I REMEMBER WHEN
by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC
Even after many years of practice, there is always new information to learn in the health care field. In fact, it is imperative that all health care professionals realize that such a career entails a commitment to life long learning. This is reflected in the number of seminars, symposiums and conferences which are scheduled on going basis to help all of us stay current with the latest information and approaches to treatment.
What has changed
Over the years there have been a number of changes to the way injuries are now treated:
- Whiplash injuries - Cervical (neck) collars were very common 10-20 years ago. Now they are seldom seen nor prescribed. They can lead to weakening of the neck muscles, restriction in movement and delay your recovery. If you injure your neck be sure to check with your health care professional to see if a collar (soft or hard) is clinically necessary.
- Disc injuries - At one time, patients with disc injuries (with associated leg pain or sciatica) were advised to restrict themselves to bed rest for 1-2 weeks. Now most health care professionals only usually recommend 2-3 days of rest at the most. The focus is on activity and rehabilitation; not inactivity and a sedentary life style. For instance, sitting or driving for long periods of time is discouraged and movement is encouraged.
- Back braces - At one time it seemed like almost every patient that presented with a lower back injury was wearing a back brace. In some instances, back braces will provide support for the lower back or lumbosacral area. BUT in most cases these braces are not needed and there does not appear to be a conclusive opinion among health care professionals that these braces will either prevent lower back injures OR hastens one's recovery. A patient can also become dependent on things like a cervical collar and lower back braces which in turn can weaken the supporting postural muscles and adversely affect your recovery.
- Heat versus ice - Every week, patients present to the clinic with a combination of muscular strain and/or ligamentous strain type injuries. These injuries should be dealt with by applying ice to the injured area - what is referred to as cryotherapy. The frequency and duration of icing depends on the area and severity of the injury. However as a general 'rule of thumb' apply ice 3-4x/day for periods of 15-20 minutes. This would be a reasonable first approach. Never apply ice directly to the skin; always place a paper towel, tea towel or wear a shirt between the ice pack and your skin. Always be sure to check with your health care professional.While heat is soothing, it can aggravate your injury by increasing the degree of irritation and inflammation - somewhat like having a sunburn and jumping into a hot shower! We all know that a cool shower feels much better on skin which has been exposed to too much sun. Another example is when you burn your finger on the stove - do you put it under hot water or cold water? Of course - cold water!
- Exercises - We all know exercises are important. Patients who suffer a whiplash injury, disc herniation, sprain or strain should be prescribed exercises. These not only facilitate a 'speedier recovery' but if done on an ongoing basis, usually help to reduce the possibility of a reoccurrence. The 'rule of thumb' is that if a patient has had two episodes of significant lower back pain then he/she is 10 times more likely to have a third episode. Despite this, humans are creatures of habit - unfortunately, the vast majority of patients do not continue on with their exercises once the pain is gone. In other words, we often see a patients' compliance or diligence with their exercises being directly related to how much pain they are having.
- Check-ups - Doing your back exercises between periodic check-ups with your chiropractor is important. This is just like flossing, brushing and rinsing your teeth on a daily basis, between your dental check-ups.
So Anything Else
Over the years there have been multiple studies that demonstrate that chiropractic care is effective and cost-effective for the treatment of neck and back pain. Many of these studies involve Workers' Compensation type cases and to be sure WCB in Nova Scotia could use our help. The number of WCB claims involving back injuries has changed very little over the past decade. Since 1994, the percentage of claims involving back injuries has been around 32%.
Anything on the horizon?
Research is ongoing across Canada and in other areas of the world regarding neck and back pain. Every year there is new information and new approaches. Stay tuned for what's new out there!
Reprinted with permission of download a printer friendly version
The Seniors' Advocate. P.O. Box 5005, Waverly, Nova Scotia, B2R 1S2