Wednesday, October 31, 2012

Distraction Test

Distraction Test

The complaints of patients with chronic or degenerative conditions of the cervical disc are quite different from those of patients with acute conditions. Patients with chronic conditions experience intermittent episodes of pain, discomfort, and muscle spasm. Exacerbations come from exertion. Pain and stiffness may result from weather changes or unexplained causes. Radiculopathy is not always present. Hyporeflexia, motor weakness, and sensory disturbance (especially paresthesia) are common.

1.  Delay in the onset of symptoms.  If the symptoms are not written down and documented within a few hours or days after the crash, then it is very difficult for the patient to say he/she had pain when there is no written evidence.  This can be a critical issue in a case, for example, the first doctor to note that the patient had a traumatic brain injury was made 8 to 10 months after the collision.

2.  Delay in seeing the first doctor.  Any significant delays between the date of the crash and seeing the doctor may create credibility issues for the case.  The patient needs to have a good explanation for waiting for several days to weeks for the first appointment.  There may be legitimate issues such as, some doctors have very busy schedules and may not have appointments available for several days.  The reasons for delays should be noted in the file.  The doctor or patient may have a vacation or work trip scheduled, be out of town for a medical emergency, may have an unrelated surgery that made it impossible to make an appointment, or may simply have not transportation available.

3.  There were conflicts in the history given by the patient in the records.  For example, patient stated in his deposition that he had never been involved in a crash before.  Records from 1989 indicate that the patient was involved in a rear-end crash.  The ER doctor notes that the patient did not use a seatbelt and the orthopedist noted that the patient did use a seatbelt.

4.  Little-to-no damage to vehicle.  The defense will advocate that the damage to the vehicle equals the injury potential (see Chapter 15 for crash speed thresholds for injuries).  There are generally few photographs taken of the vehicles that adequately show the extent of the damage.  Most jurors are going to see poor quality blow-ups of the vehicles or as the parts are removed for repairs.

5.  Impact forces not sufficient to cause any injury or was sufficient enough to have caused only mild muscular strain that would have healed without treatment within a few days may have occurred.  No mechanism of injury was possible in this collision.

6.  No objective findings to prove injuries.  No bruises, bleeding, lacerations, fractures, or photographic evidence of the injury to show the jury.

7.  The treatment that was provided was passive and has not been proven to work.  Patient’s condition would have been the same with or without treatment.  Exercise is the only thing that works.  Patient had only palliative benefits from the treatment.  No long-term benefits noted in file.  May look at deposition.  If patient states in the deposition that the treatment only helped for one to two weeks but the patient continued to have treatment for an additional four months. The case may have challenges.

8.  The duration of treatment was too long, was excessive, or was duplicative, and therefore is not justified from doctor’s experience.  The treatment costs were thus unreasonable for the mild nature of the injuries.  The osteopath, chiropractor, and physical therapist were doing similar things, and therefore the treatments were unnecessary.

9.  Gaps in treatment indicate that the patient did not have any pain.  That a reasonable person in pain would see a doctor is a common attack.

10.  Healing and full recovery takes two to four weeks.  This opinion is simply a hoax for most cases (see Chapter 7 for more about soft tissue healing).

11.  Every person will have full recovery following whiplash injuries.  Doctors and attorneys are to blame.  This is another hoax (see Chapter 13 for a review of prognostic studies).

12.  Patient saw too many providers, consistently self-referred himself or herself, and had a history of psychological problems.

13.  Documentation was poor.  The doctors did not note symptoms, or there are inconsistent statements made by the doctors.

14.  New injuries, including MVCs, falls, etc., or simply flared-up bending over are responsible for the problems.

15.  Prior injuries resulted in all of the problems.  The defense may attack the case by telling the jury that the injuries sustained 8 to 15 years earlier were responsible for the current pain, although there is not evidence of the patient being seen by any health providers for the past five to six years for any musculoskeletal pain.

16.  Prior pain and / or treatment for this pain within the past couple years clearly indicates that the patient’s pain was long-term and would have been present despite the crash.

17.  No justification for the amount of time off work.  May state that the typical patient is back to work within one week (see Chapter 12 for more information).

18.  The MRI scan results showing a bulging or herniated disc are also seen in the general population and are not related to the accident.  Typically, if any degeneration or spurring is noted in the radiology report, the defense medical and biomechanics expert will use that as his/her basis for that opinion using a “Natural Progression” theory.

19.  Future treatment is not needed.  The defense attorney may tell the jury in the opening statement that “Everyone knows that once the case settles the plaintiff’s pain will go away.”

20.  Conservative jurors who have a “Hollywood mentality” can make a case extremely difficult even with the best documentation, proof of bulging discs, and great doctors.  The jury may perceive the plaintiff as looking healthy and there are no photographs of blood and guts.  Some court districts are known as being very conservative, thus making it difficult to get any significant awards.  Some jurors may see that there is monetary motivation for the plaintiff.

Tuesday, October 30, 2012

1994 Press Release: Fast Facts About Stone Mountain Park

1994 Press Release: Fast Facts About Stone Mountain Park

GEORGIA'S STONE MOUNTAIN PARK Public Relations Department
P. O. Box 778
Stone Mountain, Georgia 30086
404/498-5633 (FAX) 404/498-5607For More Information, Contact K" Thweatt or Mauri Spalding (404) 498-5637

Georgia's Stone Mountain Park encompasses one of the world's most amazing works of nature.

Known as a place of scenic beauty, historic remembrance, recreation and enjoyment, following are some little known, yet interesting facts about Georgia's Stone Mountain Park:
* Millions of people visit the Park annually, making it one of the most-visited attractions in the United States.

* Stone Mountain is the world's largest monolith.

* Stone Mountain was formed approximately 300 million years ago by a surge of molten lava beneath the earth's surface. Initially, a two-mile thick overlay of the earth's surface covered the cooling granite. The layer eroded over the next 200 million years exposing the smooth surface of the dome-shaped rock. The mountain is 825 feet high, rises 1,683 feet above sea level and covers 583 acres of land. The surrounding 3,200-acre Park includes woodlands, lakes, recreation areas, museums, and other attractions.

* The Memorial Carving on the north face of the mountain is the world's largest bas-relief sculpture, measuring 90x190, or three acres. The figures of Confederate President Jefferson David, General Robert E. Lee and General "Stonewall" Jackson mounted on horseback depict the South's historic past. In 1912, the Memorial Carving existed only in the mind of Mrs. Helen Plane, charter member of the Daughters of the Confederacy. The first of the three sculptors to work on the project, Mr. Gutzon Borglum began work on the carving in 1923. He left two years later taking his sketches and designs, and went to carve the famous Mount Rushmore sculpture in South Dakota. After remaining untouched for 36 years, the carving was completed in 1972.

* In 1845, the newly completed Georgia Railroad allowed for the extraction of granite from Stone Mountain for commercial use. Granite quarried from Stone Mountain has been used in construction projects throughout the world, including the locks of Panama Canal, the U.S. Capitol Building, and the Imperial Hotel in Tokyo, Japan.

* Although no major Civil War battles were fought on the soil of Stone Mountain, Sherman destroyed the Georgia Railroad line between Stone Mountain and Decatur during his destructive "March to the Sea." The Union army came within close range of the mountain when it burned New Gibraltar, the small town at the base of the mountain. Today, the rebuilt town is known as the Village of Stone Mountain.

* The first written records of the mountain date back to 1567 when Captain Juan Pardo of Spain was sent to set up forts in the New World. He and his group believed the quartz surface of what they called "Crystal Mountain" was made of diamonds and rubies.

* Unique clams and fairy shrimp live in clear freshwater pools formed in the craters on the mountain. In addition to these crustaceans, rare plants and flowers, such as the Confederate Yellow Daisy, grow in the mountain's crevices.

* The Park is home to a variety of animals and endangered species; however, there is little wildlife living on the rock itself.

* John W. Beauchamp was the first person to claim ownership of the mountain when he traded with Indians for possession. Later, he traded the mountain to Andrew Johnson and Aaron Cloud for a muzzle-loading gun and twenty dollars. Because half of Georgia and part of North Carolina rest on the mountain's base, it is widely believed that Stone Mountain may be formed like some icebergs--larger underneath the ground's surface than it is above ground.

Monday, October 29, 2012

Chiropractic Care Assisting With Fertility/Infertility

Chiropractic Care Assisting With Fertility/Infertility

Can a Chiropractor help you get pregnant?

The question, “Can a chiropractor help you get pregnant?” may sound like the setup to a joke, but when a woman is having trouble conceiving it’s no laughing matter. If you’re having problems getting pregnant, you might want to consider visiting a chiropractor for a series of treatments – but keep in mind that this should just be one part of your overall strategy to deal with fertility issues.
Chiropractic and Pregnancy – How it Works

The potential connection between chiropractic care and getting pregnant is related to the nerves that run through the spine and extend to the female body’s reproductive system. According to chiropractic theory, any blocked or pinched nerves result in spinal misalignment, also referred to as subluxations or spinal distortions. Chiropractors believe that when the nerves involved in the reproductive system are blocked or otherwise not working properly, this might result in a hormone imbalance or other malfunction which could lead to infertility. Chiropractic treatment involves manipulating and readjusting the spine, relieving the pressure on nerves running through the spinal column. Once the subluxations are corrected, it is believed that a woman’s reproductive system will function better, possibly resulting in a successful pregnancy.

Chiropractic and Pregnancy – Promising Studies

The majority of published research on the connection between chiropractic treatment and pregnancy can be found in the Journal of Vertebral Subluxation Research (JVSR). A three-part series of case studies published in 2003 showed a successful correlation between women receiving chiropractic care and increased fertility. Some of the women in the study visited a chiropractor specifically for help becoming pregnant, while others went for spinal adjustments due to other concerns – and then became pregnant during the time they were treated by the chiropractor. One of the JVSR studies, from May 2003, reported “successful outcomes on reproductive integrity, regardless of factors including age, history and [prior] medical intervention.” It is not clear how chiropractic treatment can specifically benefit fertility, but one suggestion is that spinal adjustment enhances peristalsis – the contraction of smooth muscles in the body that moves material through the digestive tract and other internal systems. With regard to fertility, peristalsis is necessary to move an egg from the ovary through the fallopian tubes into the uterus. Nerve blockage could inhibit the egg’s movement, keeping it from being fertilized or even possibly preventing a fertilized egg from making it safely from the fallopian tubes to the uterus.

Chiropractic and Pregnancy – Important to Remember

While these published reports make encouraging claims, it’s important to keep in mind that the JVSR studies are not scientifically conclusive and were based on results from a relatively small number of women. Larger clinical trials, comparing chiropractic care to more conventional infertility treatments, have yet to be performed to make a definitive scientific claim about a beneficial connection between chiropractic spinal adjustments and attempts to get pregnant. At the same time, seeing a chiropractor is worth considering if you’re having problems getting pregnant.

Sunday, October 28, 2012

Adjustments For Newborns

                                Adjustments For Newborns

Greater complications during delivery result in greater neurological insult to the newborn due to injury to the head and neck. Even after vaginal births, 4.6% of term neonates suffer unexplained brain bleeds and 10% suffer neonatal encephalopathy. Because so many children had been injured with forceps deliveries, (facial nerve palsy, tearing of cervical spine musculature) vacuum extraction was developed. Suction cups are placed on the newborn's head, and the baby is literally sucked out of the mother.

When utilized, 120 pounds of pressure goes through the baby's head and neck. Decapitation occurs at 140 pounds of pressure, to give you an idea of the high forces involved. Remember when you were a little girl or boy and there was a new baby you were being introduced to? Our parents always said, "Watch his head-you don't want to hurt him." We're careful because the fontanel's of the skull are so pliable, and the neck and brain are fragile and unprotected. This is why so many babies sustain injuries to their heads and neck during vacuum extraction-the force is far greater than their little bodies can tolerate.

Adjustments to newborns contain only ounces of force. But that force is directed into the spine to facilitate health and remove subluxations. We adjust babies as soon after birth as possible, to alleviate subluxations caused by in-utero constraint and the journey down through the birth canal. There has been a lot in the media lately about children not needing Chiropractic care, but there is no better way to get a head start in life. As you all know, Chiropractic care is not a cure for anything-it is a system of wellness to help us be who we're supposed to be. It is not a cure for ear infections, for colic, for allergies, for asthma, for frequent colds, nor for ADD/ADHD.

When we listen to mothers' stories of their pregnancy, labor and delivery, the children who suffer the most from the above complaints, are the ones who've had the greatest trouble with their births. Even relatively easy deliveries can result in subluxations. That's why every child should be checked, before problems with their health even develop. That's preventive care in the truest sense-preventing subluxations in mothers to prevent subluxations in their babies during childbirth. This is why every woman needs Chiropractic through pregnancy-so that the arrival of their baby is a wonderful experience. -Dr. Martha Collins, Family Chiropractor practicing in Kingston, Ontario.

Saturday, October 27, 2012

Stone Mountain

Stone Mountain

Chiropractor- Back PainStone Mountain, located in DeKalb County about ten miles northeast of downtown Atlanta, is the largest

 exposed mass of granite in the world. A town at the base of the mountain bears the same name. Before 1800, Native Americans used the mountain as a meeting and ceremonial place. Stone Mountain emerged as a major tourist resort in the 1850s, attracting residents of nearby Atlanta and other cities. The carving of a Confederate memorial on the side of the mountain attracted national and international attention during the twentieth century. Today, Stone Mountain is a tourist attraction that draws approximately 4 million visitors a year.

Friday, October 26, 2012

Is it safe to go to a chiropractor while pregnant?

Is it safe to go to a chiropractor while pregnant?

Not only is it safe to visit a chiropractor during your pregnancy, it’s also highly beneficial. All chiropractors are specially trained to treat pregnant women, but you may want to do a little research and find one who specializes in prenatal or perinatal care. Getting regularly adjusted while pregnant is a great way to relieve the added stress on your spine that comes along with the weight gain. It can also prevent sciatica, the inflammation of the sciatic nerve that runs from your lower back down through your legs and to your feet. It’s also important to maintain pelvic balance, which is oftentimes thrown off as your belly grows and your posture changes.

Besides making you feel better during pregnancy, getting regular chiropractic adjustments can also help control nausea, prevent a potential C-section, and has even been linked to reducing the amount of time some women spend in labor.

Chiropractic care through pregnancy is not only safe, it is essential. We can look at the implications of subluxation from a bio mechanical, hormonal and neurological standpoint. It is easy for all of us to see postural changes through pregnancy-the centre of gravity changes, the weight of the baby places increased pressure on the spine and pelvis, and towards the end of the pregnancy, changes are seen in gait pattern-the "waddle." What we can't see, are the millions of different hormonal changes and chemical reactions occurring both in the mother and the developing baby--all of which are controlled and coordinated through the nervous system.

Adjustments result in easier pregnancy, significantly decreased mean labor time, and assists new mothers back to prepartum health. In one study, women receiving Chiropractic care through their first pregnancy had 24% shorter labor times than the group not receiving Chiropractic, and multiparous subjects reported 39% shorter labor times. Thirty-nine percent-that's a massive difference. In addition, 84% of women report relief of back pain during pregnancy with Chiropractic care. Because the sacroiliac joints of the pelvis function better, there is significant less likelihood of back labor when receiving Chiropractic care through pregnancy.

Body position during delivery is also critical. Any late second stage labor position that denies postural sacral rotation denies the mother and the baby critical pelvic outlet diameter and jams the tip of the sacrum up to 4cm into the pelvic outlet. In other words, the popular semi-recumbent position places the laboring woman on her back onto the apex of the sacrum, which closes off the vital space needed for the baby to get through the pelvic outlet.

Thursday, October 25, 2012

Types of Pain

                                                      Types of Pain

Acute and chronic pain, pain caused by tissue damage, pain caused by nerve damage, somatic pain, visceral pain, neuropathic pain, nociceptive pain, radicular pain, headaches, facial pain, peripheral nerve pain, coccydynia, compression fractures, post-herpetic neuralgia, myofasciitis, torticollis, piriformis syndrome, plantar fasciitis, lateral epicondylitis, cancer pain, back pain, neck pain, leg pain, foot pain, etc.

Neck/Back/Nerve Pain

Wednesday, October 24, 2012

Rotator Cuff Tear

                                                       Rotator Cuff Tear

A rotator cuff tear is a common cause of pain and disability among adults. A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Chiropractor- Shoulder PainAcute Tear: If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear: Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder -- even if you have no pain in that shoulder.

Tuesday, October 23, 2012

Brachial Plexus Tension Test

Brachial Plexus Tension Test

Clinical Pearl
Although the brachial plexus tension test involves shoulder joint movement, it also provides maximum stretch on the brachial plexus, which affects the lower branches of the cervical spine (C5) the most. If this test is positive, the early stages of a C5 nerve root disorder may be present along with the subtle signs of a positive doorbell sign (pain that occurs at the superior scapulovertebral border and radiates with the use of deep palpation of the C5 segment) and pain in the deltoid area. The deltoid pain is often misconstrued as an articular problem of the shoulder.

Dejerine’s Sign

Clinical Pearl
Patients with radicular symptoms and pronounced Dejerine’s sign, especially if it is in the lumbar spine, should be told to bend the knees and lean into a wall during a cough or sneeze. This maneuver reduces intradiscal pressure and minimizes the effect of the cough or sneeze on the nerve root. A more worrisome situation is the sudden, unexpected absence of Dejerine’s sign when all other clinical findings indicate an active nerve root compression. The loss of the sign indicates fragmentation of the disc with momentary decompression of the nerve.

Monday, October 22, 2012

Become a Historical Educator Member at Stone Mountain Park!

Become a Historical Educator Member at Stone Mountain Park!

We are excited to introduce to you our Historical Educator program. The initiative of this program is to
increase educational opportunities for teachers and students at Stone Mountain Park. Our program is built
on the belief that Historical Educators are dedicated to enriching their student’s curriculum with
educational resources and events outside of the classroom. This will be achieved through our exclusive
membership program.

How Do I become a member?
It’s easy! Historical Educator membership cards will be issued to certified public and private school
teachers that book educational field trips at Stone Mountain Park. This does not include teachers that book
science and geology programs.
What are the benefits of being a Historical Educator member?
As a member of the Historical Educator group, the member may visit any of the educational venues listed
below as often as they like during the calendar year. They will also receive complimentary parking.
Members may also bring one teaching colleague along as their guest. The member and their guest must
present a valid ID and the membership card at each venue.
Benefits of membership

 Complimentary parking with member card and ID
 Complimentary admittance to audit any already booked educational field trip program (subject to
space availability and will be arranged through the sales department)
 Complimentary entry to:
o Antebellum Plantation and Farmyard
o Discovering Stone Mountain Museum
o Indian Festival and Pow Wow in the fall

Do you want to know more about a program before you come?
As a member you may also arrange to audit any education program that is booked by another school. To
arrange this you may call 770-498-5636. This is subject to space availability and occasional cancellation.
Guidelines of membership
 Valid for the calendar year printed on membership card
 Member may bring one colleague as a guest each time they visit. Colleague must show a valid
educator ID to gain admittance to each venue.
 Membership is non-transferable.
 No other discounts or upgrades available with this membership card.
 Membership card and valid educator ID must be presented for main gate entry and to attractions
listed above.

Sunday, October 21, 2012

Chiropractic Education

                                                   Chiropractic Education
Chiropractor- Pain Atlanta

To be a chiropractor, requires at least 4 years of professional study and includes a 4-year undergraduate/college prerequisite in most states.

An internship of 1 year at a college clinic is also required for those training to become a licensed chiropractor.

Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor's degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor's degree, which may eventually become the minimum entry requirement.

Saturday, October 20, 2012

The Cervical Spine

                                                           The Cervical Spine

Back Pain- Chiropractic Care

Axioms of Cervical Spine Assessment
1.      Cervical spine syndromes are extremely common and are probably the fourth most common cause of pain.
2.      At any given time, 9% of men and 12% of women have neck pain with or without arm and hand pain, and 35% of the population can remember having had neck pain at some time.
3.      The cervical spine is the origin of a large proportion of shoulder, elbow, hand, and wrist disorders.
4.      Most people who develop pain in the neck do not seek medical attention because they regard such pain as a part of life, so they simply wait for it to disappear.

Friday, October 19, 2012

Famous people who use chiropractic care

Famous people who use chiropractic care

Mel Gibson, Joe Montana, Lance Armstrong, Arnold Schwarzenegger, Robin Williams, Denzel Washington, David Copperfield, Alec Baldwin, Whoopie Goldberg, Ted Danson, Demi Moore, Macaulay Culkin, Steven Segal, Cher, Jerry Seinfeld, James Earl Jones, Clint Eastwood, Jane Seymour, David Spade, Shirley MacLaine, Madonna, Kenny Loggins, The Eagles, Van Halen, Michael Jordan, Scottie Pippin, Charles Barkley, AtlantaFalcons team, Dallas Cowboys team, Tiger Woods, etc.

Chiropractic Care

Thursday, October 18, 2012

Things to Do at Stone Mountain Park

Things to Do at Stone Mountain

One Adventure After Another
Chiropractor- Back Pain

Serious fun. Endless adventure. It's all waiting for you at Georgia's #1 attraction. Just 15 minutes from downtown Atlanta and home to the world's largest piece of exposed granite, this natural wonderland offers 3,200 acres of excitement for every member of the family. A mountain of memories awaits you.
Soar to the top of the mountain on the Summit Skyride for an unprecedented view of the Atlanta Skyline.  Then take a trek through the treetops on Sky Hike, one of the nation’s largest adventure courses.  When your feet are back on solid ground, head to the 4-D Theater and take a hike with the wildest bears on Earth in the YOGI BEAR 4-D Adventure.  New for 2012, experience Geyser Towers! This first and only adventure of its kind brings an all-new must-do experience to Stone Mountain Park.  Ideal for the whole family, Geyser Towers features multiple levels of suspended rope bridges and net tunnels connected to towering platforms that overlook a gushing geyser.  With its sporadic eruptions and multiple offshoots, you can play in the spray or stay high and dry.  The options and the fun, are all yours!  And of course don’t miss an Atlanta tradition – the Lasershow Spectacular in Mountainvision.  This newly transformed show will wow your family with state-of-the-art digital graphics and awe-inspiring effects.  The Lasershow can be seen every Saturday, April 14 - May 19.

Wednesday, October 17, 2012

MRI Information


MRI- Chiropractic CareMRI stands for Magnetic Resonance Imaging and it is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.

There are several types of MRIs. There are head MRIs, chest MRIs, blood vessel MRIs, abdomen and pelvis MRIs, bones and joints MRIs, and Spine MRIs.

Bone and joint MRIs check for problems such as arthritis, bone marrow problems, bone tumors, cartilage problems, torn ligaments, torn tendons, or infections. It can also check for broken bones.

Spine MRIs check the discs and nerves of the spine for conditions such as spinal stenosis, disc bulges, and spinal tumors.

Tuesday, October 16, 2012

Disability and Handicap

Disability and Handicap
Disability is a present when a tissue, organ, or system cannot function adequately. A handicap exists when disability interferes with a patient’s daily activities or social/occupational performance. A marked disability does not necessarily cause a handicap. Conversely, minor disability may produce a major handicap. Both conditions require separate assessment. Patients’ perception of their problems will be molded by their adaptation to the depreciated tissue as well as their aspirations for recovery.

Assessing Disability
An aid in assessing the more important aspects of disability is the PILS mnemonic, which considers four issues:
1.      P Preventable causes of disability (e.g., falls, direct trauma)
2.      I Independence (e.g., self-care)
3.      L Lifestyle (roles, goals)
4.      S Social factors (e.g., family, friends, shelter)

Functional Assessment
A complete functional assessment includes evaluation of the following:
1.      Self-care: ability to wash, bath, attend to toilet needs, dress, cook, and feed oneself
2.      Mobility: ability to stand, transfer, walk, negotiate stairs, drive, and use public transportation
3.      Lifestyle: nature of occupation, work capacity, and Social Security benefits

Chiropractor Pain Atlanta

Sunday, October 14, 2012

Sports Injury

                                 Sports Injury

Injury- Upper/Lower Back Pain

Pain in the upper back and neck is common. It can be acute (of sudden onset and painful) or can gradually come on through poor posture and other factors.

Some sports injuries in the upper back include: costovertebral joint sprain, Intervertebral sprain, Kyphosis, Inflamed muscle attachments, scheuermanns disease, and tight muscles in the upper back and neck.

Sports injuries in the neck include: whiplash, cervicalgia, radiating neck pain, stiff neck, stingers and burners, spinal cord injury, broken neck, neck strain, nerve root compression, dislocated vertebrae, and a fractured larynx.

Some sports injuries in the shoulder include: frozen shoulder, winged scapula, subacromial bursitis, impingement syndrome, glenoid labrum tear, referred shoulder pain, shoulder instability, pec major tendon inflammation, long head of biceps inflammation, subscapularis inflammation, supraspinatus inflammation, and rotator cuff tendonitis.

Saturday, October 13, 2012

Visitor information- Stone Mountain

Visitor information- Stone Mountain

The City of Stone Mountain hosts a visitors center located at 891 Main Street, Stone Mountain; (770) 879-4971.  Information about current activities and attractions is available Monday - Friday 10-4.
The town is named for Stone Mountain, the largest exposed granite dome in North America. Stone Mountain harbors plant and animal life found no other place in the world. The mountain has contributed to the city's economy both through its continuing status as a tourist attraction, and its former use as a granite quarry. It is also the site of a famous giant carving commemorating the military leaders of the Confederacy as well as a state park and museum, including a tourist railroad.

Friday, October 12, 2012


                The inflammatory and repair processes are no longer simple events to describe in light of the increased knowledge in this field. The review that follows is only a brief resume of the salient events associated with tissue repair, particularly concerning the soft tissues. For further information, the reader is referred to recent reviews listed at the end of the paper.
               Wound healing refers to the body’s replacement of destroyed tissue by living tissue and comprises two essential components – Regeneration and Repair. The differentiation between the two is based on the resultant tissue. In regeneration, specialized tissues are replaced by the proliferation of surrounding undamaged specialized cells. In repair, lost tissue is replaced by granulation tissue which matures to form scar tissue. This review concentrates on the events and processes associated with the repair process.
               Probably the most straightforward way to describe the healing process is to divide it up into broad stages which are not mutually exclusive and overlap considerably. There are several different ways to “divide up” the entire process, but the allocation of 4 phases is common and will be adopted here – these being Bleeding, Inflammation, Proliferation and Remodeling.

Stone Mountain Clinic

Bleeding Phase
             This is a relatively short lived phase, and will occur following injury, trauma, or other similar insult. Clearly if there has been no overt injury, this will be of little or no importance, but following soft tissue injury, there will have been some bleeding. The normal time for bleeding to stop will vary with the nature of the injury and the nature of the tissue in question. The more vascular tissues (e.g. muscle) will bleed for longer and there will be a greater escape of blood into the tissues. Other tissues (e.g. ligament) will bleed less (both in terms of duration and volume). It is normally cited that the interval between injury and end of bleeding is a matter of a few hours (6-8 hours is often quoted) though this of course is the average patient. Some tissues will continue to bleed for a significantly longer period, albeit at a significantly reduced rate. A crush type injury to a more vascular tissue – like muscle – could still be bleeding (minimally) 24 hours or more post trauma.

Inflammatory Phase
             The inflammatory phase is an essential component of the tissue repair process and is best regarded in this way rather than as an “inappropriate reaction” to injury. The inflammatory phase has a rapid onset (few hours) and swiftly increases in magnitude to its maximal reaction (2-3 days) before gradually resolving (over the next couple of weeks). It can result in several outcomes (see below) but in terms of tissue repair, it is normal and essential.

Proliferation Phase
              The proliferation phase essentially involved the generation of the repair material, which for the majority of musculoskeletal injuries, involved the production of scar (collagen) material. The proliferation phase has a rapid onset (24-48 hours) but takes considerably longer to reach its peak reactivity, which is usually between 2-3 weeks post injury (the more vascular the tissue, the shorter the time taken to reach peak proliferative production). This peak in activity does not represent the time at which scar production is complete, but the time phase during which the bulk of the scar material is formed. The production of a final project (a high quality and functional scar) is not achieved until later in the overall repair process. It is usually considered that proliferation runs from the first day or two post-injury through to its peak at 2-3 weeks and decreases thereafter through to a matter of several months post trauma.

Remodeling Phase
               The remodeling phase is an essential component of tissue repair and is often overlooked in terms of its importance. It is neither swift nor highly reactive, but does result in an organized and functional scar which is capable of behaving in a similar way to the parent tissue (that which it is repairing). The remodeling phase has been widely quoted as starting at around the same time as the peak of the proliferative phase (2-3 weeks post injury), but more recent evidence would support the proposal that the remodeling phase actually starts rather earlier than this, and it would be reasonable to consider the start point at around 1-2 weeks.
               The final outcome of these combined events is that the damaged tissue will be repaired with a scar which is not “like for like” replacement of the original, but does provide a functional, long-term “mend” which is capable of enabling quality recovery from injury. For most patients, this is a process that will occur without the need for drugs, therapy or other intervention. It is designed to happen, and for those patients in whom problems are realized, or in whom that magnitude of the damage is sufficient, some ‘help” may be required to facilitate the process. It would be difficult to argue that therapy is “essential” in some sense. The body has an intricately complex and balanced mechanism through which these events are controlled. It is possible however, that in cases of inhibited response, delayed reactions or repeated trauma, therapeutic intervention is of value.
               It would also be difficult to argue that there was any need to change the process of tissue repair. If there is an efficient (usually) system through which tissue repair is initiated and controlled, why would there be any reason to change it? The more logical approach would be to facilitate or promote the normality of tissue repair, and thereby enhance the sequence of events that take the tissues from their injured to their “normal” state.

Inflammatory Reaction
               Inflammation is a normal and necessary prerequisite to healing. Following the tissue bleeding which clearly will vary in extent depending on the nature of the wound, a number of substances will remain in the tissues which make a contribution to the later phases. Fibrin and fibronectin form a substratum which is hospitable to the adhesion of various cells.
               Complex chemically mediated amplification cascade that is responsible for both the initiation and control of the inflammatory response can be started by numerous events, one of which is trauma. Mechanical irritation, thermal or chemical insult, and a wide variety of immune responses are some of the alternative initiators, and for a wide range of patients experiencing an inflammatory response in the musculoskeletal tissues, these are more readily identified causes.
               There are two essential elements to the inflammatory events, namely the vascular and cellular cascades. Importantly, these occur in parallel and are significantly interlinked. The chemical mediators that make an active contribution to this process are myriad. In recent years, the identification of numerous “growth factors” have led to several important discoveries and potential new treatment lines.

Vascular Events
               In addition to the vascular changes associated with the bleeding, there are also marked changes in the state of the intact vessels. There are changes in the caliber of the blood vessels, changes in the vessel wall and in the flow of blood through the vessels. Vasodilation follows an initial but brief vasoconstruction and persists for the duration of the inflammatory response. Flow increases through the main channels and additionally previously dormant capillaries are opened to increase the volume through the capillary bed. The cause of this dilation is primarily by chemical means (histamine, prostaglandins and complement cascade components C3 and C5) while the axon reflex and autonomic system exert additional influences. There is an initial increase in velocity of the blood followed by prolonged slowing of the stream. The white cells marginate, platelets adhere to the vessel walls and the endothelial cells swell. In addition to the vasodilation response, there is an increase in the vasopermeability of the local vessels (also mediated by numerous of the chemical mediators), and thus the combination of the vasodilation and vasopermeability response is that there is an increased flow through vessels which are more “leaky”, resulting in an increased exudate production.
               The flow and pressure changes in the vessels allow fluid and the smaller solutes to pass into the tissue spaces. This can occur both at the arterial and venous ends of the capillary network as the increased hydrostatic pressure is sufficient to overcome the osmotic pressure of the plasma proteins. The vessels show a marked increase in permeability to plasma proteins. There are several phases to the permeability changes but essentially, there is a separation of the endothelial cells, particularly of the venules, and an increased escape of protein rich plasma to the interstitial tissue spaces. The chemical mediators responsible for the permeability changes include histamine, serotonin (5-HT), bradykinin and leukotreines together with a potentiating effect from the prostaglandins.
               The effect of the exudate is to dilute any irritant substances in the damaged area and due to the high fibrinogen content of the fluid. A fibrin clot can also form, providing an initial union between the surrounding intact tissues and a meshwork which can trap foreign particles and debris. The meshwork also serves as an aid to phagocytic activity. Mast cells in the damaged region release hyaluronic acid and other proteoglycans which bind with the exudate fluid and create a gel which limits local fluid flow, and further traps various particles and debris.

Cellular Events
                The cellular components of the inflammatory response include the early emigration (within minutes) of the neutrophils (polymorohonucleocytes or PMN’s) from the vessels. This is followed by several other species leaving the main flow, including monocytes, lymphocytes, eosinophils, basophils and smaller numbers of red cells (though these leave the vessel passively rather than the active emigration of the while cells). Monocytes, once in the tissue spaces become macrophages. The main groups of chemical mediators responsible for chemotaxis are some components of the complement cascade, lymphokines, factors released from the mast cells in the damaged tissue.
               The PMN escapees act as early debriders of the wound. Numerous chemical mediators have been identified as having a chemotactic role, for example, PDGF (platelet derived growth factor) released from damaged platelets in the area. Components of the complement cascade (C3a and C5a), leukotreines (released from a variety of white cells, macrophages and mast cells) and lymphokines (released from polymorphs) have been identified.
               These cells exhibit a strong phagocytic activity and are responsible for the essential tissue debridement role. Dead and dying cells, fibrin mesh and clot reside all need to be removed. As a “bonus”, one of the chemicals released as an end product of phagocytosis is lactic acid which is one of the stimulants of proliferation – the next sequence of events in the repair process.
               The inflammatory response therefore results in a vascular response, a cellular and fluid exudate, with resulting oedema and phagocytic activation. The complex interaction of the chemical mediators not only stimulates carious components of the inflammatory phase, but also stimulates the proliferative phase. The course of the inflammatory response will depend upon the number of cells destroyed, the original causation of the process and the tissue condition at the time of insult.

Inflammatory Outcomes
Resolution is a possible outcome at this stage on condition that less than a critical number of cells have been destroyed. For more patients that come to our attention, this is an unlikely scenario.
               Suppuration, in the presence of infective microorganisms will result in pus formation. Pus consists of dead cell debris, living, dead and dying polymorphs suspended in the inflammatory exudate. Clearly the presence of an infection will delay the healing of a wound.
               Chronic inflammation does not necessarily imply inflammation of long duration, and may follow a transient or prolonged acute inflammatory stage. Essentially there are two forms of chronic inflammation: either the chronic reaction supervenes on the acute reaction or may in fact develop slowly with no initial acute phase. Chronic supervening on acute almost always involves some suppuration while chronic ab initio can have many causes including local irritants, poor circulation, some micro-organisms or immune disturbances. Chronic inflammation is usually more productive than exudative – it produces more fibrous material than inflammatory exudate. Frequently there is some tissue destruction, inflammation and attempted healing occurring simultaneously.
               Healing by fibrosis will most likely be taking place in the tissue repair scenario considered here. The fibrin deposits from the inflammatory stage will be partly removed by the fibrinolytic enzymes and will be gradually replaced by granulation tissue which becomes organized to form the scar tissue. Macrophages are largely responsible for the removal of the fibrin, allowing capillary budding and fibroblastic activity to proceed (proliferation). The greater the volume of damaged tissue, the greater the extent of, and the greater the density of, the resulting scar tissue. Chronic inflammation is usually accompanied by some fibrosis even in the absence of significant tissue destruction. The effects of acute inflammation are largely beneficial. The fluid exudate dilutes the toxins and escaped blood products include antibodies (and systemic drugs). The fibrinogen forms fibrin clots providing a mechanical barrier to the spread of micro-organisms (if present) and additionally assist phagocytosis. The gel-like consistency of the inflammatory exudate also makes a positive contribution by preventing the spread of the inflammatory mediators to surrounding, intact tissues.

Thursday, October 11, 2012

CDC reports eighth fungal meningitis death

ATLANTA (WLS) - Health officials estimate that 13,000 people may have been exposed to contaminated lots of an epidural steroid that has been linked to a rare fungal meningitis that has infected 105 people across nine states, killing eight of them. Fourteen new cases and one new death have been reported since Sunday.
Although the number of cases has increased, the outbreak does not include any new states. The number of people with fungal meningitis, which is not spread person-to-person, has grown by 64 percent since Friday.
The outbreak of aspergillus meningitis has been linked to spinal steroid injections, a common treatment for back pain. A sealed vial of the steroid, called methylprednisolone acetate, was found to contain fungus, according to the U.S. Food and Drug Administration.
The states with reported cases include Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia. Tennessee has the most cases, with 35, including four deaths.
"FDA is in the process of further identifying the fungal contaminate," said Dr. Ilisa Bernstein, acting director of the FDA's Center for Drug Evaluation and Research Office of Compliance. "Our investigation into the source of this outbreak is still ongoing."
The steroid came from the New England Compounding Center in Framingham, Mass., a specialty pharmacy that has recalled three lots of the drug and shut down operations. Calls to the pharmacy were not immediately returned and its website is down.
Roughly 75 clinics in 23 states that received the recalled lots have been instructed to notify all affected patients.
"If patients are concerned, they should contact their physician to find out if they received a medicine from one of these lots," said Dr. Benjamin Park of the U.S. Centers for Disease Control and Prevention, adding that most of the cases occurred in older adults who were healthy aside from back pain.
Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis, such as headache, fever, dizziness, nausea and slurred speech, are subtler than those of bacterial meningitis and can take nearly a month to appear. Left untreated, the inflammatory disease can cause permanent neurological damage and death.
"Fungal meningitis in general is rare. But aspergillus meningitis -- the kind we're talking about here -- is super rare and very serious," said Dr. William Schaffner, president of the National Foundation for Infectious Diseases and chairman of preventive medicine at Vanderbilt University Medical Center in Nashville. "There's no such thing as mild aspergillus meningitis."
The disease is diagnosed with a lumbar puncture, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.
"Treatment could be prolonged, possibly on the order of months," said Park, adding that the IV treatment would require a hospital stay.
Unlike bacterial and viral meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.
The FDA has, however, advised health providers to stop using any product made by the New England Compounding Center during the investigation.