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Welcome our newest RMT!

Jason Verbruggen is our newest Registered Massage Therapist! He comes to us with great references from his previous clinic in Burlington, and he officially starts with MiltonBackDoc on Monday February 26th, 2018. Jason started off his career as a paramedic.  After getting a taste of what it was like to help others in extreme situations,…
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Skiing looks fun, but I might get hurt!

Ski season is in full swing, and with the (mostly) cold weather this year, the slopes are in great shape, and conditions are excellent. Given the great ski season so far, I initially wanted to do a blog post about common skiing injuries, because who wants to get hurt in the middle of the season?…
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Do I need an Xray?

Commonly, when patients go to a walk-in clinic for a recent onset of low back, or neck , or other pain, they'll be sent for an xray to rule out any serious pathology.  Not surprisingly, when patients experience pain, they then think an xray holds the answer, and if not, an MRI must!  The truth is, imaging often creates more concern and questions than it addresses.  Our chiropractors don't routinely recommend radiographs (xrays), and we don't refer patients back to their doctors for imaging unless we feel it's really necessary.

Why? We look at the evidence.  In fact, there isn't just good evidence from clinical study, there are guidelines developed based on this evidence that have been provided to family doctors and walk-in doctors across the province!

Choosing Wisely Canada, a group of leading Canadian physicians, in partnership with the Canadian Medical Association, recommends against routine imaging for low back pain and headaches, unless "red flags" are present.

Dr. Mike Evans, a leading clinician-researcher who practices at St.Michael's hospital in Toronto, and teaches family medicine at the University of Toronto, has a great video on screening and imaging tests, who sums it up better than I can.

Xrays, and even MRI studies, often don't change the course of care for musculoskeletal complaints.  A thorough history with the patient will usually answer the necessary questions to determine if there are any "red flags" present that would warrant further study, such as progressive weakness, neurological deficit, or certain markers of underlying metabolic disease.  If the patient does not have any of these "red flags" then diagnostic imaging will typically demonstrate

  • age related changes: degenerative changes in joints, thinning/narrowed discs, compressed vertebrae (related to osteoporosis)
  • congenital (present since birth) anomalies: such as an extra vertebra, or a differently shaped bone

or

NOTHING UNUSUAL.

This delay to wait for imaging typically results in frustration for the patient, in having to take extra time out of their schedule to get the imaging done, only to have nothing come of it, and their symptoms persist.

But what about those "age related" changes?  Couldn't they mean something?  Or "congenital anomalies"?  That sounds risky, doesn't it?

The answer is NO.  Truthfully, imaging use as it relates to health outcomes, particularly in low back pain has been studied extensively over the last 10-15 years.  What has been found is:

  • between 30-50% of people have findings on imaging (xray or MRI) that do NOT relate to their area of symptoms
  • in a study where 98 people with NO low back pain were sent for imaging, 66% of them demonstrated changes consistent with those changes seen in people with back pain
  • the severity of changes on an xray or MRI do NOT match with the severity of symptoms, meaning that you can have dramatic changes on imaging with very few symptoms, or, very few changes present on imaging with dramatic symptoms.

The first, and best, step, in evaluating a new episode of low back pain is to get assessed by a trained practitioner who takes the time to complete a full and thorough review of your health history, your symptoms and your daily activities, completes testing - including range of motion, neurological and orthopedic testing - and who screens you for red flags that would warrant further investigation.  If that practitioner recommends therapy or home care that you feel comfortable with, pursue it!  If you are not improving within a few weeks, address this concern with that practitioner, or return to your family doctor, prepared with the information of what treatment you did do.

Winter Walking

This blog was developed as a collective effort by the Southwest Region (Ontario) Falls Prevention Network (SWRFPN). Safe Winter Walking Resource Information Physical activity throughout the year is a part of healthy aging and can help prevent falls and fractures. Top Tips for Winter Walking: Be prepared with reflective gear, warm clothing, and non-slip footwear.…
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