Contemporary Chiropractic Practice. Keith Overland, DC, CCSP, FICC

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1 Contemporary Chiropractic Practice Keith Overland, DC, CCSP, FICC

2 Dr. Keith Overland 1981 Graduate from New York Chiropractic College Private Practice in Norwalk Connecticut Immediate Past President of the American Chiropractic Association Post Graduate faculty University of Bridgeport College of Chiropractic Former Chiropractor NY Mets baseball club Former Chiropractor US Olympic Speed Skating team

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6 2015 Gallup poll Gallup-Palmer College of Chiropractic Inaugural Report Americans' Perceptions of Chiropractic According to a new Gallup report commissioned by Palmer College of Chiropractic, 33.6 million U.S. adults (14 percent) seek chiropractic care each year. Previous studies from other sources, including the 2012 National Health Interview Survey, have measured yearly chiropractic use at about 20.6 million U.S. adults (8 percent). The report, officially named, the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic, also indicates that more than half of U.S. adults view doctors of chiropractic positively and agree they're effective at treating neck and back pain. Key highlights: Nearly 70 percent of adult Americans believe chiropractors are effective at treating neck and back pain. The majority (57 percent) of adults are likely to see a chiropractor for neck or back pain. More than 1/2 of all U.S. adults have visited a chiropractor, and more than 1/4 of them would choose chiropractic care first for back or neck pain. Nearly 1/2 of all U.S. adults don't know if their insurance covers chiropractic care.

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8 Spinal Manipulation, medication, of home exercise with advice for acute and sub acute Neck pain A randomized trial Gert Bronfort, DC, PhD; Roni Evans, DC, MS; Alfred V. Anderson, DC, MD; Kenneth H. Svendsen, MS; Yiscah Bracha, MS; and Richard H. Grimm, MD, MPH, PhD + Author Affiliations From Northwestern Health Sciences University, Pain Management and Rehabilitation Center, and Berman Center for Outcomes and Clinical Research at the Minneapolis Medical Research Foundation, Minneapolis, Minnesota. Abstract Background: Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain. Objective: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. Design: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT ) Setting: 1 university research center and 1 pain management clinic in Minnesota. Participants: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks. Intervention: 12 weeks of SMT, medication, or HEA. Measurements: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks. Results: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome. Limitations: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature. Conclusion: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. Primary Funding Source: National Center for Complementary and Alternative Medicine, National Institutes of Health.

9 Journal of the American Board of Family medicine- July-Aug 2015 Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain Matthew A. Davis, MPH, DC, PhD, Olga Yakusheva, PhD, Daniel J. Gottlieb, MS and Julie P.W. Bynum, MD, MPH +Author Affiliations From the University of Michigan, Ann Arbor (MAD, OY); and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Geisel School of Medicine, Hanover, NH (MAD, DJG, JPWB). Corresponding author: Matthew A. Davis, MPH, DC, PhD, University of Michigan, 400 North Ingalls, Ann Arbor, MI ( Abstract Background: Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods: We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results: We found a positive association between regional supply of chiropractic care and PCP services (r s = 0.52;P<.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, ) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions: Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults.

10 Harvard Health Publications\ Harvard Medical School Chiropractic care for pain relief Chiropractic is a health care system that holds that the structure of the body, particularly the spine, affects the function of every part of the body. Chiropractors try to correct the body s alignment to relieve pain and improve function and to help the body heal itself. While the mainstay of chiropractic is spinal manipulation, chiropractic care now includes a wide variety of other treatments, including manual or manipulative therapies, postural and exercise education, ergonomic training (how to walk, sit, and stand to limit back strain), nutritional consultation, and even ultrasound and laser therapies. In addition, chiropractors today often work in conjunction with primary care doctors, pain experts, and surgeons to treat patients with pain. Most research on chiropractic has focused on spinal manipulation for back pain. Chiropractic treatment for many other problems including other musculoskeletal pain, headaches, asthma, carpal tunnel syndrome, and fibromyalgia has also been studied. A recent review concluded that chiropractic spinal manipulation may be helpful for back pain, migraine, neck pain, and whiplash. There have been reports of serious complications, including stroke, following spinal manipulation of the neck, although this is very rare and some studies suggest this may not be directly caused by the treatment. Spinal manipulation is a generic term used for any kind of therapeutic movement of the spine, but used more precisely it is the application of quick but strong pressure on a joint between two vertebrae of the spine. That pressure twists or rotates the joint beyond its normal range of motion and causes a sharp cracking noise. That distinctive noise is believed to be caused by the breaking of a vacuum or the release of a bubble into the synovial fluid, the clear, thick fluid that lubricates the spinal and other joints. Spinal manipulation can be done either directly by pushing on the vertebrae or indirectly by twisting the neck or upper part of the body. It should be done to only one spinal joint at a time. Chiropractors and other practitioners accomplish this by positioning the body so the force they exert is focused on one joint while parts of the spine above and below it are held very still. Most spinal manipulation treatments take somewhere between 10 and 20 minutes and are scheduled two or three times a week initially. Look for improvements in your symptoms after a couple of weeks. In addition, a chiropractor may advise you about changing your biomechanics and posture and suggest other treatments and techniques. The ultimate goal of chiropractic is to help relieve pain and help patients better manage their condition at home.

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15 A Favorite Quote You can t claim the future by clinging to the past Keith Overland D.C. doco57@aol.com

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