REVIEW OF RECENT JOURNAL ARTICLE
DR DOUGLAS R KENNEDY
BOULDER CO

Journal of musculoskeletal pain
volume 18, number three, 2010
the official Journal Journal of the international Myopain Society

review: title: An overlooked diagnosis in rheumatology: benign joint hypermobility syndrome.
Authors: Omer Faruk Sendur, Bengu Beydag, Odabasi, Yasemin Turan

Abstract
objectives: in this paper we aim to present the new developments in the clinical findings and treatment of benign joint hypermobility syndrome, in the light of recent studies, in an effort to give a better understanding of provider review for the doctors involved.

Findings: hypermobility is a clinical fine independent of any rheumatic disease is characterized by movement of joints beyond the normal range of motion. It is associated with some system pathologies in which the main findings are correlated with the musculoskeletal system and can be easily confused with some hereditary connective tissue disorders. Clinical signs of this benign joint hypermobility syndrome are considered in a range from joint instability to various problems, such as varicose veins and low bone mineral density.

Conclusions: the clinical effects of the JHS are poorly understood by general practitioners and, furthermore, it may be misdiagnosed or neglected by rheumatologists to. For this reason, the clinical signs of the syndrome should be while recognizing patients should be informed about the syndrome.

The symptoms that the authors found to be associated with this benign joint hypermobility syndrome include the following:
knee pain, back pain, foot pain, headache, growing pains, Polly arthralgia, joint swelling, stiffness, flulike symptoms, anxiety, sleep disturbance, poor coordination, clumsiness, dyspraxia, dyslexia, learning difficulties, easy bruising, muscular cramps, clicky joints, palpitations, fatigue, weight walking as a child, stress incontinence, and paresthesias.

Clinical findings of benign joint hypermobility syndrome:
joint stability disorders of proprioception, poor response to anesthetics, autonomic disturbances, low bone density, pes planus or flat feet, sprains, meniscus caring, fracture, scoliosis, costochondritis, sacred iliac joint just instability. Additionally Reynard's phenomena, skin fragility and skin laxity, paper scarring, vascular findings, neuropathies, knee pain, traumatic arthritis, Baker's cyst, temporal mint tubular joint dysfunction, congenital hip dislocation.

The clinician should be looking for some signs such as: the thumb passably touching the interior of the forearms, dorsi flexion of the small finger past 90∞, the ability of the patient to hyperextended elbow greater than 10∞, hyperextension of the knee beyond 10∞, and being able to touch the floor with the palms of the hands while standing with their knees extended and bending forward.

The authors developed a five-point hypermobility questionnaire. The following questions when asked can give a good indication of the need for further study and investigation.
1. Can you now or could you ever placed her hands flat on the floor without bending your knees
2. Can you now or could you ever been jerked him to touch her forearm?
3. As a child, did you amuse your friends by contorting your body and strange shapes or could you do the splits?
4. As a child or teenager, did your kneecap or shoulder dislocate on more than one occasion?
5. Do you consider yourself "double-jointed"?

It should be noted that if the patient answers in the affirmative on two or more of the five questions, the authors believe that they do have hypermobility syndrome. Statistically when a patient answers yes to two or more of the questions, the sensitivity is 85% in the specificity is 90%.

TREATMENT:
the authors believe that epic education is probably the most important thing a doctor can do. It's important for the patient to understand the importance of ergonomics and body mechanics. This will help lower the incidence of back pain. The patients are also told to avoid aggressive sports, but to participate in mild sports and jobs that require movement. Taping and splints can be helpful as well.

Medication: the authors report that medication may or may not be helpful.

Physical treatment modalities: there's not enough evidence who regards to physical therapy in the syndrome.

Spinal manipulations: the authors did not address spinal manipulation in this study. It is my opinion that if a patient has hypermobility syndrome they should not, I repeat, they should NOT be manipulated with high velocity thrust. Gentle mobilizations may be useful to help balance the spine.

Douglas R Kennedy, DC, Cert.Acup.
Kennedy chiropractic and acupuncture
Boulder, CO 80301, 80302, 80303.
Www.Colopainclinic.com
(303) 546-6325

A lot of patients and friends have asked, "why are you changing your clinic name?"

 The simple reasons are as follow:

• Looking for a name that is more descriptive than "chiropractic" since that word doesn't fully encompass the extensive set of skills and services available.
• Some people are afraid of seeing a chiropractor...due to stories they have heard,etc.
• I would like to take my personal name out of the clinic name so that when I retire in 10 years, I will have a Brand Name that can help me sell the clinic to a great Doctor.  Unless he or she happens to be named "Kennedy" it will be better to find a more neutral name that describes the services and location.
• Want a name with a modern "zippy" feel to it.  Time to get with the times!

If you would like to submit a few name suggestions, please go to the FaceBook page below. "Like" us, and go to the "EVENTS" link on the left hand side of the page.

https://www.facebook.com/pages/Chiropractor-Boulder-CO-Douglas-Kennedy-DC/124467660897056#!/pages/Chiropractor-Boulder-CO-Douglas-Kennedy-DC/124467660897056?sk=events

Douglas Kennedy   www.ColoPainClinic.com    Kennedy Chiropractic & Acupuncture

What are Axial Spinal Reflexes or ASR's?

Every Human Body Utilizes Axial Spinal Reflexes (ASR's). Axial Spinal Reflexes are hardwired into our nervous systems. No aspect of our physical body can bypass this basic pathway (the spine) or remain unaffected by these fundamental reflex reactions. ASR's are believed to have originated as a defense mechanism, a way for our bodies to sense danger and move away from it, even before our brains registered the threat (the way you would instantly duck your head away from something that brushed against it from behind). Our Modern lifestyle, 'turns on' ASR's in a number of ways including stress, repetitive motion, poor ergonomics, diet, environmental and dietary toxins, lack of exercise, trauma and much more. ASR's routinely get "stuck on" and resulting pain, dysfunction, and performance impairment develops.

What do Axial Spinal Reflexes do?

ASR's have a profound affect on your health, mobility, and performance. ASR's cause reflex reactions such as prolonged muscle and ligament contraction.
Prolonged muscle contraction results in muscle weakness, fatigue, spasms, trigger points, myofascial pain, soft tissue fibrosis, distorted posture, and aberrant joint motion.

Prolonged ligament contraction results in joint compression and pain, sclerotomal or referred pain, nerve compression, and degenerative arthritis.

What is Spinal Reflex Analysis?

Where all other therapies currently focus on simple reflex reactions, Spinal Reflex Analysis (SRA) focuses on the ASR, the root cause of these reactions. SRA is a fast and extremely accurate system of identifying the involved axial spinal reflex and 'turning them off' through specific SRA based treatment programs.

How do I get SRA treatment?

SRA is available to you through our office.  Each SRA Certified practitioner is trained to understand and identify the axial spinal reflex mechanisms at work in your body at the time of treatment, and to utilize SRA treatment protocols specific to their area of expertise.  For Instance, the Chiropractor will determine which ASR pattern is active and then will treat with a carefully mapped series of chiropractic adjustments to 'turn off' the reflex.  A benefit of SRA is that it allows care givers from all fields to work together with precision and clarity, enhancing the care given in each area of expertise and maximizing the effectiveness of your overall care plan.

SRA and Performance

SRA has been shown to significantly enhance performance output in sports and other physical activities. Accuracy, speed, endurance and power improvements are noted routinely, and proven in scientific studies. 

Axial spinal reflexes (ASR's) cause prolonged muscle and ligament contraction

Prolonged muscle contraction results in muscle weakness, fatigue, spasms, trigger points, myofascial pain, distorted posture, aberrant joint motion, poor injury recovery and performance impairment

Prolonged ligament contraction results in joint pain, sclerotomal pain, nerve compression, and degenerative arthritis

All therapies currently focus on these reactions, as opposed to the axial spinal reflex, as the causative factor of impaired performance

Only SRA provides rapid identification and accurate treatment of the axial spinal reflex, profoundly impacting your ability to maximize training and performance

SRA works with your current training program. It does not alter or replace it!

Special Thanks to Dr Frank Jarrell, DC

I have been reading a lot about the European economic situation lately. Greece has a very high likelihood of not being able to make payments and go into default. If this occurs it may have a domino effect on many of the other European countries. Some economic specialty advisors are suggesting this could be catastrophic and may even make the recession/depression of 2008 look like a small one!

Now maybe a very good time to move your retirement funds into a safer haven; gold and silver still look good.

For more information about this  Google John Mauldin, Investor Insight.  Good Free Stuff.

 All the Best,  Dr Doug

SOURCE: PH&W Magazine December 2008

By Dennis Bertoli

PH&W HEALTH: Top Secret

There are a few things that you may not know about D.C.’s, which surprised us, included the mounting research.

1.   Their education is equal to their medical colleagues …
        and might be better in some areas. [1]

This might be difficult to accept, but chiropractic students spend markedly more hours in the classroom than medical students, especially in the areas of anatomy, physiology, orthopedics, and x-ray. [2] Of course, their training is different since “Chiros” concentrate on muscles, bones, joints, and nerves. Their education only touches on medication, emergency situations, etc. Many are beginning to think this gives them a better background in physical rehab.

A study of the curriculum of North American chiropractic and medical colleges found “Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar.” [2]

Even more interesting was a test given to both chiropractic and medical students. Chiropractic students scored higher than medical students did on the musculoskeletal (bones, joints, and muscles) portion of the exam, while the medical students faired slightly better in other areas. [1]

In another study, chiropractors and chiropractic students tested “significantly higher” in reading X-Rays when compared with their medical colleagues in a study at the University of California Medical Center. [3]

2.   They do more than crunch backs and necks

While chiros are known for treating back and neck problems with joint manipulation, most are well versed and board certified to perform physical therapies. They are also licensed to function as primary care physicians. [4] Based on their education many use nutrition as a form of treatment.

3.   It’s safe

Even though ghost stories of adjustments gone wrong are common, the actual risk of injury from chiropractic treatment is rare. [5] Generally, the malpractice insurance that doctors have to pay is based, among other things, on their field. Chiropractors as a group pay the less for malpractice insurance than any other type of physician. Why? Lawsuits claiming injuries or negligence are less common against chiropractors.

In the past there was concern that there was an increased risk of stroke could upper neck manipulation treatments. However a 7-year study organized by The United Nations and the World Health Organization just found that there is no association with chiropractic treatment and stroke. [6]

4.   They took the AMA to court … and won … twice

For decades chiropractors were campaigned by the AMA (American Medical Association) as not being “real doctors” and met fierce resistance from medical organizations. Chiropractors claimed the AMA was trying to snuff out the competition with fear tactics and bogus research. The U.S. Supreme Court agreed with them in 1987… and again in 1990. It was found that the AMA was guilty of illegal antitrust activities against the chiropractic profession, ordered an injunction on their activity, and forcing them to print the courts findings in the Journal of the American Medical Association.

5.   M.D.’s and D.C.’s are now working together

It’s becoming more common to find integrated offices, where M.D.’s, D.O.’s, and D.C.’s are working side-by-side. Many medical offices now try to provide multi-specialty approaches to treatment. With natural forms of treatment becoming more popular, drugless forms of treatment have become preferred by many over pain-medication.

One survey of 266 medical students at Georgetown University revealed more than 75% felt that alternative medicine techniques should be included in their curriculum. [7] Chiropractic, acupuncture, herbal medicine, and nutritional supplements were the most desired areas of interest. PH&W

The views expressed in this editorial are soley those of PH&W Magazine and do not reflect the opinion of any contributing parties or advertisers.

Sidebar: In a basic test designed by orthopedic residency professors to test the knowledge of medical residents vs. chiropractic students, 82% of medical school graduates failed the examination. [8] Four years later the test was simplified and, once again, 78% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. [9] When this test was given to final quarter chiropractic students 70% of them passed the same exam! [10]

References:

1.   Assessment of knowledge of primary care activities in a sample of medical and chiropractic students
J Manipulative Physiol Ther. 2005 (Jun); 28 (5): 336-44
http://www.chiro.org/LINKS/ABSTRACTS/
Assessment_of_Knowledge_of_Primary_Care_Activities.shtml

2.   A Comparative Study of Chiropractic and Medical Education
Altern Ther Health Med. 1998 (Sep); 4 (5): 64 75
http://www.chiro.org/LINKS/ABSTRACTS/Comparison.shtml

3.   Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic
Spine. 1995 May 15;20(10):1147-53; discussion 1154
http://www.ncbi.nlm.nih.gov/pubmed/7638657

4.   Chiropractic: a profession at the crossroads of mainstream and alternative medicine
Ann Intern Med 136 (3): 216–27
http://www.chiro.org/ChiroZine/ABSTRACT/
Chiropractic_Profession_at_Crossroads.shtml

5.   Safety of chiropractic manipulation of the cervical spine: a prospective national survey
Spine. 2007 Oct 1;32(21):2375-8; discussion 2379
http://www.chiro.org/LINKS/ABSTRACTS/Safety_of_Chiropractic_Manipulation.shtml

6.   Bone and Joint Decade Task Force
Press Release: “Seven-Year Neck Pain Study Sheds Light on Best Care.”
February 2008
http://www.newswire.ca/en/releases/archive/February2008/15/c2658.html

7.   A large-sample survey of first- and second-year medical student attitudes toward complementary and alternative medicine in the curriculum and in practice
Georgetown University School of Medicine, Washington, DC, USA
Altern Ther Health Med. 2007 Jan-Feb;13(1):30-5
http://www.chiro.org/alt_med_abstracts/ABSTRACTS/A_Large_sample_Survey.shtml

8.   Adequacy of Medical School Education in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 1998 (Oct); 80-A (10): 1421–1427
http://www.chiro.org/ChiroZine/ABSTRACTS/Adequacy.shtml

9.   Educational Deficiencies in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 2002 (Apr); 84–A (4): 604–608
http://www.chiro.org/ChiroZine/ABSTRACTS/Educational_Deficiencies.shtml

10.   A Comparison of Chiropractic Student Knowledge Versus Medical Residents
Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255
http://www.chiro.org/ChiroZine/ABSTRACTS/
A_Comparison_of_Chiropractic_Student_Knowledge.shtml