Proudly Treating Families of Chicagoland Since 2000

Dr. Andre is temporarily not accepting patients, sorry for the inconvenience.

Give us a Call
+1 (847) 679-6480
Read | Stretch Your Body
Article| Stretch Your Life

Tag: Nexpert Chiropractic

Nexpert Chiropractic - Dr. Andre PisarevNewsNexpert Chiropractic
By Office Staff Carpal Tunnel Syndrome ,

Carpal Tunnel: Results of a Clinical trial of Two Treatments

Carpal tunnel syndrome occurs when the median nerve, which starts at the neck and runs from the forearm into the hand, becomes compressed or squeezed at the wrist. In some cases there may also be compression at the spine.

The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger), as well as impulses to some small muscles in the hand that allow the thumb and fingers to move.

A recent study in the Journal of Manipulative and Physiological Therapeutics compared two different conservative treatments for patients with mild to moderate carpal tunnel symptoms. One treatment was the Graston technique, which uses an instrument to rub the forearm, wrist and hand areas to breakdown scar tissue and adhesions. In the other treatment a chiropractor applied deep pressure by hand to the same areas. These treatments are thought to release tight muscles and myofascial restrictions.

The patients got the treatments twice each week for four weeks followed by one treatment a week for two additional weeks. The patients also did at-home stretching exercises. They did not use common conservative treatments such as wrist splints and anti-inflammatory medications.

After both interventions, there were objective improvements to nerve conduction latencies (nerve function), wrist strength, and wrist motion. The patient symptoms of pain also improved, and both groups reported high satisfaction with the care they received.

Despite surgery being in widespread use in the US for carpal tunnel syndrome, it is important for conservative treatments to be tried prior to an invasive operation.

The surgical complication rates are low but when they do occur, can be devastating. In addition to direct surgery costs, one has to also consider disability payments (not working), and rehabilitation that may take several weeks. These costs can be substantial. For this reason, many medical doctors recommend conservative treatments first.

Of all the conservative options, manual therapy by a chiropractor is an excellent choice. It comes without the side effects associated with long-term use of medications.

A comprehensive examination by a Doctor of Chiropractic can determine if your carpal tunnel symptoms are likely to respond to care. He or she can also advise on at-home stretching exercises that can be done to help recovery. In some cases, hidden spinal and neck problems can influence carpal tunnel symptoms, and be the key to treating the cause vs. the symptom.

By Office Staff Carpal Tunnel Syndrome ,

Carpal Tunnel Syndrome – Chiropractic vs. Medical Treatment

There are many patients who suffer from Carpal Tunnel Syndrome (CTS). In fact, CTS is one of the most common work related injuries. In spite of multiple studies that show the benefits of chiropractic treatment with patients suffering from CTS, many medical doctors are unaware of the studies and still tell their patients that chiropractic treatment is either ineffective, or may actually harm them. This unsupported ill advice can easily result in the patient not even considering chiropractic care as a potential effective form of treatment. This can be especially damaging to a patient who cannot tolerate anti- inflammatory medications such as Ibuprofen, Aleve, or aspirin. In fact, side effects secondary to stomach pain (gastritis and/or ulcer) can be quite common, especially at the recommended dose of 2400 mg / day. Moreover, if poor tolerance to these medications exists and a unsatisfying response to conservative medical treatment occurs, the “next step” offered to the patient may be surgery. Surgery that may have been avoidable had chiropractic treatment been considered on an equal par to non-surgical medical care.

There are several studies available that will enlighten those who simply are not aware of the effectiveness of chiropractic care in the treatment of CTS. In 1998, a 91 patient group was divided in half and treated for 9 weeks by either a non-surgical medical approach or by a chiropractic treatment approach. The medical approach included the use of 800 mg of Ibuprofen, 3x/day for 1 week, 2x/day for 1 week, and 800mg as needed to a maximum of 2400 mg/day dose for 7 weeks, as well as the use of a nighttime wrist splint. The chiropractic group utilized manipulation of the bony joints and soft tissues of the spine and upper extremity for 3x/week for 2 weeks, 2x/week for 3 weeks, and 1x/week for 4 weeks, in addition to ultrasound over the carpal tunnel and a wrist splint at night. It was reported that BOTH the medical and the chiropractic patient groups did equally well stating, “significant improvement in perceived comfort and function, nerve conduction and finger sensation.”

In 2007, two different chiropractic approaches were compared and found to both be equally effective in improving nerve conduction, wrist strength, and wrist motion as well as patient satisfaction and daily activity function. These improvements were maintained for 3 months in both groups equally as well. Another study reported significant improvements in strength, range of motion, and pain after chiropractic treatment was given to 25 patients diagnosed with CTS. The majority of the patients reported continued improvements for 6 months or more. There are other studies but I think the point is obvious – chiropractic treatment helps patients with CTS.

The type of treatment that one may receive when being treated by a chiropractor includes manipulation of the bony joints of the neck and upper extremity. The objective of this is to improve the mobility of the joints and loosen the muscles through which the nerves pass, particularly, the median nerve that runs through the carpal tunnel and innervates the 2nd to 4th fingers. There are several exercises of both stretching and strengthening types that strive for similar goals. Physical therapy modalities such as low-level laser therapy have reported beneficial results. Other modalities such as ultrasound, interferential current (IFC), ice massage/cupping over the tunnel, and others may also be utilized. Nighttime wrist splints or braces also help to keep the wrist straight so that prolonged bending of the wrist at night is not possible. There may be other treatment approaches that your chiropractic physician may suggest on an individual case basis.

By Office Staff Carpal Tunnel Syndrome ,

Carpal Tunnel Syndrome (CTS) – What Does Research Show?

So often we hear, “…well if it’s so good, show me the proof!” Chiropractic case management of CTS has been well established for many years. And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS. If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

  1. Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial” J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment. The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, & 800 mg as needed for 7 wks) plus a night wrist splint. Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.
  2. Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting. Also, soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures. Also, a significant reduction in pain and distress ratings was reported.
  3. Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5In 1973, Upton and McComas first proposed the presence of the “double crush syndrome.” Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., “double crush syndrome” was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed. The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.
By Office Staff Carpal Tunnel Syndrome ,

Do I Have to Have Surgery For Carpal Tunnel Syndrome?

“For the last few months, I’ve been waking up at night with numbness and tingling in my hand. Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep. When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery. What are my non-surgical options?”

CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed. Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.

There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology. In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically. A partial list of non-surgical care options include:

  1. Rest – Giving the inflamed CTS time to heal is therapeutic but not always an option.
  2. Activity/job modifications – Avoiding certain activities or modifying them by taking breaks during the work day, slowing down the pace of the job, altering the position of the job task, such as propping up a part so that the wrists do not have to bend to the extremes, or when necessary, complete avoidance of the job task.
  3. Wrist Splint – This is a brace that maintains the wrist in a neutral position so it cannot easily bend. When the wrist flexes or extends, the pressure inside the carpal tunnel (on the palm side of the wrist) increases significantly, placing additional pressure on the already pinched median nerve. Wrist splints are especially useful at night.
  4. Nerve Gliding Exercises – These are exercises that stretch the wrist joint and muscle tendons (as well as the median nerve inside the carpal tunnel), with the objective of breaking adhesions that limit the normal glide or movement of the nerve in the forearm and wrist.
  5. Manual therapy techniques – These include manipulation of the arm including the forearm, wrist, and hand and sometimes the neck and shoulder, when needed. The objective is to improve the range of motion of the joints and soft tissues that may be participating in the process of median nerve pinching.
  6. Anti-inflammatory medication / nutrients – Medications include aspirin, ibuprofen, naproxen and similar prescription drugs. Nutritional options including herbs (such as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may also help. Ice is also anti-inflammatory and direct, on-the-skin ice massage is quite effective.
By Office Staff Carpal Tunnel Syndrome ,

Carpal Tunnel Syndrome – What Can You Do For It?

Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?” As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like CTS:

  1. A thorough history is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive. Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
  2. A Physical Exam to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
  3. Treatment can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
  4. Home Therapies are the main topic for this Health Update. What can YOU do for CTS?

Here are some of the things that you, the CTS sufferer can self-manage:

A Carpal tunnel splint is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.

Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as:

  1. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand)
  2. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand).
  3. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch!
  4. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times.
  5. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table– elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times.
  6. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed.
  7. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down.
  8. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the doorframe, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.

Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.

By Office Staff Headaches ,

The Importance of Headache Diagnosis

All good doctors know the importance of getting an accurate diagnosis of a patient’s problem. But why is this so important? It’s important because without knowing what is the disease or injury, the treatment cannot be directed to the actual problem.

Unfortunately, when it comes to headaches, many patients do not receive an accurate diagnosis. If a patient were to see a doctor with a pain in the head and the doctor were to conclude that you have a pain in your head (headache), this tells little about the actual problem. In headache patients, we’ve become very good at labeling problems-giving them a name. If the headache comes and goes we call it episodic. If it occurs suddenly we call it acute, and if it occurs over many years we say it is chronic. But are these labels really helpful?

The reality is everyday people show up in doctors offices, obtain cursory examinations and walk out with a prescription for their head pain. Not all doctors do this, of course, but with the time constraints of managed care and the insurance company oversight, a doctor’s visit is just not what it used to be. When was the last time you had a house call from a doctor? Of course, the worst case is when a patient acts as their own doctor, sees an advertisement for a pill and does the diagnosing himself or herself!

In chiropractic, we may also label your headache as tension-type, migraine or chronic, but a good chiropractor will not stop there. The label does not give much of an indication of what needs to be done, and more importantly we still do not know the CAUSE of the pain. Clinical experience and research over many decades has shown that many headaches are actually caused by injuries to the neck and spine. But if a doctor does not examine the neck, they may not discover these hidden injuries. Sometimes an astute doctor will take a history and it may be discovered you had a whiplash or other neck trauma, months or even years earlier. This is important information to get at the cause.

We take a comprehensive approach to headache patients at our clinic. A detailed history about the location, duration, and quality of pain is followed up by a thorough physical examination, especially of your spinal column. We may also order imaging tests such as x-rays to see the positions of the individual vertebrae in your neck.

The normal neck has a forward curve or arch, which keeps your head upright and directly above your shoulders. When this curve is lost, the patient’s head is thrust forward in the classic “bad posture” stance. Making sure your neck is both flexible, and in good postural alignment, is critical to maintaining good health.

By Office Staff Headaches ,

Chiropractic Manipulation: A New Study Regarding Headaches

Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

By Office Staff Headaches ,

Headaches – How Does Chiropractic Work?

Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

By Office Staff Headaches ,

Side Effects of Chiropractic vs. Medications for Headaches

Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.

It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDs, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX-2 selective inhibitors, such as Celebrex.

According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Acetaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).

Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.”

Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medications for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.

The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.

By Office Staff Back Pain ,

Chiropractic Care For Low Back Pain – What Does the Research Say?

There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain. Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.” But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history. In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today. Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care. Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):

  1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437. http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml
  2. Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada.http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
  3. Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR).http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870
  4. Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up. British Medical Journal 1995 (Aug 5); 311 (7001): 349–351http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml
  5. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1); 29 (1): 79–86. http://www.ncbi.nlm.nih.gov/pubmed/14699281