Dec 30, 2009

Chiropractic Approach to Tension Headaches and Neck Pain

Chiropractic Approach to Tension Headaches and Neck Pain

In my San Diego chiropractic clinic we treat hundreds of people each year with headaches. Some of the more common types of headaches that we see are the: migraine headache, cluster headache, caffeine headache, vascular headache, spinal headache and tension headaches.

Like its’ label implies, muscle tension headaches occur secondary to hypertonic or overly tight muscles. In many cases, the muscle tension that causes the headache is a direct result of neck pain or dysfunction. This article will focus on the tension headache because it is the most common type of headache and the type most often linked to neck pain.

This article will describe in both how and why some people get tension headaches and what can be done for them both at home and with chiropractic care.

To begin with, most people think of their skull as being covered only with skin. What many don’t know is that underneath the skin lies a thin layer of muscle. Another well known fact regarding muscle tension headaches is that the pain that the patient feels is from these muscles, not from the brain.

Most of the time this layer of muscle that covers the skull maintains normal resting muscle tone. During these times, the patients are free from the effects of muscle tension and the resulting headaches.

Stress, whether from work, home or social situations can cause these muscles to tighten. Think of an irritated persons’ furrowed brow. This reaction to stress can cause the muscles covering the skull to spasm resulting in muscle tension and a tension headache. Typically, the headache will fade as the muscle spasm resolves.

Another common source of muscle tension headaches is the neck and upper back. There is a thin layer of muscle that connects the top vertebra in your neck to the base of your skull. This muscle group is known as the suboccipital muscles. When we are stressed or injured (as in a whiplash accident), the neck muscles can tighten and spasm resulting in neck pain, back pain and muscle tension headaches as well.

There are many muscle groups and layers of muscle that overlap in the neck and upper back. Chronic tightness of these muscles can also trigger the onset of a chronic headache. If indeed your headache is caused by muscle tension, it will certainly improve as the muscle tension decreases.

Headache relief can come from several different treatments. A common home remedy for headache involves the use of ice packs. Ice packs can be applied to the head or neck in 20 minute sessions. Ice packs will remove inflammation built up in the muscles and calm the nerves. Teaching yourself relaxation techniques can also be very effective if you carry the proper mindset.

Muscle tension headaches also result from minor misalignments of the vertebra in the neck called subluxations that can trigger muscle spasms and pain that create the headache. Subluxations irritate the joints of the spine and the associated nerves resulting in the muscle tightening (spasm) around the joint as a protective mechanism.

Chiropractic adjustments help restore the normal healthy balance of the muscles that move and support the spine. A healthy spine is not bound by muscle tension and much less likely to trigger a muscle tension headache. A treatment program with an experienced chiropractor can result in dramatic improvements in patients suffering from chronic muscle tension headaches.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Dr. Steve Jones (619) 280-0554
10393 San Diego Mission Rd Suite 130,
San Diego.
CA. 92108

www.jonespainrelief.com

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Read More Articles on Chiropractic, Nutrition, Preventative Health, Back pain, Neck Pain and more

Chiropractic, headaches, migraine, tension headache, neck pain, muscle tension

Dec 12, 2009

Low Back Pain Treatment

Low Back Pain Treatment

I have been practicing chiropractic care in San Diego for the last 15 years. In that time I have seen many different types of lower back injuries that all generate some level of back pain or disability. Back pain severity can range anywhere from a mild ache to an intense, severe bout that can cause total disability.

For most of these people, the joint most likely to be involved is the sacroiliac joint. We have two sacroiliac joints. They are located just to the left and right sides of the spine at your beltline. These joints are both the largest and the strongest joints in your spine. They have the largest muscles and the strongest ligaments to provide for their movement and support.

These joints also have a close relationship with the bottom two vertebra of your lumbar spine. The sacroiliac joints are attached to the L4 L5 vertebra with ligaments that essentially create a situation in which the health of each of these joints is dependent on the health of the other adjacent joints.

The L4 L5 S1 and sacroiliac joint complex is very durable while allowing a great range of motion. This joint complex, however, is also subjected to incredible levels of stress as a result of poor posture, sitting, sports injuries and improper lifting techniques. Patients who sustain injuries in this area are dumbfounded that they cannot recall any particular injury that “threw their back out”.

Like any other joint in your body, the sacroiliac joints weaken and eventually are injured by ongoing low levels of stress. We often see people who have suffered a severe back injury involving the sacroiliac joints following an activity such as picking a sock up off the floor or some other mundane task. An injury following a task such as this indicates a long standing problem that should be addressed by a competent chiropractor.

Low back injuries that are not promptly addressed with formal therapy can easily become chronic leading to more severe aggravations in the future.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Dr. Steve Jones (619) 280-0554
10393 San Diego Mission Rd Suite 130,
San Diego.
CA. 92108

www.jonespainrelief.com

Visit our Adjustable Economical Mouse Pad website to learn more about or Buy Ergo Nav

Visit my San Diego Chiropractic Website to make an appointment

Read More Articles on Chiropractic, Nutrition, Preventative Health, Back pain, Neck Pain and more

Dec 3, 2009

Medical Myths Overheard in a Chiropractors Office

Medical Myths Overheard in a Chiropractors Office

In my San Diego based Chiropractic clinic, I hear wives tales regarding health and fitness all the time. The one that I hear most often doesn’t have anything to do with neck pain or back pain – it has to do with knuckle cracking. It seems that almost everyones’ parents have told them “Don’t crack your knuckles, they will get big and full of arthritis when you are older!” Believe it or not, this is not true. Cracking joints that are weight bearing ie, your neck, back, knees and ankles, etc can be harmful if you are not a trained chiropractor, but cracking your knuckles is only irritating to other people.

A study was just released that examined 7 common medical myths that are being circulated today. They are as follows:

Two US researchers took seven common beliefs and searched the archives for evidence to support them.

Despite frequent mentions in the popular press of the need to drink eight glasses of water, they found no scientific basis for the claim.

The complete lack of evidence has been recorded in a study published the American Journal of Psychology, they said.

The other six "myths" are:

Reading in dim light ruins your eyesight

The majority of eye experts believed it was unlikely to do any permanent damage, but it might make you squint, blink more and have trouble focusing, the researchers said.

Shaving makes hair grow back faster or coarser

It has no effect on the thickness or rate of hair regrowth, studies say. But stubble lacks the finer taper of unshaven hair, giving the impression of coarseness.

Eating turkey makes you drowsy

It does contain an amino acid called tryptophan that is involved in sleep and mood control. But turkey has no more of the acid than chicken or minced beef. Eating lots of food and drink at Christmas are probably the real cause of sleepiness.

We use only 10 per cent of our brains

This myth arose as early as 1907 but imaging shows no area of the brain is silent or completely inactive.

Hair and fingernails continue to grow after death

This idea may stem from ghoulish novels. The researchers said the skin dries out and retracts after death, giving the appearance of longer hair or nails.

Mobile phones are dangerous in hospitals

Despite widespread concerns, studies have found minimal interference with medical equipment.

The research was conducted by Aaron Carroll, an assistant professor of pediatrics at the Regenstrief Institute, Indianapolis, and Rachel Vreeman, fellow in children's health services research at Indiana University School of Medicine.

I hope that you enjoyed this information. Happy Holidays!

More Soon

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

www.jonespainrelief.com

Visit our Adjustable Economical Mouse Platform website to learn more about or Buy Ergo Nav

Visit my San Diego Chiropractic Website to make an appointment

Read More Articles on Chiropractic, Nutrition, Preventative Health, Back pain, Neck Pain and more

Nov 30, 2009

Causes of Back and Neck Pain

Causes of Back and Neck Pain

Like many across the United States my Chiropractic Office in San Diego provides treatment for neck pain and back pain. Although chiropractic care helps many different conditions, it is often viewed as treatment for just back pain and neck pain.
When dealing with back pain and neck pain, it is important to have your pain evaluated by a healthcare professional. Dismissing back pain and neck pain as insignificant can lead to more significant health issues.
Many conditions can cause back pain and neck pain, ranging from injury and infection too twisting or turning “the wrong way”.   Injuries such as those sustained in an automobile or other accident can damage muscles, joints, ligaments, and vertebrae.

Overuse or under use of the back muscles is by far the most common cause of back pain that manifests as tightening or spasm of the muscles that connect to the spine.   Inflammation and swelling often occur in the joints and ligaments, especially in the cervical and lumbar regions, as people age.

A herniated disc occurs when the nuclear pulposus, the inner material of the disc, pushes through a tear in the annulus fibrosis, the outer material of the disc causing nerve root compression.   The cervical and lumbar regions of the spine have the most mobility and the discs there are more likely to wear down or be injured. Ninety percent of disc herniations occur in the lower two lumbar vertebrae.

Spinal stenosis, the narrowing of the spinal canal, can cause spinal cord irritation and injury. Conditions that cause spinal stenosis include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration. Spinal stenosis most commonly occurs in older individuals as a result of vertebral degeneration.

A pinched nerve, or radiculopathy, occurs when something rubs or presses against a nerve, creating irritation or inflammation. Radiculopathy can result from a herniated disc, bone spur, tumor growing into the nerves, and vertebral fracture, and many other conditions.

Sciatica is a certain type of radiculopathy that involves inflammation of the sciatic nerve. Pain is experienced along the large sciatic nerve, from the lower back down through the buttocks and along the back of the leg.

A spinal tumor that originates in the spine (primary tumor) or spreads to the spine from another part of the body (metastatic tumor) can compress the spine or nerve roots and cause significant pain.

Infections of the vertebrae (e.g., vertebral osteomyelitis), the discs, the meninges (e.g., spinal meningitis), or the cerebrospinal fluid can compress the spinal cord and result in serious neurological deterioration, if it is not diagnosed and treated immediately.

Arthritis often affects the facet joints which are formed by two adjacent vertebra and direct or guide movement of the spine.   As the joints degenerate, they loose their normal alignment, and the cartilage and fluid that lubricates the joints may deteriorate. Bone then rubs against bone, which can be very painful.

These are just a few of the conditions that can cause back pain and neck pain. Most cases of back and neck pains are due to mechanical causes and can be readily addressed by a chiropractor. The point is, however, neck pain and back pain is a warning signal that should not be ignored.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Nov 17, 2009

Low Back Pain Treatment San Diego

San Diego Low Back Pain Treatment

Lower back pain is one of the most frustrating things for patients to deal with. I have had what I consider bad lower back pain, bad neck pain and other injuries that get my full attention. Of all of these conditions, I think that lower back pain has been the worst spine complaint that I have had. Since I became a chiropractor in San Diego, I have taken informal surveys of my patients regarding the area of their backs that create the greatest level of disability when aggravated and more often than not the answer is lower back pain.

Chiropractic care for lower back pain is pretty straight forward. Usually low back pain is accompanied by muscle spasms which have to be addressed first. Most low back pain patients do very well with treatment that begins with the application of hot packs and electrical muscle stimulation. Electrical muscle stimulation sounds intimidating to some people but it is a very comfortable, relaxing form of therapy that is excellent at soothing muscle spasms.

Once the muscles have been relaxed as much as possible, the affected joints of the lower back can be adjusted. Much like the sound of electrical muscle stimulation, some people find the sound of having their joints manipulated intimidating. In fact, the overwhelming majority of even first time chiropractic patients find the joint manipulations to be comfortable and soothing to their back pain.

Chiropractic care is delivered as a series of treatments rather than a single session. That is not to say that you may not attain 100% relief with one session, but you shouldn’t count on it. The rule of thumb in regards to how much care you may need for a low back issue is that you must allow for one week of active care (2 to 3 visits per week) for each month that you have had a particular problem. This level of frequency and consistency will ensure the greatest level of recovery with chiropractic care.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Nov 7, 2009

Four Steps to Neck Pain Relief:

Four Steps to Neck Pain Relief:

My San Diego chiropractic office sees a regular flow of patients with neck pain. I use a variety of chiropractic adjustments and physiotherapy modalities to help relieve the pain and stiffness that accompanies neck pathologies. In addition to treatment that I perform here in the office for neck pain, there are many steps and procedures that can be taken by the patient outside of my direct care.

Here is a list of four pro-active steps that you can take to avoid neck pain.

1)    Avoid activities that instigate neck pain
2)    Stretch
3)    Exercise
4)    Watch Your Posture

Let’s begin with number one. This sounds simple, but avoiding activities that instigate neck pain seems to skirt peoples’ minds. It is kind of like that old doctors’ saying, “if it hurts don’t do it!” You would be surprised by how many of my patients come in with neck pain, or hip pain, arm pain, back pain, and say, “you know doc, every time I do (fill in the blank) I hurt my neck.” It is the strangest thing but it happens over and over.

Stretching is also very important in relieving neck pain. With stretching, it should be done as a prevention, not a cure. This means that by stretching daily, you can help prevent a neck pain crisis. Usually, stretching during a neck pain crisis will aggravate your symptoms rather than relieve them. Stretching on a consistent basis can go a long way towards improving your health. I recommend / hand out specific exercises to my patients on a regular basis. The patients who do their exercises seem to do much better than those who don’t.

Exercise is also very important. By the time we reach adult years, we have usually suffered at least one significant sprain / strain type injury. These injuries happen as a result of falls, whiplash, heavy lifting and various sports injuries. Sprain / strain type injuries can damage the ligaments in the neck resulting in a weak link. For many people, the only way to add stability to their necks is with exercise. Just like stretching, however, exercise must be habit that is begun for an episode of pain. Exercising muscles that span a dysfunctional joint is a sure fire recipe for further aggravation.

One of the more difficult ways to prevent neck pain is by watching your posture. Posture is a difficult thing to control because we tend to do our work in front of us which makes it easy to tilt our heads down and round our shoulders forward. This posture causes anterior weight bearing and creates a tremendous amount of stress on the neck and upper back. Proper ergonomic set ups at both work and home do a great deal to help us with posture. The most important item concerning posture is to simply be aware of it and to straighten up whenever we think of it.

More coming soon!

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Oct 20, 2009

Stress and General Tension:

Stress and General Tension:

Picture this; you are just finishing a grueling work week. Your neck hurts and your shoulders are tight. It feels as though your shoulders a drawn up around your ears.

Does all this sound familiar? It should. Stress affects us everyday. The pressures of work and personal relationships can make us feel like a giant knot all by themselves. For most of us, however, this is just the beginning of our stress. Physical ailments that exist because of current conditions and those that continue to haunt us from the past i.e. old auto accident injuries, falls off our bicycles, years of postural stress etc. also contribute directly to our general tension level.

I am sure that most of my readers can recall a time when they went to work with some kind of neck pain or other body ache that made them much less amicable.

The process that takes place is simple and much more damaging then you might think. Our bodies are very good at compensating for stresses whether they are physical or emotional. However, if the stresses exist for a long enough period of time or if they are compounded by other stresses, our bodies start to express this build up of stress in various ways. For some people, stress and tension will generate headaches. For others the continued stress will trigger episodes of neck or back pain.

For either of the above examples, the process that takes place involves the body responding to stress with muscle tension. More often than not, our physical response to stress involves a tightening of the muscles in the shoulders and upper back. In addition to this tightening of muscles causing neck and back pain, it also raises blood pressure, burns energy causing physical fatigue and in some people causes mental fatigue.

Unfortunately, we are probably stuck with our jobs and although stressful, we elect to keep our relationships. These things are pieces of our lives that many of us have no choice but to accept (we could if we really wanted).

We can more easily take better care of our bodies. Proper ergonomics at work and home, breathing techniques, yoga, exercise, massage and of course chiropractic treatment can go a long way in counteracting stress and general tension.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Oct 16, 2009

Ergonomically Yours Blog

Ergonomically Yours

Articles about Ergonomics Issues and Products, this is the blog for a website we are building at the moment that will be selling many different Ergonomic Office Products

Yours SEO4Chiros

The Chiropractors SEO

Oct 15, 2009

The Computerized Office and Its Effects on Workers

The Computerized Office and Its Effects on Workers

Hundreds if not thousands of books and articles have been written that deal with the short and long term negative effects of working with computers.

As a chiropractor practicing in San Diego, I see a constant flow of new patients who complain of neck pain, shoulder pain, arm pain, wrist pain and hand pain as a result of long work days that mostly consist of sitting at a computer. It doesn’t stop there. Because sitting is especially stressful for the lower back we see plenty of computer operators who complain of low back pain as well.

It seems that the computer spares no body part from pain, discomfort and sometimes disability.

The most damaging characteristics of computer work can be summed up in two related triggers that stimulate our bodies to react to this type of work.

The first of these triggers involves the way the muscles of our necks, upper backs, arms and hands are used during computer work.

Whenever we are working on our computers our fingers are moving a mile a minute while the rest of the muscles of our upper extremities are in a static contraction. Muscles are designed to move joints through an entire range of motion. When we work at our computers these muscles simply contract to hold joints in a fixed position. When muscles act in this way they build up lactic acid, become irritated and inflamed and eventually fatigue and become painful. The long-term effects of this process include tendonitis, carpal tunnel syndrome, trigger finger, etc, etc.

The second trigger involves postural stress. It is human nature to lean forward into our work. Leaning forward improves our ability to see what we are working on. This posture typically includes bending forward at the waist, rounding our shoulders forward and craning our necks forward. Each of these body positions by themselves is capable of causing pain and discomfort. When we are doing computer work it is not unusual to have all three of these postural stresses working on us at the same time.

Controlling these stresses is of utmost importance in order to prevent injury. Taking short one or two minute stretching breaks for the arms and hands every twenty or thirty minutes is very helpful. Icing the painful areas is helpful as well. Finally, becoming aware of your posture and doing what you can to eliminate postural stress will help.

There are other articles on this topic in this blog and in my chiropractic blog at www.jonespainrelife.com/blog that will give you more information on how to control the stresses of computer work.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Oct 11, 2009

Short North Accident Injury Care

Short North Accident Injury Care: "# SEO for Chiropractors

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.

Call Steve Jones at
(619) 280 0554
San Diego Chiropractic

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Better Health Steve Jones

Oct 10, 2009

Computer Ergonomics

Computer Ergonomics: "Sitting, Reaching and Posture
August 22nd, 2009

Sitting and reaching have a profound impact on your posture. Both sitting and reaching stress the spine. Reaching stresses both the spine, shoulder, elbow and wrist. Sitting and reaching contribute to poor posture that can cause neck pain, shoulder pain, back pain and wrist pain.

Sitting has a negative impact on your back for several reasons. Since our spines were made to move, it should come as no surprise that hours on end of sitting in a static position leads to injury.

In addition to a lack of movement, the sitting posture itself is structurally stressful to the spine. When we are standing upright, the lower back should have a sweeping forward curve which promotes stability by reducing pressure on the discs that separate our vertebra. Sitting reverses the normal curve in our lower backs and increases the pressure on the discs leading to an increased chance of injury.

From a postural standpoint, the sitting position can promote rounded shoulders, slumping forward of the upper back and jutting forward of the jaw. Not only are these postures unattractive but they contribute to the development of tendonitis and result in stretch weakness of the involved muscles.

There are volumes of information regarding ideal sitting postures both on the web and within other posts on this site. Sorting out your posture with the use of a good ergonomic chair will help you maintain good posture and spinal health.

Reaching at or beyond your normal arc of motion also contributes to poor posture and cumulative trauma type injuries, especially of the neck and shoulder. It is vitally important to the health of your frame to keep objects that you use on a regular basis within easy reach. Your phone, the mouse, stapler, etc., if used frequently through the course of your day, should be within your immediate reach. Objects that are used less frequently can be kept farther away, closer to the edge of your comfortable reach.

Take a good look at your work space. Making a few simple changes will help save your posture and your spinal health.

Here’s To Your Health

Dr. Jones
San Diego Chiropractic

(619) 261-6590

Recent Posts

What Causes a Stiff Neck?

What Causes a Stiff Neck?

Stiff necks are one of the most annoying forms of spinal discomfort. Waking with a stiff neck in the morning almost certainly assures you of having an uncomfortable day. We see many patients each year with stiff necks in my San Diego chiropractic clinic.

The medical term for a stiff neck in torticollis. Torticollis usually prevents the head / neck from being turned or tilted to one side or another.

When the affected individual attempts to rotate or tilt their head / neck into the restricted range of motion they are met with increasing pain that is more often than not enough to prohibit the movement.
Torticollis is a protective splinting of muscles in the neck caused by the brain's perception of bodily injury. Many torticollis patients presenting to our clinic usually have no history of trauma or illness to explain the severity of their symptoms.

Patient history often includes frequently sleeping near an open window or in front of an air conditioner. We see patients that drive convertibles who are also prone to getting torticollis.

Pain medications and muscle relaxants have limited effects in certain individuals. One such man presented to the Emergency Department (ED) complaining of having awoken with severe neck pain and immobility. The attending ED physician diagnosed the patient as suffering from acute torticollis. The patient was medicated first with an intramuscular injection of Toradol and oral Flexeril, which proved ineffective.

Injection of the narcotic Demarol followed. Reporting minor relief, the patient was discharged with prescriptions for both a nonsteroidal anti-inflammatory analgesic and a muscle relaxant.

The patient returned to the ED later that evening. He complained that neither his pain nor his mobility had improved, in spite of all the medication. The evening ED shift decided to obtain a chiropractic consultation, hoping to increase the patient's mobility and decrease pain and the need for additional narcotic analgesia.

History and examination revealed findings consistent with a diagnosis of acute spasmodic torticollis. The patient exhibited severely restricted cervical ranges of motion, antalgia, muscle spasm and vertebral joint fixation. Radiographic examination revealed signs of degenerative joint disease, but was negative for fracture or pathology.

I applied electrical muscle stimulation and moist heat to the patient's neck in preparation for spinal manipulation. The purpose of the adjunctive therapy was to help relax muscle and ease pain to facilitate the manual procedures and spinal adjustment. As the patient relaxed with the adjunctive therapy, we discussed the severity of his pain and immobility in contrast to the lack of significant examination and radiographic findings.

The patient appeared to understand that the torticollis was a protective splinting caused by the brain's perception of bodily injury. As with many torticollis patients presenting to our ED, there was no history of trauma or illness to explain the severity of the patient's symptoms. Patient history included frequently sleeping near an open window or in front of an air conditioner.

After removing the adjunctive therapy modalities, I performed manual therapy to further increase the patient's mobility before performing cervical adjustments. With the patient seated, I asked him to turn his head as far as possible to the painful side. I held his head still and asked him to try to turn further. I instructed him to push hard, but not enough to move my hands. After a few seconds, I told him to relax.

As he relaxed, I also relaxed my grip on his head, allowing his head to move slightly toward the painful side. I had the patient repeat this several times, and then several times to the other side, until he appeared unable to achieve increased range of motion.

For the second part of the manual therapy, I stood behind the patient, held his mastoid and parietal areas between my hands, and lifted gently. I held my forearms against his shoulders and asked him to push up against my resistance. As he pushed, I instructed him to take a deep breath and hold it.

The patient's physical and emotion tension increased as he simultaneously contracted his upper trapezius muscles and held his breath. I asked him to concentrate on the feeling of relaxation as he lowered his shoulders and exhaled. As he released the tension on his upper trapezius muscles, I added additional traction force. The patient repeated this procedure several times until less muscle spasm was palpable.

With the patient more relaxed and in less pain, I proceeded to have him lie supine for cervical adjustments. I attempted to put the patient at ease by explaining that we would approach adjustment of his neck in a slow, progressive, "step-wise" fashion.

I explained that he might hear a popping sound as the joints moved, which could be loud, as it involved the inner ear, separated from the cervical spine by little more than an inch. I assured him that if at any time during the procedure, he had a sense that the adjustment would hurt, he could let me know and I would defer the adjustment for another day. I also demonstrated the amount of force I would use by making a sample adjusting thrust to his arm. Cervical adjustments were performed bilaterally, with increased mobility noted.

The patient tolerated the entire procedure well and without complications. His range of motion was approximately 90 percent of normal upon discharge from the ED. He did not require any additional prescriptions for medication. Upon leaving. he stopped at the nurse's station to thank the staff for its help and to demonstrate his increased range of motion.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Oct 3, 2009

Types of Headaches

Types of Headaches

At my chiropractic office in San Diego, one of the most common complaints that new patients present with is headaches. To many of us who don’t suffer from chronic or severe headaches, this condition may seem a minor health problem. However, they have major implications on the affected patient and on society as a whole. In 2007, headaches accounted for over 10 million doctor visits in the U.S. alone and are one of the most common reasons for absences from work and school.

Medications from the general practitioner offer temporary pain relief, but do nothing to correct the cause. Chiropractic care, however, is more geared towards correcting the underlying causes behind many types of headaches. This article will define the five basic types of headaches - tension, toxic, sinus, cluster and migraine so you can get a better grasp on what type of headache you may be dealing with.

Tension Headaches
Tension headaches are by far the most common type of headache. Approximately 80 percent of our population suffers from occasional tension headaches, about 5 percent suffer from daily tension headaches. Women are twice as likely to suffer from tension headaches as men.

Tension headaches can last anywhere from 30 minutes to several days. The most common symptoms associated with this type of headache are band-like pain, pressure or throbbing of the head. The severity can increase significantly with headache frequency. Tension headaches usually have multiple causes, including emotional stress; depression; inadequate rest; poor posture; and / or chiropractic subluxation, causing pressure on nerves. More often than not, this type of headache usually occurs as the result of a combination of the fore mentioned causes.

Toxic Headaches
Toxic headaches are the least recognized type of headache in the medical community. That being said, this type of headache is easily identified when directly associated with exposure to a toxin.

Sinus Headaches
Sinus headaches are common and occur around the forehead, cheekbones, eye orbits, and the base of the nose. Drugs rarely correct the causes of sinus headaches, and commonly leave the patient with chronic sinus problems.

Cluster Headaches
Cluster headaches are usually one-sided and are considered to be one the most intense types of headaches. Fortunately, however, they are uncommon and affect less than one in 1,000 people. They typically start before age 30 and occur in time frames that vary from two weeks to three months. The headaches tend to occur one to three times a day and last for 30-90 minutes. They usually wake the patient one to two hours after going to bed.
After the cluster period, the occurrence of these headaches may cease for months or years, only to recur at a later date. These attacks appear to be linked to the circadian rhythms associated with the pineal gland and hypothalamus, which regulate the sleep and wake cycles. These headaches are also associated with seasonal changes in spring or fall.

Migraine Headaches
Migraine headaches are a vascular-type headache that is associated with changes in the size of the arteries inside and outside the brain. It is estimated that 28 million Americans suffer from migraines, and an estimated 13 million have not yet been diagnosed. More women than men get migraines. Of those diagnosed, 25 percent suffer four or more attacks a month; 35 percent suffer 1-4 attacks a month; and the remaining 40 percent suffer one or less attacks a month. It is common for migraines last four hours to three days.
Four out of five migraine sufferers have a family history of migraines. Children have a 50 percent chance of having migraines if one parent has migraines, and a 75 percent chance of having migraines if both parents have them.

There are many potential migraine triggers that include stress; chemicals; caffeine; weather conditions; hormonal cycles; fatigue; poor sleep patterns; and meal-skipping. Symptoms may include an aura which can be described as a; sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. Children having migraines also may look pale and experience dizziness, blurred vision and/or fever or stomach upset.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Sep 30, 2009

Repetitive Stress Trauma

Repetitive Stress Trauma: An Introduction

Repetitive Stress Trauma or RST is described entirely by the words that make up the phrase. Repetition implies that the injury is the result of more than one exposure. Typical RSTs result from weeks, months or years of performance of a repetitive task with a specific body part. Stress is the result of inadequate recovery time in between exposures to the repetitious task. Trauma, of course signifies bodily injury as a result of the repetitive stress.

Health care workers primarily view Repetitive Stress Trauma as an occupational or work injury. This thought is based on government statistics which indicate that those who work are more likely to develop an RST injury. While these statistics can’t be denied, they also need to be taken into proper context. In my San Diego based chiropractic clinic, we see many patients with RST injuries. Most of the time, most of the trauma is related to work, more specifically to computer work. Additionally, many of these injured people spend upwards of six hours per day on their computers while at work only to come home, eat dinner, and then sit at their own computers for hours on end as well. It doesn’t matter where the stress comes from, the injury remains the same. That being said, in my 15 years of experience in dealing with RSTs I have found the primary source of irritation to be the work environment.

At this point I will go off on a tangent for just a moment … or more. One of the services that my office offers is ergonomic evaluations. Since most of my patients are in computer related occupations, most of my evaluations are on computer set-ups. Typically, when I question my patients about their work stations I hear the following, “Well, it is pretty good except for FILL IN THE BLANK.” At this point I usually suggest that I come to their place of work and evaluate their work station. They are usually way out of the ideal ergonomic set-up. I see keyboards, mice, monitors and phones positioned in ways that will certainly lead to a worsening of their condition.

RSTs, ergonomics and permanent disability are important topics. As such, I will end this article at this point and be back tomorrow or Tuesday with a continuation of what I have started. This topic will be covered over the next three or four posts. Stay tuned.

More soon.
Doc

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Work Station and Reaching

Work Station and Reaching:

Have you ever noticed how tight your neck, upper back and shoulders are after a long day of sitting at the computer?

There are a number of factors that contribute to this tightness. Simply the stress of deadlines, an overbearing boss or an annoying co-worker can make your shoulders rise up and your head push forward. And this stress is the result of just the emotional stress of work. When you add the real physical strains of a poorly designed work station on top of the emotional stresses that already exist you have a perfect recipe for a repetitive stress injury.

A large part of designing an ergonomically friendly workstation revolves around limiting the “reach” for items that are frequently accessed.

The distance that you have to reach for any object in your workspace can have major implications on your health. In general, workers should have the items that they use on a regular basis through the day such as the mouse and keyboard for computer users or the telephone for a receptionist or a sales person, positioned close to their bodies so as to avoid awkward or overreaching.

As a general rule, the best positioning for your keyboard and mouse allows you to operate them while your shoulders hang straight down at your sides and elbows are slightly extended. This position reduces the stress of overreaching and allows for completion of your tasks with less muscular effort.

There are many ergonomic apparatus that allow for proper placement of your computer input devices. Pull out keyboard trays, split keyboards, mouse platforms and even foot controls help reduce the ongoing stresses of computer input.

Even with these devices, it takes awareness to maintain an ergonomically friendly work environment. Adjustable Economical Mouse Platform

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Sep 23, 2009

Chronic Pain vs Acute Pain, Whats the Difference

Chronic pain is defined as pain that persists longer than 90 days beyond the course of the natural expected healing time. As a chiropractor in San Diego, I get calls from both new and established patients on a regular basis who complain of back pain, neck pain, etc. One of the factors that comes into play when planning a chiropractic treatment program is the duration of the patients pain. In genereral, the longer that a patient suffers with a painful condition, the longer / more intense the treatment is needed in order to fix it. Acute or recent episodes of pain respond much quicker than do chronic conditions.

Pain is very difficult to quantify by any practitioner. Pain is subjective in nature and completely defined by the person experiencing the symptoms, the fact that chronic pain can exist without an obvious cause makes it much more difficult to treat.

I see the difficulties that my chronic pain patients have with their conditions on a daily basis. Aside from the actual pain that they experience, those who suffer with chronic pain often limit their activities for fear of exacerbating their conditions. They also have a much harder time focussing on mental tasks as the pain is a constant source of distraction. The more severe the pain, the more difficulties these people have with attention demanding tasks.

While we strive to avoid pain, pain is a wonderful tool of the nervous system. Pain lets us know of actual or potential tissue damage with an unpleasant sensation that directs our attention to the affected area so that we can either immediately take action to stop the process or focus on healing the injured body parts. Chronic pain sensations are a bit more insideous.

Chronic pain often involves a decrease in the sensativity of the nerve fibers that send messages of pain from the damaged area. With a decreased sensativity (threshold), the nerve is much more likely to transmit painful sensations to the brain then a healthy nerve / tissue combination. This activity within the nervous system is know as a wind up phenomenon and it is very difficult to stop once it has been established. In some other cases, nerve fibers that normally don’t carry painful sensations not only begin to transmit pain signals but it is thought that they may actually generate the signals themselves.

In my office, chronic pain is often the result of untreated sprain / strain type injuries of the joints. In untreated or under-treated sprain / strain injuries, the joint or the muscles that move the joint are laden with scar tisuue that acts to either limit or alter motion of that joint. With time, the awkward, unnatural biomechanics of the scar tissue laden joint results in irritation, inflammation and finally pain and spasm. While chiropractic care is often successful at re-establishing “clean” biomechanics of a joint, it is always better to get the care in the beginning of an injury versus waiting for that injury to become chronic, with a requiring more care with a decreasing chance of complete recovery.

Because of the possibility of an acute painful condition becoming a chronic one, I always encourage my patients to take care of themselves immediately when they first start to experience pain. I have practiced chiropractic care for almost two decades now and I can say that chronic painful conditions of the spine are devastating. Not only do they make you expereince pain, but in most instances they limit your physical activities creating a situation that can easily degrade from inactivity secondary to pain, to deconditioning and eventually to obesity and ill health in general leading to a dissatisying lifestyle.

The bottom line on chronic pain is this – avoid it if you can. Don’t ignore your pain. Painful acute conditions that are left untreated can easily spiral into a chronic condition that has the potential to alter your lifestyle in a negative way.

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

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Sep 19, 2009

Carpal Tunnel Syndrome What to do about CTS?

What to do about Carpal Tunnel Syndrome?

Initially, treatment involves resting the affected hand and wrist and avoiding the activities that caused or may worsen symptoms. Night time immobilization of the wrist in a splint to avoid further damage from twisting or bending is often helpful.    Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, can ease the pain.   Ice packs, prednisone and / or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide relief.

Stretching and strengthening exercises are very important for people whose symptoms have improved. If symptoms persist for 6 months or longer, your physician may recommend surgery to sever the band of tissue around the wrist (flexor retinaculum) to reduce pressure on the median nerve.

The recurrence rate of carpal tunnel syndrome following treatment is high. The majority of patients never recover completely. Reports show that the majority of Carpal Tunnel Release Surgeries are authorized again within 24 months of the initial procedure.

The best way to treat carpal tunnel syndrome is to prevent it. Eliminating as many repetitive tasks as possible will help stave off the onset of carpal tunnel syndrome.
The following suggestions can go a long way in preventing the onset of carpal tunnel syndrome:

1)    Take frequent breaks, rest from repetitive tasks is vital
2)    Use correct posture, postural stress can affect the nerves as they exit the spine
3)    Eliminate repetitive over-reaching. Stretching for a mouse or phone on a regular basis generates postural stress.
4)    Stretching and regular exercise are of great help
5)    Ice pack application on aggravated wrists helps.
6)    Rotate your job duties when possible, ie don’t keyboard or mouse for hours on end if you can also be working on dictation or some other task that gives you a break from the computer.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Sep 16, 2009

How Does Ergonomics Affect You?

Those of you have read my blog posts both here and at www.jonespainrelief.com/blog1 know that ergonomics is the study of how we can manipulate our work environment to both improve work performance and reduce injury-causing fatigue.

Obviously, the cost of injury drives the study of ergonomics. This is a good thing. Most employers, especially those who run large corporations are detached from their employees – both physically and emotionally. Were it not for the actual cost of employees’ injuries, many employers would not know or care about their workers’ ergonomic situation.

In the world of ergonomics, there are six separately identifiable variables that affect work performance and fatigue. These six variables are:

1)    Workload
2)    Each Individuals Physiological Response to the Workload
3)    The Individuals Size & Strength Capabilities
4)    Biomechanical Variances
5)    Human Factors
6)    Work Organization

The questions that should be answered by examining the variables listed above are not limited to but include:

1)    Can You Perform a Task Once Without Injury
2)    Do You Physically Fit Your Workplace
3)    Are You Strong Enough
4)    Can You Perform the Task For Seconds to Minutes Without Fatigue or Injury
5)    Will Injury Occur if the Work is Performed Over Months or Years
6)    Do You Have the Mental Capacity to do the Work

These variables directly affect an individual’s ability to perform certain job duties with or without producing an injury.

The reason that I have decided to include this dry and academic sounding material in this blog is to help provide some very general guides that can be used to evaluate your fit for your work duties.

I have patients who were injured at work who are not good fits for their work. They either lack the strength, the height or the endurance to effectively perform their work tasks.

If you find yourself in such a situation you should ask for or pay for an ergonomic analysis of your work environment. Many large companies either have an ergonomics department or have access to an ergonomic specialist.

Writers Bio

Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Back Pain & Sitting

Sitting Postures and Back Pain

Sitting is a pain in the @#$%&! Or at least a pain in the back.

Our spines do not like sitting as a rule. If you remain seated in the same position for a long enough period of time you will experience some level of discomfort.

Although there are many reasons that sitting eventually causes discomfort, one of these reasons cannot be avoided. The natural center of gravity for a sitting human being is approximately 1 inch in front of the belly button. In order to park our upper bodies over our center of gravity we have to either lean forward eliminating the support of our backrests or slide our butts downward and forward assuming a slumped position. Often these postures are accompanied by crossed legs or feet and leaning our elbows on the desk or our armrests in order to promote stability of the spine.

Poor posture often results from chairs and work stations that are void of proper ergonomic considerations. Postural stress causes discomfort in the neck, back and arms resulting in fatigue and fidgeting. It comes as no surprise that these consequences of poor posture have a negative effect on your mood, your concentration and your productivity.

In the long run, poor posture can cause chronic back pain, neck pain and a host of syndromes that affect the upper extremity as a whole.

I found an excellent definition of poor posture in a book called “Backs” by Leonard Ring in which he defined poor posture as “a faulty relationship of the various parts of the body which produces increased strain on supporting structures”.

As important as proper sitting posture is for a younger person with an otherwise healthy back, it is of much greater importance to those who are older and may have some level of arthritis in their spines or a history of injury. Arthritis weakens the joints in the back and makes it more sensitive to the stresses of prolonged sitting when using good posture and much more likely to suffer consequences in situations that involve poor posture. A history of back injuries is also detrimental to the spine during sitting positions especially when it is exposed to the stress of poor posture. All of those old gymnastics, football, hockey and general horseplay falls and jolts have a cumulative effect that decreases our ability to endure stressful postures.

The bottom line is that there are many good sources on the Internet that describe the characteristics of proper sitting positions. The more stress that you can eliminate from your sitting postures the happier your back will be.

Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

Sep 15, 2009

Prognosis & Fees Personal Injuries Personal Injury Case

Prognosis Personal Injury Case:
The need for future care and the amount of settlement for that care is based on an accurate prognosis. Due to overuse, the term "guarded" has lost most of it's meaning in the medical/legal world.

We contend a more accurate system will benefit the patient, insurance carrier, representing attorney, treating doctor, and most important, the profession as a whole.

The prognosis should encompass facts from the history of the accident, physical examination, and the radiographic studies.

Personal Injuries Lawsuit Fees:

As one might imagine, this is also a hotly debated subject. We fully believe the doctor has the prerogative to charge any fee he chooses for the level of service rendered.

For example, a charge of $5,000/visit can be made and reimbursement can be sought. However, it should be realized an uphill battle for total reimbursement will ensue. In other words, the fees charged may only be paid at the end of expensive litigation and in all likelihood will not be the amount billed.

We strongly suggest the doctors use fees which are both usual and customary to their geographic location.

Relative value studies can be a key to determine these fees. Use of these accepted relative value guides is a powerful weapon for the attorney when he argues the reasonableness of the charges as they are able to show the fees fell within an accepted range and do not represent an unreasonable amount on the doctor's part.

The treating practitioner should realize both the legal and insurance communities consider all aspects of the personal injury case to be negotiable. This would certainly include the fees charged by the doctor.

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Writers Bio

Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.

Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs. www.JonesPainRelief.com

Call Steve Jones at his San Diego Chiropractic Clinic

(619) 280 0554

End Points of Care Personal Injury Case

End Points of Care for a Personal Injury Case

In our experience, this is often the most debated aspect of the personal injury case. The attorney is again forced to justify the length of his client's care, and thereby support the amount billed as well. The care rendered should be reasonable and fall within reasonable guidelines for treatment duration.

In our opinion, when one or more of the following occurs, the patient has reached the maximum point of medical/chiropractic improvement from the type of care rendered.

1.    If the patient's condition gets worse under the care rendered.

2.    When the patient's subjective complaints have clearly reached the upper and lower limits. An example is when the patient's subjective complaints have reached a point where the treatment rendered only "makes them feel better" for a few days and then they are the same as before the visit.

It is clear that the feeling of being "better" for a few days is only temporary and the patient has more than likely reached the clinical limitations of matter from the type of care rendered.

This is not to say the patient does not have complaints, or that the care does not make him feel good, only that further treatment will more than likely be of very little clinical benefit. Thus, the criteria for determining the end points of care.

3.    When the patient fails to make clinical progress between lengthening dates of service. All care is based on achieving a preinjury status.

If the patient fails to make progress between visits over an expected period of time, the clinical potential for further healing is remote.

Treatment, after these points have been achieved, increases the total amount of services rendered and makes a timely settlement more difficult.

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Narrative Reports for Soft Tissue Injuries personal Injury Cases

Narrative Reports for Soft Tissue Injuries personal Injury Cases

In our experience, this is far and away the greatest downfall in the well managed soft tissue case. We, as a profession, have become dependent on the computer generated narrative report.

In our opinion, and that of the legal community as well, these types of reports often do not represent original thought or an accurate depiction of the patient's condition. The various legal arenas involved in personal injury suits take a very dim light as to the veracity of these types of reports.

The narrative report must also be an accurate reflection of the treatment rendered. All sections of the report should correlate to eliminate inconsistencies, and above all should represent accurate and original work. Remember, the attorney will use the report as a settlement tool. It should contain answers, not new problems.

The quality and accuracy of the narrative report should not be underestimated.

It alone represents months of care, the patient's basis for future medical considerations, prognosis, and most important of all, reimbursement for the services rendered. "He who botches the report, botches the case."

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Special Tests for Soft Tissue Injuries

Special Tests for Soft Tissue Injuries

The use of special imaging and diagnostic procedures are becoming more popular in the clinical management of patients. Attorneys will be placed in the position of justifying the expense and use of these tests to the claims adjustor or judge. The doctor should consider the following questions before ordering such tests:

What is the clinical criteria for performing the test? If based solely on the patient's subjective complaints, this represents a very poor criteria.

Is the test both sensitive and specific for the condition? Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI), for example, represent procedures which are both sensitive and specific. However, their use is often inappropriate in an uncomplicated soft tissue injury. Thermography, in comparison, is very sensitive, yet due to vast testing and interpretation variables, often renders the use of this test questionable.

Is the testing procedure well accepted in the scientific literature? For example, the timely use of paraspinal EMGs producing $900 to the incurred bills, in our experience, will bring the settlement process to a halt. The treating doctor may contend that the use of this special procedure was clinically necessary, but the insurance carrier will only reimburse those procedures proven in the clinical and literary arenas.

How will a "positive" or "negative" test alter the form of care rendered? A "positive" paraspinal EMG finding, in our experience, has never produced a change in the type of care rendered. For that matter neither has a "negative" result.

Is the test timely? The thermogram, for example, would be expected to be "positive" on the first days following the trauma, thus, negating the clinical criteria for performing said test during the acute stages of injury. For the above reasons, plus the high fees associated with these procedures, we feel the improper use of these tests often produces prolonged reimbursement to all parties; patients, attorneys, and doctors.

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Dr. Steve Jones (619) 280-0554
10393 San Diego Mission Rd Suite 130,
San Diego.
CA. 92108