Health Professionals
The health professionals at Kawartha Therapeutic Centre firmly believe that better health care is provided to the patient when health professionals work together as a team.
We work together with health care providers of other disciplines and make it our mission to effectively communicate to them important clinical information relating to the assessment, diagnosis and plan of management (with the patients’ permission).
When a patient of yours is referred to our office you can expect:
- A thorough history taken, assessment, diagnosis, and plan of management provided.
- A clinical update to be sent to you detailing the above-mentioned history/exam/diagnosis/plan of management.
- Current, evidence-based treatment
- A referral back to you if we are unable to resolve your patient’s case.
We do not take referrals for granted, and will provide your patient with the time and energy needed to recover from injury and improve their quality of life.
Frequently Asked Questions from Medical Doctors
- What does your assessment consist of?
- Do you perform the same orthopedic tests that I do?
- How many treatments are needed?
- Do you x-ray each patient?
- What about the safety of neck adjustments?
- Can chiropractic provide a preventative function?
- What is the education of chiropractors?
- What is medical acupuncture?
- What conditions does medical acupuncture treat?
- What are the benefits of medical acupuncture?
- What is an Active Release Techniques (ART) treatment like?
- How does Active Release Techniques work?
What does your assessment consist of?
A detailed history is taken, which includes not only injury-specific questioning, but also a systems review, past medical history, current and past medications, family history, and lifestyle questions. Physical examination may include a visual inspection, relevant neurological examination (sensory/motor/reflex/cranial nerve), range of motion testing, palpatory evaluation, and orthopedic tests.
Do you perform the same orthopedic tests that I do?
A lot of the tests are the same. Indeed, the Orthopedic textbooks that we use are the same as those that you use. However, for your convenience and reference, I have included a list of names and descriptions of specific orthopedic tests that we may use.
How many treatments are needed?
The simple answer is – “it depends”.
It depends on many factors: Severity of injury, age of the patient, age of the injury (acute vs sub-acute vs chronic), workplace factors, lifestyle factors, past history of injury to the area, medical history, psychological factors, motivation and attitude are ALL factors that can influence the required number of treatments needed.
For some patients, one treatment plus appropriate exercise prescription and recommendations for self-help are all that are required. For some acute injuries, six to eight weeks of care may be required to become pain-free. Our goal is to have you in minimal to no pain in the shortest time frame possible – we like to see significant results within a few visits. If we don’t see such change, we will re-evaluate, and pursue other forms of treatment.
Further, length of a treatment program can depend on your treatment goals. For some, the goal is pain-relief - and pain-relief alone. As stated, this goal can often be achieved very quickly. For other patients, the treatment goals may include not just pain-relief, but also rehabilitative strategies to alter structure, functioning, and or behavioral patterns.
Here are two examples to illustrate this point:
Example #1: A patient presents with headaches and neck pain that have been worsening over the past few months. A thorough examination reveals no neurological abnormalities, but multiple areas of tight, strained, over-worked postural-related musculature in the upper back and neck, as well as several cervical spinal segments with restricted mobility. Orthopedic testing indicates that the headaches are originating from the neck. At this stage, the patient is only interested in one thing – pain relief! Treatment, consisting of gentle, specific manual therapy, muscle treatment, stretching and electro-modalities, diminishes the pain. It also relieves the musculature tension and improves the mobility in the cervical spine. With pain relieved, treatment can end at this stage. However, if the patient is interested, we can also address the ongoing strain (that lead to the original pain and can cause future pain) related to his/her poor posture and other lifestyle factors. Manual therapy, stretching of appropriate muscles, strengthening/stabilizing of other muscles, and ergonomic consideration are needed to make the biomechanical corrections and better position the body to handle ongoing daily physical stressors.
Example #2: A patient presents with intense acute low back pain, but has had periodic bouts of back pain over the past ten years. The first phase of treatment focuses on pain-relief. This may include gentle manual/mobilization therapy, modalities, and ice therapy. The patient responds quickly, and pain is drastically reduced. A second (optional) phase of treatment could address the underlying factors that contribute to the recurring pain. In this case, it is found in a thorough biomechanical evaluation, that transverse abdominus and multifidus musculature – 2 key players in spinal stability – are weak – and need to be strengthened. (This can only be done after pain has been reduced). Strengthening these muscles leads to increased spinal stability and reduces the chance of future aggravation of symptoms.
It should be emphasized that all treatment is optional, and can be stopped at any time. Treatment is customized, and tailored to meet the goals of the individual.
Do you x-ray each patient?
No. The use of x-rays as a diagnostic tool by chiropractors (and all health professions) is governed in Ontario by guidelines as set out by the Healing Arts Radiation protection Commission (HARP). X-rays can play an important role in diagnosis, but should only be taken when a need has been determined by a careful case history and physical examination. In our office, the vast majority of patients do not require x-rays.
What about the safety of neck adjustments?
Scientific evidence clearly shows that this is a very safe procedure. However, there has indeed been negative press pertaining to this subject – and make no mistake, we do not take this subject lightly. Our office recognizes the concern and anxiety that can exist over this procedure, and for this reason, offers several other effective alternatives to the treatment of neck injuries (including: gentle mobilizations, the use of gentle modern adjustive equipment, Active Release Techniques, PNF stretching, rehabilitative exercises, physical therapy modalities (ultrasound, TENS/IFC), acupuncture).
It should be emphasized again, however – for the record – that the risk of a serious adverse reaction (eg. vertebral artery dissection) as a result of traditional spinal manipulation is very, very low. The Canadian Medical Association Journal, based on the most factual data available, puts the risk at 1 in 5.8 million (1). To put that in perspective, the risk of a serious neurological complication from cervical spine surgery is greater than 15,000 per million, and the mortality rate is almost 7,000 per million (2). The risk of a serious gastrointestinal bleed from taking aspirin over an extended period is approximately 1 in 1000, or 400 times greater than the risk of damage from a neck adjustment (3).
Another recent study, conducted by the Institute for Clinical Evaluative Studies, concluded that the risk is so low that it is difficult to calculate an accurate risk ratio (4).
Most recently, a study published in the journal Spine, concluded that there is no more risk of suffering from a stroke from visiting a chiropractor’s office than visiting a physician’s office. (5). For more information on this study, you may read a Globe and Mail summary of this study.
In summary, this office does use alternatives to traditional neck manipulation in the treatment of neck injuries. We felt the need to address this important issue, however, and clarify what the published studies have concluded about the true risks of serious adverse reactions associated with neck manipulation.
References:
- Arterial dissections following cervical manipulation: the chiropractic experience. Haldeman, S, Carey P, Townsend M, Papadopoulos, C, Canadian Medical Association Journal, Vol 165, No 7, 905-6, 2001.
- A risk Assessment of Cervical Manipulation V. NSAIDs for the Treatment of Neck Pain. Dabbs V, Lauretti WJ. Journal of Manipulative and Physiological Therapeutics. 18:530-36, 1995.
- Ibid.
- Chiropractic Manipulation and Stroke: A Population-Based Case-Control Study. Rothwell, DM, Bondy Sj, Williams JI, Stroke, May 2001.
- Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-crossover study. Cassidy JD, Boyle E, Cote P, He Y, Hog-Johnson S, Silver F, Bondy, SJ. Spine;33 (4S): S176-S183, 2008.
Can chiropractic provide a preventative function?
Yes. For example, in some chronic conditions, such as osteoarthitis, chiropractic care can decrease the intensity and frequency of pain, and improve mobility. However, in this case, chiropractic (nor any other treatment) can actually cure the (arthritis) condition. Another example of this is individuals who are in highly stressful situations, and who experience highly repetitive physical and postural strain from their daily activities. In this example, although chiropractic treatment cannot take away the stressful situation, it can address the physical response to the stress. In other words, it can address the muscle tension, joint immobility, and associated pain that can be associated with the physical stressors. In these chronic conditions, pain will not disappear magically – however, over time we have had achieved great results in decreasing pain, and improving function – ultimately improving quality of life.
What is the education of chiropractors?
Chiropractic students undergo a rigorous course of study similar to that of other health care professionals, and entrance requirements are also similar. At minimum, 3 years of undergraduate study of university is required before becoming eligible to apply for admission to the Canadian Memorial Chiropractic College (CMCC). The vast majority (greater than 80%) of students have already completed a baccalaureate degree before applying. The chiropractic program itself is an additional four years of full-time study, including a year long internship in the College’s clinics.
The academic program at CMCC, like the other accredited health professionals, includes courses in anatomy, biochemistry, physiology, neurology, embryology, radiology, immunology, microbiology, pathology, nutrition, principles/ethics, and the clinical sciences. In addition to the academic program, chiropractic education requires hands-on clinical experience under direct supervision of highly-qualified chiropractic faculty. This experience includes clinical assessment, diagnosis, treatment, and referral protocols.
As well, chiropractors receive training in radiology which covers a range of topics from radiation biophysics and protection to clinical x-ray interpretation and diagnosis. Radiology training consists of more than 360 contact hours followed by application during clinical internship.
CMCC faculty is comprised of experts in such disciplines as medicine, pathology, psychology, biological sciences, as well as chiropractic.
What is medical acupuncture?
Medical acupuncture is a biomedical approach to acupuncture that combines traditional acupuncture and acupuncture theory with modern, biomedical knowledge, practiced by Western-trained health practitioners (e.g. chiropractors, physicians, physiotherapists). Coupling traditional Chinese acupuncture methods, with our current concepts in neuroanatomy, neurophysiology, and pathophysiology, allows Western practitioners to better organize clinical information to generate safe and more efficient treatments for their patients using acupuncture as a sole therapy, or in combination with other therapies. With medical acupuncture, healthcare practitioners take a proper, thorough history, and perform a physical and neurological examination to arrive at a diagnosis. Selection of relevant acupuncture needling sites follows. (1)
What conditions does medical acupuncture treat?
Medical acupuncture may be used in the treatment of many acute and chronic injuries and conditions. Common problems that are responsive to acupuncture include:
- Acute sprains and strains
- Pain from nerve entrapment (e.g. sciatica, carpal tunnel syndrome)
- Repetitive strain disorders (e.g. tennis elbow, plantar fasciitis, Achilles tendonitis)
- Myofascial pain patterns (e.g. temporo-mandibular joint pain, muscle tension headaches, shoulder pain, neck and back pain)
- Arthralgias (particularly osteoarthritic in nature)
- Degenerative disc disease with or without radicular pain, pain following surgical intervention (both musculoskeletal and visceral)
- Postherpetic neuralgia
- Peripheral neuropathic pain
- Miscellaneous headaches (2)
The most common chronic condition treated (with excellent therapeutic effects) is osteoarthritis. It should be noted that acupuncture (nor any treatment) actually “cures” patients of osteoarthritis – but, rather, it is part of a pain-management solution, allowing for pain-relief, and increased mobility.
In addition to the above-mentioned conditions, the World Health Organization recognizes the use of acupuncture in the treatment of various other conditions:
- Digestive disorders: irritable bowel, constipation, gastritis
- Menstrual and reproductive problems: dysmenorrhea, infertility
- Respiratory problems: sinusitis, asthma, recurrent respiratory tract infections
- Stress and psycho-emotional problems (3)
What are the benefits of acupuncture?
The benefits of acupuncture have been widely studied. The main benefits can be summarized as follows (4):
- Control of pain (analgesic) and endorphin release
- Anti-inflammation
- Healing and regeneration
- Muscle relaxation
- Normalization of autonomic nervous system
- Control of addictions
- Improved sleep
- Neuroendocrine and immune responses
References:
- Fargas-Babjak A, Claraco AE. Clinical Applications of Medical Acupuncture. The Canadian Journal of CME. September 1999.
- Ibid.
- World Health Organization (WHO) Consultation on Acupuncture, Guidelines. 1996.
- Neuro-anatomical Acupuncture Volume 1: Musculo-Skeletal Disorders. Wong JY. 1999.
What is an Active Release Techniques (ART) treatment like?
Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements. ART is unique in its systematic approach to patient and tissue tolerance because patients can control their active movement during treatment. These treatment protocols – over 500 specific moves – are unique to ART. They allow providers to identify and correct the specific problems that are affecting each individual patient. ART is not a cookie-cutter approach.
How does Active Release Techniques work?
ART works by releasing the degree of tightness and or scar tissue formation that has formed as a result of injury – be it, sports injury, repetitive/cumulative strain or postural strain. Treatment is directed towards muscle, tendon, myofascial and ligament tissue, as well as the scar tissue adjacent to nerves. ART systematically works to improve tissue texture, tension, movement, and ultimately – function.