Tuesday, February 23, 2010

What is Vestibular Rehab?

By Mary Ann Gargano

When people think of physical therapy, most will think the usual: rehabilitation after shoulder or knee surgery, treatment for neck or low back pain, etc.  The general idea with physical therapy is to get the patient back to normal function.  However, most will not realize that Physical Therapists treat a vast patient population, including those with traumatic head injury, stroke, open heart surgery, various orthopedic disorders, and even Vestibular dysfunction.

Vertigo, (a sense of spinning/movement within a still environment), is characterized as a Vestibular disorder.  Our Vestibular System connects the workings of our inner ear and a specific part of our brain and helps us maintain our balance.  Vertigo is a very common complaint and can be the result of many different diagnoses.  A visit to a medical doctor is in order when someone is experiencing feelings of dizziness, or balance issues. Once a doctor determines whether the diagnosis is a Central Nervous System Disorder vs. a Peripheral Vestibular Disorder, he or she will usually prescribe medication and/or Physical Therapy. 

The most common Peripheral Vestibular Disorder, Benign Paroxysmal Positional Vertigo (BPPV), is a type of vertigo that is characterized by spells of vertigo that are of short duration (30-60 seconds), positionally induced (rolling, lying, getting out of bed, lying in a reclined chair, etc.), and commonly occur spontaneously.

The most common form of BPPV is Canalithiasis.  This is a condition where the canaliths (tiny particles of calcium carbonate) become dislodged from a part of the inner ear, and collect within the semi-circular canals, triggering false signals to the brain that your head is still moving even after it stops, causing dizziness and other symptoms. 

The type of therapy used for Canalithiasis is called CRP (Canalith Repositioning Procedure).  CRP was first described in 1992 by John M. Epley MD, and is referred to as the Epley Maneuver.  This therapy involves taking the patient through a series of head position changes that move the canaliths from the canal to the utricle.  The canaliths may then re-adhere to a special membrane, or possibly dissolve or break up, or move some place where they can’t cause symptoms.  The positions involve specifically patterned head and trunk movements and are performed while the doctor or therapist closely watches the patient for eye movements with each position change.  Once the canaliths are repositioned, the patient is offered special precautions in order to ensure that these particles remain in their new position.

The approximate cure rate for CRP is 80%.  The occurrence rate is low.  Usually one treatment is all that is necessary, but occasionally, additional treatments may be needed. Often times, symptoms of vertigo clear up on their own, and intervention is not necessary.

It is always recommended that the patient has had a recent physical examination, and up- to-date blood work, to help rule out other medical issues that may be contributing to their symptoms.

Our team of professionals, here at Advanced Wellness, is available to help with any questions or concerns you may have about your health.  If you are having problems with vertigo, please call us at 732-431-2155, to schedule an appointment for an evaluation.

Saturday, February 6, 2010

Health Update: Low Back Pain

What Do Consumers Say Works Best?
              We know that many people, in fact about 80%, hurt their back at some point in life.  In a recent survey by Consumer Reports (CR) (see the May 2009 issue), over 14,000 subscribers had low back pain (LBP) but no surgery to treat it in 2008.  More than half reported severe daily activity limitations for at least one week and 88% reported their LBP recurred throughout the year.

              Many indicated their sleep, sex life, and weight management all suffered as a result of LBP.  What is important about these findings is that once you have LBP, you’re probably going to have repeat episodes.  It’s the chronic, recurrent nature of LBP that makes it one of the most costly conditions to the injured employee, the employers, fellow workers, insurance companies, and the health care system in general.  Of interest, most of the 14,000 LBP sufferers indicated they had tried 5 or 6 different treatment approaches.  When rating the degree of helpfulness of each type of care and, their overall satisfaction with the various health-care professionals, the hands-on therapies were the top rated, with chiropractic leading the list at 59%.  Physical therapists (PT) were next at 55% though later in the article a “very helpful” rating for PT was reported at 46% vs. massage therapy at 48%.  Acupuncture was listed at third with 53%, specialty physicians at 44% and primary care physicians were rated the lowest at 34%.  Medications by prescription “helped a lot” in 44% and about 22% were helped by over the counter medication.  It is ironic that other reports have indicated that only about 15% of people with LBP go to chiropractors when research, consumer satisfaction as indicated here, and all of the international guidelines have recommended that chiropractic be considered as one of the first approaches in the management of non-surgical LBP.  What is the hesitation?

              Other interesting points in the article include that most of the LBP sufferers that elected not to seek treatment (about 35%) did so because of cost concerns or the belief that professional care would not help. Both research and the majority of the 14,000 who tried chiropractic said it helped and a LBP case was reviewed emphasizing this point. The case example emphasized the value of periodic chiropractic treatment for a worker in a heavy physically demanding job and the benefits he received from a treatment every few weeks, indicating this approach, “…is able to keep his back pain to a minimum.”  Another important point was that 44% of the 14,000 consumers reported exercise was helpful, and this represented the top placed self-help measure.  Moreover, 58% indicated they wished they had included more exercises to strengthen their back in the past year.  Chiropractic management of back pain and other musculoskeletal conditions includes exercise training during the care rendered for LBP.

              The article concludes with caution about back surgery, and references a separate CR survey completed in 2006.  They reported 60% satisfaction in about 1000 LBP consumers that had surgery in the prior 5 years compared to hip or knee replacement satisfaction at 82%. Additionally, more than 50% reported at least one problem during recovery, 16% had no improvement at all, while 8% were worse. The recommendation of obtaining at least 2 opinions was suggested prior to under going surgery, preferably one from a non-surgeon.

              Therefore, if you, a loved one, or a friend have not yet utilized chiropractic for LBP management, the time is now as all the evidence points to chiropractic as yielding the highest level of satisfaction and activity restoration for LBP sufferers.  This recommendation may be one of the most important acts of kindness that one can give to another person.

Health Update: Low Back Pain

Chiropractic Care For
Low Back Pain :
 What Does the Research Say?

There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain.  Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.”  But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history.  In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today.  Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care.  Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system:

1)    Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437.

2)    Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada.  www.chiro.org/LINKS

3)    Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). www.ncbi.nlm.nih.gov

4)    Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up.  British Medical Journal 1995 (Aug 5);   311 (7001):   349–351  www.chiro.org/LINKS/

5)   Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1);   29 (1):   79–86.  www.ncbi.nlm.nih.gov/

At our clinic, we are most appreciative to have the opportunity to provide care to our patients and strive to make the experience highly satisfying.  If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing  Advanced Wellness in Marlboro, New Jersey.

Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy.  To find out if you are a candidate for their customized treatment approach call 732-719-8148 or visit www.advanced-wellness.net.

Dr. Cilea’s Health Update: Carpal Tunnel

Carpal Tunnel Syndrome (CTS)– A New Treatment Approach

Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist.  The resulting symptoms of numbness/pain in the wrist, index, third, and forth fingers, multiple sleep interruptions, frequent shaking and flicking of the hand/fingers, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, the inability to perform work duties – especially fast, repetitive work tasks can have a devastating effect on a person’s quality of life.

While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA).  This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS.  The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA.  This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period.  Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study.  The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach.  This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group.  Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.
Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results.  Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed.  This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible.  Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side.  Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed.  A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation.  These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained. 

Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS.  Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt.  The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist.  The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients.  We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. The first step is to get an accurate diagnosis utilizing appropriate diagnostic testing.

Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy.  To find out if you are a candidate for their customized treatment approach call 732-719-8148 or visit www.advanced-wellness.net.

What is spinal decompression therapy?

Spinal decompression is a non-invasive, non-surgical treatment for certain types of chronic back pain.  Mechanical decompression works by slowly and gently stretching the spine, taking pressure off compressed discs and vertebrae. Spinal decompression is one of the most exciting medical treatments developed in many years, since it demonstrates good statistical results for long term pain relief.

The most common spinal condition treated with decompression treatment is a herniated disc. Spinal compression can cause disc herniations to expand, putting pressure on surrounding spinal nerve roots Decompression treatment takes the pressure off these damaged discs so that the disc bulge will shrink back closer to its original size.

Degenerative disc disease is also a common condition treated with decompression therapy. Loss of disc height can be exacerbated by spinal compression, causing the vertebral bodies to move closer together. This can cause nerve compression and other forms of common back pain. Decompression eliminates the overwhelming pressure on degenerated discs reducing or eliminating painful symptoms.

Facet joint syndrome is yet another condition treated with spinal decompression. Facet syndrome causes pain due to arthritic changes in the vertebral bones. Decompression helps to create more space between the vertebrae, hopefully reducing painful symptoms.

In order to determine if you are a candidate for spinal decompression a thorough history, exam and review of diagnostic tests including MRI’s will be necessary.  Once accepted a typical decompression program is 4 to 8 weeks in duration.  Over this period 12 to 20 treatment sessions are performed.  Each treatment session is approximately one hour long and includes any necessary physical therapy services.

A spinal decompression program may be covered by health insurance plans.  Each plan must be verified and discussed with patients on an individual basis.  It is important to choose a practice that has both expertise in spinal decompression and utilizes the most advanced spinal decompression technology.  The DRX 9000 and the Vax D are the industry leaders in this technology.

Dr. Cilea is the president of Advanced Wellness.  Advanced Wellness has been a leader in spinal decompression in Central New Jersey with over a thousand patients treated over the past 5 years.  They utilize the DRX 9000 technology.  To learn more about spinal decompression visit www.AdvancedDRX.com or call 732-984-9594 for a free consultation.

Health Update: Whiplash Part 2

Whiplash – What Is It?

Whiplash is a slang term for an injury to the neck that occurs as a result of a sudden jolt, classically occurring in a car accident though a slip and fall injury can sometimes result in a similar condition.  In a classic rear-end collision, the car is struck from behind and accelerated forward at speed that even if the person knew the impending collision was about to take place, bracing the body prior to impact would not prevent injury.  In fact, muscles can only be voluntarily contracted at around 800-1000 msec. and in a rear end collision, the head is “whipped” within a 300-400 msec. time frame.  Add to that, the muscles in the front of neck are initially stretched with the car is propelled forward leaving the head in a relatively extended backwards position.  Most of the headrests in cars are not properly positioned so the head often goes back much farther than the limits of our muscles, ligaments and joints may allow resulting in stretching and tearing of these tissues.  When the tissues in the front of the neck are over stretched, the “rubber band” effect propels the head forward - overstretching the muscles, ligaments, and joints in the back of the spine.  This “crack the whip” phenomenon occurs within 400-500 msec., far quicker than what we are capable of when voluntarily contracting our muscles. Here is a breakdown of what happens in a 5 mph rear-end collision:

0 msec.: At the moment of impact, the car seat just begins to move and the occupant has not yet been accelerated forward.
50 msec.:  As the back of the car seat pushes the torso forward, the spine moves forward, resulting in a straightening of the thoracic and cervical spine. About 2-3 G’s of force are exerted on the torso.
75 msec.:  This difference in motion between the neck and torso results in an S-shaped curve, where nearly all of the bending in the cervical spine takes place in the lower cervical spine.  This rapid bending in just a few joints can result in ligament damage in the lower spine.
150 msec.: Here, the torso has pulled so far forward on the lower neck that the head is forced backwards often over the head restraint.  Depending on the position of the headrest, the angle of the seat back, and “spring” effect of the seatback, the ligaments in the front portion of the spine are often injured during this phase of the collision.  About 3-4 G’s are exerted on the shoulders.
200 msec.:  Finally, the force of the car seat throws the head and torso forward. Here, 5 G’s are exerted on the head and neck as it whips forwards.  All of this is completed in less than 500 msec.

One of the reasons this occurs has to do with the ability of the car – particularly the back bumper to not deform so that the force of impact is transferred directly to the contents within the vehicle (ie., the passengers).  At higher speeds, the crushing metal absorbs some of the impact and the contents are actually less jostled and thrown about.  This helps explain how a no damage rear end collision can result in greater injury than a higher speed collision.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this Advanced Wellness in Marlboro.

Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy.  To find out if you are a candidate for their customized treatment approach call 732-719-8148 or visit www.advanced-wellness.net.

Health Update: Whiplash Part 1

What is the Best Type of Treatment for Whiplash?

Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury.  So the question on deck is, which of the health care services best addresses the injured whiplash patient?

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25).  The authors state conventional medical treatment utilized in whiplash care, "is disappointing."  The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome.  The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment.

They separated patients into one of 3 groups:

Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit."

Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement."

Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean).
The patients were then surveyed and their improvement was reported:

Group 1                                                                                                          
38% Asymptomatic
43% Improved by Two Symptom Grades
13% Improved by One Symptom Grade
6% No Improvement

Group 2
24% Asymptomatic
24% Improved by Two Symptom Grades
24% Improved by One Symptom Grade
28% No Improvement

Group 3
0% Asymptomatic
9% Improved by Two Symptom Grades
18% Improved by One Symptom Grade
64% No Improvement
9% Got Worse

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and/or those with neurological losses (group 2).  The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened.  The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3).  Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at Advanced Wellness Marlboro, New Jersey.