Odds are that we will all suffer some debilitating lower back pain at some point in our life.  Chiropractic care can help us get back into full activity, and reduce our pain.  Some chiropractic patients do not respond to traditional treatment protocols and they need to be referred out for other procedures.  Sadly, there are some people who simply fail to get better no matter what is done to help them.  The million-dollar question is:  How can we identify those people at the onset of treatment?

The STarT Back Tool can help ID people who are at risk. This modle is the medical one, so it does not include chiropractic care, but it should be added to the middle tier.

Well we can’t accurately predict who will respond to care and who will fail.  But a tool has been circulating the academic circles and has started to find it’s way into the practitioners hands.  That tool is called the STarT Back Tool.  The tool is a short questionnaire  which can help categorize patients into risk tiers.  Those with the highest degree of risk, can be treated a bit more aggressively (and more expensively in the short term).  While those patients with fairly low risk can be treated more modestly.

The modest and conservative treatment protocols end up saving a lot of money in the long run.   The rationale is sound, especially in a time of medical expense austerity.

Chiropractic patients already enjoy a huge savings when it comes to taking care of their lower back pain.  The average cost of a non-complicated lower back injury treated by a chiropractor is a fraction of what the same injury cost would be if treated by a medical doctor.  As a bonus, the risk of drug dependency in the chiropractic group is non-existent since chiropractors do not prescribe medications.

As physicians, both medical and chiropractic, we are sensitive to the amount of paperwork our patients need to fill out on their first visit.  But don’t be surprised if this paperwork gets slipped the pile.

Dr. Andrew White
St George Chiropractor who actually reads new research articles.

Start Back Questionnaire for Low Back Pain

Exercise can lead to mircro-trauma to the joints and spine

The residents of St George UT are active. They bike, run, walk, hike, play pickle-ball, and many other stressful things. Stressful? Did we just say that exercise was stressful? Yes, exercise is stressful on the body, but not always in a bad way. Stress, in this context, simply means pressure or force applied to the body. The body responds to stress in good and bad ways. When the body is injured during an activity, it’s time to call on of St George’s excellent chiropractors.

Wolf’s Law of Bone

These young seedlings need to be placed outside in order to harden. The stress of the outside environment strengthens their stem.

When bone is subjected to low grade stresses over time, new bone growth is stimulated to help secure the bone.  Think of a weak seedlings that are protected from wind.  They grow on the ground and never seem to develop strong stems.  The process of strengthening young seedlings includes placing them outside and ‘hardening’ them.  The stress of being outside, and be jostled by the wind, stimulated stronger cell wall growth and promotes a stronger stem.  If the plants are not allowed to harden, they fail to thrive.

The human body responds to stress like these plants.  As we exercise and move, our bones harden and become stronger.  This process is known as Wolf’s Law.

Stress Fracture result from focused stress

Just as the body responds favorably to stresses described above, there are times when a bone can become weakened do to too much pressure.  If a person begins a new exercise program or introduces new elements into an existing program without properly working up to the goal, they can cause focal pressure on certain bones resulting in Stress Fractures.

Here is a classic example:  a lady who used to run 5 miles everyday prior to a pregnancy, took 5 months off from running at the end of her pregnancy.  Now that the baby is a few months old, she wants to start running again.  She started running 2 miles a day for one week, then the following week was doing 3 miles.  On the third week, she was back up to 5 miles each day.  She now has pain in the middle and outside of a foot.

In this case, she was still fit enough to run.  Her heart was strong; her muscles were still fit.  But the time off allowed her bones to weaken and the quick return to full activity prompted a stress fracture.  A better idea for her would be to slow down the return to 5 miles, having her run 1 mile for the first week, then 2 miles the following week, 3 miles for 3 weeks, then 4, and finally 5 miles per day.  The slow return allows the body time to reinvest into stronger bones.

Common stress fracture injury sites

Stress fractures typically form in the legs and feet.  Here is a list of common injury sites and the typical activity causing the stress fracture.

• calcaneus — jumping, and running with strong heel plant.
• tibia/fibula — running, and soccer
• pelvis — gymnastics
• ribs — heavy lifting, coughing
• scapula, coracoid process — trap shooting
• humerus, ulna — throwing baseball, pitching
• hamate in the wrist– golf, baseball

Chiropractic treatment for stress fracture

Patients are surprised to hear that chiropractors treat stress fracture injuries.  Chiropractors who are specially trained can be a great help in getting the stress fracture to heal properly.  Of course chiropractors are not adjusting the bone with the fracture.  We focus on the processes that lead up to the injury and speed recovery of the injury.

In my chiropractic office in St George, we treat a number stress fractures.  Our focus includes the following:

• bracing the stress fracture
• balance the weight-bearing joints for a more effective load distribution
• improve joint mechanics to reduce focused stresses on the neighboring joints
• life-style education and training
• physiotherapy to the fracture to promote faster recovery and healing

Not all chiropractors treat stress fractures.  So you need to make sure you do a little home-work and select the right one.

Dr. Andrew White
Chiropractor in St George UT treating stress fractures

Stress Fracture Management

Most of us know someone who has had back surgery to fix their pain.  Instead of seeking chiropractic care first, they went for the expensive and risky knife.  How many of those people found relief and were pain free a year later?  Not many.

Back surgery has a high fail rate

Roughly half of all back surgeries fail; the patient still has pain and are even worse off following the surgery. Would they have responded better had they chosen a chiropractic approach first?  Who knows but the studies show that chiropractic care is safe, effective, and far less risky than surgery.  A recent study published in the Annals of the Rheumatic Diseases (Ann Rheum Dis 2010;69:1643-1648) suggests that surgery for back pain is over utilized.

Patients were tracked for 2 years following their surgeries.  There was no significant difference in pain levels or function between the people who had surgery and those who did not.  The major difference between the two groups dealt with the degree of post surgical scar-tissue causing a new pain syndrome.  The surgeries should be the last option.  But as this study suggests, they are being considered too quickly and are not providing the results hoped for and are even leading to more harm and more pain.

Other non-surgical options

When Dr. White talks to patients about their treatment options for lower back pain, he includes a discussion on  various protocols for pain management.   He attends medical continuing education sponsored by Dixie Regional Medical Center and hosted at the hospital.  Dr. White stays informed on the new methods and techniques which are available here in St George.  He has professional working relationships with medical pain specialists in the region.  If the patient would be better served by a team approach, then Dr. White assembles a team of specialists to work on the pain with Dr. White leading the chiropractic approach.

Innova Pain Clinic – Chiropractic St George

Back Surgery Overused, According to Study

Dr. Andrew White has been successfully treating heel pain using specific, proven protocols since 1995. Let our office help you with your heel pain.

Do your first morning steps hurt?  Do you have heel pain on the bottom of your feet?  Have you been diagnosed with Calcaneal Heel Spur?  If so, our chiropractic office in St George can help.  Heel spur pain can be sharp, stabbing, and can dramatically alter your activities of daily living.  There are treatments available and our chiropractic office is here to help.

The heel spur is a calcium deposit which grows slowly on the calcaneal bone of the foot.  The calcium deposit is often the result of chronic stress and tugging from chronic plantar fasciitis.   The spur can irritate a fat-pad which protects that portion of the heel bone.

Treatment options include:

• Custom Orthotics designed specifically for your foot, to relieve pressure from the plantar fascia.
• Ultrasound Therapy for inflammation reduction and pain relief.
• HVLA Correction to the foot joints to promote proper bone posture and movement.
• Home Exercises to reduce the growth of the spur and reduce pain.

All of these treatment options are available at Innova Pain Clinic in St George UT.  We don’t just mask the pain with medication, we get to the source of the pain and correct it.

Dr. Andrew White
Heel Pain Chiropractor St George Utah

Heel Pain Relief and Chiropractic

New research involving brain mapping and functional imaging of the brain is shedding new light on how the brain deals with chronic pain. The research also shows that the principles and applications of chiropractic theories can positively affect chronic pain.

For many years, chronic pain was believed to be bound in the sensory nerves.  We used to see people get nerves surgically cut or ablated to reduce the signals from the nerves.  We still see some peripheral nerve ablations in the lower back, from time to time.

In the last few decades, researchers found some increasing evidence that certain chronic pain was being generated and maintained in the spinal cord. Then we began to see pain-pumps surgically implanted into the spine.  These pumps can deliver certain types of medications right onto the spinal cord, hoping to reduce chronic pain.

Well, this past week, a great study got us thinking about how the brain is involved with chronic pain.  The brain begins to learn pain patterns and those patterns become associated with other events.  If effect, the pain becomes a living memory and the brain is generating memories of pain, but the pain is actually felt.

For example, have you ever smelled something peculiar and had a memory flash or something else?  We all have that time time to time.  Our brain maps associations with certain memories.  When one stimulus is interpreted, the other associated links are also recalled.  Not too long ago, I had a nice hot bowl of oatmeal with chopped peaches at the bottom.  When I reached the bottom of the bowl and bit into a peach, I was instantly flooded with memories of my grandmother who used to make our oatmeal this way.  I could picture her kitchen and table.  I could actually smell her perfume–all from memory.  The trigger of the memories was the bite of peach oatmeal.

Our brain uses association links to make sense of the world.  Unfortunately, these links can be forged even when we do not want them.  In the case of pain, flexible brain maps are being created linking pain to certain activities.  Long after an injury has healed, the brain can recall the injury and experience pain echos. These echos are being generated by the sensorimotor, as well as limbic and frontal cortex of the brain.

Chiropractic care is able to relink and reshape the brain maps in order to disassociate the pain memories.  It takes time, and a full program including home stretches and physiotherapy, but there is hope for people in chronic pain.

We know how dangerous it is for people to use opioid medications like Lortab.  So if there is some other treatment options which are effective and safe, they must absolutely be considered.

Chiropractic care focuses on restoring balance and appropriate biomechanical function to joints and nerves.  We are not out to ‘pop backs’.  Our treatment is focused and specific.  There are detailed protocols we follow in order to restore structure and function to the articulations of the body.

If you are suffering from acute pain, seek the help of a doctor of chiropractic.  Your chiropractor can help you avoid turning your acute pain into chronic pain.  If you already have chronic pain, call a chiropractor who specializes in chronic pain and unlearn those memories.

Dr. Andrew White
Chronic and Acute Pain Chiropractor St George UT

Chronic Pain as a Function of Memory??

Whiplash injuries suffered from an auto accident can show up immediately or can take some time to become apparent. I have seen many patients with chronic neck pain years following their untreated whiplash injury. Commonly the patient will say something like, “I had a car crash 2 years ago. I felt fine at the time so I did not get any treatments for my neck.”

It is important to seek treatment for injuries from an auto accident as soon as possible. A chiropractor such as Dr. Andrew White in St George, UT can treat many types of pain associated with collisions. Our treatment protocols include physiotherapy such as electrical muscle stim and ultrasound, muscle rehabilitation, and HVLA manipulation techniques.

Next time you see someone rubbing their sore neck, think about the tissues under the skin. There are muscles, ligaments, tendons, fascia, and joint capsules just to name a few. Each of those structures can be injured in a car crash. They need to be treated as well. Just because the hospital said you were fine after your accident, that doesn’t mean that there was no damage. “Fine” in the ER/hospital dictionary means, “you won’t bleed to death in the next 10 minutes.”

Think of scar tissue as a spider-web with silky cables reaching out and attaching to your soft tissues (muscles, ligaments, tendons, fascia, and joint capsules). Unlike a regular spider-web, where the silk filaments can stretch, scar tissue does not stretch well. In fact, it is contractile–it shrinks! What happens if one of those scar fibers latched onto your nerves started to shrink? It will pull and tug on that nerve. The result: nerve pain, numbness, weakness, pins and needle sensations.

If someone you know has been in an accident, even a minor one, they need to be evaluated by a chiropractor who is experienced in handling the complicated bodily damage as well as the paper-work of a personal injury case. Dr Andrew White at the Innova Pain Clinic is that type of doctor. He has been successfully treating whiplash and auto injury cases since 1995.

Almost all auto accident cases will not cost the patient any out-of-pocket expense. Utah has a special type of auto insurance called PIP. It is already built into your car insurance. You have this protection in place. Use it. It will automatically pay for your examination by Dr. Andrew White. As the patient, you will have very little paper work to do.

Compare a normal (left) neck x-ray with the whiplsh neck (right). The person on the right suffered a whiplash injury and never saw a chiropractor to get it corrected. Note the chronic injury to the discs and joints.

Ignoring whiplash is a costly mistake

Some other chiropractic offices won't even file your Medicare claim for you. But don't worry at Innova Pain Clinic, we love our Medicare patients and we are happy to submit all your Medicare claims for you.

Medicare pays for your chiropractor visit! (if you find the right chiropractor)

With all the national media being focused on the budget and cutting Medicare and Medicaid, there are a lot of misconceptions about Medicare and what types of doctor visits they will pay for.

Just to make things clear, Medicare does pay for chiropractic care. As a Medicare beneficiary, you can see an in-network chiropractor and Medicare will pay for that service. Granted Medicare does not pay for x-rays or an exam. But it does cover your manipulation treatments. Thank goodness for small favors.

Why some doctors are dropping Medicare

The problem seems to be in finding in-network (aka participating) chiropractors. With Medicare cutting their reimbursement rates each year, and our cost of doing business increasing each year, it is not surprising to find that many doctors simply can not afford to see Medicare patients. Some doctors actually lose money seeing a Medicare patient.

Some specialties have been hit extra hard with deep cuts. The chiropractic profession certainly has had to take steep cuts in recent years. I know many chiropractors who are no longer seeing Medicare patients or having chosen to be non-participating. If a Medicare patient sees a non-participating chiropractor, then the patient has to pay the doctor for the visit completely and Medicare will send the patient a small check to help cover the cost. A problem arises when the patient needs to see the chiropractor frequently and they must pay for each service. The costs can quickly add up, and the patient has to wait about 6 weeks for Medicare to send them a check. That poses a financial burden on some seniors.

Choosing the right Chiropractor

Of the chiropractors I know well, I am the only one who is Medicare participating and actively marketing to seniors. I’m happy to see seniors all day long. At Innova Pain Clinic, we will submit your Medicare claims for you. Medicare will pay its 80% and your supplement will pick up the difference. In most cases, my Medicare patients do not have any out of pocket expenses.

I have been a Medicare chiropractor for about 16 years and I have seen some changes in the program. Some of those changes were helpful to the chiropractic profession and of course some were not. Thankfully, Medicare still pays for chiropractic services and let’s hope they continue doing so.

If you are a senior in the St George area and you are looking for a chiropractor who is participating with Medicare, call the Innova Pain Clinic. I am certain you will be pleased with the quality of service.

Dr. Andrew White
Medicare Participating Chiropractor | St George UT

Choosing the right Chiropractor

Medicare pays for your chiropractor visit!

Headaches may be common, but they are not normal. No one is born with an Excedrin deficiency. Sadly, because headaches are so commonplace we begin to accept them as a part of life.

There are be many types of headaches and for each headache there are specific protocols for treatment. Your chiropractor is trained to distinguish the various types of headaches and formulate a specific treatment plan to help you.

At Innova Pain Clinic, Dr. Andrew White, has a great interest in helping headache sufferers manage their conditions and return to full activity.

Some of the more common types of headaches are:

Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time. These respond very favorably to chiropractic care. If you suffer from these headaches, you definitely need to be evaluated by a chiropractor.

Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions of the brain. These types of headaches respond positively to chiropractic care. By reducing nerve irritation in the spine a chiropractor can help reduce the nerve reflex-spasm in the blood vessels. Migraine pain is often described as pounding, throbbing pain. They can last from four hours to three days and usually occur one to four times per month. Migraines are associated with symptoms such as sensitivity to light, noise, or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.

A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis — about once a month. These types of migraines are sometimes called abdominal migraines.

Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common — although the most severe — type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into “remission”) for months or years, only to recur. The best treatment of cluster headaches is to breath pure oxygen for a short while.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling. These headaches also respond favorably to chiropractic care.

This is just a short list of the more common varieties of headaches. Rest assured that your headache will be taken seriously at Innova Pain Clinic.

Dr. Andrew White
Headache Chiropractor | St George UT

Chiropractic Treatment for Headache

Addiction to pain medication is real

Addiction is real and really dangerous. A number of news outlets picked up some reports this week about the very real dangers of using pain medications.

Research shows the risk with each pill

Here is a great example of a story which illustrates the real concern with using commonly prescribed pain meds.  No one starts their pain medication program thinking they will turn into a junkie, but sadly, too many end up like that.  How can you avoid becoming a sad statistic and a junkie?  Simple, don’t use the prescription pain medications.

Chiropractic is a safe alternative

There is a safe alternative for pain management.  See your chiropractor for your muscle and joint pain.  Sure, it might take a few treatments to get the program tailored well for you.  But it is worth it in the end.

Been There, Done That

If you have seen a chiropractor in the past and did not find much success, then try a new chiropractor.  Each one does it a little different.  Stop by our office and see what we can do for your acute and chronic pain.  We are here to help you.

Dr. Andrew White
Chronic Pain Chiropractor St George Utah

Pain Med Addiction on the Rise

Chiropractic care is safe and effective for reducing arthritis pain today, but can also slow down the progression of the disease.

Remember that arthritis is not a light switch, either off or on.  It is a slow progressive process that gets worse over time.  There are things that we can do hasten the progress.  That is to say, make it get worse faster.  We know that sedentary lifestyles, and high fat diets make arthritis grow faster.  We also know that regular exercise, proper diet, and regular routine chiropractic care can slow down the growth of arthritis.

We all get older, we all suffer the aches and pains of age.  But we all have the opportunity to slow down the aging process.  We can make our bodies last longer.  The key factors are not a mystery to anyone.  Eat better, exercise more, and seek proper preventative check-ups (annual medical exam, semi-annual dental exam, monthly chiropractic exam).

Arthritis is like the rust on this hinge. It grew slowly over-time. Neglect was the key factor. Do not neglect your spine -- don't allow it to corrode with arthritis.

The next time you hear a squeaky hinge or see rusty iron.  Remember that the object didn’t get that way over-night.  That degenerative process was slow growing and out of neglect it was allowed to continue.  Simply rubbing oil onto the hinge or iron would have saved it.  What simple thing are you ignoring?  What body hinges are you allowing to rust?

Call your chiropractor today and schedule your wellness examination visit.

Dr. Andrew White
Chiropractor St George UT

Chiropractic to Improve Arthritis