1. Spinal Conditions & Outcomes Dr. Gregg Mantonya The Mantonya Chiropractic Centers Newark ~ Hebron

2. My background Undergraduate study - Ohio U. & Marycrest Intl. U. Undergraduate study - Ohio U. & Marycrest Intl. U. 4 year Doctor Chiropractic Degree from Cleveland Chiropractic College-KC 4 year Doctor Chiropractic Degree from Cleveland Chiropractic College-KC Completed year-long study from Spine Research Inst. of San Diego for spine injury during vehicle crashes Completed year-long study from Spine Research Inst. of San Diego for spine injury during vehicle crashes Past Team Doctor for High Schools Past Team Doctor for High Schools Additional post-graduate study in Pediatric Chiropractic, Rehab, Nutrition Additional post-graduate study in Pediatric Chiropractic, Rehab, Nutrition

3. Go to... Recent Talk Handouts www.mantonyachiropractic.com

4. Chiropractic Required 2-4 yrs undergrad, 4 year Chiropractic School Required 2-4 yrs undergrad, 4 year Chiropractic School Extensive training in Musculo-skeletal and nervous systems - More hours than Medical school Extensive training in Musculo-skeletal and nervous systems - More hours than Medical school Detect & correct joint mis-alignments Detect & correct joint mis-alignments ~ These can affect nerve function Do not prescribe medication Do not prescribe medication Physicians through Medicare, Ohio BWC, Court Physicians through Medicare, Ohio BWC, Court PCP for many of our patients PCP for many of our patients

5. Chiropractic Therapy Modalities Adjusting Table Rehab Low-force Instruments

6. Conditions, Causes, Prognosis Sprain/Strains Sprain/Strains Repetitive Stress Repetitive Stress Arthritis Arthritis Discs Discs Scoliosis Scoliosis Chronic Pain Patients Chronic Pain Patients

7. Sprain/Strain

8. Will heal within 6-12 week, right?......Remodeling phase of healing, up to 12 months or more...Remodeling phase of healing, up to 12 months or more (Kellet: Acute Soft Tissue Injuries - a review of lit. Med Sci Sport Exerc, 18(5);489-500, 1986)Sprain/Strain

9. Sprain/Strain Whiplash – It’s estimated that 50% of those exposed to trauma will be injured… Whiplash – It’s estimated that 50% of those exposed to trauma will be injured… 50% will recover within weeks or months… 50% will recover within weeks or months… Leaving 20% of the initial 100% exposed to late whiplash symptoms… Leaving 20% of the initial 100% exposed to late whiplash symptoms… Approximately 5% will be disabled Approximately 5% will be disabled

10. Sprain/Strain Whiplash – At Risk For Acute Injury Female Female History of neck injury History of neck injury Poor head restraint/tall patient Poor head restraint/tall patient Use of seatbelt - 1.5 - 3 x more likely Use of seatbelt - 1.5 - 3 x more likely Out of Position/Head turned Out of Position/Head turned Non-aware of impending impact Non-aware of impending impact Increasing age (middle age & beyond) Increasing age (middle age & beyond) Impact by vehicle of greater mass Impact by vehicle of greater mass

11. Sprain/Strain Whiplash – At Risk for “Late Whiplash” Female, especially if small body mass Female, especially if small body mass Immediate/early onset of symptoms Immediate/early onset of symptoms Ligament/Joint instability Ligament/Joint instability Greater # of symptoms Greater # of symptoms Use of seatbelt - 34% vs 20% Use of seatbelt - 34% vs 20% Initial limited range of motion Initial limited range of motion Initial neurological symptoms Initial neurological symptoms Loss or reversal of cervical curve Loss or reversal of cervical curve

12. Sprain/Strain Mercy Guidelines - Factors that Complicate Recovery Used by Ohio BWC Pain longer than 8 days - 1.5 x longer Pain longer than 8 days - 1.5 x longer Severe pain - 2 x longer Severe pain - 2 x longer 4-7 previous episodes - 2 x longer 4-7 previous episodes - 2 x longer Injury on underlying condition - 2 x longer Injury on underlying condition - 2 x longer Poor compliance Poor compliance Biomechanical Stress Biomechanical Stress Psychosocial Stress Psychosocial Stress

13. Repetitive Stress Injury Carpal Tunnel Syndrome Carpal Tunnel Syndrome Common in those performing assembly line work Women 3:1 Surgery up to 90% successful…? Tendonitis Tendonitis

14. DJD – Osteoarthritis

15. Wear & Tear Arthritis Large percent are remarkably asymptomatic Large percent are remarkably asymptomatic More common in males until age 45, Females 10:1 More common in males until age 45, Females 10:1 Hip degeneration – reduced risk of osteoporosis Hip degeneration – reduced risk of osteoporosis Recent problems with pain medication Recent problems with pain medication Vioxx, Bextra, Celebrex etc

16. Discs are the spongy thing between the spinal bones Discs are the spongy thing between the spinal bones –Shock absorbers –Spacers for nerve to exit Up to 50% of people asymptomatic have lumbar disc degeneration on MRI Up to 50% of people asymptomatic have lumbar disc degeneration on MRI Up to 60% in cervical spine Up to 60% in cervical spine ~ MRI of 98 people without back pain: only 36% had a normal disc at all levels. 52% bulge at least one level 27% protrusion 1% extrusion 38% had abnormality at more than one level Disc Conditions

17. Discs Can’t “slip” Can’t “slip” Swollen Swollen Bulge - No outer fibers are torn, center has moved toward the outer rings Bulge - No outer fibers are torn, center has moved toward the outer rings Protrusion - Sometimes used in place of bulge Protrusion - Sometimes used in place of bulge Herniation - Some tearing of outer ring fibers, center moves toward outer rings Herniation - Some tearing of outer ring fibers, center moves toward outer rings Rupture - Piece of Center has gone outside of disc Rupture - Piece of Center has gone outside of disc

18. Discs - normal, top view

19. Discs - bulge, front view

20. Discs - herniation, front view

21. Discs - rupture, front view

22. Discs Rupture most likely to need surgery. Rupture most likely to need surgery. One study showed 83% of patients with herniations and radiating pain improved up to 2.5 years after…73% had actual herniation improved or resolved not just the symptoms (non-operative treatment). One study showed 83% of patients with herniations and radiating pain improved up to 2.5 years after…73% had actual herniation improved or resolved not just the symptoms (non-operative treatment). Surgery -Studies vary on it’s success, as little as 50% or worse Surgery - Studies vary on it’s success, as little as 50% or worse Pain Meds/Chiropractic, Rehab Shots, Nerve Block, Surgery

23. Back Surgery - What studies say 50-70% have complete relief of back and leg pain when followed-up at 5 years 50-70% have complete relief of back and leg pain when followed-up at 5 years 10-15% will have worse pain 10-15% will have worse pain 18-29% will undergo further surgery 18-29% will undergo further surgery

24. Scoliosis Idiopathic (unknown cause) most common type Idiopathic (unknown cause) most common type Most rapid progression during growth spurt Most rapid progression during growth spurt 10-15 degrees progression during adult years 10-15 degrees progression during adult years Complications – cardiopulmonary dz., DJD, pain, curve progression Complications – cardiopulmonary dz., DJD, pain, curve progression Tx – stretches, braces, Chiropractic, massage, surgical bracing Tx – stretches, braces, Chiropractic, massage, surgical bracing

25. Scoliosis In my practice experience, pain and disability depend upon patient’s... Physical FitnessPhysical Fitness Activity LevelActivity Level Severity of ScoliosisSeverity of Scoliosis OccupationOccupation

26. Spondylolisthesis 50% never have pain 50% never have pain Most of the others that do have another cause Most of the others that do have another cause Rarely progresses during adulthood Rarely progresses during adulthood Studies showed no worsening with strenuous sports Studies showed no worsening with strenuous sports

27. High Risk

31. Chronic Pain Patients BWC Data Pharmaceutical Reimbursement 1998$57,026,132 2003$130,000,000 Chiropractic Costs 2002$64,467,227.00 Actual cost of Chiropractic vs. Medical Claims new injury, 1998- 2002 Allopathic care + drugs = $709,709,700.95 DC care = $167,396,045.11 Long-term care costs 2002 DC - $34 million MD + Drugs - $189.6 million The longer a patient is disabled from work, the less likely they are to return. 1 in 6 Americans live with chronic pain. $120 billion a year in medical costs and lost productivity.

32. Chronic Pain Patients 30,000 hospitalizations/yr from NSAIDS use 30,000 hospitalizations/yr from NSAIDS use One study showed only 25% resolved from original pain complaint one year later One study showed only 25% resolved from original pain complaint one year later Recent Increase in Pain Management Centers Recent Increase in Pain Management Centers Chiropractic 1-2 visits/month shown to be beneficial Chiropractic 1-2 visits/month shown to be beneficial Fibromyalgia - 3-6 million Americans ~Tenderness particularly in the neck, spine, shoulders, and hips - usually after trauma. ~Most able to be fully active, may need job modification.

33. Chiropractic Terms Adjustment vs. Manipulation Adjustment vs. Manipulation Subluxation, Subluxation Complex Subluxation, Subluxation Complex Intersegmental Dysfunction Intersegmental Dysfunction

34. Info Outlets www.mantonyachiropractic.com www.mantonyachiropractic.com ~ “Chiropractic info” ~ “Kids & Chiropractic” ACA - www.amerchiro.org ACA - www.amerchiro.org ~ “insurance & managed care” ~ “insurance & managed care” Spine Research Inst. - www.srisd.com Spine Research Inst. - www.srisd.com ~ sprain/strain info/research My email - mantonyachiro@yahoo.com My email - mantonyachiro@yahoo.com