At Tigges Chiropractic, we believe that a integrative medicine approach which provides functional restoration and re-builds strength by using chiropractic manipulation, physiotherapy, rehabilitative exercise and neuro-muscular physical therapies provides the most ideal environment for complete healing and recovery. We look forward to working in conjunction with you to provide mutual patients with the most complete care possible in order to restore their comfort and function in normal daily activities.
Mission Statement
The Mission of Tigges Chiropractic is to:
- To generate a tissue-specific “working” diagnosis and appropriately treat it with time-limited passive modalities.
- To identify patients who exhibit psychosocial and/or physical risk factors which may predispose them to chronicity.
- Aggressively transition patients into Active Care/Functional Restoration/Rehabilitation program and give them a thorough understanding of all aspects of Spinal Rehabilitation Principles and Protocols.
- Develop an Outcomes Assessment Based Practice.
- Follow accepted management guidelines.
“All episodes of symptoms that remain unchanged for 2-3 weeks should be evaluated for risk factors of pending chronicity. Patients at risk of becoming chronic should have treatment plans altered to de-emphasize passive care and re-focus on active care approaches.” – Mercy Guidelines Following Accepted Treatment Guidelines:
Physician Resources
There is increasing scientific evidence that most care administered for low back conditions is either inappropriate or less than optimal. This has resulted in the enormous increase in the rate of disabling low back pain and the costs associated with the management of it.
US Agency for Health Care Policy and Research Guidelines: Relief of discomfort with either analgesics and/or spinal manipulation. Bed rest >4 days is not helpful and may further debilitate the patient.
Meta-analysis of the scientific literature has shown that manipulation speeds recovery of low back pain by 34% over other methods.
P. Shekelle, MD, Ph.D.
A. Adams, DC, Ph.D., et al. (50)
Adjustments improve the results of McKenzie exercises. Patients receiving manipulation and exercise outperformed those receiving exercises alone. Patients were classified by having a positive SI sign and an extension “bias.” Erhard & Delitto, Physical Therapy 74:1093-1100, 1994
“The main theme of management must change from rest to rehabilitation and restoration of function.” – Gordon Waddell, MD
FUNCTIONAL RESTORATION
The guiding philosophy of a functional restoration program is to restore joint mobility, muscular strength, endurance, and conditioning, as well as cardiovascular fitness leading to restoration of the ability to perform specific functional tasks such as lifting, bending, twisting, and tolerance to prolonged static positioning (i.e., sitting and standing).
Tom Mayer, MD
Tom Mayer’s article: A Prospective Two-Year Study of Functional Restoration in Industrial Low Back Injury – An Objective Assessment Procedure.
FUNCTIONAL ASSESSMENT
Although muscle strength is important, quite often in the rehabilitation setting, that is the only factor which is assessed. Functional assessment includes assessing global joint function, coordinated movement patterns (motor control), muscle length and function as well as strength and endurance. A complete functional assessment of the locomotor system must occur prior to any institution of a progressive resistance exercise program. A set of non-dynamometric strength tests (trunk extension, trunk flexion, squatting) were shown to correlate better with disability than expensive dynamometric tests.
OUTCOME ASSESSMENT BASED PRACTITIONER
In the current health care environment, there is rapid push toward finding ways in which patients with neuromusculoskeletal (NMS) disorders can be treated in the most clinically efficient and cost effective way possible. The doctor who will be sought after by third party payers will be the one who is capable of getting a patient back on his or her feet a quickly as possible with the least amount of residual disability. Insurers and other third party payers are requiring the doctor to show objective evidence of continual improvement while under care or reimbursement will cease. There are numerous means to measure outcomes including Visual Analog Scales (VAS), Pain Diagrams, Oswestry Questionnaires, Headache Disability Index Questionnaires, etc. which are extremely reliable, valid and do not require great expense or time. They are reasonably simple means to measure outcomes and can be readily instituted in your practice.
SPINE UPDATE:
Exercise and Spinal Manipulation in the treatment of LBP
Lance Twomey, Ph.D.
James Taylor, MD Ph.D.
SPINE Vol. 20, #5, PGS 615-619
“Current research clearly indicated the importance of exercise and mobility in the treatment of Low Back Pain.”
“Manipulative procedures result in more rapid pain and functional relief compared with other conservative therapies.” – SPINE Vol. 20, #5, PGS. 615-619
Four Factors Which May Predict a Longer Recovery (From the Mercy Guidelines):
- Past history of greater than four episodes
- Longer than one week of symptoms before presenting to doctor
- Severe pain intensity
- Pre-existing structural pathology or skeletal anomaly (i.e.,Spondylolisthesis) directly related to new injury or condition.
(Halderman S. Chapman-Smith, D. Petersen, DM. Frequency and Duration of Care. In Guidelines for Chiropractic Quality Assurance and Practice Parameters. Aspen 1125, 130, 1993, Gaithersburg)
Once the patient has reached the subacute stage, (normally between 1 and 4 weeks) you should start assessing and treating the functional pathologies involved with active care. This can begin with something as simple as pelvic tilt exercises and home isometric exercise programs. The Mercy guidelines state, “It is beneficial to proceed to rehabilitation phase as rapidly as possible, to minimize dependency on passive forms of treatment/care.” In addition, “All episodes of symptoms that remain unchanged for 2-3 weeks should be evaluated for risk factors or pending chronicity. Patients at risk of becoming chronic should have treatment plans altered to de-emphasize passive care and re-focus on active care approaches.”
“…there is a small window of time in low back pain care; we must act quickly within 4-6 weeks to bring patients into an active reconditioning program if we expect to return them to productive lives and prevent recurrence.”
Margaret Nordin, Spine Letter, 1994; 2:5
RESEARCH LIBRARY
- Back Pain
- Headache
- Cost-Effectiveness
- Neck Pain
- Safety
- Wellness
- Sports
- Children
- Back Pain
- The AHCPR Guideline
Bigos S, Bowyer O, et al. “Acute Low Back Problems in Adults. Clinical Practice Guideline,” Number 14, Rockville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0642; December 1994.
Chronic spinal pain – a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.
Giles LGF, Muller R.Spine 2003;28:1490-1503.
The Koes Clinical Trial
Koes BW, Bouter LM, et al. British Medical Journal. March 7, 1992; Vol. 304, No. 6827, pp. 601-605.
The RAND study
Shekelle PG, Adams A, et al. “The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel.” RAND corporation, Santa Monica, California; 1991.
United Kingdom back pain exercise and manipulation (UK BEAM) randomized trial: cost effectiveness of physical treatments for back pain in primary care
UK BEAM Trial Team. BMJ 2004;329:doi:10.1136/bmj.38282.669225.AE
Headache
The Boline Study
Boline, PD, Kassak, K, et al. “Journal of Manipulative and Physiological therapeutics.” March/April 1995; Vol. 18, No. 3, pp.148-154.
The Duke Study
McCrory DC, et al. “Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache.” Duke University Evidence-Based Practice Center, Durham, North Carolina, January 2001.
The Nelson Migraine Study
Nelson CF, et al. Journal of Manipulative and Physiological Therapeutics. October 1999; Vol. 22, No. 8, pp. 517-522.
Cost-Effectiveness
Testimony to the Department of Veterans Affairs’ Chiropractic Advisory Committee
“Testimony to the Department of Veterans Affairs’ Chiropractic Advisory Committee.” March 25, 2003.
Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs
“Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs” Muse and Associates. American Chiropractic Association 2001.
Cost Comparison of Chiropractic and Medical Treatment of Common Musculoskeletal Disorders: A Review of the Literature after 1980
Branson, Richard. “Cost Comparison of Chiropractic and Medical Treatment of Common Musculoskeletal Disorders: A Review of the Literature after 1980.” Topics in Clinical Chiropractic. 1999; 6(2): 57-68.
The Abt Study
Gaumer GL, Walker A, Su S. “Journal of Manipulative and Physiological Therapeutics.” May 2001; Vol. 24, No. 4, pp. 239-259. http://www.tnchiro.com/Research.php?topic=7&story=24
Cost Per Case Comparison of Back Injury Claims of Chiropractic versus Medical Management for Conditions with Identical Diagnostic Codes
Jarvis, Kelly; Phillips, Reed; Morris, Elliot. “Cost Per Case Comparison of Back Injury Claims of Chiropractic versus Medical Management for Conditions with Identical Diagnostic Codes.” Journal of Occupational Medicine 1991; 33(8): 847-852.
Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Legorreta AP, et al. Archives of Internal Medicine. October 11, 2004; Vol. 164, No. 18, pp.1985-1992.
The Manga Study
Manga P, Angus D. “Enhanced Chiropractic Coverage under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services.” Report to The Ontario Ministry of Health. February, 1998.
Cost-Effectiveness of Chiropractic Care in a Managed Care Setting
Mosley, Carrie; Cohen, Llava; Arnold, Roy. “Cost-effectiveness of chiropractic care in a managed care setting.” The American Journal of Managed Care 1996; 2: 280-282.
Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain
Nelson CF, et al. Journal of Manipulative and Physiological Therapeutics. October 2005; Vol. 28, Iss. 8, pp. 564-569
Disability Low Back Oregon Workers’ Compensation Claims. Part I: Methodology and Clinical Categorization of Chiropractic and Medical Cases
Nyiendo, Joanne, Lamm, Lester. “Disability Low Back Oregon Workers’ Compensation Claims. Part I: Methodology and Clinical Categorization of Chiropractic and Medical Cases.” Journal of Manipulative and Physiological Therapeutics 1991 14(3): 177-184.
Clinical and Cost Outcomes of an Integrative Medicine IPA
Sarnat, Richard,M.D., Winterstein, D.C. “Clinical and Cost Outcomes of an Integrative Medicine IPA”. J Manipulative Physiol Ther 2004,:27:336-47.
Costs and Recurrences of Chiropractic and Medical Episodes of Low Back Care
Smith, Monica. Stano, Miron. “Costs and Recurrences of Chiropractic and Medical Episodes of Low Back Care” Journal of Manipulative and Physiological Therapeutics 1997: 20(1): 5-12.
A Comparison of Health Care Costs for Chiropractic and Medical patients
Stano, Miron. “A Comparison of Health Care Costs for Chiropractic and Medical patients.” Journal of Manipulative and Physiological Therapeutics 1993: 16(5): 291-299.
The Economic Role of Chiropractic Further Analysis of Relative Insurance Costs for Low Back Care
Stano, Miron. “The Economic Role of Chiropractic Further Analysis of Relative Insurance Costs for Low Back Care.” Journal of the Neuromusculoskeletal System 1995; 3(3): 139-144.
Chiropractic and Medical Costs of Low Back Care
Stano, Miron; Smith, Monica. “Chiropractic and Medical Costs of Low Back Care.” Medical Care 34(3): 191-204.
The Effect of Chiropractic Adjustments on Movement Time: A Pilot Study Using Fitts Law|
Effect of Chiropractic Care on Heart Rate Variability and Pain in a Multisite Clinical Study
The IPA Study
Chronic back pain may shrink the brain
Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. The Journal of Neuroscience, Nov. 17, 2004 24(46):10410-10475.
A Study of Education
Coulter I, et al. “Alternative Therapies.” September 1998; Vol. 4, No. 5, pp.64-75.
Degenerative changes following spinal fixation in a small animal model.
Cramer GD, Fournier JT, Henderson CN, Wolcott CC., J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):141-54.
Self-reported Nonmusculoskeletal Responses to Chiropractic Intervention: A Multination Survey
Journal of Manipulative and Physiologic Therapuetics, June 2005, Volume 28, Issue 5, pages 294-302, Leboeuf-Yde et al.
Neck Pain
A Nonsurgical Approach to the Management of Patients with Cervical Radiculopathy: A Prospective Observational Cohort Study
Chiropractic “Only Proven Effective Treatment” for Chronic Whiplash
Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999;21(1):22-25.
Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial
Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, Koes BW, Vondeling H, Bouter LM. Ann Intern Med 2002; 136: 713722
Safety
Overview of Research about Safety
NEUROLOGY Study “Fraught With Design Flaws,” According to American Chiropractic Association
The American Chiropractic Society “What are the Risks of Chiropractic Neck Adjustments?”
William J. Lauretti, D.C.
Wellness
Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and home promotion program.
Coulter ID et al. Topics in Clinical Chiropractic 1996: June, Vol 3(2): pgs. 46-55.
Surrogate Indication of DNA Repair in Serum After Long Term Chiropractic Intervention – A Retrospective Study
Journal of Vertebral Subluxation Research
A Longitudinal Assessment of Chiropractic Care Using a Survey of Self-Rated Health Wellness & Quality of Life: A Preliminary Study
Mark J. Marino BIO and Phillippa M. Langrell BIO[Vol 3, No. 2, p 1-9]
Sports
Athletic performance and physiological measures in baseball players following upper cervical chiropractic care
Schwartzbauer J, Kolber J, Schwartzbauer, DC, Hart, JDC, Zhang J.J of Vertebral Subluxation Research 1997; 1 (4): 7
The use and role of sport chiropractors in the national football league
Stump JL, Redwood D. J Manipulative Physiol Ther 2002 (Mar-Apr); 25 (3): E2
Children
Ear Infection: A Retrospective Study Examining Improvement from Chiropractic Care and analyzing influencing factors
Froehle RM J Manipulative Physiol Ther 1996 (Mar-Apr); 19 (3): 169-177
An evaluation of chiropractic manipulation as a treatment of hyperactivity in children
Giesen JM, Center DB, Leach RA , J Manipulative Physiol Ther 1989 (Oct);12 (5):353-363
An impairment rating analysis of asthmatic children under chiropractic care
Graham, RL and Pistolese RA. Journal of Vertebral Subluxation Research 1997: 1 (4): 1-8
Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants.
L. E. Kocha, H. Kochb, S. Graumann-Bruntc, D. Stolled, J. M. Ramireze and K. S. Saternus;Forensic Science International Volume 128, Issue 3, August 28, 2002, Pages 168-176
The Colic Study
Wiberg JMM, et al. “Journal of Manipulative and Physiological Therapeutics.” October 1999; Vol. 22, No. 8, pp. 517-522.
Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and home promotion program. Coulter ID et al. Topics in Clinical Chiropractic 1996: June, Vol 3(2): pgs. 46-55.
Surrogate Indication of DNA Repair in Serum After Long Term Chiropractic Intervention – A Retrospective Study Journal of Vertebral Subluxation Research
A Longitudinal Assessment of Chiropractic Care Using a Survey of Self-Rated Health Wellness & Quality of Life: A Preliminary Study Mark J. Marino BIO and Phillippa M. Langrell BIO[Vol 3, No. 2, p 1-9]