What is an Impairment Rating?
What is an Impairment Rating?
Bay Area Chiropractor Comments: I was in Austin last week doing a worker’s compensation examination on a lady when she asked me, “What is an impairment rating?” This was one of the questions that I was being asked to determine by the state in addition to; could she return to work (RTW) and was she at maximum medical improvement (MMI). The question reminded me that a lot of the terminology that doctors take for granted can be confusing to patients.
Impairment is an alteration of an individual’s health status. To determine a permanent impairment rating, the impairment must be static and stable, sufficient time must be allowed for optimal tissue repair and it must be unlikely to change in spite of medical or surgical therapy.
In Texas, there are approximately 450 doctors (medical, osteopathic and chiropractic) certified to be a designated doctor for worker’s comp patients to determine questions such as “What is the impairment rating?” To do this, the state of Texas mandates that we utilize the American Medical Association’s “Guides to the Evaluation of Permanent Impairment” 4th edition. The guides evaluate if any surgeries were performed, is there a decrease in the range of motion (ROM) of a joint, is there a decrease in strength or sensation, has there been an amputation or fusion. The doctor then takes these values and places them in several tables, charts and figures to determine what the patient’s impairment is. Usually this number is less than what the patient thinks it should be. This is because in most cases pain is not rated. Since it cannot be measured, it cannot be rated.
Impairment ratings can be used for other examinations as well such as following any type of accident where an impairment value needs to be given to determine the effect of an injury.
Now to answer the lady’s original question of “What is an impairment rating?” it is a number value to show what percentage of your entire body (whole person) was permanently impaired as a result of the accident or injury.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Beware of The Summer Heat!
Clear Lake Chiropractor Comments: As we enter the summer, it is important that we pay attention to the heat and humidity. Whether we are working in the yard, playing sports with our friends or just lounging by the pool, we need to stay aware of the weather conditions. More importantly, we need to pay attention to how our body is reacting to the heat and humidity.
Heat emergencies have three stages: heat cramps, heat exhaustion, and heatstroke. All three stages of heat emergency are serious. It is important to treat these emergencies quickly so that they don’t progress to heatstroke, which can have lifelong consequences.
Heat cramps is the first stage. During heat cramps Heat cramps are the first stage of heat emergency. They usually happen when you’ve been physically active in the heat, but they can also occur if you haven’t been active. Heat cramps are especially likely in the elderly or small children, overweight people, and people who have been drinking alcohol. Muscle pain and tightness are symptoms of heat cramps. It is typically treated by moving out of direct sunlight and into a shaded area. You should drink cool non-alcoholic beverages without caffeine and gently massage and stretch the muscles.
Heat exhaustion has many symptoms. Some of these symptoms include muscle cramps, dizziness, mild confusion, increased heart rate or breathing, a headache, irritability, extreme thirst, nausea or vomiting, pale skin, heavy sweating or fainting. Treatment is everything listed in heat cramps plus loosening your clothes and having someone gently fan your body.
Heatstroke will have all of the symptoms of heat exhaustion plus a body temperature of 104°. The person can also have confusion, dry skin, seizures, hallucinations, rapid shallow breathing and rapid weak pulse. Heatstroke can be fatal or cause lifelong complications. Call 911 or go to the emergency room if heat illness is causing vomiting, seizures, or unconsciousness. For heat stroke you should remove any sweaty clothes and place ice under the arm pits, wrist and groin if available. If not, place cool wet towels on the chest and face.
To help prevent these problems remember to take periodic rests, drink plenty of water, wear loose fitting light colored clothes and avoid alcohol or caffeinated drinks.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Do Chiropractic Adjustments Hurt?
Clear Lake Chiropractor Comments: For patients that have never been to a chiropractor, this is surprisingly a common question. If your chiropractic adjustment is performed correctly, you should only feel a little stiff or sore after your initial chiropractic adjustment. This would be similar to the soreness that one feels when they first start going to a gym or do too much yard work. After the 1st couple adjustments you do not feel any soreness, just relief with increased mobility.
Chiropractic adjustments take pressure off of the joints and help to relieve any pressure or adhesions in the joint. Sometimes as the doctor of chiropractic corrects your spinal complaints you may also note some muscles being sore in different areas. This is not uncommon. You will start to use muscles differently as your body adapts to your correct posture. Your chiropractor will typically advise you to use ice for 20 minutes to help relieve any soreness. He or she will also suggest some stretches and later some exercises to allow the joints to retain their flexibility and to give the proper muscle support so that the problem does not reoccur.
If you have any questions or concerns about chiropractic adjustments, feel free to ask your chiropractor. They can explain the safety of spinal manipulation and why chiropractors have the lowest malpractice rates of any doctors. They can also modify their treatment to make sure that there is no discomfort.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
How To Choose A Chiropractor
Houston Chiropractor Comments: We live in a mobile society. People change jobs. Kids go off to college. When this happens, I get asked if I can recommend a chiropractor in their new area. Some towns are easy, because I know a doctor who I can trust. Sometimes I don’t have any idea.
When I first open up my clinic in 1990 my patients all came in either because they knew me or were referred by a friend or co-worker. In the early 1990’s managed care began to change healthcare with provider networks. Things changed again in the early 2000’s with the rise of the internet with searches and reviews. Now you can find out anything that you want to know about your doctor and some things that you don’t want to know about them. 😉
When choosing a chiropractor now, a personal recommendation from someone that you know and trust is still the best way. They can answer specific questions that you might not find with an online review. When we get referrals from orthopedic surgeons, podiatrists and physical therapists, the patients are very comfortable knowing that their healthcare provider has vouched for us and our treatment.
Another way to choose a chiropractor is thru your provider network if you are on an insurance plan. Every major insurance plan will have a list of doctors with their certifications and reviews. Doctors who do not meet the accepted standards of care are removed from the list. Those doctors will require you to pay more out of pocket expenses than in network providers.
A third way to choose a doctor is thru online reviews. Review sites such as Google and Yelp allow you to hear from patients talking about what they like and don’t like about the office, treatment, staff and the doctor. These sites allow you to see positive and negative comments. Yelp has a section of reviews call “not currently recommended” that lists reviews from people who haven’t registered with Yelp as users.
A final way to choose a doctor is to check with their state board to find out if they are properly registered and if the doctor has any restrictions or complaints against them. Some doctors appear friendly and ethical, but you might find out that they have a history of fraudulent billing or specific restrictions on their license.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Are Neck & Back Injuries Permanent?
Clear Lake Chiropractor Comments: One of the most common questions I get from patients after an injury is “Will I always have pain in the future”? Another common statement is to relate all current complaints to a previous accident or injury. This can be back pain from jumping off a roof when they were 15 or an auto accident that they had when they were in college. People are surprised when they are shown to have no degeneration from prior injuries or signs of prior trauma.
Most accidents or prior injuries do not cause permanent pain or impairments. The World Health Organization (WHO) states that impairment is “any loss or abnormality of psychological, physiological or anatomical structure or function”. Another way of saying it would be “a condition that interferes with an individual’s activities of daily living. The impairment becomes permanent when it has become static and stable and unlikely to change with further care.
Most accidents and injuries cause a mild to moderate sprain / strain injury or a soft tissue contusion (bruise). These injuries typically resolve in 8 weeks or less. With the proper treatment and therapy there is no permanent impairment or pain. The key to getting the problem resolved is to understand what happened to the body and providing the correct chiropractic adjustments to the joints, doing the proper therapy to minimize tissue inflammation and getting the patient to begin the necessary stretches and exercises as soon as possible. After the injury is resolved, the patient should be given a home based exercise and stretching program. These typically only take a few minutes to perform so it is easy to include in your daily routine, similar to brushing and flossing your teeth.
There are times when these injuries take longer, such as when a bone has been broken, ligaments or tendons ruptured or when surgery has been required. This is typically where permanent pain or discomfort can occur. Luckily that does not happen often.
Unfortunately some patients are told that they will always be in pain or that they can never do a particular activity again because of the injury. With a mild to moderate sprain / strain injury (this includes a small disc herniation) or contusion, you will not be limited with what you do if you are regularly doing the correct exercises and stretches. If you have not been given a home based exercise and stretching program by your previous doctor or therapist, ask your current chiropractor for a program that you can do on your own. He or she should be able to formulate a plan to get you out of pain and back to enjoying your activities of daily living. If they don’t give you a home care program, feel free to contact us for information.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Are Chiropractors Real Doctors?
Clear Lake Chiropractor Comments: It continues to amaze me that I get asked this question several times a year. Sometimes it is from people trying to be negative and sometimes from people that honestly just don’t know. Even though chiropractic has been around for 125 years and approximately 15% of the population goes to a chiropractor they still don’t know the answer.
The word “doctor” can be used as a noun or a verb. According to Merriam–Webster, as a noun, it means “a learned or authoritative teacher” and as a verb, it means “to return to good condition”. These are both definitions that relate well to chiropractors.
Now some people will see of the word “doctor” and only think of medical doctors. This is a very narrow viewpoint because it eliminates the majority of the people with a doctorate. This eliminates doctors of osteopathy (DO), doctors of dentistry (DDS), doctors of optometry (OD), doctors of theology (DTh) and all of the doctors of philosophy (PhD).
Sometimes people will assume that to be a real doctor you have to perform surgery. This eliminates even the majority of medical doctors such as pediatricians, neurologists, physiatrists, internists, cardiologists and many more.
Sometimes the person has no idea of the educational requirements to become a chiropractor. To become a Doctor of Chiropractic (DC) it takes 3 1/3 to 4 years of education after receiving your undergraduate education. The typical chiropractic curriculum has approximately 2000 hours of clinical sciences, 1500 hours of clinical clerkship plus electives to equal 4200 hours of instruction. In addition the doctor of chiropractic has annual educational hours required to maintain their license.
Hopefully this explains why the answer to the question “Are chiropractors real doctors?”, is YES. They just treat patients in a different way that doesn’t require drugs, medication or surgery.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
¿Es el cuidado quiropractico seguro durante el embarazo?
Doctor en Clearlake City Comenta: Recientemente me han llegado un gran numero de pacientes preguntandome si los ajustes quiropracticos son seguros para ellas mientras estan embarazadas. Despues de darles mis felicitaciones por tan buenas noticias,les inform que no hay ningun tipo de contraindicaciones que limiten el cuidado quiropractico durante el embarazo.
Los quiropracticos han sido entrenados para poder atender mujeres embarazadas .Como practica de cuidado rutinario de un quiropractico se incluye el bienestar de las mujeres embarazadas o intentando concebir .
Algunas personas se preguntan porque mujeres en estado de embarazo deben ser ajustadas por un quiropractico,y la manera mas simple de responder esto es que es para sentirse mejor. La mejor respuesta a esta pregunta es que su cuerpo esta cambiando rapidamente,el peso esta aumentando y se esta moviendo hacia distintas areas del cuerpo. Debido a lo que se menciono anteriormente el cuerpo empieza a sufrir de algo que es nuevo, empieza la incomodidad y la tension en las articulaciones. A medida que el embarazo progresa las articulaciones se aflojan como parte del proceso de preparacion para el parto.
Cuando mantenemos las articulaciones en movimiento minimizamos la incomodidad muscular y tipicamente la madre puede seguir con su rutina diaria sin necesidad de necesitar estar en cama bajo reposo absoluto que a la larga produce un proceso de parto si dificultades.
¿Que es cuidado quiropractico? El cuidado quiropractico incluye el diagnosticar desajustes de la columna y corregirlo con el uso de las manos o distintos instumentos para manipular y/o ajustar la columna(espina dorsal) articulaciones y musculos.Cuando se ajustan mujeres embarazadas la pression por parte del quiropractico es mas suave y gentil muy distinta de las manipulaciones que se le hacen a otros adultos.
Existen otros tratamientos en caso de que el bebe no este en la posicion indicada para el momento del parto,tal como la Tecnica Webster,pero eso lo explicare en otra publicacion.
Dr. Ward Beecher ejerce en Beecher Chiropractic Clinic localizada en 1001 Pineloch, Ste 700 Houston, TX 77062. Haga su cita ya con el mejor quiropractico en Houston llamando al (281) 286-1300. Si tiene alguna pregunta escribala en el area de comentarios.
Inyecciones Epidurales de Esteroides (ESI’S) y Manipulacion Espinal
Quiropractico de Houston comenta: La mayoria del tiempo cuando los pacientes vienen a nuestra oficina, su dolor desaparece despues de una manipulacion quiropractica a la columna (ajustes) y la terapia. Algunas paceintes han tenido su columna muy irritada e inflamada y se nosh ace necesario co-manejar el problema con un medico general que pueda darles inyecciones epidurales de esteroides (ESI’S por sus siglas en ingles). En ocasiones nos refieren pacientes medicos de manejo de dolor para que nosotros podamos hacerles manipulaciones quiropracticas y eso es despues de sus inyecciones y temenos un gran historial con escelente resultados
Las inyecciones epidurales de esteroides con un tratamiento comun para el dolor de espalda y piernas desde 1950. La mayoria de los doctores estan de acuerdo en que los resultados de estos tratamientos son temporales,usualmente duran entre una semana a un año. En algunas ocasiones las inyeccioones logran un buen resultado por si solas,pero por lo general se obtiene mejor resultado si se combina con manipulaciones quiropracticas a la columna seguidos por ejercicios de estiramiento.
Comunmente se me hace la pregunta si los ajustes son seguros despues de las inyecciones no solamente es seguro pero de gran beneficio.
A medida que la inflamacion e irritacion disminuye como resultado de las inyecciones epidurales de esteroides sera de mucho beneficio remover la irritacion que causo el dolor inicial. Con los ajustes quiropracticos,y luego los ejercicios y estiramientos,el paciente puede incrementar la flexibilidad de las articulaciones y la fuerza en la columna. Esto es de gran ayuda ya que previene que el dolor reocurra. Algunas veces se necesita hasta 3 inyecciones,las que tipicamente ocurren cada dos semanas para asi obtener el mayor beneficio. Su proveedor medico le hara saber cuantas inyecciones necesitara. Asegurese de ser visto y tratado por un medico quiropractico despues de sus inyecciones para asi sacarle el mayor beneficio a sus inyecciones.
Dr. Ward Beecher ejerce en Beecher Chiropractic Clinic localizada en 1001 Pineloch, Ste 700 Houston, TX 77062. Haga su cita ya con el mejor quiropractico en Houston llamando al (281) 286-1300. Si tiene alguna pregunta escribala en el area de comentarios.
DOCTORES DESIGNADOS PARA EL SISTEMA DE COMPENSACION LABORAL EN TEXAS
Quiropractico en Clear Lake City comenta: Recientemente recibi una invitacion como co-presidente en una conferencia en Dallas,Texas en la que enseñe a todos tipos de doctores (medicos,osteopaticos,y quiropracticos) en como empezar a trabajar de doctores designados en el Departamento de seguros de Texas en la Division de Compensacion para Empleados. La leccion estaba patrocinada por la Academia Americana de Medicos evaluadores de discapacidades (AADEP por sus siglas en ingles) http://www.aadep.org/ y el Consejo de Quiropracticos Ortopedas de Texas (TCCO por sus siglas en ingles) http://www.texascouncilofchiropracticorthopedist.org .
El seminario de entrenamiento para medicos designados fue elaborado con el proposito de proveer a los doctores y otros proveedores del cuidado de la salud con metodos para determinar la maxima mejora medica,(MMI por sus siglas en ingles) y calcular el nivel de discapacidad utilizando las guias creadas por la AMA Cuarta edicion, y para seguir el curriculum central aprobado por el Departamento de Seguros de Texas,division de compensacion laboral que les permite a los doctores buscar autorizacion completa para llevar a cabo nuevas funciones como DD bajo la HB7 y para proveeddores del cuidado de la salud que estan usando ROM, examenes sensoriales y motores para esos doctores que desean comseguir el MMIy los requirimientos de discapacidades basadps en las nuevas reglas de la division qye introduce el uso de ODG y MDA y tambien para introducir asuntos envueltos para determinar casualidades.
La legislature del 2005 hizo cambios significantes en el systema de compensacion para trabajadores en Texas con la HB7. La TDI Division de Compensacion Laboral tiene nuevas reglas que requieren que los doctores designados hayan completado un nuevo entrenamiento para conserver su titulo y quedarse en la lista de doctores designados. Adicionalmente ,el rol de los doctores designados fue expandido en el HB7 en el que se require que el doctor deremine y resuelva asuntos en relacion a la maxima mejoria medica (MMI),la clasificacion de discapacidades,regreso al trabajo y tratamiento.
A pesar de que habia una cantidad substancial de material para cubrir en dos dias,la leccion fue muy buena. El poder estar empapado de la informacion dada en la Guia de la AMA para Evaluacion de las Discapacidades Permanentes 4ta edicion, toma tiempo y esfuerzo. Como siempre el seminario fue muy bien recibido con preguntas y discusiones muy interesantes. A todos los doctores que desean estar en la lista con TDI-DWC,estudien la guia de la AMA e inscribanse en el curso y asi tendran un buen entendimiento de como ayudar a los empleados lastimados en Texas.
Dr. Ward Beecher ejerce en Beecher Chiropractic Clinic localizada en 1001 Pineloch, Ste 700 Houston, TX 77062. Haga su cita ya con el mejor quiropractico en Houston llamando al (281) 286-1300. Si tiene alguna pregunta escribala en el area de comentarios.
Common Dance Injuries
Houston Chiropractor Comments: Being in the Clear Lake area of Houston, TX, we are blessed to have several excellent dance studios for our children to learn a variety of dance forms. Over the last 30 years I have treated several hundred kids and young adults with a variety of injuries from different sports. The most common dance injuries that I have seen and had excellent results with are as a result of overuse and over training.
The most common injury that we treat is hip pain. The pain typically comes from hip flexor tendonitis or iliotibial band syndrome (ITB). This responds very well to soft tissue therapy and educating the dancers and their parents on how to proactively treat the problem.
The second most common injury that we see is injuries to the lumbar spine and sacroiliac joint. These are treated with spinal manipulation and physical modalities (electrical stimulation, traction, ultrasound, and ice/heat). Afterwards the patient is given stabilization exercises to help prevent a reoccurrence of the problem.
The third most common complaint that we work on is injuries to the knee and ankle. The knee is typically a patellofemoral (around the kneecap) pain due to a muscle imbalance or a tendonitis. This responds well by making sure that all of the muscles on the front of the thigh (quadriceps) are equally stretched out. Typically one of the muscles will become dominant and tend to get tighter. This can lead also to patella (knee cap) tracking issues. The ankle is typically due to a joint dysfunction. This can cause muscles to be used incorrectly. This responds very well to joint mobilization and physical modalities to the related tendons.
Now that you know the common injuries and how they can be treated, we will discuss how to hopefully prevent the injury to begin with. First of all you need to warm-up before training and practice. Second you need to make sure that you get enough rest and don’t over train. Third you need to wear the proper shoes. Fourth you need to eat well and stay hydrated and finally you need to do cross training exercises to build up the endurance and strength in all parts of your body.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at www.BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
