Many patients are seeking back pain relief when they visit my San Diego based chiropractic clinic.
That is not unusual since most people consider chiropractors as back pain specialists. That being said, we treat patients for a variety of ailments including neck pain, headaches, sciatic pain, carpal tunnel syndrome, etc. While all of these conditions sound like very different conditions, they are actually very similar.
Most of my patients that suffer with headaches also complain of neck pain or stiffness. In fact, many headaches are related to muscle tension that originates in the neck. The muscle tension or spasm in the neck triggers the headache. Therefore, by treating the neck with a combination of chiropractic adjustments, hot packs, ice packs, muscle stimulation and ultrasound; the muscle tension in the neck can be resolved preventing the headache.
This is just an example of how one problem in a specific region of the body can be responsible for symptoms in a separate area. Likewise, sciatica is most often related to irritation of joints and muscle spasms in the lower back. Similarly, carpal tunnel syndrome results from a process involving joints in the wrist and the surrounding muscles and ligaments.
All of the conditions that I listed above as well as many unlisted conditions follow the same path to becoming symptomatic. Either through some specific injury or ongoing trauma (such as keyboarding or mousing), the joint becomes irritated and inflamed causing pain and muscle spasm.
If the pain and spasm affects a specific nerve, the patient may experience additional symptoms such as sciatica or arm / hand pain.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Friday, October 29, 2010
Tuesday, October 19, 2010
The Role of Exercise in Building a Healthy Spine
The Role of Exercise in Building a Healthy Spine
I see many types of injuries as a Chiropractor in San Diego. Some of the common injuries can result in neck pain, back pain, chronic headaches, sciatica etc.
Causes of these injuries range from auto accidents and work related injuries to injuries caused by domestic chores, house work and sometimes things as simple as sleeping in an awkward position.
Of these injured patients, I would say that at least 50% of them, for the moment, while they are in pain they ask “what can I do for myself to make sure that this doesn’t happen again?” This question served as the inspiration for this article and I will address in this post.
To begin with, pain is a great motivator.
When people are in pain they take a proactive approach to their health. People often inquire about what kind of stretch or exercising that they can start right away. Unfortunately, the best thing that you can do while your injury is new is to apply ice packs to the injured area and rest.
Over my 15 plus years in practice I have seen a large percentage of enthusiastic patients ignore this advice and end up giving their conditions a major set back. The time to start exercising and stretching your back for most of us is when it is out of its acute stage of pain.
My biggest struggles in practice have been dealing with my patients exercise and diet habits. Exercise is one of the few things that a patient can do at home, outside of chiropractic care, to help prevent or diminish the chances of developing back pain.
After an injury, you should approach exercise cautiously – almost to a point where the exercise that you are performing feels like it is doing nothing. If you can get through a few low intensity exercise sessions like this without aggravating your condition, you should slowly add resistance which allows you to build confidence and strength at the same time.
Remember to follow a sensible approach to exercising after a back injury. Be sure to exercise and stretch under the advise of a health care professional. Strong and flexible muscles add strength and support to your spine and will provide much needed stability.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
I see many types of injuries as a Chiropractor in San Diego. Some of the common injuries can result in neck pain, back pain, chronic headaches, sciatica etc.
Causes of these injuries range from auto accidents and work related injuries to injuries caused by domestic chores, house work and sometimes things as simple as sleeping in an awkward position.
Of these injured patients, I would say that at least 50% of them, for the moment, while they are in pain they ask “what can I do for myself to make sure that this doesn’t happen again?” This question served as the inspiration for this article and I will address in this post.
To begin with, pain is a great motivator.
When people are in pain they take a proactive approach to their health. People often inquire about what kind of stretch or exercising that they can start right away. Unfortunately, the best thing that you can do while your injury is new is to apply ice packs to the injured area and rest.
Over my 15 plus years in practice I have seen a large percentage of enthusiastic patients ignore this advice and end up giving their conditions a major set back. The time to start exercising and stretching your back for most of us is when it is out of its acute stage of pain.
My biggest struggles in practice have been dealing with my patients exercise and diet habits. Exercise is one of the few things that a patient can do at home, outside of chiropractic care, to help prevent or diminish the chances of developing back pain.
After an injury, you should approach exercise cautiously – almost to a point where the exercise that you are performing feels like it is doing nothing. If you can get through a few low intensity exercise sessions like this without aggravating your condition, you should slowly add resistance which allows you to build confidence and strength at the same time.
Remember to follow a sensible approach to exercising after a back injury. Be sure to exercise and stretch under the advise of a health care professional. Strong and flexible muscles add strength and support to your spine and will provide much needed stability.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Pinched Nerves
Pinched Nerves
You are on my last nerve!
When I was a kid my mom probably said that to me a hundred times. Now my patients in my chiropractic office complain of other types of nerve issues.
Sometimes, pinched nerves accompany neck pain, back pain and headaches. Pinched nerves always result in pain traveling down either an arm or a leg resulting in what is called radiating pain. Many patients come to my chiropractic office complaining of a pinched nerve but my exam reveals simple neck pain or back pain.
There are many causes of pinched nerves. One of the worst scenarios involves a herniated disc in the spine that is putting pressure on the nerve. Herniated discs don’t always mean that surgery is required but it usually results in stretched out, more intensive treatment plans.
One of the more common causes of pinched nerves results from irritated and inflamed joints in the spine. Poor lifting habits, awkward sleeping positions, poor posture and many other aggravating activities can inflame the ligamentous capsule that surrounds the joint. As the capsule swells, it cause local muscle spasm and can cause compression or pinching of the nerve.
Like I wrote earlier in the article, pinching of the nerve causes radiating pain that travels down the leg, into an arm, down the back or sometimes up to the back of the head. Either way, pinched nerves can make you absolutely miserable.
There are several things that you can do for a pinched nerve at home. To begin with, pinched nerves usually involve inflammation and swelling. By applying ice packs to painful areas, you can reduce the inflammation and relieve some of the pain. In addition to ice pack use, you have to acknowledge and respect your pain. That means rest as much as you can – working through pain rarely works out well for the patient. Try your best to stay out of painful positions nd don’t “test” it.
Chiropractic treatment is very effective at relieving the symptoms of a pinched nerve. Instead of masking the pain with drugs, chiropractic care improves the mechanics of the joint which helps relieve the pain and improve your range of motion.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
You are on my last nerve!
When I was a kid my mom probably said that to me a hundred times. Now my patients in my chiropractic office complain of other types of nerve issues.
Sometimes, pinched nerves accompany neck pain, back pain and headaches. Pinched nerves always result in pain traveling down either an arm or a leg resulting in what is called radiating pain. Many patients come to my chiropractic office complaining of a pinched nerve but my exam reveals simple neck pain or back pain.
There are many causes of pinched nerves. One of the worst scenarios involves a herniated disc in the spine that is putting pressure on the nerve. Herniated discs don’t always mean that surgery is required but it usually results in stretched out, more intensive treatment plans.
One of the more common causes of pinched nerves results from irritated and inflamed joints in the spine. Poor lifting habits, awkward sleeping positions, poor posture and many other aggravating activities can inflame the ligamentous capsule that surrounds the joint. As the capsule swells, it cause local muscle spasm and can cause compression or pinching of the nerve.
Like I wrote earlier in the article, pinching of the nerve causes radiating pain that travels down the leg, into an arm, down the back or sometimes up to the back of the head. Either way, pinched nerves can make you absolutely miserable.
There are several things that you can do for a pinched nerve at home. To begin with, pinched nerves usually involve inflammation and swelling. By applying ice packs to painful areas, you can reduce the inflammation and relieve some of the pain. In addition to ice pack use, you have to acknowledge and respect your pain. That means rest as much as you can – working through pain rarely works out well for the patient. Try your best to stay out of painful positions nd don’t “test” it.
Chiropractic treatment is very effective at relieving the symptoms of a pinched nerve. Instead of masking the pain with drugs, chiropractic care improves the mechanics of the joint which helps relieve the pain and improve your range of motion.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Saturday, October 9, 2010
Four Steps to Neck Pain Relief
Four Steps to Neck Pain Relief:
My San Diego chiropractic office sees a regular flow of patients with neck pain. I use a variety of chiropractic adjustments and physiotherapy modalities to help relieve the pain and stiffness that accompanies neck pathologies. In addition to treatment that I perform here in the office for neck pain, there are many steps and procedures that can be taken by the patient outside of my direct care.
Here is a list of four pro-active steps that you can take to avoid neck pain.
1) Avoid activities that instigate neck pain
2) Stretch
3) Exercise
4) Watch Your Posture
Let’s begin with number one. This sounds simple, but avoiding activities that instigate neck pain seems to skirt peoples’ minds. It is kind of like that old doctors’ saying, “if it hurts don’t do it!” You would be surprised by how many of my patients come in with neck pain, or hip, arm, back, etc pain and say, “you know doc, every time I do (fill in the blank) I hurt my neck.” It is the strangest thing but it happens over and over.
Stretching is also very important in relieving neck pain. With stretching, it should be done as a prevention, not a cure. This means that by stretching daily, you can help prevent a neck pain crisis. Usually, stretching during a neck pain crisis will aggravate your symptoms rather than relieve them. Stretching on a consistent basis can go a long way towards improving your health. I recommend / hand out specific exercises to my patients on a regular basis. The patients who do their exercises seem to do much better than those who don’t.
Exercise is also very important. By the time we reach adult years, we have usually suffered at least one significant sprain / strain type injury. These injuries happen as a result of falls, whiplash, heavy lifting and various sports injuries. Sprain / strain type injuries can damage the ligaments in the neck resulting in a weak link. For many people, the only way to add stability to their necks is with exercise. Just like stretching, however, exercise must be habit that is begun for an episode of pain. Exercising muscles that span a dysfunctional joint is a sure fire recipe for further aggravation.
One of the more difficult ways to prevent neck pain is by watching your posture. Posture is a difficult thing to control because we tend to do our work in front of us which makes it easy to tilt our heads down and round our shoulders forward. This posture causes anterior weight bearing and creates a tremendous amount of stress on the neck and upper back. Proper ergonomic set ups at both work and home do a great deal to help us with posture. The most important item concerning posture is to simply be aware of it and to straighten up whenever we think of it.
More coming soon!
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
My San Diego chiropractic office sees a regular flow of patients with neck pain. I use a variety of chiropractic adjustments and physiotherapy modalities to help relieve the pain and stiffness that accompanies neck pathologies. In addition to treatment that I perform here in the office for neck pain, there are many steps and procedures that can be taken by the patient outside of my direct care.
Here is a list of four pro-active steps that you can take to avoid neck pain.
1) Avoid activities that instigate neck pain
2) Stretch
3) Exercise
4) Watch Your Posture
Let’s begin with number one. This sounds simple, but avoiding activities that instigate neck pain seems to skirt peoples’ minds. It is kind of like that old doctors’ saying, “if it hurts don’t do it!” You would be surprised by how many of my patients come in with neck pain, or hip, arm, back, etc pain and say, “you know doc, every time I do (fill in the blank) I hurt my neck.” It is the strangest thing but it happens over and over.
Stretching is also very important in relieving neck pain. With stretching, it should be done as a prevention, not a cure. This means that by stretching daily, you can help prevent a neck pain crisis. Usually, stretching during a neck pain crisis will aggravate your symptoms rather than relieve them. Stretching on a consistent basis can go a long way towards improving your health. I recommend / hand out specific exercises to my patients on a regular basis. The patients who do their exercises seem to do much better than those who don’t.
Exercise is also very important. By the time we reach adult years, we have usually suffered at least one significant sprain / strain type injury. These injuries happen as a result of falls, whiplash, heavy lifting and various sports injuries. Sprain / strain type injuries can damage the ligaments in the neck resulting in a weak link. For many people, the only way to add stability to their necks is with exercise. Just like stretching, however, exercise must be habit that is begun for an episode of pain. Exercising muscles that span a dysfunctional joint is a sure fire recipe for further aggravation.
One of the more difficult ways to prevent neck pain is by watching your posture. Posture is a difficult thing to control because we tend to do our work in front of us which makes it easy to tilt our heads down and round our shoulders forward. This posture causes anterior weight bearing and creates a tremendous amount of stress on the neck and upper back. Proper ergonomic set ups at both work and home do a great deal to help us with posture. The most important item concerning posture is to simply be aware of it and to straighten up whenever we think of it.
More coming soon!
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Wednesday, September 29, 2010
Scope of Care Frequency of Care personal injury case
Scope of Care
Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications. Treatment rendered for these injuries should represent the standard of care for the geographic area serviced. The "scope of practice" or treatment rendered should be designed to make passage through the medical/legal system easier. For example, performing reflexology on a patient's feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies. This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.
Frequency of Care
It is reasonable to assume the injured tissues will necessitate a higher frequency of care during the initial stages of injury. This is due to the fact that the patient's subjective complaints are often at or near their zenith during the first week after the accident. The injured tissues swell to their greatest degree during this time; thus, the level of the patient's complaints. As the injuries enter the subacute and chronic stages, it is reasonable to assume the treatment frequency would decrease and correlate with the clinical gains being made.
Since the goal of all treatment is to return the patient to their preinjury status, a well managed case will include decreased treatment frequency while occupational and daily activities are slowly reintroduced. In our experience, we have found a constant treatment frequency maintained from the onset of care can lead to problems for the plaintiff attorney as they have to explain this apparent inconsistency. Consider how they will attempt to explain the following questions: First, how can an accurate prognosis of the patient's future medical/chiropractic condition be measured if the treatment has remained the same? Secondly, how could the patient reach their preinjury status if the normal occupational and daily stressors were not introduced while under treatment? An unreasonable approach to treatment frequency complicates settlement.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications. Treatment rendered for these injuries should represent the standard of care for the geographic area serviced. The "scope of practice" or treatment rendered should be designed to make passage through the medical/legal system easier. For example, performing reflexology on a patient's feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies. This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.
Frequency of Care
It is reasonable to assume the injured tissues will necessitate a higher frequency of care during the initial stages of injury. This is due to the fact that the patient's subjective complaints are often at or near their zenith during the first week after the accident. The injured tissues swell to their greatest degree during this time; thus, the level of the patient's complaints. As the injuries enter the subacute and chronic stages, it is reasonable to assume the treatment frequency would decrease and correlate with the clinical gains being made.
Since the goal of all treatment is to return the patient to their preinjury status, a well managed case will include decreased treatment frequency while occupational and daily activities are slowly reintroduced. In our experience, we have found a constant treatment frequency maintained from the onset of care can lead to problems for the plaintiff attorney as they have to explain this apparent inconsistency. Consider how they will attempt to explain the following questions: First, how can an accurate prognosis of the patient's future medical/chiropractic condition be measured if the treatment has remained the same? Secondly, how could the patient reach their preinjury status if the normal occupational and daily stressors were not introduced while under treatment? An unreasonable approach to treatment frequency complicates settlement.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Thursday, September 9, 2010
The Well Managed Chiropractic Soft Tissue Injury Case
The Well Managed Chiropractic Soft Tissue Injury Case
The "Well Managed Soft Tissue Injury Case" can be a bit misleading as it means different things to different people. The insurance companies or "defense" side, seem to have one set of expectations from the medical and chiropractic communities, while those who treat these injuries have a different set of expectations from the insurance carriers. There are those on the "defense" side who maintain all soft tissue injury patients should be released after several weeks of care and any patient who complains further has a financial motive. The other extreme is typified by our personal experience with a case in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury. Neither point, in our opinion, is rational and both fail to represent a well managed soft tissue injury. The management of these patients should fall under the dual heading of "medical" and "legal" issues as both areas are critical to the case.
Neck pain treatment San Diego.
Medical
Our experience with these cases comes from clinical practice, file reviews, and contributions to the scientific literature on the subject. With this said, we are in a unique position to see cases at the request of both the plaintiff and defense. There is, despite the apparent contradiction in party philosophy, one area of commonality. Both sides utilize our opinion and both desires to know what, in our opinion, constitutes a well managed soft tissue case. Both sides, it seem, have a strong desire to be reasonable, but the different levels of expectations mentioned earlier make each party feel the other is often being unreasonable.
Legal
The plaintiff side of the issue is represented by the patient's attorney and we have discovered they are often placed in a position of "pressure" when attempting to justify some of the patient care issues common to the handling of soft tissue cases by the doctor or therapist. We believe anything which allows the claim to pass through the "legal" process easier, will be greatly appreciated by the attorney and will often result in a better long-term working relationship with the attorney. This better relationship often results in greater utilization of the doctor's services by the attorney.
If, on the other hand, the clinical treatment of the doctor or therapist causes the case to lose value, the possibility of a long-term relationship decreases dramatically. For example, the case we mentioned earlier in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury, makes the case very difficult for the attorney to move the case through the "system" and do justice to their client's interests. This type of behavior makes the claim lose value and results in protracted litigation before settlement.
This discussion is designed to address the soft tissue personal injury case and to offer what we consider are reasonable points of view which are supportable in the literature when possible. In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides. Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish. However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?
Scope of Care
Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications. Treatment rendered for these injuries should represent the standard of care for the geographic area serviced. The "scope of practice" or treatment rendered should be designed to make passage through the medical/legal system easier. For example, performing reflexology on a patient's feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies. This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.
Frequency of Care
It is reasonable to assume the injured tissues will necessitate a higher frequency of care during the initial stages of injury. This is due to the fact that the patient's subjective complaints are often at or near their zenith during the first week after the accident. The injured tissues swell to their greatest degree during this time; thus, the level of the patient's complaints. As the injuries enter the subacute and chronic stages, it is reasonable to assume the treatment frequency would decrease and correlate with the clinical gains being made.
Since the goal of all treatment is to return the patient to their preinjury status, a well managed case will include decreased treatment frequency while occupational and daily activities are slowly reintroduced. In our experience, we have found a constant treatment frequency maintained from the onset of care can lead to problems for the plaintiff attorney as they have to explain this apparent inconsistency. Consider how they will attempt to explain the following questions: First, how can an accurate prognosis of the patient's future medical/chiropractic condition be measured if the treatment has remained the same? Secondly, how could the patient reach their preinjury status if the normal occupational and daily stressors were not introduced while under treatment? An unreasonable approach to treatment frequency complicates settlement.
Duration of Care
The scientific literature indicates the vast majority of healing will take place during the first three weeks following the traumatic event. In addition, the majority of the injuries seen are limited to muscular injuries and treatment of patients over 90 days, in our experience, often hinders the solving of the legal matters. This is not to say that all soft tissue injuries need 90 days of care. Care, like the patient's injuries, are individual. But, if treatment is longer than 90 days, it should be stressed that the clinical necessity for care should be justified even more. It is the doctors responsibility to prove the care is needed, not the insurance company's responsibility to prove it's not needed. In our experience and opinion, documenting only the patient's subjective complaints, is insufficient criteria for the continuation of care. To support the need for continued care, the documentation within the file should show timely re-examinations which demonstrate objective physical examination findings. In addition, these objective signs would need to be reasonably "weighed" against the clinical potential for further healing.
Orthopedic Supports
The use of orthopedic supports, such as a cervical collar, during the acute states of the injury, is a common clinical practice in both the medical and chiropractic communities. It is, however, a double-edged sword. The most reasonable approach would entail use of these supports during the functional instability phase of injury, followed by removal as prolonged use can lead to dependency. Typically, the support is most beneficial during the ten days following the trauma. Prolonged use would support the need for additional investigation, which must include consideration of a psychological component.
X-rays
The initial use of x-rays in the well managed soft tissue injury is well supported in the scientific literature. The use of "follow-up" series of x-rays is, however, debated. We have found the use of serial x-ray studies is usually unwarranted, absent the clinical management of clear osseous injuries or delayed instability. The prudent use of x-rays should always consider the potential harm from radiation exposure. This is especially true in patients of child bearing years. The use of repeat plain film radiographs will often bring the case under immediate scrutiny, thus, complicating the settlement process.
Special Tests
The use of special imaging and diagnostic procedures are becoming more popular in the clinical management of patients. Attorneys will be placed in the position of justifying the expense and use of these tests to the claims adjustor or judge. The doctor should consider the following questions before ordering such tests:
1. What is the clinical criteria for performing the test? If based solely on the patient's subjective complaints, this represents a very poor criteria.
2. Is the test both sensitive and specific for the condition? Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI), for example, represent procedures which are both sensitive and specific. However, their use is often inappropriate in an uncomplicated soft tissue injury. Thermography, in comparison, is very sensitive, yet due to vast testing and interpretation variables, often renders the use of this test questionable.
3. Is the testing procedure well accepted in the scientific literature? For example, the timely use of paraspinal EMGs producing $900 to the incurred bills, in our experience, will bring the settlement process to a halt. The treating doctor may contend that the use of this special procedure was clinically necessary, but the insurance carrier will only reimburse those procedures proven in the clinical and literary arenas.
4. How will a "positive" or "negative" test alter the form of care rendered? A "positive" paraspinal EMG finding, in our experience, has never produced a change in the type of care rendered. For that matter neither has a "negative" result.
5. Is the test timely? The thermogram, for example, would be expected to be "positive" on the first days following the trauma, thus, negating the clinical criteria for performing said test during the acute stages of injury.
For the above reasons, plus the high fees associated with these procedures, we feel the improper use of these tests often produces prolonged reimbursement to all parties; patients, attorneys, and doctors
Narrative Reports
In our experience, this is far and away the greatest downfall in the well managed soft tissue case. We, as a profession, have become dependent on the computer generated narrative report. In our opinion, and that of the legal community as well, these types of reports often do not represent original thought or an accurate depiction of the patient's condition. The various legal arenas involved in personal injury suits take a very dim light as to the veracity of these types of reports.
The narrative report must also be an accurate reflection of the treatment rendered. All sections of the report should correlate to eliminate inconsistencies, and above all should represent accurate and original work. Remember, the attorney will use the report as a settlement tool. It should contain answers, not new problems. The quality and accuracy of the narrative report should not be underestimated. It alone represents months of care, the patient's basis for future medical considerations, prognosis, and most important of all, reimbursement for the services rendered. "He who botches the report, botches the case."
End Points of Care
In our experience, this is often the most debated aspect of the personal injury case. The attorney is again forced to justify the length of his client's care, and thereby support the amount billed as well. The care rendered should be reasonable and fall within reasonable guidelines for treatment duration.
In our opinion, when one or more of the following occurs, the patient has reached the maximum point of medical/chiropractic improvement from the type of care rendered.
1. If the patient's condition gets worse under the care rendered.
2. When the patient's subjective complaints have clearly reached the upper and lower limits. An example is when the patient's subjective complaints have reached a point where the treatment rendered only "makes them feel better" for a few days and then they are the same as before the visit. It is clear that the feeling of being "better" for a few days is only temporary and the patient has more than likely reached the clinical limitations of matter from the type of care rendered. This is not to say the patient does not have complaints, or that the care does not make him feel good, only that further treatment will more than likely be of very little clinical benefit. Thus, the criteria for determining the end points of care.
3. When the patient fails to make clinical progress between lengthening dates of service. All care is based on achieving a preinjury status. If the patient fails to make progress between visits over an expected period of time, the clinical potential for further healing is remote.
Treatment, after these points have been achieved, increases the total amount of services rendered and makes a timely settlement more difficult.
Prognosis:
The need for future care and the amount of settlement for that care is based on an accurate prognosis. Due to overuse, the term "guarded" has lost most of it's meaning in the medical/legal world. We contend a more accurate system will benefit the patient, insurance carrier, representing attorney, treating doctor, and most important, the profession as a whole. The prognosis should encompass facts from the history of the accident, physical examination, and the radiographic studies.
Fees:
As one might imagine, this is also a hotly debated subject. We fully believe the doctor has the prerogative to charge any fee he chooses for the level of service rendered. For example, a charge of $5,000/visit can be made and reimbursement can be sought. However, it should be realized an uphill battle for total reimbursement will ensue. In other words, the fees charged may only be paid at the end of expensive litigation and in all likelihood will not be the amount billed.
We strongly suggest the doctors use fees which are both usual and customary to their geographic location. Relative value studies can be a key to determine these fees. Use of these accepted relative value guides is a powerful weapon for the attorney when he argues the reasonableness of the charges as they are able to show the fees fell within an accepted range and do not represent an unreasonable amount on the doctor's part.
The treating practitioner should realize both the legal and insurance communities consider all aspects of the personal injury case to be negotiable. This would certainly include the fees charged by the doctor.
Liability
Even when all aspects of case are well managed, problems for reimbursement can ensue. If the liability for the automobile accident is disputed, the settlement will often be different when compared to an undisputed case. For example, if the treated patient is found to be 20 percent comparatively negligent for not wearing his seat belt, the final award of $10,000 would now total $8,000. This final award now reflects the 20 percent comparative negligence. In our opinion, it is not fair for the doctor to reduce his bill by any amount to compensate the patient for his negligence.
Labor Disability
There are times, most often in severe traumas, when a labor disabling status will be afforded to the patient. To justify this status and the accompanying reimbursement for lost wages, the doctor must document what specific occupational activities are prohibited by the injury. Failure to document the need for temporary disability will cause the patient to lose financial compensation for his loss of earning.
Documentation
This is a broad classification which encompasses all written words concerning this accident. We are of the opinion that "travel cards" and "fill in the blank exam forms" are no longer sufficient in the current medical/legal system. They tell what was done but not the reason. The literature is very clear as to how to properly document each of the patient's office visits. The SOAP acronym is most often used: The "S" refers to the patient's subjective complaints, the "O" refers to the objective evidence for care seen on each office visit, the "A" stands for the doctor's assessment of the patient's condition, and the "P" pertains to the treatment plan of that visit. This type of documentation is not only taught in the chiropractic schools, but is also recommended by most malpractice insurance carriers as the proper way to document each of the dates of service.
It should be mentioned that even the best attorneys can not adequately represent their clients interests without proper documentation from the doctor.
We hope this discussion has enlightened and provided a reasonable source of reference for both sides of these issues. The doctor has a heavy burden. He must not only adequately treat the patient, but also assume the responsibility placed upon him by the legal system. The financial and personal rewards for his efforts will be more than adequate for the effort expended.
An Introduction to Outcome Assessment
Mark van Hemert, DC, DACS
The design of this article is to give the chiropractic profession an introduction into the value and usefulness of clinical outcome assessment procedures. Using outcome assessment methods of case management gives the chiropractic profession an effective way to document the need for care. This results in receiving the compensation for services they rendered.
In today's environment of manage care, the attending clinician's care is constantly being reviewed and challenged. The chief areas of concern for the third-party payers is overutilization and costs. Overutilization is a problem in chiropractic, whether it be real or only perceived by outside reviewers. This perception can only be overcome on a case by case basis by objectively proving that care provided was reasonable and necessary. Á Due to the acceptance of the Mercy guidelines (Guidelines for Chiropractic Quality Assurance and Practice Parameters) by the insurance industry, the document is the authoritative reference to counter the insurance industry's attempt to limit quality and the quantity of care. The primary reason the Mercy guidelines carry a high level of acceptance and credibility by the insurance industry, is because its ratings are based on scientific evidence.
A synopsis of today's situation reveals that the care rendered by the attending clinician is constantly being challenged by the third-party carriers. IME opinions of excessive care or no permanent impairment are detrimental to the patient's medical/legal case. Cases that involve acute injury with associated liability frequently require the intervention of the court system or workers' compensation system to resolve the case.
This inherent intervention leaves the door wide open for the probing eyes and opinions of the IME. Due to a lack of knowledge and documentation by the attending physician, patients receive inadequate medical care and inferior documentation of their injury, rational for therapeutic care, determination of maximum improvement, and final impairment. Third-party carriers are aggressive in their review of care to determine the point of maximum improvement. Many clinicians feel that if patient care is within the guideline numbers, their fees will be paid. However, the therapeutic necessity of care is frequently being challenged.
A lack of knowledge of the practice guidelines does not substantiate the patient's contractual right to receive care to the maximum ability of the injury to respond to active care and improved function. Ô power... the 1980s witnessed a shift in power from the providers of health care to the payers of it ... and those practitioners whose services are labeled worthless could face financial ruin ... chiropractors are especially vulnerable."
IME was originally an acronym for independent medical examination, but the IME doctor is now chosen by and paid by the insurance industry. The acronym now stands for insurance medical examination.
The most recent development in the insurance medical examination has been the multidisciplinary examination, where a chiropractor and a medical doctor, both with higher credentials than the average clinician, examine the patient simultaneously. This creates an appearance of a high level of specialization and expertise. The opinion in a majority of these reviews is that care beyond two months is not needed. The rational is that the laying down of scar tissue is completed by the eighth week and therefore further treatment in not medically necessary or therapeutic.
They state that the patient is at maximum improvement and no further treatment is necessary. This rational does not consider the remodeling and strengthening of scar tissue, nor the need to restore maximum joint function. However, without an attending physician who is knowledgeable about the guidelines and who has accumulated objective data of improvement, the professional response to this rational will be based solely on opinion and not fact.
Mercy specifically does not give a limit for reasonable care, but observations, assessments and the definitions of care based on scientific evidence. It states that these guidelines are not designed to be a cookbook. The listed time for acute stage of care ranges from 8-16 weeks, depending on which of three cited references you go by. In reviewing those references, I believe that the eight weeks refer to the acute healing cycle of the injury, and the 16 weeks to the acute physiology or rehabilitative healing time.
The healing and rehabilitative acute stages are followed by the subacute stage, before the unresponsive chronic phase of function and pain begin. Rebuttals of IME opinions using the Mercy guidelines increase your credibility when justifying your clinical rational to claims adjudicators. The insurance industry recognizes the Mercy document as the authority in the chiropractic profession. The parameter of clinical practice that Mercy most fully addresses is the trauma induced patient. Perhaps if "Acute Traumatic Cases" had been added to the title of the guidelines the criticism of the document would have been muted. Mercy creates a solid, well thought out guideline for the traumatic personal injury and workers' compensation case. Mercy very effectively deals with narrow minded, nonflexible professional rational and makes the third-party payers conform to a set of standards which is fair to the patient and respectful of.
In 1992, David Chapman Smith, commission counsel to the Mercy guidelines, stated: "There must be a better method of judging whether a patient's condition or health status has changed, one that has scientific credibility, can withstand scrutiny by others, and provides strong evidence of good outcomes appropriateness and quality of care."
The use of outcome assessments is imperative for the practicing clinician. Only by objective documentation of improvement can the attending physician prove that his care was therapeutically necessary; thereby staving off the onslaught of critical opinions by claims adjudicators of third party payers, insurance medical examinations, retroactive governmental utilization reviews and defense attorneys.
The Mercy Conference guidelines defines "outcome assessment" as a procedure or method of measuring a change in patient status over time, primarily to evaluate the effect of the treatment. The Mercy guidelines go on to list the benefits of implementing outcome assessment into one's practice procedures for they can:
· document improvement to the patient, doctor, and third parties;
· consistently evaluate the effect of care over time;
· suggest modifications of the goals of treatment if necessary;
· help indicate the point of maximum therapeutic improvement;
· justify the type, dose, and duration of care.
Á
(Mercy, chapter 10, page 8.)
This list closely mirrors the points the IME focuses on in delivering his professional opinion. The accumulation of the patient's objective outcome assessment data during the course of care, will provide the information necessary to make these critical clinical determinations in the medical legal case. This will individualize you opinion concerning the course of care and the length of care. Treating every patient plan as a continual living, analyzing and ongoing evaluation process.
The RAND study, "Appropriateness of Spinal Manipulation for Low-Back Pain," makes this statement on treatment duration: "No scientific evidence in the literature supports any of the treatment durations for different indications that have been proposed."
Using objective outcome assessment data that Mercy rates as established and necessary in your clinical examinations, will result in clinical decisions that are defensible against reviewÔ professional opinion will determine the therapeutic necessity of care rendered. My vision is to give the practicing chiropractor the knowledge and expertise to provide to every patient the care they deserve, and to provide objective evidence for every patient and their third-party carrier for reasonable and necessary care; thereby creating an analysis system that is fair to all concerned parties.
In future articles, we will discuss how to use the latest technology to gather objective data. It is important to use the guidelines as an authority not only to guide your practice, but to insist that the IME also follow the same standard.
Mark van Hemert, DC, DACS
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
The "Well Managed Soft Tissue Injury Case" can be a bit misleading as it means different things to different people. The insurance companies or "defense" side, seem to have one set of expectations from the medical and chiropractic communities, while those who treat these injuries have a different set of expectations from the insurance carriers. There are those on the "defense" side who maintain all soft tissue injury patients should be released after several weeks of care and any patient who complains further has a financial motive. The other extreme is typified by our personal experience with a case in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury. Neither point, in our opinion, is rational and both fail to represent a well managed soft tissue injury. The management of these patients should fall under the dual heading of "medical" and "legal" issues as both areas are critical to the case.
Neck pain treatment San Diego.
Medical
Our experience with these cases comes from clinical practice, file reviews, and contributions to the scientific literature on the subject. With this said, we are in a unique position to see cases at the request of both the plaintiff and defense. There is, despite the apparent contradiction in party philosophy, one area of commonality. Both sides utilize our opinion and both desires to know what, in our opinion, constitutes a well managed soft tissue case. Both sides, it seem, have a strong desire to be reasonable, but the different levels of expectations mentioned earlier make each party feel the other is often being unreasonable.
Legal
The plaintiff side of the issue is represented by the patient's attorney and we have discovered they are often placed in a position of "pressure" when attempting to justify some of the patient care issues common to the handling of soft tissue cases by the doctor or therapist. We believe anything which allows the claim to pass through the "legal" process easier, will be greatly appreciated by the attorney and will often result in a better long-term working relationship with the attorney. This better relationship often results in greater utilization of the doctor's services by the attorney.
If, on the other hand, the clinical treatment of the doctor or therapist causes the case to lose value, the possibility of a long-term relationship decreases dramatically. For example, the case we mentioned earlier in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury, makes the case very difficult for the attorney to move the case through the "system" and do justice to their client's interests. This type of behavior makes the claim lose value and results in protracted litigation before settlement.
This discussion is designed to address the soft tissue personal injury case and to offer what we consider are reasonable points of view which are supportable in the literature when possible. In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides. Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish. However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?
Scope of Care
Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications. Treatment rendered for these injuries should represent the standard of care for the geographic area serviced. The "scope of practice" or treatment rendered should be designed to make passage through the medical/legal system easier. For example, performing reflexology on a patient's feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies. This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.
Frequency of Care
It is reasonable to assume the injured tissues will necessitate a higher frequency of care during the initial stages of injury. This is due to the fact that the patient's subjective complaints are often at or near their zenith during the first week after the accident. The injured tissues swell to their greatest degree during this time; thus, the level of the patient's complaints. As the injuries enter the subacute and chronic stages, it is reasonable to assume the treatment frequency would decrease and correlate with the clinical gains being made.
Since the goal of all treatment is to return the patient to their preinjury status, a well managed case will include decreased treatment frequency while occupational and daily activities are slowly reintroduced. In our experience, we have found a constant treatment frequency maintained from the onset of care can lead to problems for the plaintiff attorney as they have to explain this apparent inconsistency. Consider how they will attempt to explain the following questions: First, how can an accurate prognosis of the patient's future medical/chiropractic condition be measured if the treatment has remained the same? Secondly, how could the patient reach their preinjury status if the normal occupational and daily stressors were not introduced while under treatment? An unreasonable approach to treatment frequency complicates settlement.
Duration of Care
The scientific literature indicates the vast majority of healing will take place during the first three weeks following the traumatic event. In addition, the majority of the injuries seen are limited to muscular injuries and treatment of patients over 90 days, in our experience, often hinders the solving of the legal matters. This is not to say that all soft tissue injuries need 90 days of care. Care, like the patient's injuries, are individual. But, if treatment is longer than 90 days, it should be stressed that the clinical necessity for care should be justified even more. It is the doctors responsibility to prove the care is needed, not the insurance company's responsibility to prove it's not needed. In our experience and opinion, documenting only the patient's subjective complaints, is insufficient criteria for the continuation of care. To support the need for continued care, the documentation within the file should show timely re-examinations which demonstrate objective physical examination findings. In addition, these objective signs would need to be reasonably "weighed" against the clinical potential for further healing.
Orthopedic Supports
The use of orthopedic supports, such as a cervical collar, during the acute states of the injury, is a common clinical practice in both the medical and chiropractic communities. It is, however, a double-edged sword. The most reasonable approach would entail use of these supports during the functional instability phase of injury, followed by removal as prolonged use can lead to dependency. Typically, the support is most beneficial during the ten days following the trauma. Prolonged use would support the need for additional investigation, which must include consideration of a psychological component.
X-rays
The initial use of x-rays in the well managed soft tissue injury is well supported in the scientific literature. The use of "follow-up" series of x-rays is, however, debated. We have found the use of serial x-ray studies is usually unwarranted, absent the clinical management of clear osseous injuries or delayed instability. The prudent use of x-rays should always consider the potential harm from radiation exposure. This is especially true in patients of child bearing years. The use of repeat plain film radiographs will often bring the case under immediate scrutiny, thus, complicating the settlement process.
Special Tests
The use of special imaging and diagnostic procedures are becoming more popular in the clinical management of patients. Attorneys will be placed in the position of justifying the expense and use of these tests to the claims adjustor or judge. The doctor should consider the following questions before ordering such tests:
1. What is the clinical criteria for performing the test? If based solely on the patient's subjective complaints, this represents a very poor criteria.
2. Is the test both sensitive and specific for the condition? Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI), for example, represent procedures which are both sensitive and specific. However, their use is often inappropriate in an uncomplicated soft tissue injury. Thermography, in comparison, is very sensitive, yet due to vast testing and interpretation variables, often renders the use of this test questionable.
3. Is the testing procedure well accepted in the scientific literature? For example, the timely use of paraspinal EMGs producing $900 to the incurred bills, in our experience, will bring the settlement process to a halt. The treating doctor may contend that the use of this special procedure was clinically necessary, but the insurance carrier will only reimburse those procedures proven in the clinical and literary arenas.
4. How will a "positive" or "negative" test alter the form of care rendered? A "positive" paraspinal EMG finding, in our experience, has never produced a change in the type of care rendered. For that matter neither has a "negative" result.
5. Is the test timely? The thermogram, for example, would be expected to be "positive" on the first days following the trauma, thus, negating the clinical criteria for performing said test during the acute stages of injury.
For the above reasons, plus the high fees associated with these procedures, we feel the improper use of these tests often produces prolonged reimbursement to all parties; patients, attorneys, and doctors
Narrative Reports
In our experience, this is far and away the greatest downfall in the well managed soft tissue case. We, as a profession, have become dependent on the computer generated narrative report. In our opinion, and that of the legal community as well, these types of reports often do not represent original thought or an accurate depiction of the patient's condition. The various legal arenas involved in personal injury suits take a very dim light as to the veracity of these types of reports.
The narrative report must also be an accurate reflection of the treatment rendered. All sections of the report should correlate to eliminate inconsistencies, and above all should represent accurate and original work. Remember, the attorney will use the report as a settlement tool. It should contain answers, not new problems. The quality and accuracy of the narrative report should not be underestimated. It alone represents months of care, the patient's basis for future medical considerations, prognosis, and most important of all, reimbursement for the services rendered. "He who botches the report, botches the case."
End Points of Care
In our experience, this is often the most debated aspect of the personal injury case. The attorney is again forced to justify the length of his client's care, and thereby support the amount billed as well. The care rendered should be reasonable and fall within reasonable guidelines for treatment duration.
In our opinion, when one or more of the following occurs, the patient has reached the maximum point of medical/chiropractic improvement from the type of care rendered.
1. If the patient's condition gets worse under the care rendered.
2. When the patient's subjective complaints have clearly reached the upper and lower limits. An example is when the patient's subjective complaints have reached a point where the treatment rendered only "makes them feel better" for a few days and then they are the same as before the visit. It is clear that the feeling of being "better" for a few days is only temporary and the patient has more than likely reached the clinical limitations of matter from the type of care rendered. This is not to say the patient does not have complaints, or that the care does not make him feel good, only that further treatment will more than likely be of very little clinical benefit. Thus, the criteria for determining the end points of care.
3. When the patient fails to make clinical progress between lengthening dates of service. All care is based on achieving a preinjury status. If the patient fails to make progress between visits over an expected period of time, the clinical potential for further healing is remote.
Treatment, after these points have been achieved, increases the total amount of services rendered and makes a timely settlement more difficult.
Prognosis:
The need for future care and the amount of settlement for that care is based on an accurate prognosis. Due to overuse, the term "guarded" has lost most of it's meaning in the medical/legal world. We contend a more accurate system will benefit the patient, insurance carrier, representing attorney, treating doctor, and most important, the profession as a whole. The prognosis should encompass facts from the history of the accident, physical examination, and the radiographic studies.
Fees:
As one might imagine, this is also a hotly debated subject. We fully believe the doctor has the prerogative to charge any fee he chooses for the level of service rendered. For example, a charge of $5,000/visit can be made and reimbursement can be sought. However, it should be realized an uphill battle for total reimbursement will ensue. In other words, the fees charged may only be paid at the end of expensive litigation and in all likelihood will not be the amount billed.
We strongly suggest the doctors use fees which are both usual and customary to their geographic location. Relative value studies can be a key to determine these fees. Use of these accepted relative value guides is a powerful weapon for the attorney when he argues the reasonableness of the charges as they are able to show the fees fell within an accepted range and do not represent an unreasonable amount on the doctor's part.
The treating practitioner should realize both the legal and insurance communities consider all aspects of the personal injury case to be negotiable. This would certainly include the fees charged by the doctor.
Liability
Even when all aspects of case are well managed, problems for reimbursement can ensue. If the liability for the automobile accident is disputed, the settlement will often be different when compared to an undisputed case. For example, if the treated patient is found to be 20 percent comparatively negligent for not wearing his seat belt, the final award of $10,000 would now total $8,000. This final award now reflects the 20 percent comparative negligence. In our opinion, it is not fair for the doctor to reduce his bill by any amount to compensate the patient for his negligence.
Labor Disability
There are times, most often in severe traumas, when a labor disabling status will be afforded to the patient. To justify this status and the accompanying reimbursement for lost wages, the doctor must document what specific occupational activities are prohibited by the injury. Failure to document the need for temporary disability will cause the patient to lose financial compensation for his loss of earning.
Documentation
This is a broad classification which encompasses all written words concerning this accident. We are of the opinion that "travel cards" and "fill in the blank exam forms" are no longer sufficient in the current medical/legal system. They tell what was done but not the reason. The literature is very clear as to how to properly document each of the patient's office visits. The SOAP acronym is most often used: The "S" refers to the patient's subjective complaints, the "O" refers to the objective evidence for care seen on each office visit, the "A" stands for the doctor's assessment of the patient's condition, and the "P" pertains to the treatment plan of that visit. This type of documentation is not only taught in the chiropractic schools, but is also recommended by most malpractice insurance carriers as the proper way to document each of the dates of service.
It should be mentioned that even the best attorneys can not adequately represent their clients interests without proper documentation from the doctor.
We hope this discussion has enlightened and provided a reasonable source of reference for both sides of these issues. The doctor has a heavy burden. He must not only adequately treat the patient, but also assume the responsibility placed upon him by the legal system. The financial and personal rewards for his efforts will be more than adequate for the effort expended.
An Introduction to Outcome Assessment
Mark van Hemert, DC, DACS
The design of this article is to give the chiropractic profession an introduction into the value and usefulness of clinical outcome assessment procedures. Using outcome assessment methods of case management gives the chiropractic profession an effective way to document the need for care. This results in receiving the compensation for services they rendered.
In today's environment of manage care, the attending clinician's care is constantly being reviewed and challenged. The chief areas of concern for the third-party payers is overutilization and costs. Overutilization is a problem in chiropractic, whether it be real or only perceived by outside reviewers. This perception can only be overcome on a case by case basis by objectively proving that care provided was reasonable and necessary. Á Due to the acceptance of the Mercy guidelines (Guidelines for Chiropractic Quality Assurance and Practice Parameters) by the insurance industry, the document is the authoritative reference to counter the insurance industry's attempt to limit quality and the quantity of care. The primary reason the Mercy guidelines carry a high level of acceptance and credibility by the insurance industry, is because its ratings are based on scientific evidence.
A synopsis of today's situation reveals that the care rendered by the attending clinician is constantly being challenged by the third-party carriers. IME opinions of excessive care or no permanent impairment are detrimental to the patient's medical/legal case. Cases that involve acute injury with associated liability frequently require the intervention of the court system or workers' compensation system to resolve the case.
This inherent intervention leaves the door wide open for the probing eyes and opinions of the IME. Due to a lack of knowledge and documentation by the attending physician, patients receive inadequate medical care and inferior documentation of their injury, rational for therapeutic care, determination of maximum improvement, and final impairment. Third-party carriers are aggressive in their review of care to determine the point of maximum improvement. Many clinicians feel that if patient care is within the guideline numbers, their fees will be paid. However, the therapeutic necessity of care is frequently being challenged.
A lack of knowledge of the practice guidelines does not substantiate the patient's contractual right to receive care to the maximum ability of the injury to respond to active care and improved function. Ô power... the 1980s witnessed a shift in power from the providers of health care to the payers of it ... and those practitioners whose services are labeled worthless could face financial ruin ... chiropractors are especially vulnerable."
IME was originally an acronym for independent medical examination, but the IME doctor is now chosen by and paid by the insurance industry. The acronym now stands for insurance medical examination.
The most recent development in the insurance medical examination has been the multidisciplinary examination, where a chiropractor and a medical doctor, both with higher credentials than the average clinician, examine the patient simultaneously. This creates an appearance of a high level of specialization and expertise. The opinion in a majority of these reviews is that care beyond two months is not needed. The rational is that the laying down of scar tissue is completed by the eighth week and therefore further treatment in not medically necessary or therapeutic.
They state that the patient is at maximum improvement and no further treatment is necessary. This rational does not consider the remodeling and strengthening of scar tissue, nor the need to restore maximum joint function. However, without an attending physician who is knowledgeable about the guidelines and who has accumulated objective data of improvement, the professional response to this rational will be based solely on opinion and not fact.
Mercy specifically does not give a limit for reasonable care, but observations, assessments and the definitions of care based on scientific evidence. It states that these guidelines are not designed to be a cookbook. The listed time for acute stage of care ranges from 8-16 weeks, depending on which of three cited references you go by. In reviewing those references, I believe that the eight weeks refer to the acute healing cycle of the injury, and the 16 weeks to the acute physiology or rehabilitative healing time.
The healing and rehabilitative acute stages are followed by the subacute stage, before the unresponsive chronic phase of function and pain begin. Rebuttals of IME opinions using the Mercy guidelines increase your credibility when justifying your clinical rational to claims adjudicators. The insurance industry recognizes the Mercy document as the authority in the chiropractic profession. The parameter of clinical practice that Mercy most fully addresses is the trauma induced patient. Perhaps if "Acute Traumatic Cases" had been added to the title of the guidelines the criticism of the document would have been muted. Mercy creates a solid, well thought out guideline for the traumatic personal injury and workers' compensation case. Mercy very effectively deals with narrow minded, nonflexible professional rational and makes the third-party payers conform to a set of standards which is fair to the patient and respectful of.
In 1992, David Chapman Smith, commission counsel to the Mercy guidelines, stated: "There must be a better method of judging whether a patient's condition or health status has changed, one that has scientific credibility, can withstand scrutiny by others, and provides strong evidence of good outcomes appropriateness and quality of care."
The use of outcome assessments is imperative for the practicing clinician. Only by objective documentation of improvement can the attending physician prove that his care was therapeutically necessary; thereby staving off the onslaught of critical opinions by claims adjudicators of third party payers, insurance medical examinations, retroactive governmental utilization reviews and defense attorneys.
The Mercy Conference guidelines defines "outcome assessment" as a procedure or method of measuring a change in patient status over time, primarily to evaluate the effect of the treatment. The Mercy guidelines go on to list the benefits of implementing outcome assessment into one's practice procedures for they can:
· document improvement to the patient, doctor, and third parties;
· consistently evaluate the effect of care over time;
· suggest modifications of the goals of treatment if necessary;
· help indicate the point of maximum therapeutic improvement;
· justify the type, dose, and duration of care.
Á
(Mercy, chapter 10, page 8.)
This list closely mirrors the points the IME focuses on in delivering his professional opinion. The accumulation of the patient's objective outcome assessment data during the course of care, will provide the information necessary to make these critical clinical determinations in the medical legal case. This will individualize you opinion concerning the course of care and the length of care. Treating every patient plan as a continual living, analyzing and ongoing evaluation process.
The RAND study, "Appropriateness of Spinal Manipulation for Low-Back Pain," makes this statement on treatment duration: "No scientific evidence in the literature supports any of the treatment durations for different indications that have been proposed."
Using objective outcome assessment data that Mercy rates as established and necessary in your clinical examinations, will result in clinical decisions that are defensible against reviewÔ professional opinion will determine the therapeutic necessity of care rendered. My vision is to give the practicing chiropractor the knowledge and expertise to provide to every patient the care they deserve, and to provide objective evidence for every patient and their third-party carrier for reasonable and necessary care; thereby creating an analysis system that is fair to all concerned parties.
In future articles, we will discuss how to use the latest technology to gather objective data. It is important to use the guidelines as an authority not only to guide your practice, but to insist that the IME also follow the same standard.
Mark van Hemert, DC, DACS
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Monday, July 19, 2010
Neck Pain, Upper Back Pain and Shoulder Pain
Neck Pain, Upper Back Pain and Shoulder Pain – A Chiropractors Perspective
As a practicing chiropractor, I see a large number of patients with neck pain or upper back pain that begins to affect one or both shoulders. Frequently, the opposite occurs as well where a shoulder injury aggravates the neck. The biomechanics of the shoulder joint and the joints of the neck and upper back are dependant on each other for proper function.
Many conditions of the neck and upper back affect the shoulder and visa versa. There is a good reason as to why this happens and I will use this article to explain it.
There is that old statement regarding the human body that goes something like “everything is connected”, of course in this instance we are talking about anatomy – specifically a kinematic chain.
In a kinematic chain, the function / health of adjacent joints are dependant on each other. A simple example of a breakdown among joints in a kinematic chain and the resulting consequences would be as follows; a person sprains their ankle, limps on that ankle for several days and then develops knee pain secondary to the limp caused by the injured ankle. If the limping or gait impairment continues for any period of time, the irritation can involve the hip and eventually the low back. The ankle, knee, hip, sacroiliac joints and the joints of low back all form a kinematic chain.
In a similar yet more complicated kinematic chain, the vertebra of the cervical and thoracic spine are intertwined with the shoulder joints. The shoulder is made up of a series joints that allows for a tremendous amount of movement in a number of planes.
Compared to the knee, for example, that only allows for about 120 degrees of flexion and very little rotation and translation, the shoulder is incredibly mobile. While, like the shoulder joint has ligaments and a joint capsule that tie the humorous to the scapula and the clavicle, the primary source of stability of the shoulder joint is the muscles, many of which attach into the cervical and thoracic vertebra.
Regarding the spine – in particular the cervical and thoracic spine – the joints found in the spinal column have considerably less motion than do most other joints in the body. That being said, the cervical spine displays the greatest amount of motion found in the spine while the thoracic spine is the most limited in its flexibility. The fact that many of the big muscles of the neck and upper back insert onto the scapula and the clavicle links these two joint complexes together.
In many cases, shoulder pain or dysfunction can result in spasms of the larger muscles that act to stabilize the shoulder – most of these muscles originate from the vertebra of the neck and upper back. The stress of this spasm can cause pain or dysfunction in the neck and upper back. Because of the shared muscles between the neck, upper back and shoulder girdle, the exact opposite scenario can occur with a primary spinal problem causing muscle spasms that have a negative effect on the shoulder.
Both the shoulder and the neck joints display complex, compound movements. Adjacent joint complexes like these that share major muscle groups make for an increased likelihood of pain / dysfunction affecting more than one group of joints.
In my practice, the two most common activities that I see that lead to pain / dysfunction of the neck, upper back and shoulder are computer work and single sided sports injuries like pitching, bowling, golf, etc. When confronted with neck pain and shoulder pain, I advise my patients to apply ice packs to the affected area in 20 minute sessions at least twice daily and limit the offending activity for two or three days. If the joint is not dramatically better with this at home management, get in to see a chiropractor. Chiropractors are specialists in joint biomechanics and can help you make a complete recovery from many cases of neck pain and shoulder injuries.
Chiropractor,Neck Pain,Shoulder Injury,Upper Back Pain,San Diego Chiropractor,Shoulder Pain
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
As a practicing chiropractor, I see a large number of patients with neck pain or upper back pain that begins to affect one or both shoulders. Frequently, the opposite occurs as well where a shoulder injury aggravates the neck. The biomechanics of the shoulder joint and the joints of the neck and upper back are dependant on each other for proper function.
Many conditions of the neck and upper back affect the shoulder and visa versa. There is a good reason as to why this happens and I will use this article to explain it.
There is that old statement regarding the human body that goes something like “everything is connected”, of course in this instance we are talking about anatomy – specifically a kinematic chain.
In a kinematic chain, the function / health of adjacent joints are dependant on each other. A simple example of a breakdown among joints in a kinematic chain and the resulting consequences would be as follows; a person sprains their ankle, limps on that ankle for several days and then develops knee pain secondary to the limp caused by the injured ankle. If the limping or gait impairment continues for any period of time, the irritation can involve the hip and eventually the low back. The ankle, knee, hip, sacroiliac joints and the joints of low back all form a kinematic chain.
In a similar yet more complicated kinematic chain, the vertebra of the cervical and thoracic spine are intertwined with the shoulder joints. The shoulder is made up of a series joints that allows for a tremendous amount of movement in a number of planes.
Compared to the knee, for example, that only allows for about 120 degrees of flexion and very little rotation and translation, the shoulder is incredibly mobile. While, like the shoulder joint has ligaments and a joint capsule that tie the humorous to the scapula and the clavicle, the primary source of stability of the shoulder joint is the muscles, many of which attach into the cervical and thoracic vertebra.
Regarding the spine – in particular the cervical and thoracic spine – the joints found in the spinal column have considerably less motion than do most other joints in the body. That being said, the cervical spine displays the greatest amount of motion found in the spine while the thoracic spine is the most limited in its flexibility. The fact that many of the big muscles of the neck and upper back insert onto the scapula and the clavicle links these two joint complexes together.
In many cases, shoulder pain or dysfunction can result in spasms of the larger muscles that act to stabilize the shoulder – most of these muscles originate from the vertebra of the neck and upper back. The stress of this spasm can cause pain or dysfunction in the neck and upper back. Because of the shared muscles between the neck, upper back and shoulder girdle, the exact opposite scenario can occur with a primary spinal problem causing muscle spasms that have a negative effect on the shoulder.
Both the shoulder and the neck joints display complex, compound movements. Adjacent joint complexes like these that share major muscle groups make for an increased likelihood of pain / dysfunction affecting more than one group of joints.
In my practice, the two most common activities that I see that lead to pain / dysfunction of the neck, upper back and shoulder are computer work and single sided sports injuries like pitching, bowling, golf, etc. When confronted with neck pain and shoulder pain, I advise my patients to apply ice packs to the affected area in 20 minute sessions at least twice daily and limit the offending activity for two or three days. If the joint is not dramatically better with this at home management, get in to see a chiropractor. Chiropractors are specialists in joint biomechanics and can help you make a complete recovery from many cases of neck pain and shoulder injuries.
Chiropractor,Neck Pain,Shoulder Injury,Upper Back Pain,San Diego Chiropractor,Shoulder Pain
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Wednesday, May 19, 2010
Chiropractic Care for Arm and Wrist Pain:
Chiropractic Care for Arm and Wrist Pain:
Have you ever slept on your arm and had it fall asleep? Imagine if it just felt like that all the time.
A few months ago I had a young lady come to my San Diego Chiropractic office with these complaints. In addition to numbness and tingling, she had neck pain, shoulder pain, arm pain, wrist pain and hand pain. She also complained of weakness in her left hand, which was resulting in clumsiness and was affecting her work as an executive secretary.
These complaints are seen with regular frequency in my office. The process is a familiar one and common with many musculoskeletal conditions that involve the nervous system. Usually, postural stresses such as leaning over a desk or computer will eventually irritate a specific joint in the spine. The irritation of the joint causes inflammation of the muscles and ligaments that surround that joint. This inflammation will cause compression of the local nerves resulting in pain and muscle spasm. If the nerve compression persists, numbness, tingling and weakness of the related muscles will follow.
This patient was displaying signs and symptoms of long-term nerve root compression that involved her left arm and hand.
We treated her with chiropractic manipulations that were delivered with the specific goal of eliminating the nerve root compression. She was also treated with ice packs, hot packs, electrical muscle stimulation and ultrasound in order to address the soft tissue inflammation. In addition to in office care she was given a set of stretches and exercises for at home therapy and advised to use ice packs daily for twenty minutes per session.
It took approximately eight weeks of active care, which is three treatment visits per week, to relieve 90% of her pain and 90% of her left arm weakness. The rest of her symptoms will resolve with at home therapy and chiropractic care delivered on an as needed basis for flair-ups that will occur in the future.
This is just one example of the many different types of cases that resolve with chiropractic care in my office.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Have you ever slept on your arm and had it fall asleep? Imagine if it just felt like that all the time.
A few months ago I had a young lady come to my San Diego Chiropractic office with these complaints. In addition to numbness and tingling, she had neck pain, shoulder pain, arm pain, wrist pain and hand pain. She also complained of weakness in her left hand, which was resulting in clumsiness and was affecting her work as an executive secretary.
These complaints are seen with regular frequency in my office. The process is a familiar one and common with many musculoskeletal conditions that involve the nervous system. Usually, postural stresses such as leaning over a desk or computer will eventually irritate a specific joint in the spine. The irritation of the joint causes inflammation of the muscles and ligaments that surround that joint. This inflammation will cause compression of the local nerves resulting in pain and muscle spasm. If the nerve compression persists, numbness, tingling and weakness of the related muscles will follow.
This patient was displaying signs and symptoms of long-term nerve root compression that involved her left arm and hand.
We treated her with chiropractic manipulations that were delivered with the specific goal of eliminating the nerve root compression. She was also treated with ice packs, hot packs, electrical muscle stimulation and ultrasound in order to address the soft tissue inflammation. In addition to in office care she was given a set of stretches and exercises for at home therapy and advised to use ice packs daily for twenty minutes per session.
It took approximately eight weeks of active care, which is three treatment visits per week, to relieve 90% of her pain and 90% of her left arm weakness. The rest of her symptoms will resolve with at home therapy and chiropractic care delivered on an as needed basis for flair-ups that will occur in the future.
This is just one example of the many different types of cases that resolve with chiropractic care in my office.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Sunday, May 9, 2010
Why You Need a Cleansing Diet.
Why You Need a Cleansing Diet.
In my San Diego Chiropractic Center we treat people as a whole. In general, chiropractors are concerned about the typical neck pain and low back pain complaints that our patients have, however, dietary concerns are addressed as well. The value of a properly spine can’t be ignored but if you have a poor diet consisting of high calorie, difficult to digest junk food you are not being as respectful to your body as you could be.
Cleansing diets can help you turn your health around. A cleansing diet should be used any time your digestion is sluggish or if you feel heavy, congested or lethargic. There are a variety of other symptoms for which a cleansing diet may be appropriate include headaches, fatigue, bad breath or if you experience other digestive discomforts like gas, bloating and constipation.
The first step with any type of cleansing diet is to cut out the junk food. Junk food includes: food additives, snacks, desserts, canned foods, processed foods and salty foods. The basic idea is to eat fresh foods that are freshly prepared and to keep meals very simple. Also, try to decrease the size and frequency of meals, and be sure to eat slowly and chew your food thoroughly.
The next step is to distinguish between the heavy and light food groups. Carbohydrates, proteins and fats are considered heavy food groups while fruits, vegetables and herbs are considered light food groups. The light food groups are the foods that we use for cleansing. In a balanced diet, heavy food group meals are evenly counterbalanced with portions from the light food groups. For the purposes of a cleansing diet, the heavy foods portions are reduced while we increase the portions from the light food groups.
Next, simple carbohydrates like sugars and refined flours should be eliminated completely. Complex carbohydrates like whole grains can also be eliminated or sharply reduced for up to a week.
The next step is to eliminate animal-based proteins. Animal-based proteins include pork, red meat, poultry, fish, eggs and dairy. These proteins are dense and highly nourishing foods and are unsuitable for a cleanse. These foods come from animals that are high on the food chain and are likely to carry environmental toxins.
During this cleanse, we can eat plant-sourced protein in small quantities. The best choice for plant based proteins is simple well-cooked whole grain and bean combinations. In general the smaller the bean, the easier it is to digest. The mung bean is well-known for its cleansing and protective qualities. Brown rice and lentils are another good complete protein combination. Nuts and seeds also provide protein but are higher in fat and best eaten fresh in very small quantities or avoided altogether.
Organic fruits are perhaps the best cleansers and are best if eaten alone.
Your cleansing diet can be supported by gentle stretching, aerobic exercise, deep breathing, chiropractic care and massage. Remember to leave ample time between meals and limit your eating times so that no food is eaten between 7 p.m. and 9 a.m. A short cleanse can be accomplished in three days.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
In my San Diego Chiropractic Center we treat people as a whole. In general, chiropractors are concerned about the typical neck pain and low back pain complaints that our patients have, however, dietary concerns are addressed as well. The value of a properly spine can’t be ignored but if you have a poor diet consisting of high calorie, difficult to digest junk food you are not being as respectful to your body as you could be.
Cleansing diets can help you turn your health around. A cleansing diet should be used any time your digestion is sluggish or if you feel heavy, congested or lethargic. There are a variety of other symptoms for which a cleansing diet may be appropriate include headaches, fatigue, bad breath or if you experience other digestive discomforts like gas, bloating and constipation.
The first step with any type of cleansing diet is to cut out the junk food. Junk food includes: food additives, snacks, desserts, canned foods, processed foods and salty foods. The basic idea is to eat fresh foods that are freshly prepared and to keep meals very simple. Also, try to decrease the size and frequency of meals, and be sure to eat slowly and chew your food thoroughly.
The next step is to distinguish between the heavy and light food groups. Carbohydrates, proteins and fats are considered heavy food groups while fruits, vegetables and herbs are considered light food groups. The light food groups are the foods that we use for cleansing. In a balanced diet, heavy food group meals are evenly counterbalanced with portions from the light food groups. For the purposes of a cleansing diet, the heavy foods portions are reduced while we increase the portions from the light food groups.
Next, simple carbohydrates like sugars and refined flours should be eliminated completely. Complex carbohydrates like whole grains can also be eliminated or sharply reduced for up to a week.
The next step is to eliminate animal-based proteins. Animal-based proteins include pork, red meat, poultry, fish, eggs and dairy. These proteins are dense and highly nourishing foods and are unsuitable for a cleanse. These foods come from animals that are high on the food chain and are likely to carry environmental toxins.
During this cleanse, we can eat plant-sourced protein in small quantities. The best choice for plant based proteins is simple well-cooked whole grain and bean combinations. In general the smaller the bean, the easier it is to digest. The mung bean is well-known for its cleansing and protective qualities. Brown rice and lentils are another good complete protein combination. Nuts and seeds also provide protein but are higher in fat and best eaten fresh in very small quantities or avoided altogether.
Organic fruits are perhaps the best cleansers and are best if eaten alone.
Your cleansing diet can be supported by gentle stretching, aerobic exercise, deep breathing, chiropractic care and massage. Remember to leave ample time between meals and limit your eating times so that no food is eaten between 7 p.m. and 9 a.m. A short cleanse can be accomplished in three days.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Thursday, April 29, 2010
Legal Issues with Soft Tissue Injury Case
Legal Issues with Soft Tissue Injury Case
The plaintiff side of the issue is represented by the patient's attorney and we have discovered they are often placed in a position of "pressure" when attempting to justify some of the patient care issues common to the handling of soft tissue cases by the doctor or therapist. We believe anything which allows the claim to pass through the "legal" process easier, will be greatly appreciated by the attorney and will often result in a better long-term working relationship with the attorney. This better relationship often results in greater utilization of the doctor's services by the attorney.
If, on the other hand, the clinical treatment of the doctor or therapist causes the case to lose value, the possibility of a long-term relationship decreases dramatically. For example, the case we mentioned earlier in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury, makes the case very difficult for the attorney to move the case through the "system" and do justice to their client's interests. This type of behavior makes the claim lose value and results in protracted litigation before settlement.
This discussion is designed to address the soft tissue personal injury case and to offer what we consider are reasonable points of view which are supportable in the literature when possible. In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides. Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish. However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
The plaintiff side of the issue is represented by the patient's attorney and we have discovered they are often placed in a position of "pressure" when attempting to justify some of the patient care issues common to the handling of soft tissue cases by the doctor or therapist. We believe anything which allows the claim to pass through the "legal" process easier, will be greatly appreciated by the attorney and will often result in a better long-term working relationship with the attorney. This better relationship often results in greater utilization of the doctor's services by the attorney.
If, on the other hand, the clinical treatment of the doctor or therapist causes the case to lose value, the possibility of a long-term relationship decreases dramatically. For example, the case we mentioned earlier in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury, makes the case very difficult for the attorney to move the case through the "system" and do justice to their client's interests. This type of behavior makes the claim lose value and results in protracted litigation before settlement.
This discussion is designed to address the soft tissue personal injury case and to offer what we consider are reasonable points of view which are supportable in the literature when possible. In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides. Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish. However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Whiplash Accidents Injury Care San Diego
Whiplash Accidents
In my San Diego based Chiropractic Clinic we provide treatment for those patients involved in auto accidents on a regular basis. The most common injury resulting from car accidents is whiplash.
Whiplash is most frequently associated with rear-end auto accidents in which the heads of those in the front car are suddenly snapped backward and forward by the acceleration caused by the impact. The more descriptive medical phrase used to convey this type of injury is cervical acceleration/deceleration (CAD) trauma or syndrome. CAD accurately describes the rapid movements that can injure the vertebrae of the neck and the muscles and ligaments that support them.
Anyone can be subjected to whiplash at almost any speed, even in a minimal-force auto accident at speeds as low as 5mph. Incidents that cause whiplash can also be related to other incidents or mishaps in which the head is pushed or jerked beyond its normal range of motion. Whiplash commonly causes serious and chronic neck pain, as well as back pain, headaches blurred vision, ringing in the ears, nausea, numbness and dizziness. More serious injuries such as bruising of the brain can sometimes occur in auto accidents.
The sudden accident that caused the initial whiplash injury may fade into memory, but the physical and psychological damage of whiplash can become chronic, severely eroding the victim's quality of life. Chiropractic techniques are particularly well-suited to relieving the neck pain and other debilitating effects of whiplash because they can
• restore movement lost after the accident,
• overcome muscle weakness and enhance muscle tone,
• speed recovery, and
• diminish chronic symptoms that can persist or recur over many years.
Chiropractic adjustments and supportive treatment have proved successful for many thousands of patients. Chiropractic care significantly reduce patients' distress and allow them to return to their normal activities.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
In my San Diego based Chiropractic Clinic we provide treatment for those patients involved in auto accidents on a regular basis. The most common injury resulting from car accidents is whiplash.
Whiplash is most frequently associated with rear-end auto accidents in which the heads of those in the front car are suddenly snapped backward and forward by the acceleration caused by the impact. The more descriptive medical phrase used to convey this type of injury is cervical acceleration/deceleration (CAD) trauma or syndrome. CAD accurately describes the rapid movements that can injure the vertebrae of the neck and the muscles and ligaments that support them.
Anyone can be subjected to whiplash at almost any speed, even in a minimal-force auto accident at speeds as low as 5mph. Incidents that cause whiplash can also be related to other incidents or mishaps in which the head is pushed or jerked beyond its normal range of motion. Whiplash commonly causes serious and chronic neck pain, as well as back pain, headaches blurred vision, ringing in the ears, nausea, numbness and dizziness. More serious injuries such as bruising of the brain can sometimes occur in auto accidents.
The sudden accident that caused the initial whiplash injury may fade into memory, but the physical and psychological damage of whiplash can become chronic, severely eroding the victim's quality of life. Chiropractic techniques are particularly well-suited to relieving the neck pain and other debilitating effects of whiplash because they can
• restore movement lost after the accident,
• overcome muscle weakness and enhance muscle tone,
• speed recovery, and
• diminish chronic symptoms that can persist or recur over many years.
Chiropractic adjustments and supportive treatment have proved successful for many thousands of patients. Chiropractic care significantly reduce patients' distress and allow them to return to their normal activities.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Monday, April 19, 2010
Chiropractic Care for Neck Pain and Headaches:
Chiropractic Care for Neck Pain and Headaches:
Do you seem to get headaches whenever you get neck pain?
If so, you are dealing with a very common problem. My San Diego chiropractic office sees people on a regular basis who suffer from these symptoms. Neck pain is often accompanied by headaches because of the muscle tension that is so often present with neck problems.
I am sure that many of you have heard of muscle tension headaches. More often than not, muscle tension headaches begin in the neck where tightness has developed for a variety of reasons. Sometimes neck injuries such as those from auto accidents or postural stress secondary to sitting in front of a computer all day will cause the neck muscles to tighten up.
Tight muscles in the neck cause muscle tension on the back of the head. This tension causes the muscles that cover your skull to spasm. Between the aggravation of tight muscles and neck pain, headaches will often become a companion to your neck pain.
Treating muscle tension headaches often requires a multifaceted approach. Chiropractic care will help relieve a great deal of the muscle tension and spasm. Chiropractic adjustments relax muscles, restore normal joint motion and eliminate the associated neck pain. In addition to chiropractic manipulations, therapies including electric muscle stimulation, ultrasound and ice packs are beneficial to help reduce the muscle spasms that help cause the tension headaches.
Another important part of elimination or reducing the number of muscle tension headaches that you experience is to identify what sets them off. Postural stresses associated with computer work, reading, certain types of work or specific hobbies can lead to stress in the neck that causes headaches. Identifying the culprits and either eliminating them or modifying them helps greatly in controlling your headaches.
The bottom line is that neck pain and muscle tension headaches are closely related and often successfully treated with chiropractic care.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Do you seem to get headaches whenever you get neck pain?
If so, you are dealing with a very common problem. My San Diego chiropractic office sees people on a regular basis who suffer from these symptoms. Neck pain is often accompanied by headaches because of the muscle tension that is so often present with neck problems.
I am sure that many of you have heard of muscle tension headaches. More often than not, muscle tension headaches begin in the neck where tightness has developed for a variety of reasons. Sometimes neck injuries such as those from auto accidents or postural stress secondary to sitting in front of a computer all day will cause the neck muscles to tighten up.
Tight muscles in the neck cause muscle tension on the back of the head. This tension causes the muscles that cover your skull to spasm. Between the aggravation of tight muscles and neck pain, headaches will often become a companion to your neck pain.
Treating muscle tension headaches often requires a multifaceted approach. Chiropractic care will help relieve a great deal of the muscle tension and spasm. Chiropractic adjustments relax muscles, restore normal joint motion and eliminate the associated neck pain. In addition to chiropractic manipulations, therapies including electric muscle stimulation, ultrasound and ice packs are beneficial to help reduce the muscle spasms that help cause the tension headaches.
Another important part of elimination or reducing the number of muscle tension headaches that you experience is to identify what sets them off. Postural stresses associated with computer work, reading, certain types of work or specific hobbies can lead to stress in the neck that causes headaches. Identifying the culprits and either eliminating them or modifying them helps greatly in controlling your headaches.
The bottom line is that neck pain and muscle tension headaches are closely related and often successfully treated with chiropractic care.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Friday, April 9, 2010
Yoga and Chiropractic
Yoga and Chiropractic
My sister is a long time chiropractic patient. Not my patient, she lives 700 miles away from my chiropractic practice in San Diego, so she does not get free care from her little brother, she has to pay for it.
About ten years ago, my sister took up Yoga – about nine years ago she called me one day and said “Hey Steve, this Yoga thing is great, I bet that if all of your patients took up Yoga that they wouldn’t need you anymore!” I actually took this as a compliment because I had originally encouraged her to do Yoga – and now she was feeling better because of it.
While I know that the practice of Yoga is a wonderful method for keeping your muscles stretched and your spine flexible, it is a compliment for chiropractic, not a substitute.
Many of my peers consider my philosophy regarding the management of my chiropractic patients a bit odd. Instead of placing my patients on long term care programs, I prefer to get my patients out of pain as quickly as possible and then give them a combination of stretches and exercises that they can do at home that will help stabilize their area of pain.
Those of you who have not tried Yoga should do so. Yoga is a discipline that constantly challenges your physical being. The positions used in Yoga routines test your body and mind with combinations of stretching, strength training and balance that very few other disciplines can offer.
From a purely physical standpoint, Yoga helps even your muscle tone, improve your balance and coordination, build strength, prevent injury, focus your breathing, improve your posture and elongate muscles. Mentally, Yoga allows to focus on the “now” which helps reduce stress and consequently, reduce muscle spasms among other things.
It is because of all of the benefits of Yoga that I recommend it to most of my friends and patients. Combining the benefits of Chiropractic care’s ability to break down scar tissue and adhesions that limit or alter normal joint motion and Yoga’s benefits as discussed above makes for an exceptional approach to treating neck pain, back pain and many other musculoskeletal conditions that I see in my office.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
My sister is a long time chiropractic patient. Not my patient, she lives 700 miles away from my chiropractic practice in San Diego, so she does not get free care from her little brother, she has to pay for it.
About ten years ago, my sister took up Yoga – about nine years ago she called me one day and said “Hey Steve, this Yoga thing is great, I bet that if all of your patients took up Yoga that they wouldn’t need you anymore!” I actually took this as a compliment because I had originally encouraged her to do Yoga – and now she was feeling better because of it.
While I know that the practice of Yoga is a wonderful method for keeping your muscles stretched and your spine flexible, it is a compliment for chiropractic, not a substitute.
Many of my peers consider my philosophy regarding the management of my chiropractic patients a bit odd. Instead of placing my patients on long term care programs, I prefer to get my patients out of pain as quickly as possible and then give them a combination of stretches and exercises that they can do at home that will help stabilize their area of pain.
Those of you who have not tried Yoga should do so. Yoga is a discipline that constantly challenges your physical being. The positions used in Yoga routines test your body and mind with combinations of stretching, strength training and balance that very few other disciplines can offer.
From a purely physical standpoint, Yoga helps even your muscle tone, improve your balance and coordination, build strength, prevent injury, focus your breathing, improve your posture and elongate muscles. Mentally, Yoga allows to focus on the “now” which helps reduce stress and consequently, reduce muscle spasms among other things.
It is because of all of the benefits of Yoga that I recommend it to most of my friends and patients. Combining the benefits of Chiropractic care’s ability to break down scar tissue and adhesions that limit or alter normal joint motion and Yoga’s benefits as discussed above makes for an exceptional approach to treating neck pain, back pain and many other musculoskeletal conditions that I see in my office.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Monday, March 29, 2010
Soft Tissue Injury Case Medical
The "Well Managed Soft Tissue Injury Case" can be a bit misleading as it means different things to different people. The insurance companies or "defense" side, seem to have one set of expectations from the medical and chiropractic communities, while those who treat these injuries have a different set of expectations from the insurance carriers. There are those on the "defense" side who maintain all soft tissue injury patients should be released after several weeks of care and any patient who complains further has a financial motive. The other extreme is typified by our personal experience with a case in which the doctor treated the patient 454 times for an uncomplicated soft tissue injury. Neither point, in our opinion, is rational and both fail to represent a well managed soft tissue injury. The management of these patients should fall under the dual heading of "medical" and "legal" issues as both areas are critical to the case.
Medical
Our experience with these cases comes from clinical practice, file reviews, and contributions to the scientific literature on the subject. With this said, we are in a unique position to see cases at the request of both the plaintiff and defense. There is, despite the apparent contradiction in party philosophy, one area of commonality. Both sides utilize our opinion and both desires to know what, in our opinion, constitutes a well managed soft tissue case. Both sides, it seem, have a strong desire to be reasonable, but the different levels of expectations mentioned earlier make each party feel the other is often being unreasonable.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Medical
Our experience with these cases comes from clinical practice, file reviews, and contributions to the scientific literature on the subject. With this said, we are in a unique position to see cases at the request of both the plaintiff and defense. There is, despite the apparent contradiction in party philosophy, one area of commonality. Both sides utilize our opinion and both desires to know what, in our opinion, constitutes a well managed soft tissue case. Both sides, it seem, have a strong desire to be reasonable, but the different levels of expectations mentioned earlier make each party feel the other is often being unreasonable.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Friday, March 19, 2010
Causes of Back and Neck Pain
Causes of Back and Neck Pain
Like many across the United States my Chiropractic Office in San Diego provides treatment for neck pain and back pain. Although chiropractic care helps many different conditions, it is often viewed as treatment for just back pain and neck pain.
When dealing with back pain and neck pain, it is important to have your pain evaluated by a healthcare professional. Dismissing back pain and neck pain as insignificant can lead to more significant health issues.
Many conditions can cause back pain and neck pain, ranging from injury and infection too twisting or turning “the wrong way”. Injuries such as those sustained in an automobile or other accident can damage muscles, joints, ligaments, and vertebrae.
Overuse or under use of the back muscles is by far the most common cause of back pain that manifests as tightening or spasm of the muscles that connect to the spine. Inflammation and swelling often occur in the joints and ligaments, especially in the cervical and lumbar regions, as people age.
A herniated disc occurs when the nuclear pulposus, the inner material of the disc, pushes through a tear in the annulus fibrosis, the outer material of the disc causing nerve root compression. The cervical and lumbar regions of the spine have the most mobility and the discs there are more likely to wear down or be injured. Ninety percent of disc herniations occur in the lower two lumbar vertebrae.
Spinal stenosis, the narrowing of the spinal canal, can cause spinal cord irritation and injury. Conditions that cause spinal stenosis include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration. Spinal stenosis most commonly occurs in older individuals as a result of vertebral degeneration.
A pinched nerve, or radiculopathy, occurs when something rubs or presses against a nerve, creating irritation or inflammation. Radiculopathy can result from a herniated disc, bone spur, tumor growing into the nerves, and vertebral fracture, and many other conditions.
Sciatica is a certain type of radiculopathy that involves inflammation of the sciatic nerve. Pain is experienced along the large sciatic nerve, from the lower back down through the buttocks and along the back of the leg.
A spinal tumor that originates in the spine (primary tumor) or spreads to the spine from another part of the body (metastatic tumor) can compress the spine or nerve roots and cause significant pain.
Infections of the vertebrae (e.g., vertebral osteomyelitis), the discs, the meninges (e.g., spinal meningitis), or the cerebrospinal fluid can compress the spinal cord and result in serious neurological deterioration, if it is not diagnosed and treated immediately.
Arthritis often affects the facet joints which are formed by two adjacent vertebra and direct or guide movement of the spine. As the joints degenerate, they loose their normal alignment, and the cartilage and fluid that lubricates the joints may deteriorate. Bone then rubs against bone, which can be very painful.
These are just a few of the conditions that can cause back pain and neck pain. Most cases of back and neck pains are due to mechanical causes and can be readily addressed by a chiropractor. The point is, however, neck pain and back pain is a warning signal that should not be ignored.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
Like many across the United States my Chiropractic Office in San Diego provides treatment for neck pain and back pain. Although chiropractic care helps many different conditions, it is often viewed as treatment for just back pain and neck pain.
When dealing with back pain and neck pain, it is important to have your pain evaluated by a healthcare professional. Dismissing back pain and neck pain as insignificant can lead to more significant health issues.
Many conditions can cause back pain and neck pain, ranging from injury and infection too twisting or turning “the wrong way”. Injuries such as those sustained in an automobile or other accident can damage muscles, joints, ligaments, and vertebrae.
Overuse or under use of the back muscles is by far the most common cause of back pain that manifests as tightening or spasm of the muscles that connect to the spine. Inflammation and swelling often occur in the joints and ligaments, especially in the cervical and lumbar regions, as people age.
A herniated disc occurs when the nuclear pulposus, the inner material of the disc, pushes through a tear in the annulus fibrosis, the outer material of the disc causing nerve root compression. The cervical and lumbar regions of the spine have the most mobility and the discs there are more likely to wear down or be injured. Ninety percent of disc herniations occur in the lower two lumbar vertebrae.
Spinal stenosis, the narrowing of the spinal canal, can cause spinal cord irritation and injury. Conditions that cause spinal stenosis include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration. Spinal stenosis most commonly occurs in older individuals as a result of vertebral degeneration.
A pinched nerve, or radiculopathy, occurs when something rubs or presses against a nerve, creating irritation or inflammation. Radiculopathy can result from a herniated disc, bone spur, tumor growing into the nerves, and vertebral fracture, and many other conditions.
Sciatica is a certain type of radiculopathy that involves inflammation of the sciatic nerve. Pain is experienced along the large sciatic nerve, from the lower back down through the buttocks and along the back of the leg.
A spinal tumor that originates in the spine (primary tumor) or spreads to the spine from another part of the body (metastatic tumor) can compress the spine or nerve roots and cause significant pain.
Infections of the vertebrae (e.g., vertebral osteomyelitis), the discs, the meninges (e.g., spinal meningitis), or the cerebrospinal fluid can compress the spinal cord and result in serious neurological deterioration, if it is not diagnosed and treated immediately.
Arthritis often affects the facet joints which are formed by two adjacent vertebra and direct or guide movement of the spine. As the joints degenerate, they loose their normal alignment, and the cartilage and fluid that lubricates the joints may deteriorate. Bone then rubs against bone, which can be very painful.
These are just a few of the conditions that can cause back pain and neck pain. Most cases of back and neck pains are due to mechanical causes and can be readily addressed by a chiropractor. The point is, however, neck pain and back pain is a warning signal that should not be ignored.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
Ergonomic Office Equipment Website to learn more about or Buy Ergo Nav, the Ergonomic Mouse Pad
or Visit Ergonomic Blog, "Ergonomically Yours" And read the latest News in the Ergonomic World.
Better Health Steve Jones
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