Supportive Procedures

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Supportive Procedures

support1At Boston Spine Clinics, we use a wide gamut of supportive procedures. Our REHAB lab includes various exercise machines for the isotonic rehabilitation of the neck, low back, abdominals. We also have an extremity station to rehab the shoulders, arms, legs and knees. We also offer Swiss balls for further management of the abdominal mucles as well as a stationary bike and a treadmill. 

Dr. John Haberstroh is a Certified Chiropractic Rehabilitation Doctor. In addition to offering rehabilitation, Boston Spine Clinics also offers electrical muscle stimulation as well as intersegmental traction as suppotive procedures to relax spinal or extremity musculature, create slight motion in the spinal joints and inhbit pain. Ultra-Sound is also a modality we use, which breaks up adhesions restricting joint motion.

Boston Spine Clinicsalso has X-Ray on the premesis. For a field office, BSCs offers a fairly wide array of procedures in addition to examinations, opinions and manipulative reductions of the spine to help those who we accept for care. If you have any questions about this, please feel free to contact us at 617.666.1767.

The literature is replete with information validating supportive procedures. Here are a couple of citations.

1) Foreman, S., Croft, A., "Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome", 3rd Ed., Lippincott Williams Wilkens, 2002.
2) Jaskoviak, P., Schafer, R., "Applied Physiotherapy", ACA Press, 1986, 5th Printing 1992. 
3) Geisser ME, et. al., "A Randomized, Controlled Trial of Manual Therapy and Specific Adjuvant Exercise for Chronic Low Back Pain," Clinical Journal of Pain, 21 (6): 463-470, 11/12 2005.
4) Pearson, R, "Osteopathic Treatment for Low Back Pain," J of Osteopathic Medicine, 20-26, 6/92. *NB:this article discussed the use of intersegmental traction and it's effectiveness.
5)
BenEliyahu, DJ, "MR imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations," JMPT, 7/97. *NB: this article also demonstrated the positive effects of chiropractic manipulative reductions along with traction for patients.
6) Jackson R, "The Cervical Syndrome," 4th Ed., Springfield, Charles C.  Thomas, 1978 p285-286. *in this book Dr. Jackson actually states than anyone treating traumatic cervical spine injuries must use motorized traction units to get the best results. -Barring serious contraindications such as fracture.
7) Kellet, J, "Acute Soft Tissue Injuries-A Review of the Literature," American C. of Sports Med., Vol 18 (5), 3/86. *Hard to find article on the efficacy of early intervention with rehab and modalities in acutely injured patients.
8)
Liebenson, C, "Rehabilitation of the Spine," Lippincott Williams & Wilkins, 2nd Ed., 3/2006.
9) Liebenson, C,"Rehabilitation and the Chiropractic Practice," JMPT, Vol. 19(2), 2/96
10) Fairbank, F., et.al., "Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC stabilization trial," Brit. Med. J., 5/2005. *Very interesting article where a group of low back surgical patients were divided into two equal groups; one group went ahead with surgery, the other group received primarily aggressive rehabilitation methods and did NOT have surgery. The outcome assessments, utilizing the OSWESTRY Disability Index and the Shuttle Walking Test indicated there were no differences between the two groups which strongly suggested that the much cheaper and cost effective non-surgical approch to LBP is effective. While some of the rehab patients eventually opted for surgery, about 73% avoided surgery altogether. Considering all of these patients were going to go under the knife, this was a major breakthrough. Well worth reading in its entirety.
11) Kristjansson E, Leiveseth G, et.al., "Increased Sagittal Plane Segmental Motion in the Lower Cervical Spine in Women with Chronic Whiplash-Associated Disorders, Grades I-II: A Case Control Study Using a New Measurement Protocol," Spine, 10/2003, 28(19): 2215-2221. In this incredible article, the authors suggest this: "It is hyposthesizd that unphysiological spinal motion experienced during an auto accident may result in a persistent disturbance of segmental motion." Which is what we DCs have been saying for decades; this describes the actual vertebral subluxation complex. "The intervertebral disc is the most important struture preventing abnormal increased segmental translational motion." All of which suggests that if there is segmental hypermobility that the disc itself has been injured. "These findings suggest that some patients with whiplash need a specific exercise therapy targeting the deep segmental muscles to enhance proper segmental alignment and movement control of segmental motions in the cervical spine." Here, the authors flat out state that rehabilitation methods would be a great idea for some whiplash sufferers.

What about Electrical Stimulation?

There are a number of forms of E stim such as Interferential Current (from the word interference), galvanic, low volt and high volt. At Boston Spine Clinics, we use almost exclusively Interferential Current although the whole family of Electrical Stim settings have their place in patient therapeusis. We have had consistently great results with the use of E stim over the decades. Most practicing doctors who use therapies like this will agree. And, they are extremely safe. We've never had a patient accident with any of our modalities including E stim. The goal is to reduce pain and  inflammation and in this regard, E stim helps nicely.  See:

Glaser J, Baltz M, Nietert P, Bensen C, "Electrical muscle stimulation as an adjunct to exercise therapy in the treatment of nonacute low back pain: A randomized trial:," Vol 2 (5), Oct. 2001,  J Am Pain Soc.

Revord J, "Interferential Current (IFC)," Pain Managment, 11/99


What's Up With Traction?

There has been some controversy involving traction as a reliable treatment modality for chiropractors. Here in Massachusetts we point out the fact that currently, traction is actually listed on the Board WEB site as a modality that can be used to treat muscle spasm and relieve some of the pain in the spine as well as mobilize vertebral segments. However, as I edit this WEB page (summer, 2006), there is a move afoot in chiropractic that espouses the concept that everything we do MUST be in the literature or it is no good. Several past studies have been published that spoke against traction. They were, 1) "Acute LB Problems in Adults," US Dept. Health & Human Services, 1994, 2) "The Quebec Task Force on Spinal Disorders," Quebec Task Force, 1987.  

First, the Health and Human Services report was archived by its own authors and discarded as being hopelessly out of date several years ago. Secondly,  the Quebec Task Force was a group of MDs with one DC on the panel that ignored most of the latest (at the time) and best whiplash and therapy research. In fact, their methodology indicated that 98% of the then current literature was NOT reviewed. Their conclusions were based on when insurance companies had finished paying claims, NOT by resolutions of symptoms or patient outcome studies. Patient complaints as such were left out of the data set.

There were many other studies cited in these two flawed studies. They have been reviewed, methodology analyzed and what we have is a common problem with them all; wildly varied methodology. One study was done with innefective traction force, another study(Coxhead, et.al. 1981) didn't even think to list the pounds of traction force used, yet concluded there was no benefit from traction. But, because his study was a radomized clinical study (RCS), his paper was accepted with no questions asked. Another problem with traction studies is their generally poorly defined or non-validated patient selection. Some studies grouped all patients with LBP together and did not distinguish  between sub-groups or by DX thus, many of the patients in the various studies would not have been considered candidates  for traction by clinicians. No major anti-traction study studied reported reliability or validity of methods used to select patients. Another problem that is found with some of the "good" (RCT) research is that the treatment method is question is usually studied in isolation, rather than in combination with other forms of treatment. This is necessary to eliminate multiple variables that may make it difficult to adjudicate exactly what treatment works or not. While this approach may work in the research world, results garnered this way don't really apply to the real world of clinical operations where patients are subject to several therapies. Traction is often used in concert with other therapies such as passive extension exercises  for treatment of herniated lumbar discs. (Saal 1989 & Saunders 1993). Clinically, it could be said that combination therapies result in success, not either therapy alone. Furthermore, if either therapy were studied in isolation, results may show neither has any validity.

Consider the Saal & Saal (1989) study which reported a treatment protocol success rate of 90% (good or excellent) outcomes and a 92% return to work rate in 64 patients with herniated lumbar discs with radiculopathy. Their treatment regime included pain control measures, back school, specific exercises with traction used in the most severe subset of patients. Thus, even though traction was clearly not used alone, this study does give us a "real world" scenario of what real clinicians do in real clinical settings; that of using multiple therapies. In a separte study, (1996) Saal, et. al., reported excellent results with cervical disc herniations under similar circumstances; traction was used with other therapies such as pain control measures, manual and mechanical traction, strengthening exercises, posture control and body mechanics training. Clearly, a "rush to judgement" against traction in all of its forms is folly. The literature is flawed, to say the least, when it comes to abandoning traction.

Interesting Stuff: In an old article recently discovered, by Emil Seletz, MD, he tells us that manipulation and traction are effective modalities. How refreshing. The article was written in 1958!! By an MD no less. It is well worth reading: Seletz E, "WHIPLASH: Neurophysiological Basis for Pain and Methods used for Rehabilitation," JAMA, Nov. 1958, pp. 1750-1755. In this article, Seletz states that "Treatments must be religiously carried out daily during the first two or three weeks and then about three times weekly." He also states that "traction relieves muscle spasm and enlarges the intervertebral foramina, helps to relieve obstruction to the course of the vertebral arteries, and may prevent the formation of adhesions between the dural sleeve of the nerve roots and the adjacent structures." He also stated that "using a cervical pillow is an excellent idea."

Cervical Pillows:

In an interesting article appearing in JMPT (Journal of Manipulative and Physilogical Therapeutics), the authors concluded that a well constructed cervical orthopedic pillow that supports the natural lordosis of the human cervical spine "can be recommended." Find this study at Persson L, Moritz U, "Neck Support Pillow: A Comparitive Study," JMPT 1998; 21: 237 - 240.

Valerian Root:

We are occasionally asked about the Valerian Root we give to patients after a ballistic impaction. Valerian Root is a natural herb and is a very safe, wholistic alternative to medical scripted muscle relaxants. Valerian Root is a natural muscle relaxant that can induce sleep, thus, in short it is a sedative. See Donaldson J, "Valerian Root," Insight Wellness Jour, Nov. 2004 

Dr. John Haberstroh is a Somerville chiropractor and Boston chiropractor.  Tell your friends to find us at Boston Spine Clinics.

 

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"Extremity Rehab Station"

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"Treadmill"

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"Electrical Stim"

 

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"Linear Traction"

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"Clark"

 

 


 

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marker 27 Wolcott Street
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