Author Archives Mark Croucher

What about PT for back pain

Posted by Mark Croucher
on February 22, 2016
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A recent study was published including of 4597 patients who underwent physical therapy for back pain. The findings showed that a significant percentage of patients did NOT improve to minimal clinical standards.  How Effective is Physical Therapy for Common Low Back Pain Diagnoses? A Multivariate Analysis of 4597 Patients.      Spine: February 15, 2016

Prior studies have also shown that spinal manipulation/mobilization (chiropractic care) showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.  Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up Spine:  15 March 2003 – Volume 28 – Issue 6 – pp 525-531

Meanwhile a number of studies have indicated that chiropractic treatment combined with exercise can work better than either individually for treatment of chronic neck pain.


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Coffee for muscle recovery!

Posted by Mark Croucher
on February 21, 2016
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coffeeThe benefits of coffee on skeletal muscle

In our chiropractic clinic we focus on a number of things to help our patients live healthier lives.  Diet and nutrition are paramount issues with regard to health.  We’re often asked about coffee and if its good or bad for you.

Here is a fun study from Life Sciences.  From their description, this journal is an international journal publishing articles that emphasize the molecular, cellular, and functional basis of therapy. The journal emphasizes the understanding of mechanism that is relevant to all aspects of human disease and translation to patients. All articles are rigorously reviewed.

“Coffee is consumed worldwide with greater than a billion cups of coffee ingested every day. Epidemiological studies have revealed an association of coffee consumption with reduced incidence of a variety of chronic diseases as well as all-cause mortality. Current research has primarily focused on the effects of coffee or its components on various organ systems such as the cardiovascular system, with relatively little attention on skeletal muscle. Summary of current literature suggests that coffee has beneficial effects on skeletal muscle. Coffee has been shown to induce autophagy, improve insulin sensitivity, stimulate glucose uptake, slow the progression of sarcopenia, and promote the regeneration of injured muscle. Much more research is needed to reveal the full scope of benefits that coffee consumption may exert on skeletal muscle structure and function.”

So there you have it!  A little coffee may be a really good thing.

Life Sci. 2015 Dec 15;143:182-6. doi: 10.1016/j.lfs.2015.11.005. Epub 2015 Nov 10.

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The ankle bone is connected to the…

Posted by Mark Croucher
on February 16, 2016
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deep thoughtsPatients routinely ask us why we are evaluating the function of their hips, knees and ankles when they present to us with lower back problems.  The reason is they’re related and our job is to improve your function.  Evaluate the spine and then evaluate everything that may be related.  That way you can help the patient to heal.  I like to use the old kid’s song DRY BONES.

The toe bone connected to the heel bone,
The heel bone connected to the foot bone,
The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone,
The thigh bone connected to the back bone,
The back bone connected to the neck bone,

Research on the lumbar spine has shown a relationship to wear down of the lower back spinal discs (degenerative disc disease) and areas of arthritis in the hip and knee.  A recent study in The American Journal of Orthopedics focused how degenerative damage in the lumbar spine (lower back) may be strongly related to ankle arthritis as well.

In this study there was found to be a considerable association of ankle arthritis and subsequent alteration in walking (gait) when patients had levels of lower back spinal disc damage (degeneration).  When there were multiple levels of disc degeneration there was found to be even higher odds of the development of severe ankle arthritis.

Furthermore, the presence of severe lumbar degeneration significantly predisposes individuals to the development of severe ankle arthritis.  Gait changes resulting from disc degeneration or neural compression in the lumbar spine may play a role in ankle osteoarthritis development. This association must be considered when treating patients with lumbar disc degeneration and leg pain.

In an effort to substantially and holistically address a patients problem we try to like to look at the bigger picture.  If pain relief is the only issue, there are a lot of drugs that work just fine.

Am J Orthop (Belle Mead NJ). 2015 Apr;44(4):E100-5.  Lumbar degenerative disc disease and tibiotalar joint arthritis: a 710-specimen postmortem study.

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Chiropractic in Williamsburg VA

Posted by Mark Croucher
on February 15, 2016
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considering  surgeryChronic back pain

Degenerative Disc Disease  

Sciatica – Spinal Stenosis  

Post-Surgical Back & Neck Pain

Does this sound like you?


Susan from Williamsburg says: “I have never had a Doctor as careful about listening to me and explaining the diagnosis and how to treat it, as Dr. Croucher.  He did not sugar-coat anything.  He was conservative in his outlook and delivered incremental, perceivable results.”

“My pain management doctor referred me to Dr. Carlson for lower back and right leg pain which was reduced immediately. He showed me a number of exercises to help build muscles and diet for weight control. Dr. Carlson is very knowledgeable and has a wonderful bedside manner that takes time to talk and listen to his patients.”  Tom Grummell, Newport News, VA (retired)

At The Spine Center of Williamsburg, our doctors of chiropractic have over 20 years’ experience in dealing with chronic spinal pain, spinal stenosis, disc herniation and degenerative spinal disorders.  With today’s technology, chiropractic treatment can be delivered in a number of comfortable ways without any of the “cracking and popping” that many people associate with chiropractic adjustments.  Combining these spinal treatments with the right spinal rehabilitative exercise can provide great success.  Our office participates fully with Medicare and many other insurance plans.  If you would like to see if our office has a solution for you, give us a call.

The Spine Center of Williamsburg

A Modern Chiropractic Practice






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The doctor’s diagnosis was what??

Posted by Mark Croucher
on February 15, 2016
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considering  surgeryI would like to preface this article review with my own observance.  Personally I’ve been impressed by the ability of many of my medical colleagues to assess and diagnose musculoskeletal issues.  On the other hand I’ve met some doctors that are outright terrible.  This is a problem in healthcare across the board.  It doesn’t matter if you’re talking about medical doctors, chiropractors, physical therapists etc.  One of the most common reasons patients go to the doctor in the world, is for back pain.  It accounts for one of the most prevalent reasons for disability in the United States.  Therefore, your doctor’s ability to diagnose these conditions is paramount for proper patient care.

A 2015 study in The Journal of Bone and Joint Surgery examined the competency of musculoskeletal medicine of medical students in the United Kingdom.

Two hundred and thirty students were recruited, of whom 210 were suitable for inclusion. Unfortunately, only 21% (forty-four students) passed the assessment.  When questioned, only 40% of participants considered themselves competent in musculoskeletal medicine.

Our findings suggest that medical schools may be currently failing to ensure that medical students have a basic competence in musculoskeletal medicine. Further investigation is warranted to fully assess the current training provided by U.K. medical schools in musculoskeletal medicine, and appropriate steps must be taken to improve the quantity and quality of training in musculoskeletal medicine in the United Kingdom.


J Bone Joint Surg Am. 2015 Apr 1;97(7):e36. doi: 10.2106/JBJS.N.00488.  The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom.   Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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Fear can make you hurt!

Posted by Mark Croucher
on February 14, 2016
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Feasurf shotr Avoidance – The fearavoidance model (or FA model) is a psychiatric model that describes how individuals develop chronic musculoskeletal pain as a result of avoidance behavior based on fear.

In our chiropractic practice, our focus is on the field of conservative spinal pain management and rehabilitation. We are mostly dealing with patients that have some type of chronic back or neck issue, often accompanied by neurological issues in their legs or arms (pain, numbness, weakness, tingling etc.).   A large percentage of our patients have had some type of spinal surgery that left them with a great deal of residual pain.  Other patients have been able to avoid surgery but continue to deal with chronically painful spinal issues.   Patients with these chronic issues start to behave differently.  They start to avoid anything and everything that their brain has learned might increase their symptoms.  This problem becomes a viscous cycle of negative feedback and actually worsens their painful problems.

A recent article in The Journal of Pain examined the neural components associated with pain anticipation and the changes in behavior that often occur.

This information could potentially help clinicians and patients to understand how anticipation of pain may contribute to patient pain and disability.

Our goals through treatment include:

  1. Identify the patient’s pain generator (area of injury).
  2. Through proper treatment, start to increase their abilities for normal movement.
  3. Get the patient to be able to face painful activities and learn that they can overcome.




Brain areas involved in anticipation of clinically-relevant pain in low back pain populations with high levels of pain behaviour.J Pain. 2016 Feb 1.



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Non-steroidal anti-inflammatory drugs for chronic low back pain.

Posted by Mark Croucher
on February 12, 2016
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Non-steroidal anti-inflammatory drugs for chronic low back pain.

Cochrane Database Syst Rev. 2016 Feb 10

Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pain. Two types of NSAIDs are available and used to treat back pain: non-selective NSAIDs and selective COX-2 NSAIDs.

In 2008, a Cochrane review identified a small but significant effect from NSAIDs compared to placebo in people with chronic back pain. This is an update of the Cochrane review published in 2008 and focuses on people with chronic low back pain.

Due to inclusion of Randomized Controlled Trials only, the relatively small sample sizes and relatively short follow-up in most included trials, we cannot make firm statements about the occurrence of adverse events or whether NSAIDs are safe for long-term use.

Cochrane Database Syst Rev. 2016 Feb 10


Another study in Spine 2003 Spine (Phila Pa 1976). 2003 Jul 15

Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.


The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication.

However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.


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Surgical versus non-surgical treatment for lumbar spinal stenosis

Posted by Mark Croucher
on February 12, 2016
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As we note, our interests at The Spine Center of Williamsburg lie in the influence chiropractic and conservative manual and physical interventions may have on spinal stenosis.  It tends to be the most common patient presentation we deal with.  Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine as people age.  Patients present with a number of symptoms including; leg pain, back pain, leg weakness, numbness in the legs, difficulty standing and walking, relief with sitting and bending forward.

The referenced Cochrane Systematic Review below was done to evaluate the effectiveness of different types of surgery compared with different types of non-surgical interventions in adults with symptomatic LSS.   Primary outcomes included quality of life, disability, function and pain. Also, to consider complication rates and side effects, and to evaluate short-, intermediate- and long-term outcomes (six months, six months to two years, five years or longer).

To this point the interventions we use at our office include:

  1. Lumbar flexion distraction (manually delivered traction)
  2. Lumbar flexion exercises
  3. Lumbar flexion manipulation
  4. Vibratory assisted muscular activation
  5. Lower extremity strengthening exercise
  6. Recumbent bicycle training

These conservative treatment outcomes have not been thoroughly compared to surgical outcomes to date.  Further study is needed at this point.  The Cochrane review had this to say:


Authors’ conclusions

We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.


The Cochrane Library - Trusted evidence. Informed decisions. Better health

About the Cochrane Library

The Cochrane Library (ISSN 1465-1858) is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about Cochrane groups.

About Cochrane Reviews

What is a systematic review?

A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings that can be used to inform decision making.

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Calcium for Bone Health?

Posted by Mark Croucher
on February 12, 2016
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OsteoporosiP1020154 (1)s is a big concern for everyone (not just women) and most of us know someone who ultimately died of complications of a broken hip. Development of a rounded mid back (“dowager’s hump”) can be painful in itself and indirectly drives neck/upper back and shoulder pain. Medications for osteoporosis such as Fosamax and Boniva are not without problems such as fractures and other bone disease (ironically) after prolonged use.

For decades we’ve been advised that high calcium intake equals higher bone density. This translates to dairy intake and calcium supplements. Increasingly, however, noncalcium factors are seen as more important for bone support.

Low acid foods (vegetables, fruits and roots/tubers such as carrots, beets and radishes), omega 3 fatty acids and magnesium in the diet positively correlate with high bone density but dairy intake does not. Moreover, the 1,000 to 1,500 mg per day of calcium intake usually advised cannot be provided by diet alone and is simply not something the body is accustomed to. Supplementing calcium to this degree invariably unbalances the optimal 1 to 1 ratio of calcium to magnesium.

Even worse, there is evidence that supplementing as little as 800 mg of calcium per day increases the risk of age-related macular degeneration (an incurable form of blindness).

So what can you do to maintain bone density?

* Supplements: Magnesium (500 mg/day)

Vitamin D3 (1,000 to 5,000 IU/day)

Fish oil (1,500 to 2,500 mg EPA and DHA/day)

Note: don’t take fish oil if you’re on anticoagulant medication without discussing it with your prescribing physician.

* Food: Eat more alkaline food (vegetables, fruits and tubers) and

Less acid foods (grains, cheese and meat).

* Exercise: Weight bearing activities such as walking and strength

training. Try for 2.5 hours (150 minutes) per week.

* Lifestyle: Don’t smoke and drink alcohol in moderation.

From Problems with Calcium Supplementation D. Seaman DC, MS, DABCN. Dynamic Chiropractic vol. 33, no. 24.

Post from Dr. Dan Carlson

dan carlson

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Headache relief

Posted by Mark Croucher
on February 11, 2016
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A 2016 study in BMC Musculoskeletal Disorders compared the effects of manipulation to mobilization and exercise in individuals with a type of headache called cervicogenic headache (CH).


The results of the current study demonstrated that patients with CH who received cervical and thoracic manipulation experienced significantly greater reductions in headache intensity, disability, headache frequency, headache duration, and medication intake as compared to the group that received mobilization and exercise; furthermore, the effects were maintained at 3 months follow-up. Future studies should examine the effectiveness of different types and dosages of manipulation and include a long-term follow-up.


BMC Musculoskeletal Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of musculoskeletal and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

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