Designated Doctors In The Texas Worker’s Comp System
Clear Lake City Chiropractor Comments: Recently I was asked again to co-chair a conference in Dallas, Texas to help teach all types of doctors (medical, osteopathic and chiropractic) how to become Designated Doctors in the Texas Dept. of Insurance, Division of Worker’s Compensation. The course was co-sponsored by the American Academy of Disability Evaluating Physicians (AADEP) http://www.aadep.org/ and the Texas Council of Chiropractic Orthopedists (TCCO) http://www.texascouncilofchiropracticorthopedist.org . The Designated Doctor Training Seminar is designed to provide doctors and other health care providers with methods of determining maximum medical improvement (MMI) and of calculating the appropriate impairment rating using the AMA Guides, Fourth Edition, to follow the Texas Department of Insurance, Division of Workers’ Compensation (Division) approved core curriculum for doctors seeking full authorization to perform the new functions of the DD under HB7 and for health care providers performing ROM, sensory, and motor testing for those doctors, to fulfill the MMI and impairment rating requirements per the new Rules of the Division to introduce the use of ODG and MDA and to introduce the issues involved in determining causality.
The 2005 legislature made significant changes in the Texas workers’ compensation system with HB7. The TDI Division of Workers’ Compensation has new Rules that require the Designated Doctor to have completed new training in order to be and stay on the Designated Doctor lists. In addition, the Designated Doctor role was expanded in HB7 to include determining and resolving issues regarding MMI, the impairment rating, return to work, causality, and treatment.
While there is a substantial amount of material to cover over a 2 day period, the course went very well. Being able to be well versed in the AMA’s Guides to the Evaluation of Permanent Impairment, Fourth Edition takes time and a concerted effort. As always, the seminar was well received with many interesting questions and discussions. To all doctors who wish to be on the approved doctors list with TDI-DWC, study the AMA Guides and take the course and you will have a good understanding of how to help the injured workers in Texas.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com. or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Are Physical Therapists Like Chiropractors?
Clear Lake City Chiropractor Comments: This is a fairly common question that I get asked in my office. While the simple answer is no, physical therapists do have some similarities in treatment to chiropractors. First and foremost, each individual practitioner in each profession treats in his/her own unique way so the comments below are generalities.
Doctors of Chiropractic (DC’s) diagnose, treat and prevent mechanical disorders of the musculoskeletal system which affect the nervous system and therefore one’s general health.
Chiropractors aim to maintain, restore, maximize and develop one’s functional ability through specific spinal adjustments, physical modalities and rehabilitative or therapeutic exercises. Physical therapists use rehabilitation therapy and general mobilizations, usually under the orders of a doctor, to help restore a patient to their pre-accident or illness status. Chiropractors use a holistic approach to treatment that focuses not only on the physical, but the psychological, social and emotional well being of the individual through diagnosis, treatment and intervention. The chiropractor then will typically give the patient home based exercises and stretches to prevent a reoccurrence after care is completed.
Chiropractic doctor’s practice combines aspects from both alternative and mainstream medicine. Most chiropractors work with the patients other doctors to coordinate the necessary care of the patient based on the diagnosis that we determine thru our own specific examination. Depending on the specialty of the chiropractor, he/she may have a more nutritional, neurological, sports or in my case orthopedic type of practice.
Physical therapists (PT’s) on the other hand practice in different settings such as outpatient clinics, inpatient rehabilitation facilities, extended care facilities, skilled nursing facilities, hospices, education and research centers, occupational environments and fitness centers. Care is typically directed by the diagnosis and orders of a doctor, though some PT’s are currently allowed direct access.
Chiropractic doctors and physical therapists are both currently using evidence based research to expand their knowledge and further help our patients. Hopefully in the future DC’s, PT’s and other providers of physical medicine will work together for the greater good of our patients with all providers knowing the strengths and limitations of their care.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com. or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
A Natural Solution To Back Pain
Houston Back Doctor Comments: Getting your health back after a spine injury can be problematic if you do not approach it holistically. What is meant by holism? In general it is caring for the person as a whole vs. individual parts, and using techniques that assist different bodily systems. It can be treating the mind as well as the body. It is well known that depression is an important risk factor for back pain.
When dealing with a mechanical spinal problem, the doctor needs to consider the condition of the disks and ligaments, scar tissue, muscle strength, posture, movement, and alignment. A simple prescription, while effective at reducing pain, is not a good solution in the long run. For example, the scar in muscles that is formed after injury when NSAIDs (ibuprofen) are used is much weaker. The patient needs to also consider the side effects of stomach or gastrointestinal bleeding that can come with long-term use. Leaving joints problems to sit for years while masking the pain, will just make future rehabilitation more difficult and less effective.
Pain is a signal for your body to avoid certain movements and can be very protective. While muscle pain is expected during rehabilitation, if there is ligament or joint pain, then you’re pushing it too hard.
Exercise and stretching without attention to joint injuries, will also not work over time. It’s hard to maintain exercise when there is joint pain. Chiropractic care can keep the spine and other joints flexible while you also approach the other aspects of spine function with specific exercises and stretching.
Maintaining a healthy body weight is also part of any holistic approach. If you’re overweight, this adds tremendous stress to your spine. In some cases it may be important to first get your weight down, before commencing an exercise program, or weight training.
In addition to proper weight control you have to also consider sound nutrition in terms of vitamin and mineral consumption. Most patients need to do better at eating green leafy vegetables, fresh fruits and other nutritious foods. One has to avoid harmful fats, and chemicals/preservatives that are often present in highly processed foods. Supplements such as manganese and glucosamine chondroitin may help joint health. Although there are few studies on how effective these supplements help, the downside or side effects are quite minimal.
As a doctor of chiropractic, I can advise you on integrating a holistic approach with spinal joint care, strength training, flexibility, and sound nutrition.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com. or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Torticollis and Whiplash
Doctor of Chiropractic near NASA states: Torticollis is a condition where a joint or disk is injured and you can’t move your neck. Sometimes the head is bent or turned a little to one side. And sometimes you’re straight but can barely move in any direction. This type of problem is usually caused by a disk injury. Whiplash can cause this condition or it can come on by sleeping in an awkward way.
The spine is meant to move a lot, especially the neck. This is so we can quickly look around, above, and below. When the spine cannot be moved without intense pain, it’s a sign of both a joint and nerve problem. The nerve may be pinched or compressed, stretched, or irritated by chemicals from inflammation/swelling. To protect the nerve, the body puts a splint on it with muscle spasm. This keeps you from moving your head.
If the joint injury is reduced, by aligning the bones of the spine, the healing and scar tissue will stabilize the area in alignment. If the joint is left out of alignment or is hypermobile, this can lead to future degeneration. To get the joint moving and functioning normally again, you need to have motion through the joint adjustment, and exercises to keep activated. One study showed that patients, who wear foam collars after whiplash, do worse than patients who were actively mobilized without collars. It may at first seem counterintuitive to move when pain is there, but it’s all about moving within your pain tolerances. Usually small motions are still preserved. Instead many patients wear collars or do not move their neck enough. This causes the muscles to become more inflexible and contracted. Overtime it can lead to substantial weakness and even atrophy (wasting away).
So even in the early stages of a whiplash, when the neck can barely move at all, small movements that are not painful are encouraged. The specific adjustment will reduce the irritation to the nerve that is signaling the muscles to spasm. Once the nerve is freed, then the muscle will usually release. Greater ranges of movement will follow as the body allows. This should not be hurried because the nerve and disk is at risk for re-injury in the very early stages of healing.
Medications and surgery will not correct the alignment of the spine. When the joint is sprained, it needs to be re-aligned to reduce the tension on the ligaments and disk. We can guide you through this process so the range of motion returns quickly.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Low Back Pain and Failed Back Surgery
Houston Chiropractor Comments: Back surgery is quite common in the US with hundreds of thousands of operations each year. Sometimes these are laminectomies and diskectomies and other times the spine is fused together so certain joints no longer move, a critical spinal function. The conservative medical approach/thinking is rest, medications, exercise, and physical therapy. If these fail, then epidural injections are often used. If there is little relief, at this point in the patient’s course, chiropractic care is usually not considered, and many patients follow the medical trajectory toward surgery.
Although most surgeons wouldn’t consider an operation to be effective for back pain, most patients think this is the primary concern for the surgeon. In reality, the surgery is more indicated when the nerve root is compressed and there are neurological signs such as muscle wasting, foot drop, or numbness. If back pain is the primary problem and not leg pain or numbness, then surgery should generally be avoided.
But most patients with leg pain will also have low back pain, and this low back pain can be quite severe. The patients that have this continued pain or numbness are called surgical failures. The term for this is failed back surgery syndrome. Entire medical conferences have been devoted to the topic/problem. Patients are left with few medical options after a failure and re-operation is especially 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.
Sometimes these approaches work, but too often they don’t. By their nature they cannot correct a joint problem. If you had a joint/disk injury before the surgery, it is likely it is still there. Post surgical cases should be evaluated by a chiropractor to see if there is an underlying joint problem that the can be adjusted specifically.
There may be some natural alternatives to electrical implants and long term opiate medications for pain control. Certain physiotherapy, ice and exercise 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.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Whiplash – What Can Be Done To Help?
Houston Chiropractor Comments: Whiplash occurs when the neck is suddenly and forcefully jerked, and is typically associated with car crashes. The speed at which the neck is forced upon impact is faster than we can contract our muscles in attempt to stop the forceful movement. This results in muscle, tendon, and/or ligament over-stretching, even tearing. Symptoms include stiff and painful neck movements, weakness or, the head “feels heavy” making it challenging to “hold up” as well as headache, and sometimes dizziness, ear noises, TMJ or jaw pain, and “mental fog.” What should be done if a whiplash injury occurs?
The amount or degree of damage to the soft tissues – that is, the muscles, tendons, ligaments, and disks of the neck — will be the deciding factors as to how much rest vs. activity should be initially performed. If there are no fractures, dislocations or other injuries resulting in an unstable cervical spine (neck), studies have shown rest and a soft collar is actually harmful when compared to early return to activity and exercises. Chiropractic treatment, which essentially exercises the joints of the neck, has been shown to speed recovery when performed sooner rather than later after a whiplash injury. A handy way to classify the injury includes four categories: 1) Pain with no significant abnormal clinical findings; 2) Pain with mild clinical findings and range of motion loss; 3) Pain with neurological injury (resulting in radiating arm pain); and 4) Pain associated with fracture and/or dislocation. Those suffering with category 1 or 2 injuries should minimize rest, collar use, proceed with life’s activities and not be afraid to do desired activities. More aggressive exercise and, utilizing chiropractic adjustments as soon as possible are very effective in the first two categories of injury. Category 4 (fractures and dislocations) injuries require the use of a rigid collar usually for 4-6 weeks as rest/protection is imperative. Category 3 demands careful monitoring by your chiropractor as neurological problems like arm pain and numbness, muscle strength weakness, must be watched during the healing process. The use of ice is helpful with all four categories of injury and exercise training is important and can be started sooner in the first two categories of injury.
What can you do if you sustain a whiplash injury? The first order of self-help is the use of ice. This is a much better choice over the use of heat as ice reduces swelling and pain while heat can increase swelling because it brings in more blood flow into an already swollen area. The heat may feel good during its use but most patients report the pain either returns shortly thereafter or feels worse. Ice should be used for 20 minutes on followed by 40 minutes off. The old adage of “ice for 24 hours followed by heat” does NOT apply here as ice can be performed for as long as there is pain and/or inflammation. The good news is that you will never hurt yourself by using ice but, you can make it hurt worse by using heat too soon so, when in doubt, use ice! The next, very important, recommendation is to utilize exercises to stretch and strengthen the neck and upper back region. The “general rule” of exercise is slow repetitions staying within “reasonable” boundaries of pain. That is, a good, stretch type of pain is encouraged while avoiding sharp pain. We have discussed several very practical neck stretches and strengthening exercises previously and we will again address this in the future. Posture correction of chin tucks, keeping your head back over your shoulders is very helpful as well. We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Slipped Disc – What Is That Exactly?
Clear Lake City Chiropractor Comments: “I was digging a hole in my garden and hit a rock with the shovel. After clearing the dirt from around the rock, I bent over and reached into the hole. I couldn’t get a good grip on the rock and had to twist my body to get my arm under it. As I started to move the rock, I felt something ‘give out’ in my low back and felt immediate low back pain, but it wasn’t terrible. Like a fool, I gave it another try but this time, the pain in my back was really sharp when I twisted to reach under it. Then, it felt like a knife stabbing me when I tried to stand up. Since then, I can’t stand up straight and pain is shooting down my left leg.”
The intervertebral disc is like a shock-absorber located between each vertebra in our spine extending from the tail one to the upper neck. When healthy, your discs truly do function as shock absorbers. There are two parts to the disc – the inner part (called the nucleus) which is the liquid-like center and the outer part (the annulus), which is tough, laminated and rubber-like whose job is to hold the nucleus in the center of the disk. The annulus has concentric rings which look similar to the rings of an oak tree trunk and the strength of these laminated rings is due to the fibers crisscrossing, creating a self-sealing, secure border for the nucleus center. In spite of this great anatomical structure, our discs degenerate and can crack or tear allowing the more liquid-like nucleus to leak out of the annulus creating the classic “slipped disc” (technically referred to as a herniated or ruptured disc). When the herniated disc presses into the nerve that goes down the leg, pain is felt along its course and can radiate all the way to the foot. There are five vertebrae and disks with a pair of nerves that go into each leg and depending which disc ruptures, pain will follow a different course down the leg, which is why we ask you if you feel the pain more in the back or in the front of the leg. When the disc tears prior to both disc herniation and leg pain, low back pain occurs because the nerve fibers that are normally only located in the outer third of the disc grow into the central portion of the disc, making it generate more pain.
So now for the important question, “…what can I do for it?” When you visit our office, we will ask you about how you injured your back. Often, the cause of a herniated disc can be the accumulation of multiple events over time. It certainly can happen after one major event, like our example of lifting a rock out of a hole, but that is usually the “straw that breaks the camel’s back” and not the sole cause. Many researchers have reported it is rare for a healthy disc to herniate. Rather, disk degeneration with tears already present sets up the situation where a bend plus a twist, “…finishes the job.” The orthopedic and neurological examination will usually clearly identify the level of herniation. Chiropractic treatment often includes traction types of techniques, some form of spinal manipulation or mobilization, extension exercises, physical therapy modalities like electric stimulation, low level laser, or ultrasound, and ice therapy. Core / trunk strengthening and posture management are also commonly applied and, proper bending/lifting/pulling/pushing techniques are taught. As long as you have not lost bowel or bladder control, you are better off seeing if conservative care can relieve your pain before looking at surgical options.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Neck Pain and Pinched Nerves
Clear Lake City Chiropractor Comments: “I woke up yesterday morning with severe neck pain that radiates down my right arm to my hand and I can barely move my neck without producing the shooting arm pain.” Or, “…for the last few months, I’ve had this nagging pain in my neck and when I look up, my arm goes numb.” Or, “Every time I bend my head to the left, my left arm goes numb. I’ve noticed when I lift weights; I can only curl 15 lbs with my left arm compared to 35 lbs with the right.” These are common histories describing a classic “pinched nerve in the neck.” So, what is a “pinched nerve?” To answer this, let’s first look at what a “nerve” is.
In the diagram to the left, the nerves come off the spinal cord. Those in the neck region go down the arm and those in the low back go down the legs. The spinal cord is the “highway” that brings information from the nerves in the arms, legs, trunk, etc., to the brain where information is processed. The bony spine houses and protects the spinal cord and skull protects the brain but there is no bony protection for the nerves. Nerves bring information to the brain allowing us to feel, taste, smell, see, and move our legs and arms to perform complex movements like dancing, running, gymnastics, and so on. Information is constantly going to and from the brain to allow us to function normally. The nerve can get “pinched” anywhere along its course, including the wrist (carpal tunnel syndrome), elbow (cubital tunnel syndrome), shoulder (thoracic outlet syndrome), and/or neck (herniated disk and/or arthritis). This results in a slowing down of information transmission to/from the brain and numbness, pain, throbbing, as well as weakness in strength can occur.
There are two types of conditions that commonly pinch nerves, which generally occur at different times of life – those with a herniated disk (younger > older patients) and those with arthritis (older > younger patients). A combination of the two conditions producing the pinching effect on the nerve can also occur making the diagnosis process a little trickier. The following diagram helps explain these conditions:
The nerves exit the spine through holes that can be narrowed if the jelly central part of the disk herniates outward and into the nerve pushing it against the bone that makes up the hole through which it exits the spine. A “bone spur” (as shown in the diagram to the left, coming off the left facet joint) pushing into the nerve or the thickening of the ligaments that run inside the spinal canal (eg., ligamentum flavum) can also crowd these sensitive nerve structures and cause similar symptoms.
Both of these conditions are commonly treated by chiropractors. If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Carpal Tunnel and its Diagnosis
Bay Area Chiropractor Comments: Pain in the wrist and hand can be a difficult thing to diagnose properly. The first problem that patients have is deciding what type of doctor to see. A chiropractor, internist, orthopedist, rheumatologist, or neurologist, will all agree to schedule you for an appointment, but who is best?
At your visit it’s important to have a thorough examination and to ask a lot of questions. I’d be skeptical if the doctor only examines the wrist and hand, and leaves out the elbow, shoulder and neck. The reason this is the case is that problems of the neck and other joints distal to the pain, can refer pain into the wrist and hand. Not all wrist pains are a problem with constriction at the carpal tunnel. Pain into the hand can come from compression of nerves in the neck. Your carpal tunnel pain needs to be separated from a problem in the neck, such as a radiculopathy or thoracic outlet syndrome.
Your doctor should ask are how long the problem has lasted, and if there has been any trauma. Trauma to the neck is especially important, and could be a sign that your wrist problem is really a neck injury.
For some patients, losing weight and doing specific exercises are enough to cure these types of pains. Some patients simply need to have their computer monitor adjusted, or are given stretching exercises to do between long periods at the computer keyboard. The stretching may be for the wrist, but should also address the entire arm and neck to be comprehensive. How we sit and whether there is forward head posture are also important considerations. The forward head posture can stretch your spinal cord and nerve roots making the nerves more susceptible to pressure when they eventually pass through the carpal tunnel.
In others, the problem of joint alignment needs to be properly addressed. Through specific chiropractic adjustments, the motion of the joints and their alignment can be restored. The misalignments may occur at the wrist or even the neck.
In my Clear Lake City office I treat many patients with carpal tunnel symptoms. Sometimes the problem is local to the wrist but most patients will require a more comprehensive approach. If you’d like care that emphasizes proper posture and alignment and avoids the problems of long- term medication use, then schedule an appointment today.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Headaches from Forward Head Posture
Clear Lake Area Chiropractor Comments: John Q. Public has been trained to believe that headache is a problem in the head and headache treatment and relief comes in a bottle.
While it’s true that pain medications can bring relief for a pounding headache, they rarely get at the actual cause of the problem. You have to also consider the long-term problems that can occur when you take these types of pills for years or even decades. Some long-term complications include stomach bleeding, liver and kidney problems. Plus there is the problem of not actually correcting anything and instead masking the symptoms. Pain pills are not one of the five food groups.
For many patients, the problem is not one in the head, but may have a spinal cause. Let me explain how this works…. Normally, the neck is balanced over the shoulders in an upright manner. Some people, however, they develop forward head posture where the head protrudes out away from the shoulder girdle-it looks like the bad posture your mother told to avoid. It is the slouching or turtle problem- your neck should now come out of the front of your chest. This type of posture is often seen in computer operators and others who bend over to do their work. Whiplash injuries can also create this forward head posture by disrupting the natural curve of the neck.
Over time the muscles at the back of the neck become tight and start to tug and pull at the base of the skull. This can cause head pain. Sometimes it’s a dull ache with a burning type of pain full of tension. In other patients, the headache may be more throbbing and to one side. The important thing is to address the actual cause of the problem. This is where chiropractic care is key. By correcting the forward head posture, the head is more balanced over the shoulders. Many patients will report less tension in their shoulder and upper back muscles which were really working over time.
At Beecher Chiropractic Clinic, I try to get at the cause of headaches. Usually it’s not a lack of pills in the diet, and in most patients simply correcting their posture can bring relief. Only a comprehensive examination of the full spine will determine if the cause of your headaches is spinal, and whether chiropractic will be the best option for you to regain your health.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
