Spinal Conditions & Spinal Conditions & OutcomesOutcomes

Dr. Gregg MantonyaDr. Gregg MantonyaTheThe Mantonya Chiropractic Mantonya Chiropractic

CentersCenters

Newark ~ HebronNewark ~ Hebron

My backgroundMy background

Undergraduate study - Ohio U. & Undergraduate study - Ohio U. & Marycrest Intl. U.Marycrest Intl. U.

4 year Doctor Chiropractic Degree from 4 year Doctor Chiropractic Degree from Cleveland Chiropractic College-KCCleveland Chiropractic College-KC

Completed year-long study from Spine Completed year-long study from Spine Research Inst. of San Diego for spine Research Inst. of San Diego for spine injury during vehicle crashesinjury during vehicle crashes

Past Team Doctor for High SchoolsPast Team Doctor for High Schools Additional post-graduate study in Additional post-graduate study in

Pediatric Chiropractic, Rehab, NutritionPediatric Chiropractic, Rehab, Nutrition

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Recent Talk HandoutsRecent Talk Handouts

www.mantonyachiropractic.comwww.mantonyachiropractic.com

ChiropracticChiropractic

Required 2-4 yrs undergrad, 4 year Required 2-4 yrs undergrad, 4 year Chiropractic SchoolChiropractic School

Extensive training in Musculo-skeletal and Extensive training in Musculo-skeletal and nervous systems - nervous systems - More hours than Medical More hours than Medical schoolschool

Detect & correct joint mis-alignmentsDetect & correct joint mis-alignments

~ These can affect nerve function~ These can affect nerve function Do not prescribe medicationDo not prescribe medication Physicians through Medicare, Ohio BWC, Physicians through Medicare, Ohio BWC,

CourtCourt PCP for many of our patientsPCP for many of our patients

ChiropracticChiropracticTherapy

Modalities

Adjusting Table

Rehab

Low-force Instruments

Conditions, Causes, PrognosisConditions, Causes, Prognosis

Sprain/StrainsSprain/StrainsRepetitive Stress Repetitive Stress ArthritisArthritisDiscsDiscsScoliosisScoliosisChronic Pain PatientsChronic Pain Patients

Sprain/StrainSprain/Strain

Will heal within 6-12 week, right?...Will heal within 6-12 week, right?......Remodeling phase of healing, up to 12 ...Remodeling phase of healing, up to 12

months or more months or more (Kellet: Acute Soft Tissue Injuries - a review of lit.

Med Sci Sport Exerc, 18(5);489-500, 1986)

Sprain/StrainSprain/Strain

Sprain/StrainSprain/Strain

WhiplashWhiplash – It’s estimated that 50% of – It’s estimated that 50% of those exposed to trauma will be those exposed to trauma will be injured…injured…

50% will recover within weeks or 50% will recover within weeks or months…months…

Leaving 20% of the initial 100% Leaving 20% of the initial 100% exposed to late whiplash symptoms…exposed to late whiplash symptoms…

Approximately 5% will be disabledApproximately 5% will be disabled

Sprain/StrainSprain/Strain

WhiplashWhiplash – At Risk For Acute Injury – At Risk For Acute Injury FemaleFemale History of neck injuryHistory of neck injury Poor head restraint/tall patientPoor head restraint/tall patient Use of seatbelt - 1.5 - 3 x more likelyUse of seatbelt - 1.5 - 3 x more likely Out of Position/Head turnedOut of Position/Head turned Non-aware of impending impactNon-aware of impending impact Increasing age (middle age & beyond)Increasing age (middle age & beyond) Impact by vehicle of greater massImpact by vehicle of greater mass

Sprain/StrainSprain/Strain

WhiplashWhiplash – At Risk for “Late Whiplash” – At Risk for “Late Whiplash” Female, especially if small body massFemale, especially if small body mass Immediate/early onset of symptomsImmediate/early onset of symptoms Ligament/Joint instabilityLigament/Joint instability Greater # of symptomsGreater # of symptoms Use of seatbelt - 34% vs 20% Use of seatbelt - 34% vs 20% Initial limited range of motionInitial limited range of motion Initial neurological symptomsInitial neurological symptoms Loss or reversal of cervical curveLoss or reversal of cervical curve

Sprain/StrainSprain/Strain

Mercy Guidelines - Mercy Guidelines - Factors that Complicate RecoveryFactors that Complicate Recovery

Used by Ohio BWCUsed by Ohio BWC Pain longer than 8 days - 1.5 x longerPain longer than 8 days - 1.5 x longer Severe pain - 2 x longerSevere pain - 2 x longer 4-7 previous episodes - 2 x longer4-7 previous episodes - 2 x longer Injury on underlying condition - 2 x longerInjury on underlying condition - 2 x longer Poor compliancePoor compliance Biomechanical StressBiomechanical Stress Psychosocial StressPsychosocial Stress

Repetitive Stress InjuryRepetitive Stress Injury

Carpal Tunnel Carpal Tunnel SyndromeSyndrome

Common in those performing assembly line work

Women 3:1

Surgery up to 90% successful…?

TendonitisTendonitis

DJD – OsteoarthritisDJD – Osteoarthritis

DJD – OsteoarthritisDJD – Osteoarthritis

Wear & Tear ArthritisWear & Tear Arthritis Large percent are remarkably Large percent are remarkably

asymptomaticasymptomatic More common in males until age 45, More common in males until age 45,

Females 10:1Females 10:1 Hip degeneration – reduced risk of Hip degeneration – reduced risk of

osteoporosisosteoporosis Recent problems with pain medicationRecent problems with pain medication

Vioxx, Bextra, Celebrex etcVioxx, Bextra, Celebrex etc

Discs are the spongy thing between the spinal bonesDiscs are the spongy thing between the spinal bones– Shock absorbersShock absorbers– Spacers for nerve to exitSpacers for nerve to exit

Up to 50% of people asymptomatic have lumbar disc Up to 50% of people asymptomatic have lumbar disc degeneration on MRIdegeneration on MRI

Up to 60% in cervical spineUp to 60% in cervical spine

~ MRI of 98 people without back pain: ~ MRI of 98 people without back pain:

only 36% had a normal disc at all levels.only 36% had a normal disc at all levels.

52% bulge at least one level52% bulge at least one level

27% protrusion27% protrusion

1% extrusion1% extrusion

38% had abnormality at more than one level38% had abnormality at more than one level

Disc ConditionsDisc Conditions

DiscsDiscs Can’t “slip”Can’t “slip” Swollen Swollen Bulge - Bulge - No outer fibers are torn, center has No outer fibers are torn, center has

moved toward the outer ringsmoved toward the outer rings Protrusion - Protrusion - Sometimes used in place of Sometimes used in place of

bulgebulge Herniation - Herniation - Some tearing of outer ring Some tearing of outer ring

fibers, center moves toward outer ringsfibers, center moves toward outer rings RuptureRupture - Piece of Center has gone outside - Piece of Center has gone outside

of discof disc

Discs - Discs - normal, top viewnormal, top view

Discs - Discs - bulge, front viewbulge, front view

Discs - Discs - herniation, front viewherniation, front view

Discs - Discs - rupture, front viewrupture, front view

DiscsDiscs

Rupture most likely to need surgery.Rupture most likely to need surgery.One study showed 83% of patients One study showed 83% of patients

with herniations and radiating pain with herniations and radiating pain improved up to 2.5 years after…73% improved up to 2.5 years after…73% had actual herniation improved or had actual herniation improved or resolved not just the symptoms resolved not just the symptoms (non-operative treatment).(non-operative treatment).

Surgery -Surgery - Studies vary on it’s Studies vary on it’s success, as little as 50% or worsesuccess, as little as 50% or worse

Pain Meds/Chiropractic, RehabPain Meds/Chiropractic, Rehab

Shots, Nerve Block, SurgeryShots, Nerve Block, Surgery

Back Surgery - Back Surgery - What studies sayWhat studies say

50-70%50-70% have complete relief have complete relief of back and leg pain when of back and leg pain when followed-up at 5 yearsfollowed-up at 5 years

10-15%10-15% will have worse pain will have worse pain 18-29%18-29% will undergo further will undergo further

surgerysurgery

ScoliosisScoliosis

Idiopathic (unknown cause) most Idiopathic (unknown cause) most common typecommon type

Most rapid progression during growth Most rapid progression during growth spurtspurt

10-15 degrees progression during adult 10-15 degrees progression during adult yearsyears

Complications – cardiopulmonary dz., Complications – cardiopulmonary dz., DJD, pain, curve progressionDJD, pain, curve progression

Tx – stretches, braces, Chiropractic, Tx – stretches, braces, Chiropractic, massage, surgical bracingmassage, surgical bracing

ScoliosisScoliosis

In my practice In my practice experience, pain and experience, pain and

disability depend upon disability depend upon patient’s...patient’s...

•Physical FitnessPhysical Fitness

•Activity LevelActivity Level

•Severity of ScoliosisSeverity of Scoliosis

•OccupationOccupation

SpondylolisthesisSpondylolisthesis

50% never have pain50% never have painMost of the others that do Most of the others that do

have another causehave another causeRarely progresses during Rarely progresses during

adulthoodadulthoodStudies showed no worsening Studies showed no worsening

with strenuous sportswith strenuous sports

High RiskHigh Risk

Chronic Pain PatientsChronic Pain Patients

BWC DataBWC DataPharmaceutical ReimbursementPharmaceutical Reimbursement

19981998 $57,026,132$57,026,13220032003 $130,000,000$130,000,000

Chiropractic CostsChiropractic Costs20022002 $64,467,227.00$64,467,227.00

Actual cost of Chiropractic vs. Medical Claims new Actual cost of Chiropractic vs. Medical Claims new injury, 1998- 2002injury, 1998- 2002Allopathic care + drugs = $709,709,700.95Allopathic care + drugs = $709,709,700.95DC care = $167,396,045.11DC care = $167,396,045.11Long-term care costs 2002Long-term care costs 2002DC - $34 millionDC - $34 millionMD + Drugs - $189.6 millionMD + Drugs - $189.6 million

The longer a patient is disabled from The longer a patient is disabled from work, the less likely they are to return.work, the less likely they are to return.

1 in 6 1 in 6 Americans live Americans live

with chronic with chronic pain.pain.

$120 billion a $120 billion a year in year in

medical costs medical costs and lost and lost

productivity.productivity.

Chronic Pain PatientsChronic Pain Patients

30,000 hospitalizations/yr from NSAIDS use30,000 hospitalizations/yr from NSAIDS use One study showed only 25% resolved from original One study showed only 25% resolved from original

pain complaint one year laterpain complaint one year later Recent Increase in Pain Management CentersRecent Increase in Pain Management Centers Chiropractic 1-2 visits/month shown to be beneficialChiropractic 1-2 visits/month shown to be beneficial

Fibromyalgia - 3-6 million AmericansFibromyalgia - 3-6 million Americans

~Tenderness particularly in the neck, spine, shoulders, ~Tenderness particularly in the neck, spine, shoulders, and hips - usually after trauma.and hips - usually after trauma.

~Most able to be fully active, may need job modification.~Most able to be fully active, may need job modification.

Chiropractic TermsChiropractic Terms

Adjustment vs. ManipulationAdjustment vs. ManipulationSubluxation, Subluxation ComplexSubluxation, Subluxation Complex Intersegmental DysfunctionIntersegmental Dysfunction

Info OutletsInfo Outlets

www.mantonyachiropractic.comwww.mantonyachiropractic.com

~ “Chiropractic info”~ “Chiropractic info”

~ “Kids & Chiropractic”~ “Kids & Chiropractic” ACA - ACA - www.amerchiro.orgwww.amerchiro.org

~ “insurance & managed care”~ “insurance & managed care” Spine Research Inst. - Spine Research Inst. - www.srisd.comwww.srisd.com

~ sprain/strain info/research~ sprain/strain info/research My email - My email - mantonyachiro@yahoo.commantonyachiro@yahoo.com