Van Biezen.

ZACH JOHNSON Grew Up With Chiropractic

ANOTHER TOP PGA GOLFER is Zach Johnson, who has earned about $4.4 million on the PGA Tour so far this year. He, too, is no stranger to chiropractic care. Throughout his childhood and teenage years he received chiropractic care from his father, ACA member David Johnson, DC. Like Spieth, Zach Johnson has Dr. Van Biezen on tour with him as the professional sports DC.

“I adjusted Zach throughout his formative years, but less now that he works with Troy when he is on tour,” says Dr. Johnson. “I don’t need to offer much advice because his team includes a chiropractor, strength trainer, PGA professional golf coach and sports psychologist. I occasionally adjust him when he comes home or if we are visiting him.”

Watching the high level of training and care his son receives is a bit of an eye-opener for Dr. Johnson. “I’ve always known that chiropractic care improves function and balance and reduces pain associated with the grind of repetitive movement and high-speed movement in the golf swing,” says Dr. Johnson. “However, since Zach has been on the tour, I have seen firsthand how much professional golfers rely on chiropractic care. Zach also depends on nutritional and exercise support for maintaining his high level of performance and function.”

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE
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Chiropractors For Wrist Pain
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Written by craig b

Chiropractor and Wrist Pain In Older People

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Chiropractic Care | We Care Chiropractic in Glendale Arizona

It is not often we quote an entire article but with academically researched papers from reputable organizations we sometimes make an exception. This article first appeared in 2007 but is still current and cited today. It can be read in its entirety here here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647076/

Objectives

This study examines (a) the feasibility of continued research with an older population; (b) the variety of hand-wrist conditions presented by older patients; (c) the accommodations to standard chiropractic treatment for older patients; and (d) the validity, reliability, responsiveness of measures, and preliminary estimates of outcome of treatment for general hand-wrist pain.

Methods

A cohort of 55 volunteers, first evaluated over a 5-week natural-history baseline period, was offered 5-week chiropractic treatment and then interviewed at 6 months posttreatment. Descriptive and preliminary inferential analyses are reported. Start values for power analysis are offered.

Results

The project recruited a sample of 55 and retained 47 (85%) participants over 8 months, indicating feasibility of a larger project. Participants provided strong self-reported, albeit preliminary, evidence of benefit. Mean values and SDs of pain and strength measures are provided for future power calculations.

Conclusions

Clinical research with older participants presenting with hand-wrist pain and dysfunction is feasible. Validity, reliability, and responsiveness of self-reports are demonstrated. The research presents preliminary evidence of the benefit of chiropractic treatment for older patients presenting with hand-wrist symptoms.

Introduction

Conditions of the upper extremities, particularly of the hand and wrist, often occur in older (60+ years of age) patients, but manual treatment protocols for this age group have not been identified or assessed. Because primary care, including chiropractic care, is often based on tentative, in-office diagnoses and not on more definitive and expensively generated criteria, general location and reported symptoms are frequently sufficient to guide care. This primary care research, concerning hand-wrist pain, therefore reflects the everyday reality of the chiropractic physician. This research examines (a) the feasibility of continued research with an older population; (b) the variety of hand-wrist conditions presented by older patients; (c) the accommodations to standard chiropractic treatment for older patients; and (d) the validity, reliability, responsiveness of measures, and preliminary estimates of outcome of treatment.

Complementary and alternative medicine (CAM), with allopathic care, comprise the health care system in the United States, including care for conditions of the upper extremities. Concurrent to the growing use of CAM is the increasing proportion of older people in the country. The combined effects of increased fertility and decreased mortality are “aging” the populations of Eurasia and the western hemisphere. The aging of the world’s population will be “one of the most important social phenomena of the next half century.”

Although current decreases in rates of disease and injury are followed by decreases in rates of disability in those older than 60 years, decreases in death rates for people with given disabilities increase the prevalence of those disabilities in the population as well as demands for health care appropriate to these disabilities. Among potentially or actually disabling conditions commonly seen in the elderly are conditions of the hand and wrist. For example, a recent prevalence report estimates that, relative to younger (25-34 years) people, older (55-64 years) people are 2 (women) to 5 (men) times as likely to be symptomatic for carpal tunnel syndrome. In the same report, older men and women were found to be 3 times as likely to have electrophysiologic median neuropathy than the younger people.

With the attractiveness of CAM and the growing proportion of older people in the country, it is not surprising that CAM providers, such as chiropractors, are treating an increasing number of older patients presenting with disabling conditions, including those of the hand and wrist. In research concluded in part 1 of this project, chiropractors responding to focus groups and surveys indicated wide experience with older patients presenting with conditions of the upper extremities and provided suggestions for effective treatment. Respondents stressed the importance of accommodating to older patients, using, for example, low-impact stretching exercises, rehabilitative passive stretching, traction, soft tissue work, and home exercises. Chiropractors further indicated that with older patients they considered “management” a more realistic concept in treating chronic conditions rather than “cure.” Chiropractors reported that they often accommodated to older patients’ comorbidities by using less force and a self-described “lighter touch.” Some examples included using an activator, ultrasound, full-spine work, soft tissue work, passive stretches, myofascial release, teaching and assigning home exercises and postures, and offering nutritional counseling, including supplements. This information was used to guide the development of the treatment protocol of the current research.

It is important to stress that the general focus of this research is on characteristics of older patients presenting with hand-wrist pain, and their treatment for hand-wrist pain, because these reflect the reality of the primary care chiropractor. The primary care physician provides relief and increased function to patients, as quickly and as inexpensively as possible. Providing definitive and specific diagnoses, often at high cost, is secondary and only considered when initial treatment has not provided benefit.

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

Chiropractor Services

Here is a list of the many services offered by We Care Chiropractic:

  • Relieve pain caused by accidents and injuries.
  • Regular chiropractic care.
  • Corrective exercises.
  • Lifestyle advice.
  • Massage therapy.
  • Nutrition counseling.
  • Sports injuries.
  • Spinal screenings.

Read more about all the chiropractic services one can find in Glendale.

 

 

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE

CHIROPRACTIC CARE

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Chiropractic or Massage Therapy
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Written by craig b

Chiropractor and Chronic Pain

CHIROPRACTIC CARE

623-825-4444

24/7 Emergency Auto Injury Appointments

Chiropractic Care | We Care Chiropractic in Glendale Arizona

It is not often we quote an entire article but with academically researched papers from reputable organizations we sometimes make an exception. This article first appeared in June 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112063/

Abstract

Objective

The aim of this case report is to describe the response of a patient with chronic pain who received chiropractic care in a federally qualified health center.

Clinical Features

A 61-year-old female patient with neck and back pain after a traumatic motor vehicle accident 3 years prior was referred for chiropractic care. She had neck pain, low back pain, knee pain, and pain associated with over 20 surgeries, as well as depression, opioid dependence, and low quality of life.

Interventions and Outcomes

The patient was treated with chiropractic manipulation for her low back and neck pain and was counseled on nutrition and exercise. After 6 months, she reported improvements in pain, improved quality of life, and discontinuation of opioid pain medication.

Conclusion

This patient improved after a course of chiropractic care that was integrated into a federally qualified health center.

Key Indexing Terms: Chiropractic, Analgesics, Opioid, Medically Underserved Area

Introduction

Chronic pain continues to be one of the primary reasons for medical consultations worldwide. In 2008, the United States estimated that nearly 100 million people were affected by chronic pain with an associated economic cost ranging from $560 billion to $635 billion annually in medical care and decreased productivity.

The American Academy of Pain Medicine outlines the management of nonmalignant chronic pain and recommends combination therapy, including analgesics, nonsteroidal anti-inflammatory drugs, opioids, antidepressants, and anticonvulsants. Prescription pain killers are an enormous cost to the United States, with an annual bill of $17.8 billion, of which $12.3 billion is attributed to opioids. As the public health issue of substance abuse grows, there is a strong correlation between opioid sales and opioid-related deaths. Opioid sales quadrupled from 1999 to 2015, while opioid-related deaths quadrupled during the same time period. Chiropractic care has been shown to help in managing or alleviating chronic pain without the use of drugs or surgery as well as being cost effective, considered safe, and satisfactory to a high number of patients.

Federally Qualified Health Centers (FQHCs) are federally funded community health centers that provide primary care and preventive health services in communities made up mostly of medically underserved people, such as the homeless or low-income individuals, migrant workers, or marginalized groups. These centers provide multidisciplinary and interdisciplinary healthcare. These organizations are critical for the care of urban communities where the consumers have little to no insurance or spare income, while reducing the burden on hospitals and cost of treating the underserved. There is little literature that describes the inclusion of chiropractic care within FQHC. Therefore, the purpose of this study was to present a case of chiropractic management of a patient who had previously reached a plateau in progress in regaining overall function and pain control within a FQHC.

Case Report

A 61-year-old female patient presented for chiropractic evaluation with widespread pain since a motor vehicle accident (MVA) 3 years prior. Although she experienced pain in numerous regions, she was referred within an FQHC from her primary care provider for chiropractic treatment of low back pain (LBP) and low functional capacity. In the MVA, her right lower leg was partially severed but was later reattached with multiple surgeries and skin grafts. She had multiple fractured bones, mostly in the lower extremities. She reported over 20 surgeries since the MVA. Prescription painkillers (5 mg/300 mg hydrocodone/acetaminophen initially followed by 5 mg/325 mg hydrocodone/acetaminophen) and hot packs were her main sources of pain relief. She stated that the medications made her feel groggy and often incoherent; therefore, she did not want to take them unless she was at home, which impacted her social life. Normal activities of daily living were also difficult, such as personal hygiene, getting dressed, and doing chores around the house.

Shortly before her presentation for chiropractic care, she had experience a fall secondary to low blood pressure. She had been ambulating with the assistance of a walker since recovering from the MVA due to her leg and LBP. A motivating factor for this patient to get well and start moving more was the fact that during an orthopedic consult for a knee replacement she was informed that she had to “lose weight and get healthier” before she could be a candidate for surgery. She was unable to achieve this task on her own. Her T-scores on the PROMIS Global short form during her initial chiropractic visit were 29.6 (physical) and 36.3 (mental).

A chiropractic examination was performed but was limited due to her severe limitations in mobility and fear avoidance. The examination consisted of visual inspection, visual assessment of active range of motion, testing of the deep tendon reflexes, dermatome testing, myotome testing, and palpatory findings. Aside from weakness secondary to pain and lack of sensation in the areas of skin grafts on the right lower leg, her neurologic examination was normal in the upper and lower extremities bilaterally. She had difficulty getting on and off the examination table in the prone position because of the severity of her pain levels. She also presented with a slow, shuffling gate with limited range of motion. Motion palpation revealed hypomobile segments in the lumbar, thoracic, and cervical regions.

She was given a working diagnosis of chronic pain syndrome, segmental dysfunction throughout the spine, and myalgia. A treatment plan of 2 visits per week for 4 weeks, followed by reassessment, was discussed and agreed upon. Conservative treatment was performed, consisting of the Activator technique (Activator Methods, Phoenix, Arizona) in the cervical and thoracic regions, along with Cox protocol 2 in the lumbar region, utilizing a Lloyd table (Lloyd Table Co, Lisbon, Iowa). Shortly after initiation, the treatment plan was amended to include the use of Thompson Drop and Reinert Diversified techniques, which utilized the same Lloyd table. Along with chiropractic treatment, she was educated on nutrition and therapeutic exercise. She was counseled by chiropractic student interns and chiropractic physician clinical supervisors who encouraged focusing on food intake by using a food journal, and she was given a handout regarding prudent food choices and portion control. She was encouraged to try water aerobics classes at a local gym to increase her activity levels and to aide in weight reduction. She also was directed on how to perform a home exercise program consisting of straight leg raises and balancing on 1 foot and on how to properly stand from a seated position by utilizing her core muscles appropriately.

Within several treatments, she reported feeling better, had increased mobility, and used less painkillers for palliation. Within the first month of treatment, she had improved mobility, made dietary changes, increased her social activities, began water aerobics classes, and was able to sleep through the night without waking up due to pain for the first time in the years since the MVA. Her improvement progressed steadily during the first month of care. She was able to stop using the walker and started using a cane, eventually only carrying it “just in case.”

After a month of treatment, her relative improvement enabled her to take a vacation. She was absent from care for approximately 1 month. The month after her return, she could only attend 2 visits because of transportation issues. Following that 2-month lapse in consistent care, she visited the emergency room due to severe left-sided sciatica-like pain. She had lumbar radiography performed, which demonstrated degenerative changes of the lumbar spine. She was prescribed ibuprofen 600 mg, 1 tablet every 6 hours or as needed, and discharged from the emergency room the same day. She presented again for chiropractic care at the same FQHC a few days later. Two weeks after restarting her care plan of 2 times per week for 4 weeks, followed by reassessment, the resurgence of LBP and sciatica was reduced and under control, returning to “pre-vacation” levels. Although no viable outcome measures are available for this juncture of the care plan, the patient noted “feeling great once again.”

After 3 months of chiropractic care, her T-scores on the PROMIS Global short form improved to 39.8 (physical) and 50.8 (mental). Her progress in her overall function and weight loss has made her a viable candidate for a knee replacement, and the orthopedic surgeon has agreed to perform the operation in the near future. Another result was that she reduced her reliance on and intake of prescription opioid pain medication. She received her last prescription 6 months (September 2017) after she began chiropractic care, with no refills of pain medication due to her pain resulting from her accident after that point. She eventually had a refill of pain medication 10 months later (July 2017), but only because she underwent surgery to remove the hardware from the previously injured right leg in preparation for her knee replacement surgery. The patient provided consent to report her health information.

Discussion

Chronic pain is a burden on public health in the US, affecting more Americans than diabetes, heart disease, and cancer combined. Low back pain is the most common form of chronic pain described by patients, with a lifetime prevalence of 85%. Between 1994 and 2004, Medicare expenses for LBP in the US rose 629% for epidural injections, 423% for opioid medications, 307% for magnetic resonance imaging, and 220% for lumbar fusion surgeries, all without accompanying improved outcomes for these patients. This underscores the need for more effective pain management strategies and is accentuated by the fact that prescription opioids are some of the most commonly used methods to treat chronic pain in lieu of the growing opioid epidemic.

Access to essential health care is limited in economically depressed urban areas. Federally Qualified Health Centers strive to bridge the gap of care to these areas by providing affordable, comprehensive health care. Some of the risk factors for chronic pain happen to be the same risk factors that are common among those who utilize FQHCs (low education level, low socioeconomic status, and higher rate of substance dependence or abuse). Therefore, those more likely to have chronic pain are also more likely to have their healthcare needs met at FQHCs. Also, those dependent on opioids frequently have multiple medical and psychiatric comorbidities.

The recent and ongoing literature provides ample evidence that the management of chronic pain needs amending, in part due to the amount of deaths related to prescription opioid medications. Although chiropractic care does not treat chronic pain by itself, it may serve as an important addition in an integrated healthcare setting and may play an important role in reduction of opioid dependence.

Chiropractic care not only has high patient satisfaction, it also provides positive objective results. Chiropractic care can have a positive influence on the patients’ pain and on the duration of their pain, which helps the patients and the healthcare system save money. A study found that older patients with multiple comorbidities who used only chiropractic manipulative therapy during their chronic LBP episodes had lower overall costs of care, shorter episodes of LBP, and lower cost of care per episode day than patients in the other treatment groups, which included treatment by conventional medicine. Adults with LBP are more physically and mentally unhealthy than those individuals without LBP. Murphy et al state that physical activity improves general health and halts the progression of chronic pain. Because LBP contributes to chronic pain, with a lifetime prevalence of 85% and multiple episodes years after the initial attack, it would make sense to utilize a provider that specializes in treatment of LBP. Access to chiropractic care appears to offset a patient’s demand for primary care physicians’ services, further reducing the number of opioid prescriptions written. However, chiropractic care is often out of reach for many patients with chronic pain for monetary and accessibility reasons.

In this case, the FQHC in St. Louis, Missouri, was one of the first in the country to include chiropractic services into its scope of practice, thereby offering chiropractic care to individuals who previously had no access due to cost. To our knowledge, there are few studies focused on the use of chiropractic care in FQHCs and its benefits. Multidisciplinary management of chronic pain with a biopsychosocial approach is crucial for successful treatment of chronic pain. The addition of chiropractic care in FQHCs may be beneficial in such an integrated setting, as it was for the patient in this case.

Limitations

The results are representative of a single case and may not be consistent with the results of other patients. In addition, there was a lack of consistent objective assessment tools to aid in monitoring the patient’s progress. However, her prescription medications could be tracked, and her improvement was based on subjective reporting and observation.

Conclusion

In this case study, the inclusion of chiropractic care in a FQHC was beneficial in decreasing the chronic pain and prescription pain medication usage of a patient with years of chronic pain after a car accident.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): D.J.M., R.M.

  • Design (planned the methods to generate the results): D.J.M., R.M.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): R.M.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): D.J.M., R.M.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): D.J.M., R.M.

  • Literature search (performed the literature search): D.J.M., R.M.

  • Writing (responsible for writing a substantive part of the manuscript): D.J.M.

  • Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): R.M.

Practical Applications

  • • Inclusion of chiropractic care in the treatment of chronic pain patients was beneficial at this location.
  • • Offering chiropractic care in this FQHC improved outcomes for these patients.
  • • Chiropractic care integrated in a FQHC may have the potential to relieve the number of chronic pain patients visiting primary care providers so that they may tend to other patients.

References

1. Ussai S, Miceli L, Pisa FE. Impact of potential inappropriate NSAIDs use in chronic pain. Drug Des Devel Ther. 2015;9:2073–2077. [PMC free article] [PubMed] []
2. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13:715–724. [PubMed] []
3. Rasu RS, Vouthy K, Crowl AN. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States. J Manag Care Spec Pharm. 2014;20:921–928. [PubMed] []
4. Centers for Disease Control and Prevention Opioid Overdose. 2016. www.cdc.gov/drugoverdose/ Available at: Accessed May 26, 2017.
5. Passmore SR, Toth A, Kanovsky J, Olin G. Initial integration of chiropractic services into a provincially funded inner city community health centre: a program description. J Can Chiropr Assoc. 2015;59:363–372. [PMC free article] [PubMed] []
6. Murphy AD, Griffith VM, Mroz TM, Jirikowic TL. Primary Care for Underserved Populations: Navigating Policy to Incorporate Occupational Therapy Into Federally Qualified Health Centers. Am J Occup Ther. 2017;71(2):1–5. [PubMed] []
7. The American Academy of Pain Medicine Facts and Figures on Pain. http://www.painmed.org/patientcenter/facts_on_pain.aspx Available at: Accessed April 30, 2017.
8. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22:62–68. [PMC free article] [PubMed] []
9. Lipman A, Webster L. The economic impact of opioid use in the management of chronic nonmalignant pain. J Manag Care Spec Pharm. 2015;21:891–899. [PubMed] []
10. Haddad MS, Zelenev A, Altice FL. Integrating buprenorphine maintenance therapy into federally qualified health centers: real-world substance abuse treatment outcomes. Drug Alcohol Depend. 2013;131:127–135. [PMC free article] [PubMed] []
11. Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief. 2015;189:1–8. [PubMed] []
12. Brady KT, McCauley JL, Back SE. Prescription opioid misuse, abuse, and treatment in the United States: an update. Am J Psychiatry. 2016;173:18–26. [PMC free article] [PubMed] []
13. Greenwood DM. Improvement in chronic low back pain in an aviation crash survivor with adjacent segment disease following flexion distraction therapy: a case study. J Chiropr Med. 2012;11:300–305. [PMC free article] [PubMed] []
14. Weeks WB, Leininger B, Whedon JM. The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities. J Manipulative Physiol Ther. 2016;39:63–75. [e1-e2] [PMC free article] [PubMed] []
15. Murphy DR, Justice BD, Paskowski IC, Perle SM, Schneider MJ. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropr Man Therap. 2011;19:17. [PMC free article] [PubMed] []
16. Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014;17:3–10. [PubMed] []

 

 

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It is not often we quote an entire article but with academically researched papers from reputable organizations we sometimes make an exception. This article first appeared in the April 2020 edition of The Journal Of The Canadian Chiropractic Association.

Abstract

People who have a diagnosis of cancer may develop, or already have musculoskeletal conditions, just like any other person. However, discussion about potential benefits of chiropractic treatment to this group has generally been avoided related to the fear of misrepresentation. We aimed to derive a consensus from a group of experienced chiropractors regarding their perception of what chiropractic care offered to patients with cancer. An anonymous, two stage, online, Delphi process was performed using experienced chiropractors (n=23: >10 yrs practice experience, who had treated patients with cancer) purposively selected and recruited independently. One opted out of the study, 13 actively engaged in two rounds of questions and verification; agreeing such patients gained benefit from chiropractic care but use of spinal manipulation was not essential. There was no clear consensus regarding a protocol for interaction within any multidisciplinary team treating the patient. Concerns were raised about misinterpretation of advertising any benefits for cancer patients from chiropractic care. Lack of evidence in this area was acknowledged.

Keywords: cancer, chiropractic, Delphi, evidence based care, integrated care, manual therapy, multidisciplinary practice, patient management, spinal manipulation

Introduction

Cancer is the second leading cause of death globally, accounting for 8.8 million deaths in 2015. This disease can affect almost any part of the body and has many anatomic and molecular subtypes each requiring specific management strategies. The greatest step forward in the increasing success in treatment of this disease has derived from the improvements in understanding and early detection., The mixture of diversity of presentation, commonality of the condition and the rigors of treatment would make it highly likely that people with such a problem will develop or exacerbate pre-existing musculoskeletal conditions and as a result seek care from a manual therapist at some point in their therapeutic journey.– It is critically important, therefore, that a responsible profession has protocols in place to recognize the possibility of diagnosis, facilitate access to the appropriate treatment of the condition by accurate referral or provide musculoskeletal support within part of an integrated care package for those already undergoing treatment.,

Treatment of patients with cancer is an emotive subject in complementary and alternative healthcare circles. Although treatment of the cancer itself is restricted to orthodox healthcare by law in many countries, this has not prevented reports suggesting that other therapeutic modalities can be used to “cure” the disease. Mostly such claims are based on case reports and literature reviews and refer to a wide range of Complementary and Alternative Medicine (CAM) practice, with very little focus on chiropractic.– However, this situation has created a degree of confusion and obfuscation, which has impeded serious discussion of the potential health benefits that CAMs such as chiropractic may have on issues such as the patients’ quality of life. An added problem results from the difficulty in quantifying the effects of individual components of any integrated care package as many are probably indirect benefits loosely associated with recovery and remission.– A further reason for not raising awareness of offering treatment to this group derives from allegations that CAM practitioners can delay appropriate access to care by failing to diagnose the metastatic disease in its early stages.

It is generally accepted that musculoskeletal symptoms are common reasons for patients to present to a chiropractic practice.– Indeed, the motivations for the patient with cancer to seek chiropractic care appear to be primarily the presence of neuro-musculoskeletal symptoms.–

Occasionally, patients who were unaware that the underlying cause of their symptoms was cancer present to manual therapists, on occasion being appropriately diagnosed and referred.,,,,,,– Indeed, it is important to recognize that a number of primary tumours (lung cancer for example) may initially present with musculoskeletal symptoms. The diagnosis of cancer for many of the above cases was made through a careful history and physical examination and/ or because the patient was not responsive to care.– It is generally considered that chiropractic education and continued professional development emphasises the importance of the practitioner considering progression of severity and/or frequency of symptoms as the need to trigger re-examination, which may then warrant further investigation. Additionally, the education of chiropractors includes extensive training in the recognition of diagnostic characteristics of various cancers, including the use of radiographic imaging, which can play an important part in confirming the majority of such diagnoses–. A driving force for this emphasis results from the fact that failure to diagnose, make the appropriate referral, or even the delivery of chiropractic manipulation when contraindicated could have potentially fatal consequences for the patient.–

Patients undergoing treatment for their cancer usually have to battle both the psychological effects of the diagnosis and the metabolic effects of the therapeutic approaches; both of which are likely to increase the likelihood of musculoskeletal conditions adding to their burden. However, an analysis of CAM use in Washington, based on the claims data of two large insurance companies, revealed a slightly lower proportion of cancer patients (11.6%) sought chiropractic care when compared to those patients without a diagnosis of cancer (12.3%). Although this change might be considered relatively insignificant, it does appear to be contrary to expectations based on the increased depression and anxiety as well as decreased activity (due to fatigue) that have been associated with having a diagnosis of cancer: all of which have been associated with increased musculoskeletal issues., Indeed, based on this outcome, possibly erroneously, the authors of that article concluded that spinal manipulation may not be relevant to patients undertaking cancer treatment. This perception, whether made by those delivering care or those requiring care, could be damaging to both the chiropractic profession and patients if not subjected to further consideration.

Although historically treatment plans for patients with cancer were focused on the disease, recently the importance of improving the quality of life of the patient has been recognised. As a proportion of patients with cancer do not have significant pain relief with the treatment received, it would be expected for these people to seek alternative options of pain relief. Hence, in order to quality control this aspect of the therapy, the concept of the cancer rehabilitation team has been developed. This concept aims at helping with the multidimensional problems faced by a patient with cancer; however, interpretations such as those made from the Washington study could impact on the inclusion of certain forms of CAM such as chiropractic in any integrated care package.

Currently, little information is available regarding treatment of cancer patients by the chiropractic profession, especially in Europe. The authors are aware of one initiative in the United States where the Cancer Treatment Centers of America (CTCA) promote themselves as being part of an integrative care plan adjusted on the needs of each cancer patient alongside other supportive therapies such as acupuncture and naturopathic medicine. Although their project aims to establish a more evidence informed approach showing how an integrative care plan could be of benefit for patients with cancer; to the authors’ knowledge, there is currently no published research underpinning their approach.

We therefore chose to initiate our study of this area by gaining a range of views and maybe consensus from experienced European chiropractors who had treated patients with cancer as part of their general practice. The main issue was whether they considered their treatment to have benefitted these patients. We also wished to determine the degree of engagement with the other clinical disciplines responsible for treating the patient and what approach they might choose including use of manipulation and other therapeutic interventions.

Study Aims

Primary aim: to derive a consensus regarding whether chiropractic treatment was perceived to have any benefit for patients with cancer.

Secondary aim: to determine if there was consensus of approach regarding use of chiropractic in an integrated therapy package, as part of a multidisciplinary clinical team in the treatment of patients with cancer.

Methods

A two-stage Delphi process was performed using a panel constructed from chiropractors who were members of the European Chiropractors Union (ECU). A panellist needed to be a chiropractor with over ten years practice – based experience, during which time the panellist should have treated patients who either have or have had cancer. Members of the panel were purposively selected by a committee member of the ECU independently of the research team. The selection brief was to source chiropractors in practice who complied with the inclusion criteria and would be interested in participating in this research process. The panel members were unaware of the names and locations of the other panel members.

To comply with current European Union legislation, each potential panel member was asked if they would like to consider being involved in this process, by giving approval to pass their email and practice addresses to the research team. At this point the person was signifying their interest in principle, without having detailed knowledge of the topic under investigation.

The contact details of 23 chiropractors were supplied to the research team who then circulated information detailing the research topic. At this point, the chiropractors who had shown an interest were free to choose to respond to the survey or not. Furthermore, the research team were not able to determine who had responded and who did not, which ensured anonymity for the participants. Both rounds of surveys were delivered to all members of this group who had not opted out (the panel). Informed consent was implied through both a statement in the introductory email text and as warnings given at the start and end of the questionnaire that submission would be considered implied consent to use the submitted data.

Panel members each received a personalised email with the link (active for two weeks) to the questionnaire that used the SurveyMonkey platform. This e-mail also contained reminders concerning the implied consent nature of the questionnaire, anonymity and the right to withdraw their involvement at any point up to the point they submitted their completed questionnaire. We also ensured panel members were aware that they could exit from the study at any time by simply asking to be removed from the email list.

The questionnaire mostly comprised free text option questions. Free text options were chosen to allow the panellists to include their opinions and experiences as well their management strategies regarding chiropractic care of patients with cancer.

The responses were collated and recirculated to the entire panel at the end of each survey, in order to verify that the responses and their synthesis were a true reflection of the panel’s views. Verification was performed by uploading the summary document to the online platform (SurveyMonkey) and sending a link to all the panel, giving them the opportunity to add any further comments anonymously, if they so wished.

The questions for the second round were developed based on the responses from the first round, following verification. The aim of the second round was to delve deeper into the topic and clarify some of the issues raised about use of chiropractic treatment on cancer patients. Those questions were also distributed in the form of a survey using the same platform (SurveyMonkey). Access to the second questionnaire was available for four weeks. A similar verification procedure was completed before the final analysis.

Ethical approval was granted by the chiropractic undergraduate research ethics review subgroup (granted devolved responsibility from the Faculty of Life science and Education Ethics Committee, University of South Wales).

Results

Twenty-three chiropractors were contacted to take part in the project as part of the panel by the ECU member. One of them contacted the research team asking more details about the project and decided to opt out before the release of the first questionnaire. Thirteen of the 22 remaining panellists responded to the first questionnaire (59%) with three contributing to the first verification stage. Thirteen of the 22 responded to the second-round questionnaire, with none engaging in the second verification stage. Due to the anonymity of the respondents, it was not possible to determine whether the same 13 responded to both questionnaires or not. Those engaging in the verification did so only to suggest minor changes.

Demographics of the panel

Although anonymous, limited information was available about the 13 panel members (from responses to direct questions on the questionnaire). Only one had less than 15 years’ experience; the majority (7/13) had between 15 and 20 years’ experience, with five having more than 20 years’ experience. Seven of the panel had studied chiropractic outside the UK. Details on those who chose to not to respond was not available.

Areas of unanimous or general agreement

Of those choosing to respond, it was unanimously agreed (13/13) that there were benefits that the patient with cancer could derive from chiropractic care. According to the majority of the panel (9/13) the perceived benefits were similar to those recognised and reported by patients without cancer. The panel unanimously agreed that the role of chiropractic treatment in patients with a diagnosis with cancer should not differ from its role for any other patient. The following were mentioned by at least one of the panel members:

  • Chiropractic could help a patient with cancer in terms of their: pain relief, empathy, mobility, energy levels, quality of life, sleeping patterns and function.

  • Perceived benefits of chiropractic care in this group of patients were reported to include: pain relief, sleep pattern improvement, immune system improvement, wellbeing, higher energy levels and psychological reinforcement.

The whole panel agreed that a cancer diagnosis should make a difference to a chiropractic treatment plan.

  • The range of reasons given for this included: the medication used, possibility of metastasis, possible bone density or ligamentous integrity alterations due to the cancer. Three of the panel stated that post-chemotherapy osteoporosis and cancer diagnosis must be considered a red flag before any treatment protocol be considered.

All the panel members concurred that SMT should not be used on all cancer patients. Although the panel stated that SMT was not considered necessary on all occasions; it was also stated that SMT should not be contraindicated in any plan of management. There were a range of different exclusion criteria offered, the main one being metastasis (6/13 responses). Other contraindications mentioned included stage, type and location of the tumour along with the extent of the area involved, the overall health of the patient, muscle weakness, atrophy and osteoporosis.

Interestingly, three of the five participants that had been in practice for 20 or more years and reported seeing 10 or more patients with cancer a year agreed it was appropriate to adjust areas other than the involved area, or considered first treating the patient without SMT if possible. One of this group reported using only Activator Adjusting Instrument based techniques on this category of patient.

The reasons that a patient with cancer will visit a chiropractor were not considered to be different from those of any other patient namely: musculoskeletal pain/ conditions (12/13). One panellist reported that “cancer patients seek chiropractic care for neurological complications affecting eyesight, balance, dizziness, autonomic nervous system complications and weakness”.

Additional comments made at the end of the first round included: “most patients seek chiropractic treatment after the cancer was diagnosed” and “the aim should be the improvement of the function of the patient and that multidisciplinary patient centred approach could benefit patients with cancer”.

Three of the panellists stated that chiropractors should not treat the cancer but address the neuro-musculoskeletal problems of the patient and help them by improving their function.

A further panellist stated: “patients with cancer may benefit from chiropractors and a vitalistic approach as long as it is as part of multidisciplinary management. Contraindications must be considered and weeded out very carefully. Specific chiropractic spinal manipulation guidelines must be determined, and all of the healthcare providers must work together in a patient-centred manner”.

The areas of concern raised by the panel included:

  • a lack of evidence: 8 panellists considered there was insufficient evidence to support the safety of chiropractic on patients with cancer, whereas 2 considered that there was. Additionally, one panellist outlined that there is enough evidence for safe chiropractic care in special populations like osteoporotic patients as the worry was instability or bone weakening; therefore one could extrapolate that there would be a good safety record for cancer patients as well.

  • a lack of communication with the medical team: part of the panel acknowledged that they do not communicate with the medical team (7/13). The situation with the remaining respondents (6/13) was not clear.

  • a fear of the misconception that chiropractic cures cancer instead of helping the neuro-musculoskeletal aspect of the symptoms associated with the disease or its treatment. Throughout their comments the panellists were continually underlining the need of giving a clear message that the chiropractor would not cure the cancer but only help with the MSK symptoms associated with it.

  • a lack of specific chiropractic techniques other than spinal manipulation therapy. Two of the thirteen actively engaged panel members suggested soft tissue work, a further two stated there was nothing specific to chiropractic and seven gave no answer. Interestingly two panellists replied that they use SMT if indicated and would apply SMT in other areas of the body if required.

  • chiropractors should not advertise the benefits of their care. One respondent said that such advertising was not legal in their country of practice, as new rules are limiting medical advertisement, whereas the others could not find any reason to target advertisements towards patients with cancer. In the comment field, two other panellists stated that chiropractors should not advertise any treatments specifically for cancer patients as either cancer patients are to be seen as any other patient with neuromusculoskeletal problems or because an advertisement like that could “make things worse”. Two of the panellists responded in the comment field requesting this section be removed as there was no option not to answer.

Regarding whether chiropractic as a profession should do more to advertise the benefits of chiropractic on patients with cancer, two of the 12 who responded agreed and 10 disagreed. Reasons for disagreeing were that cancer patients are not and should not be a chiropractor’s primary patient (n=1), and there is insufficient evidence to claim that chiropractic could benefit these patients (n=1). Again, the comments focussed on the possibility of the message being misconstrued as being the chiropractor is able to cure cancer, instead of that chiropractic can help the MSK aspect of the patient’s problem.

Treatment modalities used for treating patients who have been given a cancer diagnosis

Regarding whether the presence of a bone tumour could be a contraindication to SMT: 9/13 agreed and 4/13 disagreed with the statement. Ruling out presence of metastases and osteoporotic regions was the main point of concern. Although there was consensus that SMT could be used, low force techniques were considered to be safer (n= 9). Additionally, comments from a panel member (n= 1) indicated there was insufficient information provided in this question, with the decision being dependent on the primary tumour location.

While the panel agreed that the SMT does not appear necessary in the treatment plan of a patient with cancer (first round question, 13/13 agreed), the same degree of consensus did not exist when the panel were asked to suggest alternative treatment methods and comment on which would be considered specific to chiropractic. Two of the 13 answered that there is nothing specific to chiropractic, five out of 13 suggested soft tissue work, while one responded that the question was not clear. Respondents suggested the following to be alternative chiropractic specific therapies: dietary advice, adjustments of areas not affected by the cancer, use of Activator Adjusting instruments, active mediations, bio resonance, acupuncture, SOT, NU-CCA, N.E.T., SSEP, trains of four, electrostimulation, Transcranial Magnetic Stimulation, balance training and eye exercises.

Protocol for treating patients who have been given a cancer diagnosis

Although a large proportion of the respondents tended to agree on their approach regarding engagement with the medical team, there were some interesting differences within the group.

Many of the respondents (11/13) would not consider contacting the medical team of the patient to request permission to treat. However, one panellist stated they would contact the clinical team regardless of whether the patient was diagnosed with cancer, in chemo- or radio-therapy or in remission.

Approximately half of the respondents (7/13) considered that a clinical relationship between the chiropractor and the oncologist was not necessary, while six of 13 considered it to be necessary. Comments within the responses to this question showed some differences in terms of type of interaction. Two of nine who commented directly, stated that either oncologists are not open to chiropractic care in the country of practice (n= 1), or that the oncologist does not know what a chiropractor is or could do (n= 1).

Comments supportive of a multidisciplinary approach came from six of the 13 panel members. These are best encapsulated in the following statement: all healthcare practitioners working on a patient should have some clinical relationship for the benefit of the patient and that the patients’ optimal management is based on a mutual understanding of each practitioners’ role. Finally, 11/13 of the actively engaged panel agreed that a chiropractor should offer treatment to a patient who has a current diagnosis of cancer; however, two disagreed.

Discussion

There was unanimous agreement of the panel regarding the perception that patients with cancer can benefit from chiropractic treatment. Interestingly, the main reasons that a patient with cancer seeks chiropractic treatment were considered by the panel to be no different from those of any other patient, namely MSK pain and associated disorders. A better quality of life, pain relief and improved function were reported to be the most common perceived benefits of chiropractic in relation to the panels’ experience with cancer patients.

The panel agreed that a cancer diagnosis should make a difference to a chiropractic treatment plan, even if the patient seeks care when in remission. Spinal manipulative therapy was not reported as being used on all cancer patients, with exclusion criteria including the location of the tumour as well as presence of metastases or concurrent osteoporosis. Type of cancer was not mentioned as a factor by any of the panel, however, this might relate to the lack of a specific question.

One of the obvious limitations was that the panellists only had restricted clinical experience of patients with cancer, having only encountered them through their own practices. The potential lack of diversity in terms of the cancer types seen requires consideration when interpreting the comments reported here. The fact that these chiropractors have seen sufficient patients with these conditions to be comfortable discussing their treatment, however, does indicate that chiropractors should expect to see these patients in general practice.

The authors had initially considered a general questionnaire to the profession; however, a Delphi method was considered an appropriate starting place to gain some insight into the issue.

The Delphi method maximizes the benefits of using an expert/knowledgeable panel while minimizing potential disadvantages by implementing anonymity.– Furthermore, this method allows everything to be performed by email and does not require the participants to meet or interact directly. The presence of anonymity allowed those participating, the room to air their views without the inhibition that might result when discussing potentially contentious issues in a direct (face-to-face) social interaction. This was an important consideration in relation to approaching this topic area within members of the chiropractic profession, in order to gather a wide range of views. Furthermore, anonymity allows decisions to be evaluated on their merit, rather than being influenced by the strength of personality (i.e. of the person who had proposed the idea). Anonymity and confidentiality of participants are central to ethical research practice in social research.–

Using the Delphi methodology rather than focus groups allowed information exchange between numerous geographically (and temporarily) dispersed individuals in an iterative process. The belief is that there could be benefits from the exchange of information while retaining a low cost and convenience of accessing the questionnaires. In this case, the method allowed chiropractors from across Europe to answer the questionnaires in their own time and without awareness of other panel members’ views. Supplying their responses to a central point and not sharing them prevented any adverse personal interaction. This approach has been criticized for limiting the potentially positive aspects of interaction found in any face-to-face exchange of information, as these often help identify the reasons for any disagreements. The preliminary basis of this study accepted this minor disadvantage in relation to the major advantage of determining the nature of the issues.

Consensus development methods are being used to help clinical guidelines, which define key aspects of the quality of health care. However, particularly appropriate indications/suggestions for interventions, such as those revealed in this Delphi study, do not represent any clinical guidelines. Instead, these results should only be considered as a representation of a consensus between members of a small panel of European chiropractors regarding their perspective on chiropractic management of patients with cancer.

Although 23 potential participants were invited, only one actively decided to opt out. Of the remaining 22 who indicated they were interested in participating, slightly more than half (n=13) actively participated in the first round. Reassuringly, this level of participation continued into the second round, however due to the success of the anonymization process we were not in a position to determine whether participation was by the same 13 chiropractors in both rounds. The low response rate during the verification stages could be considered as reflecting a general agreement with the conclusions, however as this was not an active agreement, this can only be considered tacit approval at best.

Improvements in quality of life, pain relief and function were the most commonly reported perceived benefits of chiropractic in regard to patients with cancer. Importantly making potential patients more aware of these benefits was not considered appropriate. The debate in the profession regarding the “philosophy of chiropractic” seems to have made some chiropractors apprehensive regarding who they will talk to about chiropractic treatment in these patients, with the motivation apparently being a fear of possible misunderstanding about what the chiropractor could do. Indeed, when presenting our preliminary analysis at a major European chiropractic meeting one of the authors found that a number of chiropractic scientists misinterpreted the aim of the research. A small number of the panel expressed concerns about advertising any perceived benefits. Apart from local advertising restrictions and lack of evidence base, the main concern was that these patients should not be considered any differently from patients without a history of cancer, due to the treatment focus being neuro-musculoskeletal.

The panel agreed that chiropractors should view the patient as a “whole person” with needs reaching beyond the management of the disease entity. Indeed, the chiropractic profession has, ever since its inception, embraced such a “holistic” approach toward patient care. The generally accepted primary role of the chiropractor is to assist the patient with pain management and help the patient to increase mobility and function beyond a disease diagnosis., The panel did consider that the use of spinal manipulation might be contraindicated or require careful consideration when treating patients with cancer. When challenged regarding alternative management/treatment tools, the panel reported using a variety of tools, but only a few of them appeared to be chiropractic specific. The key feature was that each patient must be evaluated thoroughly to determine which methods (chiropractic or other) will provide the greatest benefit in the particular case. In some instances, treatment may call for non-force techniques, whereas other situations could be better addressed through use of more standard manipulative procedures. Interestingly, most of the techniques mentioned by the panel did not appear specific to chiropractic; as a variety of physical therapists, physiotherapists, osteopaths and sport massage therapists would also consider them part of their toolbox. It was agreed by all the panel who expressed an opinion (n=13) that more evidence would be needed in order for chiropractic adjustments and chiropractic specific techniques to be considered safe to use with such patients.

Although the attitude of health care providers and regulators to chiropractic has been historically negative, the opinion of the consumers has always been positive. It appears the public’s opinion of chiropractors does not suffer because of advertising, however it has been suggested that approval of the majority of clients can be helped by using a professionally designed and well-conceived advertising campaign. It has been reported that almost 77% of the general public seek and want information regarding the services a chiropractor provides. This supports the need for clarity and transparency when communicating the identity for chiropractic: as we found here, what a chiropractor considers specific to chiropractic, may not be considered to be specific to chiropractors by those outside the profession.

The vast majority of the panel agreed that chiropractors should treat patients with cancer, which provides a positive answer to the initial question. However, there was a recognition of the need for evidence to indicate whether chiropractic treatment is safe for these patients which was one of the main concerns of the panel. In addition, the panel struggled to find chiropractic specific management techniques, which could raise an issue for further research.

Although anecdotal, there has been the perception of both fear and confusion in the profession regarding the role of the chiropractor in the management of patients with cancer. This was strongly reflected in the comments made by the panel. Therefore, going forward it is apparent that evidence will be needed in order to both allay fears, define roles and facilitate in the engagement of chiropractic as part of an integrated care package for these patients. This suggests there may be a need, at least initially, to create consensus based guidelines (as there is no research available to currently inform such guidelines) that support currently considered best practice and prevent more dubious and unhelpful claims of efficacy.

This research does not present evidence supporting benefits for patients with cancer from chiropractic care, or whether spinal manipulative therapy should be used on the management of patients with a diagnosis of cancer. However, it does give evidence that experienced chiropractors both treat such patients and recognize a potential role for chiropractic in this population of patients.

Conclusions

Chiropractors treat patients who have cancer, seeking care mainly for neuro-musculoskeletal complaints. Advertising is not considered viable due to potential for adverse interpretation.

Further research is necessary regarding initially how chiropractic could gather data about the relative safety and risks of chiropractic care in such patients. Chiropractors need to establish better inter-professional relationships with the patient’s medical and rehabilitation team.

It is important to send a clear message that chiropractors do not cure cancer but only aim to help with the neuromusculoskeletal signs and symptoms. Therefore, construction and publication of consensus-based guidelines of best practice should be considered a priority.

Acknowledgements

The authors would like to acknowledge the time and contribution made by those chiropractors who responded, without which this study would not have been possible.

List of Abbreviations

ECU European Chiropractic Union
WHO World Health Organization
CAM Complementary and Alternative Medicine
SMT Spinal Manipulative Therapy
MSK Musculoskeletal

Footnotes

The authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript.

References

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We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

Chiropractor Services

Here is a list of the many services offered by We Care Chiropractic:

  • Relieve pain caused by accidents and injuries.
  • Regular chiropractic care.
  • Corrective exercises.
  • Lifestyle advice.
  • Massage therapy.
  • Nutrition counseling.
  • Sports injuries.
  • Spinal screenings.

Read more about all the chiropractic services one can find in Glendale.

 

 

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE

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Best Chiropractor Near Me
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Best Chiropractor Near Me 2021

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If you are searching online for “best chiropractor near me” in the Glendale, AZ area, then this post is for you! With over 35 years of industry experience, We Care Chiropractic should be your number one choice for massage therapy and beyond. Keep reading for company details and why seeing a chiropractor might be right for you.

Why See A Chiropractor?

For many, the first question is obvious: why would one need to see a chiropractor? Well, there are many signs that chiropractic services are a logical step in your life. For instance, joint and muscle pain can easily be relieved with the services of a chiropractor. Your joint and/or muscle pain could require more attention than just a few aspirins or pain relievers. This pain could be a result of musculoskeletal alignment. Chiropractors are trained to get your body functionally at the highest level possible. Constant headaches will also suggest a trip to the chiropractors, as these pains can be caused by dehydration or spine misalignment.

One of the most common reasons one opts for these services is to relieve chronic back pain. Many people who experience constant back pain will choose seeing a chiropractor over expensive invasive surgery. A chiropractor can also help adjust your posture to avoid further back pain. Chiropractic services can be ideal for leg pain, as well. Shooting pain or tingling tend to be signs of a slipped disc or even a pinched nerve.

The services a chiropractor can provide can come in handy for active people; not just those with chronic pain. An active person subjects their body to additional strain and pressure. Added stress can sometimes cause misalignment of the spine. Seeing a chiropractor regularly is suggested so these trained professionals can keep your body performing its best at all times.

Reasons To See A Chiropractor:

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

Chiropractor Services

Here is a list of the many services offered by We Care Chiropractic:

  • Relieve pain caused by accidents and injuries.
  • Regular chiropractic care.
  • Corrective exercises.
  • Lifestyle advice.
  • Massage therapy.
  • Nutrition counseling.
  • Sports injuries.
  • Spinal screenings.

Read more about all the chiropractic services one can find in Glendale.

 

 

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE

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What Causes Foot And Ankle Pain?

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What causes foot and ankle pain?

A number of different things can cause foot and ankle pain. Around 1 in 5 middle-aged or older people suffer from it, and women are particularly affected. The most common causes involve the soft tissues of the foot and ankle:

  • Plantar fasciitis: this usually causes pain in your heel and along the arch of the foot. Plantar fasciitis occurs when the soft tissue on the underside of the foot (the plantar fascia) becomes inflamed. The pain is often worse after being inactive or first thing in the morning
  • Achilles tendonitis: this causes pain at the back of the ankle when the Achilles tendon, which connects the calf muscles to the heel bone, becomes irritated. It can be caused by overuse, often when you start a new type of exercise or if the amount you exercise is increased
  • Ankle sprains: these occur when the ligaments (the soft tissues connecting the bones of the foot) are damaged due to an injury. There will often be pain around the ankle and bruising or swelling, as well as reduced movement

What can I do to relieve my foot and ankle pain?

Soft tissue takes time to heal, but there are a number of things you can do to help speed up the process:

  • Exercises help to relieve pain by loosening up the soft tissues in your feet. Tightness in the Achilles tendon can often have a knock-on effect on the plantar fascia, so these areas are particularly important to target. Read on for a list of suggested exercises to ease your pain
  • Resting your feet wherever possible by not running, walking or standing for too long can help to avoid any more inflammation
  • Wearing comfortable shoes with good arch support will also reduce the strain on your feet
  • Painkillers such as paracetamol and ibuprofen can help to control the pain. Ibuprofen is also an anti-inflammatory meaning it will help to relieve any swelling. Taking these as tablets or using anti-inflammatory creams can both be helpful. Remember to not take more than the recommended dose
  • Ice packs pressed against the bottom of the foot can help to reduce swelling. Do not apply ice directly to the skin; instead, try wrapping the pack in a tea towel

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

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Five Stretches For Shoulder Pain
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Five Stretches For Shoulder Pain

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Neck Stretches

  • Stand with the feet hip-width apart.
  • Let the arms hang down by the sides.
  • Look forward.
  • Tip the head to the right, trying to touch the right ear to the right shoulder.
  • Feel the stretch in the left side of the neck and shoulder.
  • Tip the head to the left, trying to touch the left ear to the left shoulder.
  • Feel the stretch in the right side of the neck and shoulder.Each time, hold the position for 10 seconds.
  • Repeat this three times on each side.

Shoulder Rolls

  • Stand with the feet hip-width apart.
  • Let the arms hang down at the sides of the body.
  • Breathe in and lift the shoulders up toward the ears.
  • Move the shoulders back, squeezing the shoulder blades together.
  • Exhale and drop the shoulders back.
  • Move the elbows forward, feeling the stretch at the back of the shoulders.
  • Repeat this 10 times.

Pendulum Stretch

  • Stand with the feet hip-width apart.
  • Lean forward and look at the ground.
  • Place the right hand on a table or chair for support.
  • Let the left arm hang down.
  • Swing the left arm gently in small circular motions, letting gravity do most of the work.
  • Continue for 30 seconds to 1 minute.
  • Change the direction of the motion.
  • Repeat this, using the other arm.

Cross-Body Arm Swings

  • Stand with the feet hip-width apart.
  • Inhale and lift the arms out to the sides, squeezing the shoulder blades together.
  • Exhale and gently bring the arms in toward each other.
  • Cross the right arm under the left, keeping both arms straight.
  • Inhale and swing the arms back out to the sides, squeezing the shoulder blades together.
  • Exhale, and gently swing the arms in toward each other again.
  • This time, cross the left arm under the right, keeping both arms straight.
  • Repeat this 10 times.

Cross-Body Shoulder Stretch

  • Stand with the feet hip-width apart.
  • Stretch the right arm out straight.
  • Bring the right arm across the body, so that the hand points to the floor on the other side of the left leg.
  • Bend the left arm at the elbow.
  • Hook the left forearm under the right arm, supporting the right arm above the elbow.
  • Use the left forearm to pull the right arm further in and across the body, stretching the back of the right shoulder.
  • Hold this for 20 seconds, then repeat the stretch on the other side.

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

AT WE CARE CHIROPRACTIC, WE GOT YOUR BACK!

CONTACT US HERE
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Stretches For Knee Pain
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Stretches For Knee Pain

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It is not often we just link to another article but a there are so many knee pain sufferers out there and we found a really good article for you. Chiropractic care can take care of your entire body and here is a post we posted last year on how chiropractic care can help with knee issues: https://chiropractorglendaleaz.com/chiropractors-for-knee-care/

The knee stretch exercises can be found at: https://www.prevention.com/fitness/g20475333/5-stretches-that-will-make-your-knee-pain-go-away/

We Care Chiropractic

Located in Glendale, AZ, We Care Chiropractic has been providing the valley with the best chiropractic services for years. We Care Chiropractic emphasizes its focus on improving overall health, which can prevent further illness and pain. Let We Care Chiropractic help your body function at an all-time high. Chiropractors are a great alternative to traditional medicine, and much less costly than any surgical repairs. Feel free to contact the team at We Care Chiropractic today!

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