Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
May, 2008, Vol. 08, Issue 05
A Common Problem, Often Misunderstood
By Ruth Werner, LMP, NCTMB
As promised, this article looks at a surprisingly common problem that is poorly understood. Polymyalgia rheumatica (PMR) is a condition of unknown cause or etiology ("idiopathic") that affects mostly Caucasian women between 50 and 80 years of age. It usually is self-limiting, which means symptoms tend to spontaneously subside within several months or a couple of years following onset. In the meantime, however, PMR can be a severe problem that substantially interferes with a person's quality of life.
Here is a comment that came in from one reader, Karen, about her client with PMR:
The client Karen describes presents a complex picture, because some of her symptoms (especially peripheral neuropathy and hot spots in her distal legs and feet) might be related to her diabetes rather than her PMR. Furthermore, the side effects of PMR treatment can interfere with diabetes management, which complicates things even further!
What Is Polymyalgia Rheumatica?
PMR literally means "many muscle and joint pains," It is a mysterious condition that involves a specific onset of extreme morning stiffness and muscle pain, often concentrated around the neck, trunk, shoulders, upper arms, hips and thighs. One person described it as feeling as if they'd worked hard in the garden or gone on a very demanding hike every single day for about two years.
Those of northern European descent have the highest incidence. Women with PMR outnumber men by about 2 to 1. The incidence among people over age 50 is fairly high. It's estimated to affect between 0.5 percent and 0.7 percent of this population. The average age at onset is 72 years, but anyone over age 50 who describes these signs and symptoms should think about getting tested for PMR. It's rare among African-Americans or Asians. This predictable racial distribution points to a genetic component for the disease.
The exact causes or etiology of PMR are unknown, but when people with this condition are compared to people without it, some differences are strongly predictable. Many (but not all) people with PMR are positive for a specific genetic marker called HLA-DR4. Evidence of past infection with several common viruses is typical. Certain kinds of white blood cells are present in the synovial capsules, tenosynovial sheaths and bursae of many people with PMR. Levels of C-reactive protein and the erythrocyte sedimentation rate (ESR or "sed rate") of people with PMR both tend to be higher than that of the general population. These tests are not definitive for PMR specifically, but they do point toward a possibility of inflammation and immune-system hyperactivity.
Signs and Symptoms of PMR
As described above, PMR most often is defined by a specific onset of pain and stiffness focused around the trunk and proximal aspects of the arms and legs. It might start unilaterally, but most people develop bilateral symptoms.
Magnetic resonance and ultrasound imaging of specific soft-tissue structures show that bursae, tenosynovial sheaths and joint capsules in the shoulders and hips may be inflamed with PMR, but no erosion or bony adaptation is present. Many specialists suggest this inflammation contributes to the sensation of stiffness and pain in the muscles that cross these joints.
PMR also might show systemic symptoms including low fever, weight loss, weakness, fatigue and depression. While it's not a dangerous disorder and the life expectancy of a person with PMR is the same as the general population, this condition certainly can interfere with the quality of a person's life. Fortunately, it's self-limiting and symptoms usually subside within two years of onset.
Complications of PMR
PMR by itself doesn't carry a lot of potential complications, but about 15 percent of people with the condition have another immune-system hypersensitivity reaction called temporal arteritis or giant cell arteritis (GCA). This condition does have some serious consequences including a high risk of permanent visual loss and some blood vessel damage. We will look more closely at GCA in the July column.
Treatment for PMR
The good news about PMR is that it's highly treatable. This chronic, low-grade inflammatory condition responds well to steroidal anti-inflammatories and most people report a significant reduction in symptoms within a few days of initiating treatment.
The bad news, of course, is that steroidal anti-inflammatories carry a long list of serious side effects including bone thinning (patients are counseled to supplement vitamin D and calcium), insulin disruption (this has implications for patients such as Karen's client, who uses insulin to control her diabetes), edema, liver and kidney problems, and other risks. Patients who take steroids must aim for the lowest possible dose for the shortest possible period of time, and they must be vigilant about scanning for side effects that can be prevented or treated.
PMR Versus FMS
Careful readers may now be wondering about differentiating between PMR and another common, poorly understood condition, fibromyalgia syndrome (FMS). Because they are both more common in women than in men, and both involve non-injury related muscle tenderness and debilitating fatigue, the potential for confusion is large. A few delineations can help sort out these conditions:
None of those things is true for fibromyalgia syndrome. If a mature Caucasian female client reports a new onset of morning stiffness and muscle pain, it's very much worth their time to get tested for PMR, which has a different treatment protocol than fibromyalgia syndrome.
Massage for PMR
As always, judgments about massage and bodywork for clients with PMR boil down to potential risks and benefits. The risks of working with a client who has PMR include the fact that this is a demonstrably inflammatory condition, and some types of massage promote inflammation: We don't want to attract new fluid to areas like shoulders or hips that are already packed and busy. Other risks center around treatment: Does the client have any side effects related to steroid use that might interfere with the ability to deliver massage safely? These can include bone thinning, diabetes-management challenges and other complications. Remember, too, that anti-inflammatories quell pain symptoms, which makes clients easier to overtreat.
Benefits of massage and bodywork for clients with PMR can be significant if we are careful. If we can reduce muscle stiffness and fatigue without exacerbating local inflammation, what a gift for a person who always feels sore! Massage is unlikely to undo the immune system hyperactivity we observe with this condition, but it certainly can contribute to the coping skills of the client waiting for the problem to resolve.
In my next column, I will discuss the companion to PMR, giant cell arteritis (GCA). In the meantime, I'd love to hear from some of you who work with clients who have PMR, GCA or both. What's the best outcome you've seen? What will you do differently next time? This column is a place for you to share with your colleagues: What's on Your Table?
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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