Tuesday, June 5, 2012

Should I consider surgery for back pain?

Patients in considerable pain often ask at what point they should consider surgery. Surgery is the very last resort and should only be considered when all other options have been exhausted.  Often, patients dealing with intense pain, understandably, would like to get relief as fast as possible.  This approach, however, at least in the long run, is almost never a good choice.  Even very successful surgeries leave the patient with scar tissue, permanent weakness in the spine, distortion and instability.

Spinal surgery is a much less reliable type of surgery than an appendectomy, a heart valve replacement, or removing a cancerous lesion. These are very straight forward surgeries because of their very clear and obvious purpose. This is not the case with surgery for back pain. Spinal surgery is the only type of surgery that has led to a syndrome being named for its failures-- Failed Back Surgery Syndrome.  It’s reported that 10%-40% of patients who have undergone spinal surgery fall into this category. These patients develop intractable pain and functional incapacitation as a result of surgery. This syndrome only represents the short term outcome, not the long term.  The long term results are often even less satisfactory.  
Perhaps the most important reason the surgical option is not a good one is that it’s difficult to determine the exact cause of low back pain.  Multiple studies have shown that MRIs are only 50% accurate in determining the cause. The MRI can picture areas of abnormal tissue, but low back pain functions on many complex levels. Simply removing abnormal tissue does not guarantee success.  Often healthy tissue is cut, damaged or removed and the tissue causing the pain is left behind.  Also, scar tissue produced during the surgery often crowds the injured nerve, creating its own, sometimes more serious, problem.  In addition, cut muscles and newly formed scar tissue will change the basic mechanics of the spine, creating early spinal degeneration and pain.  Most importantly, surgery does not address the underlying mechanical abnormalities that originally caused the back pain.

Further Reading:  
Medical Insurance perspective on back surgery:
Failed Back Surgery
An interesting alternative
USA Today article

  1. Fager C. A., Freiberg S. R. (1980). "Analysis of failures and poor results of lumbar spine surgery.". Spine 5 (1): 87–94. DOI:10.1097/00007632-198001000-00015. PMID 7361201
  2. Spengler D. M. et al. (1980). "Low-back pain following multiple lumbar spine procedures. Failure of initial selection?". Spine 5 (4): 356–60.

Thursday, May 27, 2010


Car Accident: Common Questions

Q: What if I feel fine following the car accident?
Q: Should I see a chiropractic (D.C.) a general practitioner (M.D.) or a physical therapist (P.T.)
Q: The insurance company has been calling, asking me to settle. What should I do?
Q: If I've seen a medical doctor (M.D.) do I still need to see a chiropractor?
Q: Should I see an attorney before I see the chiropractor?
Q: What if my car was barely damaged?
Q: How do I pay?

Q: What if I feel fine following the car accident?
A: It's still very important to see your doctor following the accident. Symptoms following a car accident can vary from obvious physical signs such as muscle stiffness, neck pain, headaches, memory loss, fatigue, difficulty concentrating, numbness and tingling, back pain, difficulty sleeping, to more subtle injuries that do not have obvious physical symptoms. Post-traumatic osteoarthritis (early degeneration of the joints) is one of these more subtle injuries that can show up many years later as stiffness and muscle spasm in the back. One patient came in approximately six months following the accident complaining of an increased frequency and severity of headaches over the last month. They were taking twelve ibuprofen every day and were concerned about the side effects. An x-ray was taken which showed a near complete loss of curvature in their neck as a result of whiplash. Scar tissue had developed as well as the early signs of osteoarthritis.

Q: Should I see a chiropractic (D.C.) a general practitioner (M.D.) or a physical therapist (P.T.)
A: The first person you need to see is your physician. This would be your chiropractor (Doctor of Chiropractic) or your general practitioner (Medical Doctor). Both can refer and supervise care given by a Physical Therapist. The benefit of going to your chiropractor for a car accident or automobile accident is that chiropractors are specialists in the biomechanics of the human body and treat these types of injuries every day. Another benefit is that, since the early 80's, physical therapy has been part of the chiropractic doctorate program. This means that your chiropractor can help you, not just through the acute stages of the injury, but also through rehabilitation and see you through to full recovery.

The Journal of Orthopedic Medicine in a 1999 article points out the superiority of chiropractic care for patients suffering from long term whiplash. The article noted that previous studies show that 26 of 28 or 93% of patients treated for whiplash became better with chiropractic care. The article states “chiropractic is the only proven effective treatment for whiplash.”

Q: The insurance company has been calling, asking me to settle. What should I do?
A: Do not settle until you have seen your chiropractor and received a full exam. Once you settle, the insurance company will no longer pay for your care. Injuries do not always show up right away. Sometimes weeks or months may pass before symptoms develop. A full exam, including an x-ray, can help you evaluate whether or not you will be needing medical care.

Q: If I've seen a medical doctor (M.D.) do I still need to see a chiropractor?
A: Yes, a chiropractor is an expert in biomechanical injuries. When you visit your M.D., they will take your temperature, blood pressure, and evaluate you for any life threatening conditions. They will then most likely release you with pain medication to mask the symptoms of your injury. Sometimes they will refer you to a Physical Therapist before sending you to a chiropractor. This decision is often a mistake. Patients who use pain medications to mask acute pain and who force their bodies through a rehab program before they have the biomechanical cause treated can exacerbate their condition and suffer long term chronic injuries.

Q: Should I see an attorney before I see the chiropractor?
A: It is very important to see the chiropractor first. The findings from the exam will give you the information you need to decide whether an attorney is necessary. If so, your chiropractor may be able to refer you to a reputable attorney who specializes in car accidents.

Q: What if my car was barely damaged?
A: You should still consult your chiropractor. In several documented studies done by Charles Carroll, M.D., Paul McAtee M.D. And Lee Riley, M.D, evidence was provided that “The amount of damage to the automobile bears little relation to the force applied to the cervical spine (neck) of the occupants.”

Q: How do I pay?
A: You are 100% covered for medical expenses by your car insurance. Treatment for injuries is part of your auto insurance policy. This part of your policy is referred to as P.I.P. and is mandatory for all auto insurance policies in Oregon. Treatment is fully covered by the auto insurance policy no matter who is at fault. Seeking medical treatment will not raise your deductible or affect your insurance policy. There is no co-pay. It is your chiropractor's responsibility to submit the paperwork and communicate with the insurance company.

Thursday, May 20, 2010


It's not uncommon for people to seek chiropractic care for the treatment of vertigo. Vertigo is characterized by the perception of dizziness or motion when one is stationary. Some describe a sensation of being pulled toward the floor or toward one side of the room. Symptoms of vertigo are intensified by moving the head or changing position in any way.

In my office, the majority of patients presenting with vertigo fall into one of three treatable categories:

1.Benign Paroxysmal Positional Vertigo ( BPPV ): Patients present with intermittent ( i.e. come and go) sensations of vertigo that last a few seconds to a few minutes. Other associated symptoms may include a migraine headache, light headedness, nausea, imbalance that can be caused by any change in position. Individuals suffering from vertigo most often experience symptoms when they tilt their heads back to look up. Symptoms of BPPV are caused by dislodged calcium crystals moving through the semicircular canals of the inner ear. BPPV can be caused by a head injury or the degeneration of the inner ear in older people. My treatment of BPPV is very simple and involves either Epley's or Semmont's maneuvers. These are non-adjustive gentle techniques used to move the calcium deposits out of the inner ear. If BPPV was caused by a head injury, as part of the treatment, I would also treat any associated neck dysfunction.

2.Menier's disease: Patients not only present with signs of vertigo but often with associated ringing in the ears, hearing loss, and ear pressure. This type of vertigo can last hours to days. The cause of Menier's type vertigo is uncertain but is generally believed to be related to excess fluid in the inner ear that bursts or spills from its normal channels. My treatment of Menier's disease focuses primarily on diet and nutrition but, depending on the patient, may also include chiropractic adjustive treatment of the ear and upper neck.

3.Cervical Vertigo: Patients present with vertigo that, occasionally, is associated with ringing in the ears or general ear discomfort. There should be no hearing loss. Cervical vertigo often follows an injury to the head or neck, usually related to a car accident. The symptoms may present a day or 6 six months following the accident. The most common cause of cervical vertigo is mechanical pressure on the spinal cord caused by a disruption in the curve of the neck. My treatment of cervical vertigo focuses on restoring the proper movement and function of the neck. The treatment often includes soft tissue massage, ultrasound, gentle mechanical traction and decompression as well as chiropractic adjustments.

Wednesday, February 10, 2010


Vascular inflammation often contributes to and may, in fact, be the cause of complaints such as tension and sinus headaches, jaw pain, neck discomfort, fatigue, as well as low back pain. The mechanism by which vascular inflammation works is through inflammation of the arteries and veins that form the vascular structure of the meninges, the thin material that lines and protects the brain and spinal cord. For example, in the case of chronic sinus congestion, the cause is often thought to be allergies or some structural abnormality. Most of the time, however, the actual cause is vascular inflammation which blocks the areas of drainage. This congestion often leads to bacteria accumulation and an infection, a symptom which is mistakenly treated with antibiotics, while the actual cause is ignored.

Vascular inflammation, in addition to causing a variety of headaches, also causes pain in the spinal cord all the way down to the low back. A constant popping and grinding sound in your neck and back may not be due to any structural dysfunction or arthritis but an area in your spinal cord that is chronically inflamed. Treating vascular inflammation is complex. It cannot be treated solely with medication or even a series of chiropractic visits. The treatment must be holistic. Most importantly, it involves dietary modifications which eliminate trigger causing foods in the diet.

Previous approaches on treating vascular inflammation have often been unsuccessful because they focus on one suspected triggering factor at a time. A triggering factor includes stress, heat, barometric pressure, as well as dietary items like caffeine, chocolate, and MSG. These triggering factors do not work in isolation but together. One day may be very stressful, and it's on that day that you eat a chocolate muffin and your symptoms flare up. Another day you may not be experiencing any stress and the chocolate muffin may not cause you any trouble. It is this type of thinking that causes people to to give up too quickly on the diet component of their treatment.

When going into this diet, it is extremely important that you realize that each of these foods stack on top of each other until they reach a level where your symptoms flare up. If you are suffering from chronic pain caused by vascular inflammation, the level in your system is already above this point which means, in order for this diet to work, almost everything on this list must be eliminated for a period of two months.

For more information on the details of this diet please contact me at 503.232.3139

Thursday, September 10, 2009


Studies done by the U.S. Department of Health and Human Services show that the typical American diet does not provide a sufficient amount of vitamins and minerals. Okay, that comment falls under the common sense category; however, even people who eat the right foods can suffer from nutrient deficiencies. Those same studies indicate that 92 % of American’s are deficient in one or more nutrients under the Recommended Daily Allowance(RDA). The levels set under the RDA are the minimum levels needed to prevent rickets and scurvy. They are far from what is needed for someone to feel even 50% healthy.
The vitamin deficiencies I’m talking about don’t cause acute diseases like scurvy and rickets but the chronic type of diseases. These are the types of diseases that sneak up on you over the years because you basically feel fine. These diseases include: blindness, osteoporosis, heart disease, cancer, diabetes, dementia, and more.
The best place to start in preventing these diseases is a high quality multivitamin. It’s very confusing since there are many choices out there. Some of the essential things you want the multivitamin to have are mixed carotenoids, which include lutein and zeaxanthin, as well as at least 400 mcg of folate and a mixed B vitamin-complex. You also want to look for a multivitamin that comes from whole food sources. This is a new concept in the industry which involves not separating the vitamins and minerals from their food source. In this way, the body can absorb nutrients the way it is meant to.
There are many good multivitamins on the market. I take “Nature’s Way Alive Whole Food Energizer.” This doesn’t have the mixed carotenoids. I get those through another supplement, “Nature’s Plus Ultra Source of Life Liquid with Lutein.” I order both of these through vitacost.com. If you know any other good multivitamins please let me know so I can pass it on. So far, these are the ones I have used. They have worked well for me.


There are many preventive drugs for migraine headaches -- calcium channel blockers, beta-blockers, anti-seizure medications, and antidepressants. These all work poorly, if at all, and are often accompanied by frequent side effects. Attempts at providing relief for migraine headaches has gone as far as injecting Botox into the neck muscles to ease the patient’s symptoms.

Recently, new medications have been developed that can stop a migraine after it has started. These are part of a new class of drugs called triptans. They include Imitrex, Maxalt, and Zomig. While these new drugs do work much better, they have potential side effects which include strokes. They are also incredibly expensive and very addictive.

The challenge with migraines is that they are treated by doctors more as a cause than a symptom. Migraines can be caused by a number of dysfunctions in our bodies which include: food allergy/bowel and gut imbalances, chemical triggers, hormonal imbalances, magnesium deficiency, mitochondrial imbalances, structural problems

Often patients have migraines following a recent car accident, but often it is not this clear cut. For instance, if you have a chronic migraine associated with tight, irritable, crampy symptoms, this may point toward a nutritional deficiency in magnesium. If your migraine is associated with your period, along with severe PMS, bloating, sugar cravings, breast tenderness, and irritability your migraine might be due to hormone imbalances such as an imbalance in estrogen and progesterone.

In other words, migraines are a huge problem but are also very preventable. The answer is taking the time to investigate, not simply applying a medication or short chiropractic adjustment that may only work to successfully mask the symptom.

How cholesterol really works

Cholesterol may not be the best way to measure one’s risk of heart disease. Studies on the use of statin drugs are showing that controlling inflammation is the mechanism by which the risk of heart disease is decreased. In fact, a study of a nonstatin drug called Zetia showed that drugs designed solely to reduce cholesterol without reducing inflammation actually increase ones risk of heart disease. (1) Zetia, in particular, while lowering cholesterol, actually increased the accumulation of fatty plaques in the arteries and increased the patient’s risk of a heart attack. Another new nonstatin drug, torcetrapib, was recently pulled from the market in 2006. Studies of this drug showed that, while raising HDL levels and lowering LDL in the 15,000 people, the cholesterol altering effect of the drug, in fact, caused more heart attacks and strokes.(2)
The best way to battle heart disease is not to focus on lowering cholesterol numbers but to focus on lowering inflammation with a proper diet and appropriate exercise. Statin drugs are still effective at lowering inflammation but should be used only as a last resort.

(1) Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, Pfeffer MA, Braunwald E; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005 Jan 6;352(1):20-8.
(2) Kastelein JJ, van Leuven SI, Burgess L, Evans GW, Kuivenhoven JA, Barter PJ, Revkin JH, Grobbee DE, Riley WA, Shear CL, Duggan WT, Bots ML; RADIANCE 1 Investigators.Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. N Engl J Med. 2007 Apr 19;356(16):1620-30.