Chiropractic Works with Dr. Birk

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Posted: October 17, 2012
By: Dr Ruminder Birk

Fibromyalgia affects 1-3% of the Canadian population. Approximately the same percentage of the population is affected by chronic fatigue syndrome, which is a closely related disease. Woman seem to be more affected with fibromyalgia and CFS than men. This vast amount of adults reporting these symptoms makes this a substantial public health issue.

Symptoms typically include pain affecting muscles, tendons and ligaments. Studies have shown a decrease in endurance and voluntary muscle strength in patients with fibromyalgia.  Specifically, it has been shown that muscle strength was 35% less compared to patients without fibromyalgia.  Possible causes This reduction in strength could be one cause of the disease or a secondary effect due to inactivity. Osteoporotic patients with fibromyalgia have impairment in strength of lumbar and abdominal muscles and in measurement of chest expansion.

There are several studies that show benefits of pain reduction and improved aerobic capacity when fibromyalgia patients begin a moderate exercise program. In general, patients are more successful (they stick with it) with low intensity exercises as opposed to high intensity programs. Walking is a good exercise to begin with. Even if pain occurs during the activity, the patient should be encouraged to continue. Inactivity and pain-avoidance behavior is likely to increase symptoms further. Common fears include the fear activity will cause more pain, the fear due to misunderstandings that pain with activity means further damage, or the fear that the pain is a symptom of serious disease. If symptoms increase substantially with the exercise, then the patient should back off of the intensity and do a more gradual approach.

As pain is reduced there is typically also a change in the psychological wellbeing of the individual.

Heavy resistance exercise has also been shown to affect fibromyalgia symptoms. In one study, thirteen elderly women performed a heavy-resistance fatiguing protocol (5 sets of leg presses with 10 repetitions maximum) before and after a 21-week strength-training period. The strength training led to large increases in maximal force and contributed to the improvement in loading performance. The increased strength also seemed to reduce pain in the muscles.

These studies indicate that inactivity is often a problem in fibromyalgia and that getting moving, walking, and even strength training at the gym can have potentially positive impacts on your pain. You should consult a competent health care provider prior to starting any exercise program. This assessment should include a comprehensive spinal and extremity evaluation to make sure there are no joint problems, which could affect your ability to exercise effectively.


Failed Back Surgery and Low Back Pain

Posted: October 1, 2012
By: Dr Ruminder Birk

Back surgery is quite common in North America; at times these are laminectomies and diskectomies, and other times the joints can no longer move because the spine has fused together.  Conservative medical approaches include rest, medication, exercise, and physical therapy. In the event these fail, epidural injections are often used. At this point in the patient's course of care, if there is little relief, chiropractic care is usually not considered and patients are directed toward surgery.

Most surgeons wouldn't consider an operation to be effective for back pain. In reality, the surgery is more indicated when the nerve root is compressed producing neurological signs such as muscle wasting, foot drop, or numbness.  If back pain is the primary issue, not leg pain or numbness, surgery should be avoided.

Most patient with leg pain will have severe low back pain. Patients with continued pain or numbness are called surginal failues- failed back surgery syndrome. Patients are left with few medical options afterward and re-operation is problematic.  The patient may be prescribed an opiate patch, or perhaps an implanted spinal cord stimulator, or both.  These devices send electrical impulses through tiny wires that carry the signal to different areas of the spinal cord.

These approaches may work sometimes, but too often they don't. If you had a joint/disc injury before surgery, it is likely still there. Post surgical cases should be evaluated by a chiropractor to see if there is an underlying joint problem that can be adjusted.

There may be some natural alternatives to electrical implants and long term opiate medications for pain control. Certain physiotherapy, ice, exercise, and massage can be incorporated into a comprehensive drugless management program. Even counseling and behavior therapy can help to lessen the need for medications. Usually patients can be safely adjusted after the initial surgery has healed (about six weeks). It is important to consider all options before repeat operations. Active rehabilitation combined with specific chiropractic care can be the solution for many patients