Friday, March 26, 2010

Dizziness responds to the Epleys maneuver-treatment for BENIGN PAROXYSMAL POSITIONAL VERTIGO in NYC


Dizziness responds to the Epleys maneuver- BENIGN PAROXYSMAL POSITIONAL VERTIGO
I have been treating one of my patients that has been a regular Chiropractic patient for years when he came in with a totally different set of symptoms. He described having dizziness,vertigo,being light headed and feeling a bit nauseous and it usually was triggered by getting out his bed.
He only had these symptoms for a week or so and did not do anything out of the ordinary, immediately I thought of BPPV- which is short for Benign Paroxysmal positional vertigo. Read more about BPPV here

Basically Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle" (figure1 ). While the saccule also contains otoconia, they are not able to migrate into the canal system. The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure. It was invented by Dr. John Epley. Click here for a low bandwidth animation. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.
I have used the Epley's maneuver many times over the years in my NYC practice with great success.
Whats nice about this procedure is it is very easy to do and is painless and very effective.
I have have seen patients that where so bad that they where on medications like Antivert and could barely function respond amazingly in two to three visits.
To make a long story short,He was in yesterday and told me that his symptoms where 100% gone in that one visit,he couldn't believe it.
If you have been suffering with Dizziness or vertigo and have been searching for someone in NYC to do the Epley's maneuver feel free to call us at (212)645-8151 or visit the website at www.livingwellnewyork.com

Back pain treatment NYC, Neck pain treatment NYC, Herniated and Bulging disc NYC
Sciatica NYC

Tuesday, March 23, 2010

Health Care Reform: ACA Calls it a "Historic First" and a "Big win" For Chiropractic

Health Care Reform: ACA Calls it a "Historic First" and a "Big win" For Chiropractic

By Dynamic Chiropractic Staff

The national health care reform bill signed into law today (March 23rd) by President Barack Obama was called a "big win" for the chiropractic profession by the American Chiropractic Association (ACA).

ACA lobbyist Rick Miller said "what you see in the bill is a recognition that our profession is standing with other professions on a fairly equal basis."

Three parts of the massive, and highly controversial bill, highlighted this newfound recognition at the federal level:

1. Provider Non-discrimination

"We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider's license is inappropriate and now must stop," said ACA President, Rick McMichael, DC, in a formal statement.

"While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one's license, and they have said that such discrimination must stop."

The provision in Section 2706 of the law says "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law."

John Falardeau, ACA's Vice President of Government Relations said, the "non-discrimination language will be applicable to all health benefit plans both insured and self-insured. National health care reform is designed to eventually cover 30 million currently uninsured Americans. The non-discrimination language will, over time, apply to those individuals as well. However, that number of covered individuals pales in comparison to the 55 percent of workers who are currently covered by self-insured plans that will be affected by the Harkin non-discrimination language. The potential impact in this regard cannot be overstated."

2. Community Health Teams

The new law specifically includes DCs as potential members of interdisciplinary community health teams, on equal footing with other health care providers.

These teams are integrated groups "of providers that include primary care providers, specialists, other clinicians, licensed integrative health professionals and community resources to enhance patient care, wellness and lifestyle improvements," according to an ACA statment. McMichael said, "This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the health care team."

3. National Health Care Workforce Commission

The law creates a National Health Care Workforce Commission which is charged with analysis and developing projects on the needs of the nation's health care workforce and also specifically includes chiropractors in the definition of health professionals. "In addition, chiropractic colleges are included among the health professional training schools to be studied. The National Health Care Workforce Commission is tasked with providing comprehensive, unbiased information to Congress and the Obama Administration about how to align federal health care workforce resources with national needs," according to the ACA.

McMichael said, "Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession."

Falardeau called it a "very big win for chiropractors, going forward."

Dr. McMichael noted, "Our partners on the Chiropractic Summit were important team members in securing these critical inclusions for the benefit of our profession and our patients. We thank all team members for their good collaborative work on this major effort and future efforts to come."


Chiropractic care in NYC visit www.drshoshany.com

Tuesday, March 16, 2010

Chiropractic, Spinal Decompression and the Graston technique-Fix your back for good!


Fix your back for good.

Chiropractic,Spinal Decompression and the Graston technique


The other day one of my patients was waiting to go on our Spinal decompression table in my NYC Chiropractic office
and he brought an article to my attention that was in a magazine in our waiting room. I read it and the information is pretty much on point.
Go out and pick up the April issue of the Men's Journal.

The Complete Guide To Your Back
by: Catherine Price from the Men's Journal April 10

No other common injury affects your quality of life like a bad back. But because it bears so much of the weight of everyday life, the back is one of the easiest parts of your body to injure. With more than 140 individual muscles and 33 individual bones - not to mention the most important nerves in your anatomy 0 it’s complex, making injuries frustratingly hard to diagnose and treat. Thus, 80 percent of all adults experience back pain of some kind or another during their lives, causing 5 million people to see a doctor each year for back issues in the U.S.
But here’s the good news: More than 90 percent of back problems can be resolved without surgery. In most cases, you ca care for the pain on your own by using anti-inflammatories, icing the affected area, and taking a short break from normal activity. But you do need to know what’s ailing you.
The first step is figuring out if you have a muscle, disc, or joint problem. Having an idea of what’s wrong before you even set foot in a doctor’s office could make all the difference. If you do need to see a doctor, there are plenty of noninvasive tactics your physician can prescribe to alleviate the pain, from certain exercises and stretches to massage. And if you end up needing to go under the knife, your future isn’t necessarily bleak. From microdiscectomies to artificial disc replacements, the techniques are constantly getting better and less invasive. But as with any injury, the key is prevention, and here you’ll find the essential exercises and gear you need to help keep your back healthy.

Muscle Strains

Technically speaking...

A back strain encompasses anything from overstretching to the complete tearing of the muscle fibers. I can happen to any of the back’s large muscles, including the lats, traps, and obliques, as well as the smaller muscles that connect to the spine, helping support your weight and allowing you to move. Injuries to muscles in the hips and glutes can also cause back pain: When they spasm, they can pull on your spine.

The Causes

Muscle strains can happen to a perfectly healthy person with good flexibility and muscle symmetry - any sort of abrupt or awkward movement, from serving a tennis ball to leaning over in a strange positions, can cause an injury. But those who have muscle asymmetries (abdomen muscles that are much stronger than back muscles, for instance) are more likely to injure their backs due to the fact that larger muscles will pull the smaller, weaker muscles into an unnatural position. In addition, people who don’t drink enough water will lose muscle elasticity and become more injury prone; so will those who do not properly warm up and stretch prior to exercise. In any case, pain from an injured muscle can be accompanied by bruising, swelling, or a palpable knot under the skin. The pain, which might be dull, achy, or throbbing, usually feels like it’s deep in your body, but it usually does not travel to your arms and legs.

The Advice

Muscle injuries usually respond well to anti-inflammatories like Advil. With muscle pain, it can be tempting to stay in bed, but try not to: Restricting your movement for more than a day or two can actually slow down healing. Even the most debilitating pain should resolve itself in 10 days,” says Drew Demann, director of services at Manhattan Spine and Sports Therapy. “If it hasn’t, you need to see a doctor, who could prescribe Graston technique or active release techniques”.

The Treatments

Graston Technique

Good for both acute and chronic muscle problems, it’s a treatment that uses a specially designed smooth metal tool rubbed hard into the skin to break up adhesions in your muscles - sort of like using a metal bar to iron out a wrinkled tablecloth. Graston is different from a massage because it comes at knots from the side instead of above and can apply considerably stronger force. In some cases, the goal of Graston is actually to increase inflammation, in an attempt to force the body to go through a full inflammatory cycle and heal the injury. Search for certified specialists at www.Grastontechnique.com

Active Release Techniques

This form of stretching helps break up scarred and tight tissue to release the muscles that are causing pain. In it, a therapist has the patient flex the injured muscle, and he or she helps guide you into movements that stretch the clenched muscle. Results typically occur within four or five sessions, but they’re sometimes immediate. You can find a specialist at www.Activerelease.com, but also ask your doctor or physical therapist if he or she has been trained in ART. (Since therapists have to pay a yearly fee to be included in the site’s directory, there are great practitioners not on the list.)











Bulging & Herniated Discs

The spongy cushions between each of your vertebrae are essential for smooth, pain-free movement. When one bulges or ruptures and starts pushing on a nerve, the resulting pain can be debilitating

AT RISK: Anyone who sits for long periods of time.

Diagnosis

Technically Speaking...

First of all, there’s no such thing as a slipped disc. that’s just a layperson’s term for a bulging or herniated disc. A bulging disc happens when the spongy inside presses against the disc wall (the annulus), causing it to bulge and push on a nerve. a herniated disc means the spongy inside pushes through the annulus, which usually impinges on nerves even more.

The Causes

Discs can naturally degenerate over time, making these types of problems most prevalent in people ages 30 to 50. Once the annulus becomes weak, it’s less effective in containing the cushioning. Then it just takes a smaller trigger - a cough, leaning over to pick something up, getting out of the car (or, of course, something bigger, like an abrupt move in sports) - to cause a bulge or herniation.

What It Feels Like

If a mildly bulging or herniated disc isn’t hitting a nerve, it’s not usually an issue. But when it is, it can cause a lot of pain. Pain from either problem can be present for a long period of time and does not always respond well to anti-inflammatories. If this is the case, patients need to see a doctor as soon as possible and have an MRI done to find out exactly what the problem is.

Nonsurgical Treatment Options

Decompression Therapy

It’s the same thing a chiropractor tries to achieve manually: A spinal decompression machine pulls your spine lengthwise with very precise and powerful amounts of force to stretch tight muscles and take pressure off your discs. the core of a typical disc is highly pressurized (think of a well-inflated car tire). By pulling on your spine, a spinal decompression table can dramatically reduce that pressure, encouraging the periphery of the disc to retract inward, drawing the nucleus of the disc back toward the center and pulling fresh blood and fluid into the area, which can reduce inflammation that might be pushing on a nerve.

Surgical Treatment Options

Microdiscectomy

Removal of part of the disc that’s pushing against your nerve. Best for those whose bulging or herniated disc is hitting a nerve.

Spinal Fusion

Fusing together of vertebrae so they stay in the correct alignment. Best for older patients with arthritis as well as disc problems

Artificial Disc Replacement

Replacement of the disc with a synthetic one. Best for younger people willing to take a chance on new technology.







Joint Issue

Back joints are vulnerable to arthritis, strains, and sprains.
AT RISK: Older people and those who play sports that involve twisting.

Sacroiliac Joint Dysfunction

Diagnosis

Most joint problems in the back are related to arthritis, and as such tend to show up in older people, but sacroiliac joint dysfunction is an exception. Unfortunately, doctors don’t seem to know exactly what causes it, but they know exactly what causes it, but they do know it’s an irritation in the sacroiliac joint, which connects the base of the spine to the pelvis. Pain usually occurs on one side of the lower back, but it cal also affect the buttocks.

Treatment Options

There’s no imaging test for sacroiliac joint dysfunction, so it’s usually diagnosed by manually pressing on the joint to see if there’s pain or injecting a painkiller into the specific area to determine if that’s where the discomfort originates. It tends to go away and never requires surgery.

Facet Joint Syndrome

Diagnosis

Facets are the joints that stabilize the spine, and they can become arthritic, causing pain that tends to hurt more when your arch backward. Bad posture, trauma (like whiplash from a car accident), and repeated twisting motions, such as swinging a golf club, can also irritate facets. Facet joint syndrome usually occurs in the neck or lower back and can also cause pain in the buttocks and shoulders.

Treatment Options

Doctors usually prescribe a conservative mixture of anti-inflammatories, steroid injections, and physical therapy. If those don’t work, surgical options include radiofrequency neurotomy, where a surgeon inserts an electrode into your back and uses an electric current to actually destroy the facet’s nerves.


This was a very informative article that validated a multi-disciplinary approach to treating and preventing back pain.
In our NYC office we have a team of Medical doctors,Chiropractors and Physical therapists working to not only end your pain but strengthen the muscles that stabilize the spine. Visit us @ www.livingwellnewyork.com
We accept most PPO plans and offer late evenings and Saturdays.
Call us today at (212) 645-8151.

Wednesday, March 10, 2010

Stopping Shin Splints

The weather seems to be starting to turn in the city these last few days. Before you know it, people will be getting into spring athletics and revving up their engines for sports, and along with the increased level activity comes an increased risk of injury. One of the more common athletic injuries we encounter at Living Well Medical in NYC is medial tibial stress syndrome, commonly referred to as shin splints.

While there are a number of different causes for shin splints, it's generally connected with physical exertion. Of course, physical exertion is a pretty broad topic, so let's get a little more specific. Running/sprinting is commonly associated with shin splints, or more accurately the mechanics of running.

Over the course of a single stride, weight is first placed on the heel. As you moved through the stride, that weight is transferred to the ball of the foot through a rolling motion; there is a very slight inward turn of the foot to equally distribute force across the ball of the foot.

At least, that's what's supposed to happen. Improper biomechanics can prevent proper and even distribution of the force that is generated with running across the foot, which is approximately 3 times your body weight. If you aren't running with correct form, that a lot of stress being placed on a single side of the leg. Shin splints is often felt on the inside of the legs because of overpronation, the act of rotating the ankle too much as the weight is shifted from the heel to the ball of the foot.

Overuse of the supporting muscles in the inner, or medial area, of the calf can lead to stinging pain during activity. Over time, if untreated, it can potentially lead to a stress fracture of the tibia.

Shin splints is pretty serious business, and it just hurts. At my office, Living Well Medical, in New York City we usually start to see more patients suffering from shin splints during the change in seasons around this time of year. If you are having trouble getting over the pain, we can treat the pain and help you prevent it in the future. Technology like gait analysis can help doctors create custom orthotics for your shoes that can correct improper biomechanics. Give us a call today at 212-645-8151 for more information.

- Dr. Shoshany

Wednesday, March 03, 2010

Surgery contrasted with conservative care of Sciatica patients


Surgery contrasted with conservative care of Sciatica patients

Disc surgery may be a luxury that society cannot afford, Except for the few cases wherein an emergency loss of neurologic function occurs, most cases of disc herniations recover on their own with conservative care. The 30,000 failed spinal operations per year consume an "extraordinary amount" of societal resources.
During the first 6 to 8 weeks of care for herniated disc cases, little reason is seen to plan invasive management because only a small percentage of patients with herniated discs should consider surgical intervention. Long term results of surgery are only slightly better than both conservative measures and the natural history of a lumbar disc herniation.

Non surgial spinal decompression for herniated disc in NYC
Quality of Life after disc surgery
Disc surgery does not appear to return patients to work any faster or prevent long term disability any more effectively than nonoperative treatments. It does, however offer a significant benefit in terms of quality of life and symptom alleviation. In can afford 5 extra months of comfortable living over a 10 year period, compared with nonoperative treatments.

So with this information I am often asked - When does a patient with back pain and or leg pain become a surgical candidate?

Patients with a definite diagnosis of ruptured lumbar interverbral disc (IVD) and sciatica or other radicular pain with neurologic signs and symptoms should be carefully observed and treated by nonsurgical means for 4 to 8 weeks, unless the patient presents with progressive loss of motor,bladder or bowel function or has excruciating pain that canot be relieved by nonoperative measures.

Surgery seldom Necessary
The life time incidence of surgery for back pain and sciatica range from 1 to 3%; 50% of patients with disc hernia induced sciatica will recover spontaneously in 4 to 6 weeks. Although surgery hastens the recovery from disc hernia induced sciatica; it seems to have little influence on risk if recurrence.
Only 5 to 10% of symptomatic lumbar disc patients require surgery, and the best overall plan is to help patients avoid back disease by encouraging them to modify risk factors,provide them with preventive exercises, and teach them proper and improper methods of lifting.
Another question that is often asked is ok to delay a disc surgery and if so does it cause permanent nerve damage.
If a person undergoes surgery, regardless whether early or late,within a 12 week period, it does not really influence outcome in terms of future motor function.
In fact, a slightly increased risk is seen of sensory loss (feeling) if surgery is preformed too early.
There is the same long-term relief of pain. No evidence currently exists to intervene early with surgery- even when the patient has a dropped foot. If a person has cauda equina syndrome, however this is an acute surgical situation. The cauda equina syndrome occurs in only 1 to 2% of all lumbar disc herniations that come to surgery.
So the moral of the story is exhaust all Non-surgical options before surgical methods.
I utulize non-surgical spinal decompression in conjuction with physical therapy,Cox-flexion distaction technique, SpineForce Rehab and cold laser therapy in my practice
in NYC www.drshoshany.com