The California 4th District Court of Appeals has issued a decision on an issue that has been pending in an unresolved fashion since the early 1990s when Labor Code § 3208.3 was amended to provide that injuries arising from lawful good-faith personnel actions. In County of San Bernardino v WCAB (McCoy) the applicant alleged both psychiatric injury and migraine headaches from job stresses. At trial, the employer was able to show the job stresses complained of by the applicant constituted lawful, good-faith personnel actions and the workers’ compensation judge denied injury based on Labor Code § 3208.3(h).

The applicant appealed and the WCAB reversed the WCJ as far as the migraine headaches were concerned. The WCAB concluded Labor Code § 3208.3(h) was limited only to the psychiatric diagnosable conditions under the DSM4R. The psychiatric condition could be barred under that section because according to the WCAB, migraine headaches were an organic consequence to the stress and not diagnosable as a psychiatric condition. The WCAB remanded for the WCJ to award medical treatment and TTD. Defendant appealed the reversal but their petition for reconsideration was denied by the board.

Defendant’s appeal to the 4th District was initially denied but the Supreme Court granted the request for review and transferred back to the appellate court, ordering it to grant review. The court took note of the significance of such a step:

“Indeed, McCoy asserts that the Board’s decision involved a routine application of settled law to a factual situation that was hardly novel, and there is no reason for this court to grant a writ of review. Our Supreme court believes otherwise because it has granted county’s petition for review and transferred the matter to us with directions to issue a writ of review. We have done so.  The Supreme court’s action does not ipso jure establish that County is entitled to the relief sought, but it does mean that we must decide the issue presented with the parties having an opportunity to argue the issues.  (Dickey v. Workers’ Comp. Appeals Bd. (1990) 224 Cal.App.3d 1460, 1463.)  We can safely infer that issues presented are not a matter of settled law.”

Having decided the issue was one which was not settled, the court set about settling the issue.  Noting there was no definitive law on this subject and only conflicting decisions from the WCAB, the court looked to the enacting legislation for guidance on what was intended by the Legislature:

“There is no case authority applying the good faith personnel action provision in situations where work-related stress manifests itself in physiological symptoms such as gastrointestinal disorders or, as in this case, headaches… Although there is a dearth of authority on this specific issue, our determination of legislative intent is not rudderless.  We agree with Pacific Gas & Electric Co. that we must consider the public policy goals in determining whether an award of benefits is warranted.  By enacting section 3208.3 the “Legislature made quite clear that it intended to limit claims for psychiatric benefits due to their proliferation and their potential for fraud and abuse.  Therefore, any interpretation of the section that would lead to more or broader claims should be examined closely to avoid violating express legislative intent.”  (Pacific Gas & Electric Co., supra, 114 Cal.App.4th at p. 1182.)

… ‘Section 3208.3 was enacted as part of the Margolin-Greene Workers’ Compensation Reform Act of 1989.  It is part of the Legislature’s response to increased public concern about the high cost of workers’ compensation coverage, limited benefits for injured workers, suspected fraud and widespread abuses in the system, and particularly the proliferation of workers’ compensation cases with claims for psychiatric injuries.’ ”  (Pacific Gas & Electric Co v. Workers’ Comp. Appeals Bd., supra, 114 Cal.App.4th at pp. 1180-1181.)”

Rejecting applicant’s efforts to limit the impact of Labor Code § 3208.3 to only psychiatric injury, the court specifically applied the statutory limitation to physical injuries which are derivative of stress where that stress was a result of lawful, good faith personnel actions:

“In such a circumstance, we must conclude that section 3208.3, subdivision (h), precludes recovery for physical manifestations that are directly and solely resulting from the psychological injury suffered as a result of good faith personnel actions.  Any other result would undermine the purpose of the law to limit such claims because of their potential for fraud and abuse.  It would be relatively easy for a claimant to avoid this bar by asserting internal problems and symptoms, such as upset stomach, headache and sleeplessness, but not injury to the psyche per se.  There is no better example of this than the present case where McCoy added the claim for migraine headaches—a preexisting condition—on the first day of trial.  We conclude that the good faith personnel action defense precludes recovery for psychiatric injuries with resulting physiological manifestations solely caused by stress from such actions.

Conclusions and Observations:

There indeed have been conflicting WCAB panel and writ denied cases on this specific issue.  Applicant made an unconvincing effort to portray this issue as settled based on a strict statutory interpretation, without success.  The court pointed out that the applicant raised the issue of migraine headaches at the time of trial in an apparent effort to head off the pending lawful good faith personnel defense that he apparently figured out was a winner for defendant.  This court astutely figured out the applicant’s effort was intended to sidestep the statute and obtain the same benefits as he sought on a psychiatric basis.

It is also very interesting to note the court’s holding does not appear limited to migraine headaches. The court specifically mentions gastrointestinal complaints as being a similar type of condition that can fall under the same guidelines. The question then arises how far can this decision be expanded?  Will it apply to cardiovascular complaints, Stress related strokes etc.  The underlying rational of the court would seem to be equally applicable to any physical manifestation of a stress related condition that otherwise met the statutory criterion.

What the decision does not address is conditions which are multifactorial.  Labor Code § 3208.3(h) only requires a condition to be “substantially causes” by lawful, good faith personnel actions.  Does this mean a stress related condition will be barred if it is 35-40% causally related to the personnel action or does the condition have to be totally caused by the personnel action?  Can the same rule apply to predominate causation for psychiatric injuries?  If stress related organic conditions are limited by Labor Code § 3208.3(h) will not subdivisions (b) [predominate causation threshold] or (d) [6 months of employment] also apply.

It seems likely the court’s decision only scratches the surface of the complex series of questions.  Answers that yesterday seemed very certain are suddenly not so clear.

WorkCompCentral subscribers may download the case by clicking the case title in the sidebar.

Richard M. “Jake” Jacobsmeyer is a founding partner of the Shaw, Jacobsmeyer, Crain & Claffey law firm in Oakland.

• Before 1980, fewer than 1 in 10 people were obese.
• Today, the majority of the population are overweight or obese in 19 of the 34 OECD countries.
• Some countries – Korea, Switzerland, Italy, Hungary, England - have stabilized the growth of the epidemic.
• Korea and Japan have the lowest prevalence rates, at 3.8 and 3.9 percent of the population, respectively
• The U.S. edges out Mexico as the most obese country: 33.8 percent of the total population is overweight or obese
• Estimates allocate 1-3% of health expenditures to obesity-related problems; in the U.S., the estimate is 5-10%

The paper includes brief discussions on child obesity, the social disparities of obesity, and what governments can do to combat the problem, including a lengthy sidebar on “fat taxes” – special taxes on foods and beverages that are considered to be unhealthy.  Some countries that have imposed fat taxes include Denmark, Hungary, Finland and France.  The sidebar analysis includes brief descriptions of what food and/or beverage groups incur the additional tax.

Source: Sassi, Franco, and Devaux, Marion.  Obesity Update 2012. Paris, France: Organization for Economic Co-operation and Development, February 2012.  http://www.oecd.org/document/55/0,3746,en_2649_37407_49715511_1_1_1_37407,00.html

Obesity and the Economics of Prevention: Fit Not Fat. Paris, France: OECD, 2010.  This is the original 265-page report published in September 2010.  An executive summary, background notes, and additional ancillary material is available at http://www.oecd.org/document/31/0,3746,en_2649_37407_45999775_1_1_1_37407,00.html#Executive_Summary.

Before saying yes to back surgery, make sure you consider the risks. A study in Effective Clinical Practice asserts that medical risks significantly increase if you are past middle age and undergoing high-risk surgery.

The study focused on the death rates for 14 different types of surgeries, specifically high-risk surgeries among 1.2 million patients, age 65 and older. Age was the main predictor of operative mortality. The risk of death among the older patients was “frequently” higher than 10%. Operative death for patients age 80 years or older was more than double the risk than for patients age 65 to 69. Next to age, the type of procedure was next best indicator of risk. The riskiest procedures included heart valve replacement and partial lung or esophagus removal, with over 15% operative mortality rate in patients over 80.

Before considering back surgery, be sure to consider all medical risks, including those associated with age and the procedure. Make sure you have investigated all treatment options with your doctor of chiropractic before electing to undergo surgery.

Finlayson EVA, Birkmeyer JD. Operative mortality with elective surgery in older adults. Effective Clinical Practice, July/August 2001:4(4), pp. 172-177.

Always do your research!!! Contact www.rbspinecenter.com for an appointment with a pain management specialist! 858-345-4114

If you or someone you know is suffering from chronic back pain, rest assured that there are treatment options beyond back surgery. Research has provided significant evidence supporting nonsurgical treatment methods for chronic back pain. In fact, research has shown that surgery is overused when treating chronic back pain.

The New England Journal of Medicine supports this claim, stating that intervention of any type is only recommended for back pain that last for more than three weeks. The study provided recommendations for treating lower back pain through both medical and alternative intervention. Among the recommended treatments are suggestions for intensive exercise, including strengthening and aerobic conditioning. Chiropractic care was also recommended as an effective treatment, and massage therapy has also shown potential to treat lower back pain.

The study stated that other commonly misused methods include radiography and advanced imaging procedures (such as an MRI). These procedures should only be used in extreme cases of suspected systemic disease, loss of function, or severe nerve pain. Surgery, the study reported, should only be considered when all conservative and extreme medical treatment methods have failed. The study reported that the best recommendation for a healthy lower back is to remain active with plenty of exercise, to keep the back muscles and legs conditioned.

Deyo R, Weinstein J, et al. Low back pain. The New England Journal of Medicine 2001:344(5), pp363-369.

Look at our site for more information about Low back pain and Surgeries… Learn before you go under the knife. www.rbspinecenter.com

A study by Woodward, Cook, Gargan and Bannister found 93% of the patients studied under chiropractic care for chronic whiplash injuries had improved.

They further stated “…no conventional (medical) treatment has proven to be effective in these established chronic cases.”

Studies on the efficacy of chiropractic care for patients suffering with pain secondary to whiplash injury are appearing in the literature. In 1996, Woodward et al. published a study in Injury on the efficacy of chiropractic treatment of whiplash injuries.1 The authors of this study were from the Department of Orthopedic Surgery in Bristol, England.

“Forty-three per cent of patients will suffer long-term symptoms following ‘whiplash’ injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic ‘whiplash’ syndrome. The severity of patients’ symptoms was assessed before and after treatment using the Gargan and Bannister (1990) classification. Twenty-six (93 per cent) patients improved following chiropractic treatment (U = 34, P < 0.001). The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic ‘whiplash’ injury.”

Woodward MN, Cook CH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27(9):643-645.

In 1994, Gargan and Bannister published a paper on the recovery rate of patients with whiplash injuries and found that if patients were still symptomatic after three months, there was almost a 90% chance they would remain so.2 Gargan MF, Bannister GC. The rate of recovery following whiplash.

Eur Spine J 1994;3:162.

“No conventional medical treatment has been shown to be effective in these established chronic whiplash injury patients.”

Barnsely L, Lord S, Bogduk N. Whiplash injury, a clinical review. Pain 1994;58:283. Bogduk N. Post whiplash syndrome. Aust Fam Phys 1994;23:2303.

(Mealy, K, Brennan H, Fenelon, GCC, “Early Mobilization of Acute Whiplash Injuries,” Brit. Med. Journal, Vol. 292:8 3/1986), the authors clearly showed that early active care including movement/cavitation of the spinal joints was more effective than cervical collars and bed rest.

At a mean of 15.5 years post whiplash trauma, 70% of the whiplash injured patients continued to complain of symptoms referable and related to the originial accident. 80% of women and 50% of men continued to have symptoms at 15 years.

Squires, B, Gargan, MF, Bannister, GC, “Soft-tissue Injuries of the Cervical Spine: a 15 year Follow-up,” J of Bone and Joint Surg. (British), Vol. 78B(6), 11/96, p 955-7. From the University of Bristol, England

Why not get help by those trained to correct the major cause of peripheral neuropathy?

Data from the National Board of Chiropractic Examiners’ Job Analysis of Chiropractic lists arm and leg neuropathy as the second most common nerve problem treated by chiropractors.

Often neuropathy is caused by a degenerating spine pressing on the nerve roots. This can happen in any of the vertebral joints from the neck all the way down to the tail bone.

The Single Most Important Solution To Your Neuropathy

By using a specialized unique and  gentle techniques, I’m able to release the pressure that has built up on the nerve. This allows the nerve to heal and the symptoms to go away.

Numerous studies have proven the effectiveness in helping nerve conditions…

“Manipulation [chiropractic adjustments], with or without exercise, improved symptoms more than medical care did after both 3 and 12 months.”– British Medical Journal

Patients showed an 85.5% resolution of the nerve symptoms after only 9 chiropractic treatments. – Journal of Chiropractic Medicine 2008

With chiropractic care, patients had “significant improvement in perceived comfort and function, nerve conduction and finger sensation overall.” – JMPT 1998

“Significant increase in grip strength and normalization of motor and sensory latencies were noted. Orthopedic tests were negative. Symptoms dissipated.” – JMPT 1994

What these studies mean is that with our specialized , unique approach and  care, you could soon be enjoying life…without those aggravating nerve problems.

Here’s What To Do Now

Call today 858-345-4115 and we can get you scheduled for your consultation, exam and nerve test as soon as there’s an opening.

Our office is located just off the 15 Fwy, next to Sharp Reese Stealy Medical Center, just a few minutes from you.

In many aspects, massage is the most natural of natural remedies. Touching your body where it hurts seems to be a basics instinct, like our innate fight or flight mechanism. And many health practitioners claim that massage, no matter how superficial or deep, provides powerful results.

Massage has developed greatly over time! There are in fact many different types of massage techniques but we have listed four of the most commonly used methods from our own office experience.

SWEDISH MASSAGE uses soothing, tapping and kneading strokes to work the entire body, relieving muscle tension and loosening sore joints. Swedish massage is more superficial and there are five basic strokes. They are effleurage (stroking); petrissage (muscles are lightly grabbed and lifted); friction (thumbs and fingertips work in deep circles into the thickest part of muscles; tapotement (chopping, beating, and tapping strokes); and vibration (fingers are pressed or flattened firmly on a muscle, then the area is stimulated by shaking briefly for several seconds. Techniques of effleurage and tapoement seem to be the favorites. This method is commonly used at spas.

DEEP TISSUE MASSAGE targets chronic tension in muscles that lie far below the surface of your body. You have five layers of muscle in your back, for instance, and while Swedish massage may help the first couple of layers, it won’t do much directly for the muscle underneath. Deep muscle techniques usually involve slow strokes, direct pressure or friction movements that go across the grain of the muscles. Massage therapists will use their fingers, thumbs or occasionally even elbows to apply the needed pressure. This method is best used with certain long standing injuries which seem to be persistent and require a bit more to release spasm.

SPORTS MASSAGE is designed to help you train better, and recover quicker, .whether you’re a world class athlete or a weekend enthusiast. The techniques are similar to those in Swedish and Deep tissue massage, but can be altered to meet an individual athletes needs. Pre-competition massage can help warm up muscles and improve circulation before competition, and also energize or relax an athlete and help him or her focus on the competition. Post-competition massage can help rid toxins and waste products out of the body and increase recovery time.

NEUROMUSCULAR MASSAGE is a form of deep tissue massage that is applied to individual specific muscle group’s muscles. It is used to increase blood flow, reduce pain and release pressure on nerves caused by injuries to muscles and other soft tissue. Neuromuscular massage helps release trigger points, and muscular adhesions (areas which form due to micro traumas) and can also “refer” pain to other parts of the body. Relieving a tense adhesion or trigger point area in your back, for example, could help ease pain in your neck, shoulders, low back, etc. This technique is especially beneficial when used with spinal manipulation and adjunct forms of physical therapy.

At RB SPINE  CENTER we have special programs designed to help make it affordable for anyone who wishes to receive the benefits of MASSAGE THERAPY. Many of our massages cost as little as $39.00/hour. All of our massages are supervised by licensed health care providers, ensuring your optimum benefit and comfort.

Call today to experience the benefits of massage.

“Supporting Your Health”.

RB SPINE CENTER
858-345-4114
www.rbspinecenter.com

While the researchers of the original study never recommended the once-a-day aspirin regimen, the pharmaceutical industry immediately began a massive press release campaign that distorted the research report. The press releases at the time gave the impression that the daily aspirin was a sure-fire way to prevent heart attacks. The news was picked up by most newspapers and even medical doctors began “prescribing” aspirin as a preventive measure.

Thanks in part to this deceptive marketing campaign, Americans take more than 25 million aspirin tablets every day, despite the fact that:

* 1,600 children die each year from allergic reactions to aspirin;

* patients with blockage of arteries to the brain are three times more likely to have a stroke if they are taking aspirin;

* dyspepsia and gastrointestinal hemorrhage occur in 31% of those taking 300 mgs. of aspirin per day;

* even low doses of aspirin can increase the risk of brain hemorrhage; and

* other side effects can include anemia, bleeding ulcers, confusion and dizziness, and numerous other problems.

A new study confirms the risk of aspirin and says that the supposed “benefits” don’t apply to most people. In fact, according to the authors, people without a history of cardiovascular disease (such as heart attack or stroke) are unlikely to benefit from a regular dose of aspirin, given the associated risk of internal bleeding.

The research, published in the Archives of Internal Medicine, January 9, 2012, is the largest study to date on the effects of aspirin in people without established cardiovascular conditions.

Researchers from Professor Kausik Ray’s group at St George’s, University of London investigated the drug’s effectiveness in primary prevention and the prevalence of side effects. They also assessed whether aspirin had any impact on the risk of death from cancer among people considered at risk of cardiovascular disease.

They analyzed data from nine clinical trials involving more than 100,000 participants without a history of cardiovascular disease. Half of the participants took aspirin and half took a placebo. The average participant in the aspirin arm of these trials took aspirin for about six years.

The researchers found that aspirin in conventional daily or alternate day doses reduced the risk of total cardiovascular disease events by just 10% – and this was largely due to a reduction in non-fatal heart attacks. It did not result in a reduction in other cardiovascular disease events, including death from heart attack or fatal or non-fatal stroke.

The study also showed that this benefit was almost entirely offset by a 30% increase in risk of life-threatening or debilitating internal bleeding events. This means that while one cardiovascular disease event was averted for every 120 people treated with aspirin for about six years, one in 73 people suffered from potentially significant bleeding during the same period.

The lead author of the report, Dr. Rao Seshasai, said the evidence that aspirin may prevent future cardiovascular disease events in people with established heart attacks or strokes is indisputable.
“However, the benefits of aspirin in those individuals not known to have these conditions are far more modest than previously believed and, in fact, aspirin treatment may potentially result in considerable harm due to major bleeding.”

By concurrently investigating the effects that aspirin had on death from cancer in the same population, the researchers found that, contrary to some recent reports, aspirin did not reduce the risk of death from all cancers.

Dr. Seshasai added: “There is an enormous interest in understanding the role of aspirin in cancer prevention. No evidence of benefit was found in the studies reviewed, but more research is needed given these were only of six years in duration.”

A Reuters report noted: “… with no expected H1N1 outbreak along the lines of last year’s heavily hyped version, this season’s sales could be slower for drugstores, groceries, and big-box retailers as fewer flu-stricken consumers come into pharmacies looking for cures and Kleenex.”

Less flu means less income for the drug makers and the millions of drug stores, department stores and pharmacies around the globe that make a significant portion of their revenue from the vaccine trade.

The profits from vaccines is staggering.

Last year, global vaccines sales reached $28 billion, up from $26 billion in 2009, $24 billion in 2008 and $18.5 billion in 2007. Although US stores love to claim they give out “free vaccines,” almost all of these freebies are paid by vouchers issued by the US federal government, which spends about $4 billion per year to purchase vaccines and fund the “free” vaccine program.

At the same time, thanks mainly to the Internet, reports about the dangers and ineffectiveness of vaccines have circulated among consumers and a major backlash appears to be gaining momentum.

Comments on personal blogs, news sites, and discussion forums are increasingly showing growing dissatisfaction with the clear profit motives of major drugstore chains, and of the push for more and more vaccines.

Blogger Cathy Jameson’s observations on a recent trip to a local drugstore, posted on the Age of Autism site (ageofautism.com), is typical: “Every counter, every shelf and every display screamed FLU SHOT. Even the stereo speaker system blared a flu shot commercial! I couldn’t escape the drivel repeating over and over again.”

Mike Adams, editor of the popular alternative health site NaturalNews.com, reported on the public outcry against “harassment” by Walgreens employees pressuring people to get vaccinated. “Multiple accounts from NaturalNews readers describe aggressive verbal harassment by Walgreens employees who appear to be “over the top” in pushing flu shots, even onto pregnant women,” he noted.

Adams also stated that his site has received reports from people identifying themselves as Walgreens employees, who claim they’re “being rewarded with incentives or threatened with reprimands if they met a certain ‘goal’ of pushing a certain number of customers into getting flu shots.”

Celebrities like Jenny McCarthy, Jim Carrey, Chuck Norris, Charlie Sheen, Britney Spears, and Lance Armstrong have joined the chorus of voices raised in opposition to the increasing use of vaccine drugs. While often blasted on the Internet for their stands, their high-profile statements have generated interest among the mainstream public.

The backlash has become so obvious that even the World Health Organization (WHO) is being forced to deal with it. In opening the WHO’s executive board meeting last year, the head of the WHO cited anti-vaccine sentiments as a worrisome trend that may be very difficult to change. WHO Director-General Margaret Chan said: “In some cases, persuading the public to seek vaccination has become even more problematic than during the pandemic. As documented in the report on immunization, the problem of public mistrust extends well beyond influenza vaccines…. This is a worrisome new trend that needs to be addressed.”

Stemming the tide may be impossible, given the numerous research reports being published that counter vaccine claims of safety and effectiveness.

In 2010, a research report that reviewed 50 studies of flu vaccine use in healthy adults concluded: “The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms… Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.” (“Vaccines for preventing influenza in healthy adults,” Cochrane Database of Systematic Reviews 2010, Issue 7.)

Another research study that added fuel to the anti-vaccine backlash was published in theJournal of Virology in November 2011. The study found that while the vaccine may prevent some cases of influenza in children, the drug compromises the immune system but also “hampers the development of virus-specific CD8+ T cell responses.” Since T cells or T lymphocytes play a central role in cell-mediated immunity, the vaccines could actually be making children more susceptible to flu and other viruses. (“Annual Vaccination against Influenza Virus Hampers Development of Virus-Specific CD8 T Cell Immunity in Children “Journal of Virology, Nov. 2011).

Terry A. Rondberg, DC, president of the World Chiropractic Alliance, said there may be an upside to the bad news about vaccines.

“People are looking for natural, drug-free ways to protect their health and chiropractors will be in the ideal position to help them,” he stated. “We have to continue our public education program to let people know that chiropractic adjustments have been shown to strengthen the immune system and enhance overall wellness. We have to make sure they don’t believe the myth that we are only effective for low back pain.”

FHP affects much of the population – men and women, adults and children, alike. Whether due to computer ergonomics, carrying a heavy backpack, a weak core, or trauma causing muscle imbalance, the fact is that the public is more affected by FHP today than ever before.
When a child carries a heavy, book-laden backpack, the head is forced forward to counter balance the weight, resulting in abnormal stress to the discs, joints, nerves of the neck, shoulders, and lower back. Positioning computer screens too low, coupled with the repetitive motion of moving the head forward to read the screen, is another primary cause of FHP.

When kids play video games or watch TV in poor posture, the repetition of sitting in one position for long periods of time causes the body to adapt to this bad posture. In fact, the bent-over posture of a 60-year-old woman with a dowager’s hump, has its seeds in the posture of a 16-year-old girl slumping in front of a TV or computer for hours on end.

Despite ample evidence that posture affects physiology, function and balance, the medical community does not give FHP proper attention. We in the chiropractic community, on the other hand, see this potentially devastating condition for what it is – a true malady. (”Forward Head Posture leads to long-term muscle strain, disc herniations, arthritis and pinched nerves.” Mayo Clinic Health vol 18 #3 Mar2000.)

The average patient walks into our office overweight and carrying a 10-15 pound head an inch or more in front of his or her shoulders (the effects of gravity on this now-unbalanced object results in an effective weight of 45+ pounds). With this condition, all of the compensating mechanisms go into effect – rounded fibrotic shoulders, and a core that’s proportionately weak to the cervical lordotic curve (or lack of it) – resulting in undue stress on the nervous system as well as reduced health and well-being.

We can treat this condition with an “active care program…… Part of your active care program should include a self-help component, so you empower your patients for a lifetime of good health.
Although it’s great to have systems in place that utilize a variety of different therapeutic exercises when billing for active care services, if your emphasis is on using exercise machines – or even bands, Bosus’, balls, etc. – the patient can only benefit while in your office, as it relates to changing muscle memory and reducing FHP. That is, if you’re even focusing on reducing FHP and core strengthening. If not, your patients are missing out on this huge benefit of care, postural improvement.

In addition to providing active care in the office, teach your patients how to properly exercise key posture muscles when at home, in the gym, or at work. This will result in changing muscle memory to achieve and sustain a neutral neck, as well as shoulders that are loose and upright, and at the same time develop a stronger core. We all want this result!

The exercise program should address the following five aspects of fitness that all work together for good health

by Elizabeth Welch, DC