Referral. Stuart Firsten, DC.. Doctor of Chiropractic, Novi, Michigan, Oakland County, MI

Relief. Chiropractic. Naturally.

Stuart A. Firsten, DC Doctor of Chiropractic Novi, Michigan 248.489.0766

INFORMATION FOR PHYSICIANS - MAKING A REFERRAL FOR CHIROPRACTIC CARE

Which patients should be considered for chiropractic care?
A referral for Chiropractic treatment is appropriate for most patients with acute/subacute and/or chronic mechanical/myofascial cervical, thoracic or lumbosacral spinal related pain.

Typical conditions seen include whiplash, stable radiculopathy, lumbar stenosis, facet syndrome, costotransverse capsulitis, sacroiliac joint pain, spinal strain/sprain, non-specific spinal pain, discogenic low back pain, myofascial pain syndromes and cervical headaches.

Patients with cervical or lumbar degenerative disc disease, including intervertebral disc derangement, bulging or herniations commonly respond well to chiropractic management. Treatments may include forms of traction (e.g., flexion-distraction), Mckenzie (extension) therapy and/or manual therapy technique.

Patients with spine related repetitive strain disorders typically obtain good outcomes.

How much care is necessary for a patient to improve with chiropractic treatment?
Most patients will demonstrate improved function and pain relief within a few treatments. Others may require more prolonged care. In some cases patients experience immediate relief following the first treatment. The acute, uncomplicated spine pain patient typically achieves significant relief within 2-4 weeks of care. Chronic or more complicated acute patients may require four to five weeks to obtain the best response from care.

Patients with chronic or permanent conditions may be treated under a “disease management” model. Once the patient has reached a point of maximum therapeutic benefit in a comprehensive treatment program, manipulation and adjunctive therapies may be provided on a periodic or PRN as needed basis to maintain functional and symptom gains. A primary goal is to encourage independence from treatment.

After clinical evaluation which may include such standardized procedures as comprehensive case history, orthopedic, neurologic and x-ray examination when necessary, treatment may commence on the first visit when appropriate. Treatment recommendations may include some or all of the following:

Spinal manipulation / adjustments to areas of joint dysfunction
Soft tissue mobilization procedures such as ischemic compression massage, trigger point therapy, myofascial release technique to improve circulation and reduce scar tissue and/or adhesions
Therapeutic exercise instruction to improve muscles balance, strength, and coordination
Patient education to improve posture, proprioceptive and motor control
Flexion distraction technique and/or manual traction

Specific therapeutic goals will be established for a patient’s individual treatment plan:

Short-term goals include reducing pain and restoring normal joint function and muscle balance
Long-term goals include restoring functional independence and tolerance to normal activities of daily living

To reach these goals we may prescribe a specific number of office visits, such as 1 to 3 visits/week for 2 to 4 weeks, followed by a re-examination at the end of an initial therapeutic trial. At the re-evaluation, the response to treatment will be evaluated to determine whether:

Continued treatment remains appropriate
Release of the patient from active care when therapeutic goals have been met is indicated
Referal to another health care specialist is warranted

Is chiropractic manipulation safe?
Spinal manipulative therapy is generally very safe. There are relative and absolute contraindications to spinal manipulation that have been identified in the literature.

The most common side effect experienced by patients receiving spinal manipulation is short-term soreness in the area of the treatment.

The most concerning potential complications from spinal manipulation are cauda equina syndrome (CES) and vertebral basilar artery injury (VBAI). The likelihood of these complications is approximately 1: 4.5 million (VBAI) to 1: 100 million (CES).

A history of spinal surgery, osteoporosis, healed fracture, disc herniation without significant or progressive neurologic deficit, scoliosis, chronic arthopathies, degenerative changes, some acute injuries and joint instability are not absolute contraindications to treatment.

Absolute contraindications include severe or progressive neurologic deficit, infections or malignancies, acute bone demineralization, acute fracture/dislocation and acute arthropathies.

A contraindication to spinal manipulation in one region of the spine rarely precludes treatment in another region. If techniques cannot be modified to accommodate the patient’s condition, manipulation is withheld.

How does manipulation work?
Spinal manipulation results in post treatment increase in range of motion, decreased adjacent soft tissue tenderness, improved function and decreased pain.

Although the exact mechanism is not clear, current models that explain the treatment benefits following spinal manipulative therapy (SMT) include: motion segment unbuckling, meniscoid inclusion release, intra-articular adhesion / fringe release, stimulation of joint mechanoreceptors and/or relaxation of hypertonic muscle. Centrally mediated reflexes are also being investigated.

Why is there such variation in treatment among chiropractors?
The chiropractic profession is philosophically divided into two primary groups; (1) those who adhere to many of the traditional chiropractic theories that promote lifelong care, and (2) those who work on an integrated, evidence based care model.

Evidence based chiropractors commonly work on a physical medicine model to diagnose and treat their patients. Spinal manipulation is one component of the management strategy, which also draws from those therapies that are shared with physical therapists and physiatrists. Evidence based chiropractors administer therapeutic treatment modalities such as hot/cold therapies and instruct patients in rehabilitative exercises, stretching, posture, ergonomics, lifestyle changes and proper diet. Many evidence based chiropractors work cooperatively within hospitals and integrated care centers.

Philosophically based chiropractors advocate that spinal manipulation (referred to an “adjustment”) improves health through reducing sub-clinical neurologic impairment by correcting intervertebral joint dysfunction (referred to as a “subluxation”). Theoretically, spinal adjustments are directed at restoring neural homeostasis, rather than administered to treat a clinical disorder. Also, regular adjustments are administered as a means of preventive healthcare. Some philosophically based chiropractors do not seek a clinical diagnosis other than “subluxation”, and may not exercise standard examination and treatment procedures.

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Stuart A. Firsten, DC,rsten, DC, Chiropractor Novi, Michigan, Oakland County, MI, Chiropractic Care, Doctor of Chiropractic, Back pain, Low back pain, Neck pain, Headache, Headaches, Pain, Pinched Nerve, Disc decompression, Adjustment, Spinal adjustment, Spine Care

Stuart A. Firsten, DC, Chiropractor Novi, Michigan, Oakland County, MI, Chiropractic Care, Doctor of Chiropractic, Back pain, Low back pain, Neck pain, Headache, Headaches, Pain, Pinched Nerve, Disc decompression, Adjustment, Spinal adjustment, Spine Care

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