Author: Superadmin

Recovery after exercise is an essential element of any training program or workout routine. Athletes, coaches, and healthcare practitioners look to the recovery period between training and competition to maximize performance gains. Intense bouts of exercise can lead to dehydration, fatigue, soft tissue damage, and increased body temperature; altogether, these effects can disrupt many of the body’s physiological systems, like the nervous, cardiovascular, and immune systems (Peake, 2019). The overall goals of post-exercise recovery are to “restore homeostasis, replace fuels and fluids, repair the body’s tissues, and rest” (Peake, 2019). There are various nutritional and physical interventions that can help individuals achieve these goals, including rehydration, hydrotherapies, massage, and sleep. Joint manipulation is one of the many other techniques being discussed in the research domain of post-exercise recovery. 

Joint manipulation is a manual therapy performed by chiropractors and physical therapists (PTs) that involves applying force to one’s spinal or peripheral joints to relieve restriction and improve joint function (Sears, 2021). There are several different techniques that a practitioner may use or favor. Osteopathic manipulative therapy (OMT) is a similar technique (often used to treat chronic pain) that also involves “moving and manipulating a person’s muscles and joints to help diagnose, prevent, and treat certain conditions” (Rowden, 2022). Doctors of osteopathy (DOs) are qualified to perform OMT as part of their medical training. In recent years, OMT has also garnered some discussion as a physical intervention to aid recovery after intense training or physical exertion. 

A study published in the Journal of Manipulative and Physiological Therapeutics in 2021 investigated the effects of OMT on cardiovascular autonomic parameters after a rugby match (Carnevali et al., 2021). Researchers assessed measures of heart rate, heart rate variability, and mean arterial pressure in 23 male players after one session of OMT, “both 18 to 20 hours after a rugby match and in a corresponding no-match condition, in a randomized, sham-controlled, crossover study design” (Carnevali et al., 2021). Compared with the no-match condition, “signs of reduced heart rate variability and elevated mean arterial pressure and heart rate were found 18 to 20 hours after a rugby match” (Carnevali et al., 2021). Significant increases in heart rate variability and a significant reduction in mean arterial pressure were observed after OMT in both conditions. And while heart rate and heart rate variability responses to reactivity were not affected by previous match competition, they were “significantly larger after OMT compared with sham treatment” (Carnevali et al., 2021). Overall, the study suggested cardiovascular autonomic changes in rugby players post-competition, which may be indicative of “prolonged fatigue and incomplete recovery.” In these players, researchers observed that a single session of OMT was followed by favorable changes in cardiovascular autonomic parameters, suggesting that joint manipulation may be a positive part of post-exercise recovery. 

Without proper recovery, athletes may experience under-recovery or even “overreaching,” which is the “buildup of training and/or training stress leading to temporary impairment of performance capacity, with (or without) psychophysiological indicators of maladaptation” (Peake, 2019). When overreaching occurs, it can take days or weeks to completely restore performance capacity. Adequate recovery, however, can allow for a greater tolerance for training and positive physiological adaptations that bolster improvements in athletic performance. Further research into joint manipulation and OMT could lead to the development of additional physical interventions for the post-exercise recovery period.  

References 

Carnevali, Luca, Francesco Cerritelli, Franco Guolo, and Andrea Sgoifo. “Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial.” Journal of Manipulative & Physiological Therapeutics 44, no. 4 (May 1, 2021): 319–29. https://doi.org/10.1016/j.jmpt.2020.09.002. 

Peake, Jonathan M. “Recovery after Exercise: What Is the Current State of Play?” Current Opinion in Physiology, Exercise Physiology, 10 (August 1, 2019): 17–26. https://doi.org/10.1016/j.cophys.2019.03.007. 

Rowden, Adam. “Osteopathic Manipulative Therapy: What to Know.” Medical News Today, February 28, 2022. https://www.medicalnewstoday.com/articles/osteopathic-manipulative-therapy. 

Sears, Brett. “Joint Manipulation in Chiropractic and Physical Therapy.” Verywell Health, December 17, 2021. https://www.verywellhealth.com/joint-manipulation-5207019. 

According to the Centers for Disease Control and Prevention (CDC), the adult obesity rate in the U.S. is over 40%.¹ Poor nutrition is an additional, related issue experienced by many. Dietary science and nutrition have grown more prominent in preventive medicine, for weight control as well as many other aspects of health. The efficacy of different dietary approaches, including calorie restriction (eating less than a specific number of calories each day) and time-restricted eating (eating at specific times of day), are particularly important. Indeed, both time-restricted eating and calorie restriction, in addition to the combination of the two, have shown health benefits.

Studies in a variety of animals, ranging from worms and flies to mice, rats, and primates, have shown that restricting calories can lead to a longer, healthier life. Such experiments report weight loss, improved metabolism, lower blood pressure, improved immunity,² and reduced inflammation.³ Fascinatingly, a key gene has even been found to mediate the effect between calorie restriction and longer life: sustained calorie restriction leads to it being down-regulated, which is a crucial factor to lowering inflammatory mechanisms and contributing to longevity.⁴ 

In parallel, certain studies have shown that time-restricted eating helps not only to reduce calorie intake but also to improve cognition and yield a number of anti-inflammatory effects.⁵

A randomized clinical trial from 2022 that studied nearly 140 patients across 12 months suggested that time-restricted eating was associated with a 1.9 kg difference in weight loss compared to calorie restriction on average, although the magnitude of the effect was not statistically significant. The results seemed to clearly point to a strategy of time-restricted eating combined with caloric intake restriction, as prescribed according to current dietary guidelines, as a viable and sustainable approach for obesity management. Furthermore, the study laid forth an important benchmark for a dietary lifestyle intervention combining quality, quantity, and timing of nutrition.⁶ 

A study from 2021 focused on mice showed that fasting drives the molecular, metabolic, and life-lengthening effects of a calorie-restricted diet. Using a series of feeding regimens, the researchers specifically dissected the effects of calories and fasting – clearly demonstrating that fasting alone results in many of the physiological and molecular effects of calorie restriction.  

A more recent study from 2022 that followed hundreds of mice over their lifespans found that calorie restriction combined with time-restricted eating boosted longevity. Indeed, the study’s results showed that eating only during the most active time of day substantially extended the lifespan of mice on a reduced-calorie diet.⁷ A reduced-calorie diet alone extended the animals’ lives by 10% . However, feeding mice when they were most active, i.e. only at night, extended their lives by about 35%. The particular combination of a reduced-calorie diet and a nighttime eating schedule added on nine months to the animals’ typical two-year median lifespan. (The analogous strategy in humans would be to limit eating to daytime hours.) 

Although they ultimately represent different strategies for supporting metabolic health and weight loss maintenance, both time-restricted eating and calorie restriction have benefits. Individuals should select a strategy that best suits their lifestyle, while keeping in mind that the quality of food, alongside its quantity and intake program, remains one of the important facets of healthy nutritional habits.

References 

1. Products – Data Briefs – Number 360 – February 2020. Available at: https://www.cdc.gov/nchs/products/databriefs/db360.htm. (Accessed: 29th August 2022) 

2. Spadaro, O. et al. Caloric restriction in humans reveals immunometabolic regulators of health span. Science (80-. ). 375, 671–677 (2022). doi: 10.1126/science.abg7292. 

3. Calorie restriction, immune function, and health span | National Institutes of Health (NIH). Available at: https://www.nih.gov/news-events/nih-research-matters/calorie-restriction-immune-function-health-span. (Accessed: 29th August 2022) 

4. Candels, L. S., Becker, S. & Trautwein, C. PLA2G7: a new player in shaping energy metabolism and lifespan. Signal Transduct. Target. Ther. 2022 71 7, 1–2 (2022). doi: 10.1038/s41392-022-01052-5. 

5. Stockman, M. C., Thomas, D., Burke, J. & Apovian, C. M. Intermittent Fasting: Is the Wait Worth the Weight? Current obesity reports (2018). doi:10.1007/s13679-018-0308-9 

6. Liu, D. et al. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N. Engl. J. Med. 386, 1495–1504 (2022). doi: 10.1056/NEJMc2207023. 

7. Acosta-Rodríguez, V. et al. Circadian alignment of early onset caloric restriction promotes longevity in male C57BL/6J mice. Science (80-. ). 376, 1192–1202 (2022). doi: 10.1126/science.abk0297. 

Prebiotics are a relatively new concept in nutrition science. Prebiotics were first introduced and defined in 1995 as food components that are not digested by the one eating but by the microbes living in their gut (1). They can be thought of as food for probiotics (2). Although the study of prebiotics is still ongoing, this field has attracted significant attention due to our growing knowledge of the importance of a healthy gut microbiome (1,3,4). The benefits of prebiotics include increasing the production and absorption of vitamins and minerals, as well as indirectly leading to the benefits of probiotics by stimulating probiotic growth (1,5). 

Using the original, strict definition of prebiotics, only one class of compounds fit the criteria: fructooligosaccharides (FOS), which are short- or medium-length carbohydrates and can be further divided into oligofructose or inulin. Garlic, onion, artichoke, and asparagus contain high levels of FOS (1). Studies show that FOS encourages the growth of bifidobacteria, a genus of gut inhabitants that is important for normal digestive health and is thought to help control the levels of pathogenic microbes in the gut (1,3,4,6). Bifidobacteria are often used as probiotics (1,3,4). 

Specifically, bifidobacteria seem to compete with and even directly inhibit the growth of other types of gut microbes that can be harmful, including clostridia, E. coli, and salmonellas (1,3,6). In addition, they can stimulate immune defenses and facilitate the production, absorption, and/or digestion of various nutrients (1,3,6). Prebiotics thus also carry these benefits by supporting the growth of bifidobacteria in particular.   

Furthermore, the fermentation of prebiotics by gut microorganisms produces short-chain fatty acids (SCFAs), which have antipathogenic effects, serve as metabolic fuel and modulators throughout the body, and are thought to improve the absorption of several minerals in the colon (1,3,6). 

Over the years, there has been significant debate as to the most useful definition of prebiotics. The original definition specifies that the compound a) is not digestible (by the host), b) selectively stimulates the growth of gut bacteria, and c) thus improves health. Other researchers have proposed expanding prebiotics to include compounds that positively impact microbiomes across the body and not just in the gut, that are not necessarily fermented by gut microorganisms, or that change the composition of the gut microbiome (3). Under alternative definitions, t-galactooligosaccharides (tGOS), lactulose, and dietary fibers broadly may be considered prebiotics as well (3). All prebiotics and prebiotic candidates so far are carbohydrates (3,6). 

Our understanding of prebiotics is evolving as additional research is performed. Depending on the exact definition used, prebiotics may be considered to have a narrower or broader range of benefits toward health, but in general, they support the normal, healthy functions of the gut microbiome. These include protection against pathogens and symbiotically assisting with nutrients and digestion. Currently established prebiotic compounds fall under the umbrella of dietary fibers, and further research may find that the broad benefits of dietary fibers – for example, lower risk of cardiovascular disease and diabetes – may be connected to prebiotics (6). Many fruits and vegetables contain prebiotics or candidate compounds, especially those that contain high levels of complex carbohydrates, and some supplements are also available (2,5).  

References 

1. Gibson, G. R., & Roberfroid, M. B. (1995). Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. The Journal of Nutrition, 125(6), 1401-1412. doi: 10.1093/jn/125.6.1401 

2. Villines, Z. (2018). “What is the difference between prebiotics and probiotics?” Medical News Today. https://www.medicalnewstoday.com/articles/323490 

3. Bindels, L. B., Delzenne, N. M., Cani, P. D., & Walter, J. (2015). Towards a more comprehensive concept for prebiotics. Nature Reviews Gastroenterology & Hepatology, 12(5), 303–310. doi:10.1038/nrgastro.2015.47 

4. Roberfroid, M. (2007). Prebiotics: The Concept Revisited. The Journal of Nutrition, 137(3), 830S–837S 

5. Mayo Clinic Staff. (2021). “Prebiotics, probiotics and your health.” Mayo Clinic. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058 

6. Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients, 5(4), 1417-1435. doi:10.3390/nu5041417 

Prebiotics and probiotics are two related components of food and nutrition with major benefits for health. Probiotics are living microorganisms that can live in your gut and have a positive impact on digestion and other physiological processes. A normal, healthy gut contains an incredibly large number of microbes, most of which are beneficial – together, this is referred to as the gut microbiome. Prebiotics, in contrast, are a relatively newer concept and are defined as substances that provide food for probiotics (1,2). 

The purported benefits of prebiotics and probiotics are wide-ranging, from digestive health to mental health. Some of the benefits are well-supported by rigorous research, whereas others are so far only supported by small observational studies or anecdotal accounts. This article will focus on probiotics, with a companion article discussing prebiotics. 

Probiotics can be found in many fermented foods, such as yogurt, kimchi, kombucha, and fermented cheeses. Probiotic supplements are also widely available. In terms of digestive health, researchers have found some evidence that probiotics can help patients with irritable bowel syndrome (IBS) and infectious or antibiotic-associated diarrhea (3-7). 

IBS is difficult to treat, as the underlying cause is not well understood. Patients with IBS have been found to have a different gut microbiome profile, but it is not clear whether that is a cause or an effect (3,5). Trials of probiotics have reported conflicting results, but a review by Moayyedi et al. concluded that the overall evidence suggests probiotics have a benefit for IBS patients, though further research is needed to determine what the best treatment protocol is, given that there are many different types of probiotics and given the heterogeneity of IBS itself (3-5). 

The link between probiotics and diarrhea caused by a disruption to the normal gut microbiome is more intuitively clear. Dysbiosis, caused by either being infected by a harmful gut microorganism or by antibiotics that broadly kill gut microorganisms and leave space for harmful ones to proliferate, can be improved by adding beneficial microbes back into your system. Probiotics can improve recovery in infectious diarrhea and can also help prevent diarrhea in patients taking antibiotics (3,4,6,7). 

Other purported benefits of probiotics include reducing lactose intolerance, improving mental health, treating inflammatory bowel disease, reducing the risk of colorectal cancer, combating side effects of radiation therapy and chemotherapy, and improving immune function (2-4,8). However, research in several of these areas is still in early stages or has not found much support. Current knowledge is limited by the fact that this field of research is relatively young, many existing studies were not appropriately designed to be able to provide high quality evidence for either the benefits of probiotics or lack thereof, and the gut microbiome is an extremely rich and complex ecosystem (1,3,4). 

Probiotics can be a healthy addition to your nutritional plan. They have known benefits for the digestive system and may have benefits for other areas of health as well. In particular, recent research has found a link between the gut and the nervous system, and one major question in this field is whether probiotics may improve neurological, mental, and/or cognitive health (3,4). Anyone with questions about whether to add probiotics to their nutritional plan should consult a trained professional, such as a dietitian or chiropractor with training in nutrition. 

References 

1. Mayo Clinic Staff. (2021). “Prebiotics, probiotics and your health.” Mayo Clinic. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058 

2. Villines, Z. (2018). “What is the difference between prebiotics and probiotics?” Medical News Today. https://www.medicalnewstoday.com/articles/323490 

3. Sanders, M. E., Guarner, F., Guerrant, R., et al. (2013). An update on the use and investigation of probiotics in health and disease. Gut, 62(5), 787–796. doi:10.1136/gutjnl-2012-302504 

4. Gareau, M. G., Sherman, P. M., & Walker, W. A. (2010). Probiotics and the gut microbiota in intestinal health and disease. Nature Reviews Gastroenterology & Hepatology, 7(9), 503–514. doi:10.1038/nrgastro.2010.117 

5. Moayyedi, P., Ford, A. C., Talley, N. J., et al. (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 59, 325-332. doi:10.1136/gut.2008.167270 

6. Guarino, A., Vecchio, A. L., Canani, R. B. (2009) Probiotics as prevention and treatment for diarrhea. Current Opinion in Gastroenterology, 25(1), 18-23. doi:10.1097/MOG.0b013e32831b4455 

7. Goldenberg, J. Z., Yap, C., Lytvyn, L., et al. (2017). Probiotics for the prevention of Clostridium difficile‐associated diarrhea in adults and children. Cochrane Database of Systematic Reviews, 12. doi:10.1002/14651858.CD006095.pub4 

8. Shaukat, A., Levitt, M., Taylor, B. C., et al. (2010). Systematic Review: Effective Management Strategies for Lactose Intolerance. Annals of Internal Medicine, 152(12), 797-803. doi:10.7326/0003-4819-152-12-201006150-00241 

Mobile phone use is ubiquitous in modern society and affords a wide range of benefits, such as connecting people and providing access to information. However, mobile phones have also been linked to a number of health issues. For example, many researchers and clinicians within psychology argue that extreme and problematic mobile phone use can fit the criteria of a behavioral addiction (1). Mobile phones have also been associated with joint problems, particularly in the hands and neck. This issue warrants the attention of several professional fields for research, prevention, and treatment, including primary care doctors, ergonomic specialists, orthopedic doctors, and chiropractors. 

Technological and behavioral changes have outpaced the rate at which the human body can evolve. In the musculoskeletal system, for example, the adverse effects of sitting for long periods (such as at a desk job) and some types of repetitive motion (such as in assembly line work and sports training) are well established. With mobile phones, users often engage in several unnatural positions or movements that can cause joint problems: the majority of the weight is often supported by just the pinkie finger, the arm may be bent in the same position for long periods, the thumbs or another preferred typing finger is used over and over, and the neck is often bent in a suboptimal position. Common problems related to mobile phones include pain, stiffness, or numbness, which can occur in the finger, hand, wrist, or neck joints depending on the individual (2,3).  

Awareness of this issue has been increasing through anecdotal reports and a growing body of research. Orthopedic doctors in Madrid reported two adults in their thirties with osteoarthritis of the trapeziometacarpal joint, a joint at the base of the thumb. Osteoarthritis is caused by gradual wear and tear of joints; it is uncommon in younger adults. Trapeziometacarpal joint osteoarthritis is even more uncommon but can be caused by repetitive thumb activities. Other studies have also reported inflammation of tendons, synovial sheaths, and fascia due to mobile phone use (4).  

Another group of researchers performed a retrospective analysis of 70 individuals who reported pain related to extensive use of handheld devices (mobile phones, tablets, game controllers), were diagnosed with a musculoskeletal disorder of the upper extremities, and underwent rehabilitation. Patients were more likely to have symptoms in their dominant hand. The diagnosed conditions included tendinosis and myofascial pain syndrome. Data suggested that the joint problems were linked to the predominant usage of a specific finger/thumb. Fortunately, patients recovered with rehabilitation, which is a positive sign for other providers seeking to design treatment plans for joint problems associated with mobile phones (5). 

In addition to data linking joint problems to mobile phones based on reported symptoms, studies looking for a mechanistic explanation have examined how muscles are used during phone use in symptomatic and healthy individuals. Xie et al. used electromyography on postural muscles in the neck and shoulders, and muscles controlling hand and thumb movement. Participants with neck/shoulder pain had higher muscle activity in postural muscles than healthy controls. Results suggest that unbalanced neck positioning is related to neck/shoulder pain, though whether the relationship is causal could not be determined. In addition, one-handed texting was associated with higher muscle load than two-handed texting (6). 

Individuals who frequently use mobile phones should try to stay aware of their head, neck, and upper back posture to prevent strain. Using two hands when possible may be beneficial for hand and finger joint health, while adding a device to change how you grip your phone (such as a pop grip) may also help (2,3). Ice and splinting, physical therapy, and chiropractic may be appropriate for treating pain. Overall, the best prevention strategy is to avoid phone overuse. 

References 

1. Gutiérrez, J. D.-S., de Fonseca, F. R., and Rubio, G. Cell-Phone Addiction: A Review. Frontiers in Psychiatry, 2016;7:175. DOI:10.3389/fpsyt.2016.00175 

2. Waston, K. “How to Prevent Smartphone Finger and Smartphone Thumb.” Healthline, 2021. https://www.healthline.com/health/smartphone-finger 

3. Moyer, M. W. “Text Neck, Pinkie Pain and Other Ways Phones Can Wreck Our Bodies.” The New York Times, 2022. https://www.nytimes.com/2022/04/28/well/live/neck-joint-pain-phone.html 

4. Canillas, F., Colino, A., and Menéndez, P. Cellular Phone Overuse as A Cause for Trapeziometacarpal Osteoarthritis: A Two Case Report. Journal of Orthopedic Case Reports, 2014;4(4):6-8. DOI: 10.13107/jocr.2250-0685.213 

5. Sharan, D., Mohandoss, M., Ranganathan, R., and Jose, J. Musculoskeletal Disorders of the Upper Extremities Due to Extensive Usage of Hand Held Devices. Annals of Occupational and Environmental Medicine, 2014;26:22. 

6. Xie, Y., Szeto, G. P. Y., and Madeleine, P. A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck–shoulder pain. Ergonomics, 2015;59(1). DOI: 10.1080/00140139.2015.1056237 

Back pain in children and adolescents occurs more frequently than previously thought (Bernstein, Haus). Incidence depends on age and physical activity, but it may reach up to 24-36% of the pediatric population (Haus). While back pain in adults has been extensively studied, leading to its recognition as a leading cause of disability and a large burden on the healthcare system, back pain in children has received relatively less attention (Bernstein). Current data suggests that it is more likely to be caused by an identifiable, specific underlying cause than for adults; furthermore, some causes of pediatric back pain are serious conditions warranting rapid treatment (AAOS, Bernstein). 

There are several mechanical problems that can arise from physical activity or physical habits, which are often acute and treatable. Haus and Micheli (2012) propose that sports-related injuries contribute to the surprisingly high incidence of pediatric back pain. As is generally the case within the musculoskeletal system, acute injuries or chronic overuse can damage joints and cause pain (AAOS, Haus). The combination of intensive sports training and anatomical changes due to growth can place excessive pressure on the spine and back muscles (Haus). This type of back pain can usually be managed with rest, NSAIDs if needed, and progressive rehabilitation (AAOS, Haus). 

One concern, especially with children, is that heavy backpacks may overload the back. However, there are conflicting points of view – the American Academy of Orthopaedic Surgeons lists carrying a heavy backpack as a cause of muscle strain and imbalance, but a study found no association between heavy backpacks and back pain in school-age children (Haus, AAOS). 

There are also a number of other spinal conditions that can cause back pain in children. While one study found that lumbar strain or spasm was the most common diagnosis given to adolescents with low back pain (at 9%), the next most common were scoliosis (5%), degenerative disc disease (2%), and disc herniation (1%) (Yang). Scoliosis can increase the risk of other back injuries due to imbalanced load during sports. Degenerative disc disease and disc herniation are more common in pediatric athletes than pediatric non-athletes – this population and their parents/guardians should be aware of the risks and consider whether instances of back pain may have underlying pathology instead of being an acute injury (Haus). Other potential causes of pediatric back pain include spondylolysis (stress fracture), spondylolisthesis (slipped disc), and more rarely, infection or tumor (AAOS, Bernstein, Haus, Yang). 

In many cases, pediatric back pain can be managed conservatively with good outcomes. However, there are key factors that should prompt urgent care-seeking: back pain in children aged 4 or younger and back pain with fever, weight loss, nighttime pain, or weakness (AAOS, Berstein, Haus). 

Treatment for children with back pain varies depending on symptoms, diagnosis, and individual-specific factors. Many musculoskeletal injuries and conditions can be managed with a combination of rest, anti-inflammatory medication, and physical therapy. Surgery may be required for some cases of spinal fracture, herniated disc, progressive spondylolisthesis, severe scoliosis, and tumor (Berstein, Haus). Chiropractic management may also be appropriate: a study found that 62% of a group of pediatric patients with low back pain experienced a clinically important decrease in reported pain and 87% perceived a clinically important improvement within a 6-week treatment course. However, patients with chronic low back pain were less likely to respond within the treatment period (Hayden). 

References 

American Academy of Orthopaedic Surgeons. (2019). “Back Pain in Children.” OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/back-pain-in-children/ 

Bernstein, R. M., & Cozen, H. (2007). Evaluation of back pain in children and adolescents. American family physician, 76(11), 1669–1676. 

Haus, B. M., & Micheli, L. J. (2012). Back Pain in the Pediatric and Adolescent Athlete. Clinics in Sports Medicine, 31(3), 423–440. doi:10.1016/j.csm.2012.03.011 

Hayden, J. A., Mior, S. A., & Verhoef, M. J. (2003). Evaluation of chiropractic management of pediatric patients with low back pain: A prospective cohort study. Journal of Manipulative and Physiological Therapeutics, 26(1), 1–8. doi:10.1067/mmt.2003.11 

Yang, S., Werner, B. C., Singla, A., & Abel, M. F. (2017). Low Back Pain in Adolescents. Journal of Pediatric Orthopaedics, 37(5), 344–347. doi:10.1097/bpo.0000000000000653  

Chiropractic care is useful as a treatment for many conditions, including low back pain [1]. LBP is one of the leading reasons why Americans visit medical practitioners, as well as a significant contributor to opioid use in the country [1]. Despite chiropractic care’s demonstrated efficacy in helping sufferers of LBP, not all health insurance plans in the United States cover chiropractic care, and those that do tend to do so sparingly [2]. This article will explore differences in chiropractic care coverage across health insurance plans, as well as the adverse effects of limited coverage on patients. 

Most health insurance plans include some coverage for chiropractic care [3]. Heyward et al. conducted a survey of 15 commercial, 15 Medicare Advantage Health, and 15 Medicaid plans [2]. The plans they surveyed represented more than 50% of insured people in the US [2]. On the whole, all three types of plans tend to cover chiropractic care [2]. 

Despite this broad-based coverage, benefits could be subject to certain limits that reduce patient access to chiropractic services [2]. Commercial insurers and Medicaid tend to subject patients to visit limits for chiropractic care [2]. Instead of visit limits, other Medicaid plans may require that beneficiaries receive prior authorization, meet certain conditions, or acquire a referral before visiting a chiropractor [2].  

Meanwhile, Medicare only allows beneficiaries to receive chiropractic coverage if they need to fix a vertebral subluxation [4]. Any other form of chiropractic care, as well as any examinations that the chiropractor orders, will not be covered [4]. This coverage strategy is incoherent, given how chiropractic care for a variety of conditions is associated with reduced opioid-associated disability, lower medical costs, and faster recovery, among many other benefits [5]. 

Costs varied across insurers as well. Medicare Advantage requires beneficiaries to pay a median $20 co-payment for in-network care or a 35% co-insurance fee for out-of-network care [2]. By comparison, commercial insurers place a significantly higher out-of-pocket cost on beneficiaries. Patients pay on average a $60 co-payment per visit if their provider is in-network or a 50% co-insurance fee for out-of-network providers [2]. After meeting their deductible, Medicare beneficiaries pay 20% of the Medicare-Approved Amount for chiropractic services [4]. 

Evidently, there are major deficiencies in chiropractic care coverage across US health insurance plans. Given the many advantages of chiropractic care, these shortcomings are significant. Davis et al. estimated that, for every 1,000 Medicare beneficiaries, reduced access to chiropractic care results in an increased cost of $114,967 [6]. Furthermore, chiropractic care has helped dampen the opioid pandemic by providing patients with nonpharmacological alternatives to back and neck problems [3]. By reducing access to chiropractic care, efforts to combat opioid overuse may be impaired. 

Because of heightened costs, visit limits, and other obstacles, many people who may benefit from chiropractic care cannot access it [1]. To address this issue, researchers recommend pushing for nonpharmacological care, possibly through financial incentives, instructive advocacy, policymaking, or a combination of approaches [1]. By legitimizing nonpharmacological options as frontline treatments for chronic conditions, chiropractic care may become more broadly insured across the US [1]. 

References 

[1] C. M. Goertz and S. Z. George, “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain–Time for a Change,” JAMA Network Open, vol. 1, no. 6, p. 1-3, October 2018. [Online]. Available: DOI: 10.1001/jamanetworkopen.2018.3037. 

[2] J. Heyward et al., “Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers,” JAMA Network Open, vol. 1, no. 6, p. 1-14, October 2018. [Online]. Available: DOI: 10.1001/jamanetworkopen.2018.3044. 

[3] B. J. Eovaldi and B. McAlpine, “Increased Utilization of Spinal Manipulation by Chiropractors to Tackle the Opioid Epidemic,” Medical Care, vol. 59, no. 12, p. 1039-1041, December 2021. [Online]. Available: DOI: 10.1097/MLR.0000000000001633. 

[4] “Chiropractic services,” Medicare. [Online]. Available: https://www.medicare.gov/coverage/chiropractic-services. 

[5] R. A. Leach, “Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs,” Journal of Chiropractic Humanities, vol. 27, no. C, p. 29-36, December 2020. [Online]. Available: DOI: 10.1016/j.echu.2020.10.002. 

[6] M. Davis et al., “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults,” Journal of Manipulative and Physiological Therapeutics, vol. 44, no. 5, p. 353-362, June 2021. [Online]. Available: DOI: 10.1016/j.jmpt.2021.05.002. 

Low back pain (LBP) is a significant burden on health levels and healthcare costs in the United States [1]. Not only can sufferers of LBP experience severe, often disability-inducing pain, but they may also require costly medical care to treat their conditions [1]. Unfortunately, neither the chief cause nor the ideal treatment for LBP is certain [2]. Fortunately, many treatment options for low back pain are available to patients, including chiropractic care and physical therapy (PT) [2]. When deciding whether to opt for one over another, there are a few key characteristics and discoveries that patients and their medical teams should keep in mind. 

Chiropractic care consists of a wide array of treatments, including electrical stimulation, heat or ice application, and, most commonly, joint manipulations for the correction of subluxations [3]. In the context of LBP treatment, there has been disagreement among experts about the appropriate role of chiropractic care [2]. 

Some of this debate may have been quelled by a 2018 study [2]. The study sought to analyze the efficacy of chiropractic in treating LBP [2]. The researchers compared how active-duty military personnel complaining of LBP fared with usual care alone (ranging from pharmaceutics to PT) versus usual care combined with up to twelve chiropractic treatments [2]. At the end of the six-week treatment period, the usual care plus chiropractic group reported less severe pain, reduced disability, diminished pain medication use, improved function, and higher satisfaction [2]. According to these results, chiropractic appears to be an effective treatment for LBP.  

Similarly, physical therapy has reportedly contributed to improved outcomes when compared to no treatment or medical intervention alone [1]. The central objective of PT is to prevent further disability and improve functional capability [4]. For combating low back pain, the most effective forms of physical therapy appear to be active strategies, such as yoga, tai chi, and other forms of exercise [4]. Because no single form of PT has emerged as superior to all others, researchers suggest that patients employ a diversity of techniques, chosen according to personal preference [4]. 

Multiple studies have compared chiropractic care and PT’s respective effects on LBP. For instance, a 2006 UCLA study focused on the differences in disability, remission, and pain intensity among LBP patients sorted into four groups: chiropractic with and without physical modalities, and medical care with and without PT [5]. After 18 months of analyzing their subjects, Hurwitz et al. found that the groups were relatively equivalent across the primary outcomes [5]. However, the chiropractic group had a “greater likelihood of perceived improvement,” suggesting that this technique may be associated with a boost in confidence [5]. 

Further evidence suggests that each method may have unique benefits. Gudavalli and colleagues compared flexion-distraction (FD), a chiropractic technique, with active trunk exercise protocol (ATEP), a form of PT [6]. The FD patients experienced greater pain relief, leading the researchers to conclude that FD may be more appropriate for patients with chronic LBP or those with radiculopathy [6]. Meanwhile, patients with recurrent pain improved most under ATEP [6].   

Besides the severity of the patient’s condition, cost may also influence which treatment they choose. A 2020 study found that the total average cost for LBP patients who opted for chiropractic treatment was $48.56 lower than those who chose physical therapy [1]. 

Nevertheless, there is no ideal treatment for low back pain. However, by considering their degree of pain, their desire for extra motivation, and budget concerns, patients can make a more informed choice between physical therapy and chiropractic care. 

References 

[1] N. Khodakarami, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation,” Healthcare, vol. 8, no. 44, p. 1-8, February 2020. [Online]. Available: https://doi.org/10.3390/healthcare8010044. 

[2] R. H. Shmerling, “Should you see a chiropractor for low back pain?,” Harvard Health Publishing, Updated August 16, 2019. [Online]. Available: https://www.health.harvard.edu/blog/should-you-see-a-chiropractor-for-low-back-pain-2019073017412. 

[3] B. Sears, “Here’s How Chiropractors and Physical Therapists Are Different,” VeryWell Health, Updated September 3, 2021. [Online]. Available: https://www.verywellhealth.com/chiropractor-vs-physical-therapy-5194093. 

[4] E. A. Shipton, “Physical Therapy Approaches in the Treatment of Low Back Pain,” Pain and Therapy, vol. 7, no. 2, p. 127-137, September 2018. [Online]. Available: https://doi.org/10.1007/s40122-018-0105-x. 

[5] E. L. Hurwitz et al., “A Randomized Trial of Chiropractic and Medical Care for Patients With Low Back Pain: Eighteen-Month Follow-up Outcomes From the UCLA Low Back Pain Study,” Spine, vol. 31, no. 6, p. 611-621, March 2006. [Online]. Available: https://doi.org/10.1097/01.brs.0000202559.41193.b2. 

[6] M. R. Gudavalli et al., “A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain,” European Spine Journal, vol. 15, no. 7, p. 1070-1082, December 2005. [Online]. Available: https://doi.org/10.1007/s00586-005-0021-8.