By Office Staff Chiropractic Chiropractic Education, Nexpert Chiropractic

Chiropractic Education

Many people seem surprised to find out that the chiropractic education process is so extensive. I usually reply, “…whether you’re planning to become a chiropractor, medical doctor, or dentist, it takes four years of college followed by and additional 4-5 years of additional education (med school, dental school, chiropractic college) simply because there is that much to learn about the body to become a competent health care provider. “

Hence, depending on the area of interest a person has in the health care industry, it takes a similar amount of time to complete the educational program.

DID YOU KNOW…

The initial step is completing a typical “pre-med” undergraduate or college degree.
Courses including biology, inorganic and organic chemistry, physics, psychology, various science labs, as well as all the liberal art requirements needed to graduate are included in the undergraduate education process.
Many states now require 4 years of college in addition to the 4 to 5 academic years of chiropractic education to practice in their particular state.
Once entering a chiropractic university, the same format exists as most health care disciplines.
The basic sciences are covered in the first half of the educational process after which time successful completion of the National Boards Part I examination is required to move into the second half – the clinical sciences.
From there, internships, residency programs, preceptorship programs become available to the chiropractic student.
Once graduated, residence programs including (but not limited to) orthopedics, neurology, pediatrics, radiology, sports medicine, rehabilitation, internal medicine, and others are options. Many various Masters and doctorate programs in specialty areas are also available.

This chart shows the similarities between three health care delivery approaches, DC, MD, and DPT (doctor of physiotherapy). Curriculum Requirements For the Doctor of Chiropractic Degree (DC) in comparison to the Doctor of Medicine Degree (MD) and the Doctor of Physical Therapy Degree (DPT):

*Does not include hours attributed to post-graduation residency programs.

AS YOU CAN SEE, THE ACTUAL NUMBER OF AVERAGE CLASSROOM AND CLINICAL STUDY HOURS PRIOR TO GRADUATION IS EVEN HIGHER FOR CHIROPRACTIC COMPARED TO THE MD AND DPT CURRICULUM.

It should be noted that this does not include additional educational training associated with residency programs, which are available in the three disciplines compared here.

At one of the chiropractic colleges, the academic core program or Clinical Practice Curriculum consists of 308 credit hours of course study and includes 4,620 contact hours of lecture, laboratory and clinical education.

There are 10 trimesters of education arranged in a prerequisite sequence.

The degree of Doctor of Chiropractic (D.C.) is awarded upon successful completion of the required course of study.

In order to receive a degree, a student must have satisfied all academic and clinical requirements and must have earned no less than the final 25 percent of the total credits required for the D.C. degree, allowing up to 75 percent of the total credits through advanced standing.

The academic program may be completed in three and one-third calendar years of continuous residency. Graduation, however, is contingent upon completion of the program in accordance with the standards of the College, which meet or exceed those of its accrediting agencies.

In addition to courses included in the core curriculum, a variety of procedure electives are available to the students. These electives are designed to complement the study of adjustive procedures included and facilitate investigation of specialized techniques.

As a doctor of chiropractic, we are committed to providing the highest quality care available to our patients. We coordinate care with other doctors when appropriate in quest of reaching the goal of our helping our patients in the most efficient, economic, and evidence-based approach possible.

By Office Staff Whiplash Nexpert Chiropractic, The Only Proven Effective Treatment for Chronic Whiplash?

The Only Proven Effective Treatment for Chronic Whiplash?

You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?” This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications. On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between. Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging. To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care. The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.” In the study, 93 patients were divided into three groups consisting of:

Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;
Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,
Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.

The average time from injury to first treatment was 12 months and an average of 19 treatments over a 4 month time frame was utilized. The patients were graded on a 4-point scale that described their symptoms before and after treatment. Grade A patients were pain free; Grade B patients reported their pain as a “nuisance;” Grade C patients had partial activity limitations due to pain; and Grade D patients were disabled.

Here are the results:

Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.
Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.
Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.

This study is very important as it illustrates how effective chiropractic care is for patients who have sustained a motor vehicle crash with a resulting whiplash injury. It’s important to note the type of patient presentation that responded best to care had neurological complaints and associated abnormal neck range of motion. This differs from other non-chiropractic studies where it is reported that patients with neurological dysfunction responded poorly when compared to a group similar to the Group A patient here (neck/shoulder pain, reduced neck ROM, and with normal neurological function).

By Office Staff Whiplash Nexpert Chiropractic, Whiplash – What is the Best Type of Treatment?

Whiplash – What is the Best Type of Treatment?

Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury. So the question on deck is, which of the health care services best addresses the injured whiplash patient?

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22- 25). The authors state conventional [medical] treatment utilized in whiplash care, “is disappointing.” The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit”; Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement”; Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.”

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3).Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

By Office Staff Whiplash Nexpert Chiropractic, What Really Causes Whiplash?

What Really Causes Whiplash?

Whiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening. This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”

The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.

Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more. The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed. The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car. When metal crushes, energy is absorbed and less energy affects the vehicle’s contents (technically called plastic deformity). This is exemplified by race cars. When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision. Sometimes, all that is left after the collision is the cage surrounding the driver.

Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury. Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm. If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue. These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years. There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.

By Office Staff Whiplash Nexpert Chiropractic, Whiplash Facts

Whiplash Facts

Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” or WAD, was introduced. The WAD classification of whiplash patients includes 3 main category (WAD I, II and III) and a few years later, WAD II was broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:

WAD I: Patients have complaints but no objective findings meaning we cannot reproduce your pain during our examinations
WAD IIa: Patients have complaints with objective findings but a normal range of movement of the neck and no neurological findings (normal strength and sensation ability)
WAD IIb: Same as WAD IIa except here, neck movements are decreased
WAD III: Here, neurological abnormal findings (weakness and/or sensation) are present.
WAD IV: Includes fractures and dislocations. Because of this unique difference, this category is often left out of the research that uses this category system to determine prognosis of the WAD case.

This system is very useful as it has the ability to predict the results in a case long before the conclusion of the case.

We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, less damage to the car transfers greater forces to the contents inside because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).

Symptoms of whiplash vary widely. Most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post- traumatic stress syndrome, sleep disturbance, and social isolation can occur.

Diagnosis is based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice and later heat, exercise, pain management and avoiding prolonged use of a collar. Chiropractic includes all of these as well as manipulation, mobilization, muscle release methods, and patient education. Prompt return to normal activity including work is important to avoid the negative spiral into long term disability.

By Office Staff Whiplash Car Accidents and Mild Traumatic Brain Injury, Nexpert Chiropractic

Car Accidents and Mild Traumatic Brain Injury

When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal. Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt. When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events. Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, “…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!”

Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.

As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash. This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.

The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.

The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.

By Office Staff Fibramyalgia Fibromyalgia And Your Upper Neck, Nexpert Chiropractic

Fibromyalgia And Your Upper Neck

How can a spinal problem possibly contribute to your fibromyalgia symptoms? As with many disorders, especially pain, the nervous system is involved. The nervous system can get affected thorough structural changes in the spinal column. The classic one is the disk bulge producing a painful sciatic nerve. But, there are also other ways to interfere with the function of nervous system.

When viewing the neck from the side, there should be a forward curve with your head above your shoulders, not in front of them. When forward head carriage is present or when there is a reduction in this forward arch, this may cause additional strain to the upper cervical spine or spinal cord, allowing delicate nerves to be compromised. Chiropractic care should improve your posture if this forward head carriage is present.

The upper neck can also be influenced by malalignment/subluxation of the upper vertebrae, such as the atlas. This small bone supports the weight of the skull and is necessary for the great rotational range of motion of the neck.

During neck trauma, the head and neck can be put through a violent range of motion that causes the soft tissues (muscles and ligaments) to tear. Blows to the head, childhood or sports injuries and even poor sleeping posture, can cause the upper neck vertebrae to displace, injuring the soft tissues of the joint. Swelling and inflammation can also be a source of irritation to the nervous system. Scar tissue can develop after trauma, which may affect the precise movements of the upper neck.

The atlas surrounds the spinal cord and as it displaces, it can also pull or tether the spinal cord through attachments of delicate ligaments (dentate). This could cause irritation to the nervous system.

The disorders of poor posture and displaced vertebrae can be assessed through x-rays. Range of motion tests are necessary to see how your function may be affected. In some patients, fibromyalgia symptoms can improve substantially. However, most people will need a comprehensive approach that also incorporates an exercise program and nutritional or weight loss support. Chiropractic care is a natural alternative for those who wish a drug-free and non- invasive approach. It carries few risks of side effects and is balanced by the potential to help patients who also have spinal disorders contributing to their poor health.

By Office Staff Fibramyalgia Fibromyalgia – Can Chiropractic Help... Who Says, Nexpert Chiropractic

Fibromyalgia – Can Chiropractic Help… Who Says?

Fibromyalgia (FM) is one of the most commonly diagnosed soft tissue conditions in most branches of health care, including chiropractic. A paper was recently published with the primary purpose to review the existing literature / published research to determine what aspects of chiropractic treatment are the most commonly used and, to determine the quality of those treatment approaches. The emphasis of the study was to look at non-drug, conservative forms of therapy, rather than medication based approaches.

Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/ body awareness, vitamins, herbs, and dietary modification. Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise. This study places chiropractic in a very favorable position in the management of FM.

Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications. Patients with FM require a multi- dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population.

Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition. Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary. When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.

By Office Staff Fibramyalgia Fibromyalgia & Chiropractic Care, Nexpert Chiropractic

Fibromyalgia & Chiropractic Care

Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.

Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?

The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.

Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.

By Office Staff Fibramyalgia Fibromyalgia: I Have It... Now What?, Nexpert Chiropractic

Fibromyalgia: I Have It… Now What?

“…I was told by my doctor that I have fibromyalgia and I don’t know what to do. I’ve noticed that over the last couple of years that I’ve been having a progressively harder time doing simple tasks that I used to take for granted like folding laundry, ironing, cooking, cutting up vegetables, sewing, driving a car, holding a book, and even sleeping has become very challenging. I have to take many breaks while I’m doing these tasks and even take a nap in the middle of the day. I never used to have to do that! My family doctor initially seemed interested in helping me. He listened to me, took some blood, took some x-rays, and then said ‘….everything looks fine.’ His conclusion was that I must have fibromyalgia – I’ve never even heard of that! He prescribed many different drugs. One was to help me sleep but all it did was knock me out to the point where I couldn’t get up in the morning and felt so groggy that I couldn’t function. Then, he tried this other one and I felt like I wanted to crawl out of my skin! I’ve tried 3 or 4 different drugs and the side effects were all worse than what I’m dealing with, without the drugs. He finally concluded, ‘…you’ll just have to learn how to live with it.’ Well, thank you very much, doctor! Tell me HOW to do that?”

That feeling of helplessness and not knowing what to do next is a common complaint among fibromyalgia (FM) sufferers and the fact is, many patients with FM simply CAN’T just “…learn to live with it,” and need guidance.

One such patient recently presented in such situation. After a detailed history, the chiropractor checked her vital signs, performed a physical exam that included observation, palpation, range of motion, physical performance testing, orthopedic and neurological tests and then sat down to discuss the findings and what specific things chiropractic could offer her. The chiropractor laid out a treatment that consisted of the following:

Leg length correction: she had a 12mm short right leg, a tipped pelvis with a compensatory curve in the low back. Heel lifts were recommended.
Foot orthotics: she had flat feet and rolled in ankles that were altering her gait pattern.
Exercises: she was quite deconditioned (out of shape) and needed help with flexibility, strength and endurance, balance/coordination, and aerobic function.
Spinal manipulation: She had areas in her spine that were not properly moving and she had to compensate and use other parts too much, setting up faulty movement habits.
Nutritional counseling: She was consuming too many glutens (wheat, oats, barley, rice) which can make you feel tire/fatigued/”wiped out” all the time. She was placed on a strict gluten-free diet and encouraged to use of several nutrients.
They discussed “realistic goals.” This was probably the MOST important part for her. She was told NOT to expect a “cure” but rather, a means of “controlling” FM. It was emphasized that expecting “too much” will set her up for disappointment and treatment failure. They discussed ways she could control or minimize the symptoms of FM and what the role of chiropractic played in that management process. They also discussed finding a family doctor who was willing to work with her chiropractor.

Her doctor reports she is doing very well, independent of regular doctor visits, and is for the first time in a long time, happy with her ability to control her FM condition.

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