Non-Pharmacological Interventions for Pain:! Chiropractic Manipulative Therapy!

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1 Non-Pharmacological Interventions for Pain:! Chiropractic Manipulative Therapy! Dr. Marie Rudback, DC, CCSP, ART! Chiropractic Physician, Certified Chiropractic Sports Physician, Active Release Technique Certified! Disclosures: Board Member of the Pain Standards Task Force!

2 Chiropractic Care! Regulated by Oregon Board of Chiropractic Examiners: wide scope of practice includes: chiropractic manipulative therapy, soft tissue mobilization therapy, therapy exercises, and many adjunctive therapies (cyrotherapy, therapeutic ultrasound, taping, cold laser, pulsed magnetic field, kinesio-taping, etc, etc).! Approach to care can be varied with board approved specialty techniques or devices. Each office may have different therapy offerings. Many specific techniques and protocols (Diversified, Cranial Sacral, Activator, Webster, Thompson, etc).! Patient Education: Chiropractors can clarify misunderstandings about pain, encourage movement and teach patients self management strategies for pain management and recovery.! Ergonomics: chiropractors can evaluate the way a patient uses their body when performing activities and suggest changes avoid further problems.!

3 Chiropractic Treatment in a Snap Shot! Chiropractic Manipulative Therapy: Spinal joint mobilization to help restore biomechanical joint alignment and promote healing! Soft Tissue Mobilization: Therapy to muscle, tendon, ligament to enhance therapy, to lengthen and restore optimal function, helps break down scar tissue and adhesion in and around joint and associated tissues! Joint Mobilization and Manipulation: gentle joint movement (active and passive) can be performed to restore normal biomechanics in the upper and lower extremity and mandibular joints!!

4 Chiropractic Treatment in a Snap Shot!! Rehabilitative Exercises: prescribe rehab exercises to promote muscle strength, flexibility, and neuromuscular control. Patient can move to customized self-directed program of home exercise, as appropriate with injury recovery. Activity or sport specific injuries may require more specific performance therapy activities.! Adjunctive therapy options: Ultrasound, Low Level Laser Therapy (cold laser), vibration plate, electric stimulation therapies, foot orthotics, yoga, massage, supplements, nutritional counseling, programs for special populations (pregnancy, bariatric, diabetic, arthritis, etc). Many options to aid in patient recovery and goals for therapy.!

5 Common Musculoskeletal Conditions! Headache TMJ, tension, migraine, nerve impingement! Neck Pain cervicalgia, sprain, strain, myalgia, Thoracic Outlet Syndrome, Whiplash, Torticollis, disc injury and radicular pain syndromes! Mid-Back Pain thoracalgia, rib pain, scapular pain, sprain, strain, myalgia, dorsal neuralgia! Low Back Pain lumbago with or without sciatica, myalgia, sprain, strain, pelvic distortion, pregnancy related low back pain, referred pain and radicular pain syndromes! Upper Extremity shoulder pain, tendonitis, Golfer s elbow, Tennis Elbow, Carpel Tunnel syndrome, tendonitis, myalgia! Lower Extremity sciatica, gait coordination, balance and fall prevention, post pregnancy hip/pelvic pain, Runner Knee, plantar fasciitis, sprains, strains, tendonitis, myalgia!

6 Chiropractic Therapy: What is the goal of treatment?! Patient centered-reduce pain, improve function, enhance performance (VAS, OPS, PSFS, ADL s, PSFS)! Quantifiable measurement-standardized subjective and objective score (Oswestry, Keele University STarT Back Screening Tool, Extremity Disability Index, SAT, SLS, Balance, Jull s Test, etc)! Action plan for success-alignment of joint, stabilization of joint, rehabilitation of soft tissues/nerve/skeletal!

7 Chiropractic Treatment- What the research says Chiropractors as spine care experts are well-placed to deliver an effective and evidence-informed alternative as part of the solution to the opioid crisis. Chiropractors working in collaborative teams with other health professionals is resulting in very positive outcomes and we anticipate significant growth in the involvement of chiropractors in helping to tackle the opioid crisis. (1)! Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function. (2)!

8 Chiropractic Treatment- What the research says Several non-pharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind-body interventions. Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain. (3).! These results indicate that spinal manipulative therapy (SMT) has a direct local/ regional hypoalgesic effect on experimental pain for some types of stimuli. Recently, it has been hypothesized that SMT reduces the potential for central sensitization by inhibiting second pain. One mechanism underlying the effects of SMT may be the ability of manipulation to alter central sensory processing by removing sub-threshold mechanical or chemical stimuli from paraspinal tissues. Another possibility is that SMT could have a regional effect, although still at the spinal level of the manipulative input. Some authors suggest an effect on the dorsal horn of the spinal cord or on the periaqueductal grey area. SMT is also thought to affect reflex neural outputs to both muscle and visceral organs by affecting both paraspinal muscle reflexes and motoneuron excitability. (4).!

9 ! Look well to the spine for the cause of disease ~Hippocrates! 1. Guideline for Opioid Therapy and Chronic Noncancer Pain. CMAJ (May 8); 189 (18): E659 E666.! 2. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA (Apr 11); 317 (14): ! 3. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine 2017 (Apr 4); 166 (7): ! 4. The Effect of Spinal Manipulative Therapy on Experimentally Induced Pain: A Systematic Literature Review. Chiropractic & Manual Therapies 2012 (Aug 10); 20 (1): 26.!