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Spinal Conditions

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4 year Doctor Chiropractic Degree from Cleveland Chiropractic College-KC ... Carpal Tunnel Syndrome. Common in those performing assembly line work. Women 3:1 ... – PowerPoint PPT presentation

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Title: Spinal Conditions


1
Spinal Conditions Outcomes
  • Dr. Gregg Mantonya
  • The Mantonya Chiropractic Centers
  • Newark Hebron

2
My background
  • Undergraduate study - Ohio U. Marycrest Intl.
    U.
  • 4 year Doctor Chiropractic Degree from Cleveland
    Chiropractic College-KC
  • Completed year-long study from Spine Research
    Inst. of San Diego for spine injury during
    vehicle crashes
  • Past Team Doctor for High Schools
  • Additional post-graduate study in Pediatric
    Chiropractic, Rehab, Nutrition

3
www.mantonyachiropractic.com
  • Go to...
  • Recent Talk Handouts

4
Chiropractic
  • Required 2-4 yrs undergrad, 4 year Chiropractic
    School
  • Extensive training in Musculo-skeletal and
    nervous systems - More hours than Medical school
  • Detect correct joint mis-alignments
  • These can affect nerve function
  • Do not prescribe medication
  • Physicians through Medicare, Ohio BWC, Court
  • PCP for many of our patients

5
Chiropractic
Therapy Modalities
Rehab
Adjusting Table
Low-force Instruments
6
Conditions, Causes, Prognosis
  • Sprain/Strains
  • Repetitive Stress
  • Arthritis
  • Discs
  • Scoliosis
  • Chronic Pain Patients

7
Sprain/Strain
8
Sprain/Strain
  • Will heal within 6-12 week, right?...
  • ...Remodeling phase of healing, up to 12 months
    or more (Kellet Acute Soft Tissue Injuries - a
    review of lit. Med Sci Sport Exerc,
    18(5)489-500, 1986)

9
Sprain/Strain
  • Whiplash Its estimated that 50 of those
    exposed to trauma will be injured
  • 50 will recover within weeks or months
  • Leaving 20 of the initial 100 exposed to late
    whiplash symptoms
  • Approximately 5 will be disabled

10
Sprain/Strain
  • Whiplash At Risk For Acute Injury
  • Female
  • History of neck injury
  • Poor head restraint/tall patient
  • Use of seatbelt - 1.5 - 3 x more likely
  • Out of Position/Head turned
  • Non-aware of impending impact
  • Increasing age (middle age beyond)
  • Impact by vehicle of greater mass

11
Sprain/Strain
  • Whiplash At Risk for Late Whiplash
  • Female, especially if small body mass
  • Immediate/early onset of symptoms
  • Ligament/Joint instability
  • Greater of symptoms
  • Use of seatbelt - 34 vs 20
  • Initial limited range of motion
  • Initial neurological symptoms
  • Loss or reversal of cervical curve

12
Sprain/Strain
  • Mercy Guidelines -
  • Factors that Complicate Recovery
  • Used by Ohio BWC
  • Pain longer than 8 days - 1.5 x longer
  • Severe pain - 2 x longer
  • 4-7 previous episodes - 2 x longer
  • Injury on underlying condition - 2 x longer
  • Poor compliance
  • Biomechanical Stress
  • Psychosocial Stress

13
Repetitive Stress Injury
  • Carpal Tunnel Syndrome
  • Common in those performing assembly line work
  • Women 31
  • Surgery up to 90 successful?
  • Tendonitis

14
DJD Osteoarthritis
15
DJD Osteoarthritis
  • Wear Tear Arthritis
  • Large percent are remarkably asymptomatic
  • More common in males until age 45, Females 101
  • Hip degeneration reduced risk of osteoporosis
  • Recent problems with pain medication
  • Vioxx, Bextra, Celebrex etc

16
Disc Conditions
  • Discs are the spongy thing between the spinal
    bones
  • Shock absorbers
  • Spacers for nerve to exit
  • Up to 50 of people asymptomatic have lumbar disc
    degeneration on MRI
  • Up to 60 in cervical spine
  • MRI of 98 people without back pain
  • only 36 had a normal disc at all levels.
  • 52 bulge at least one level
  • 27 protrusion
  • 1 extrusion
  • 38 had abnormality at more than one level

17
Discs
  • Cant slip
  • Swollen
  • Bulge - No outer fibers are torn, center has
    moved toward the outer rings
  • Protrusion - Sometimes used in place of bulge
  • Herniation - Some tearing of outer ring fibers,
    center moves toward outer rings
  • Rupture - Piece of Center has gone outside of disc

18
Discs - normal, top view
19
Discs - bulge, front view
20
Discs - herniation, front view
21
Discs - rupture, front view
22
Discs
Pain Meds/Chiropractic, Rehab Shots, Nerve Block,
Surgery
  • Rupture most likely to need surgery.
  • One study showed 83 of patients with herniations
    and radiating pain improved up to 2.5 years
    after73 had actual herniation improved or
    resolved not just the symptoms (non-operative
    treatment).
  • Surgery - Studies vary on its success, as little
    as 50 or worse

23
Back Surgery - What studies say
  • 50-70 have complete relief of back and leg pain
    when followed-up at 5 years
  • 10-15 will have worse pain
  • 18-29 will undergo further surgery

24
Scoliosis
  • Idiopathic (unknown cause) most common type
  • Most rapid progression during growth spurt
  • 10-15 degrees progression during adult years
  • Complications cardiopulmonary dz., DJD, pain,
    curve progression
  • Tx stretches, braces, Chiropractic, massage,
    surgical bracing

25
Scoliosis
  • In my practice experience, pain and disability
    depend upon patients...
  • Physical Fitness
  • Activity Level
  • Severity of Scoliosis
  • Occupation

26
Spondylolisthesis
  • 50 never have pain
  • Most of the others that do have another cause
  • Rarely progresses during adulthood
  • Studies showed no worsening with strenuous sports

27
High Risk
28
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31
Chronic Pain Patients
The longer a patient is disabled from work, the
less likely they are to return.
  • BWC Data
  • Pharmaceutical Reimbursement
  • 1998 57,026,132
  • 2003 130,000,000
  • Chiropractic Costs
  • 2002 64,467,227.00
  • Actual cost of Chiropractic vs. Medical Claims
    new injury, 1998- 2002
  • Allopathic care drugs 709,709,700.95
  • DC care 167,396,045.11
  • Long-term care costs 2002
  • DC - 34 million
  • MD Drugs - 189.6 million

1 in 6 Americans live with chronic pain. 120
billion a year in medical costs and lost
productivity.
32
Chronic Pain Patients
  • 30,000 hospitalizations/yr from NSAIDS use
  • One study showed only 25 resolved from original
    pain complaint one year later
  • Recent Increase in Pain Management Centers
  • Chiropractic 1-2 visits/month shown to be
    beneficial
  • Fibromyalgia - 3-6 million Americans
  • Tenderness particularly in the neck, spine,
    shoulders, and hips - usually after trauma.
  • Most able to be fully active, may need job
    modification.

33
Chiropractic Terms
  • Adjustment vs. Manipulation
  • Subluxation, Subluxation Complex
  • Intersegmental Dysfunction

34
Info Outlets
  • www.mantonyachiropractic.com
  • Chiropractic info
  • Kids Chiropractic
  • ACA - www.amerchiro.org
  • insurance managed care
  • Spine Research Inst. - www.srisd.com
  • sprain/strain info/research
  • My email - mantonyachiro_at_yahoo.com
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