Author Archives Mark Croucher

Spinal Stenosis Signs

Posted by Mark Croucher
on February 5, 2016
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spine-center-postureA recent study published in the prestigious medical journal Spine has outlined 6 specific signs to help diagnose Lumbar Spine Stenosis.  The study was based on polls of 279 physicians from 29 different countries with an average of 19 years in practice.  The study suggests that clinicians can be 80% certain of the diagnosis by answering 6 basic questions.

The six top items were “leg or buttock pain while walking”, “flex forward to relieve symptoms”, “feel relief when using a shopping cart or bicycle”, “motor or sensory disturbance while walking”, “normal and symmetric foot pulses”, “lower extremity weakness” and “low back pain”.

Conclusions. This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of “7 history items” that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes.

Level of Evidence: 2

Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.
Tomkins-Lane, Christy PhD; Melloh, Markus MD, PhD; Lurie, Jon MD; Smuck, Matt MD; Freeman, Brian MD; Samartzis, Dino MD, PhD; Hu, Richard MD; Barz, Thomas MD; Stuber, Kent DC; Schneider, Michael DC, PhD; Haig, Andrew MD; Schizas, Constantin MD; Cheung, Jason MD; Mannion, Anne F. PhD; Staub, Lukas MD, PhD; Comer, Christine PhD; Macedo, Luciana PhD; Ahn, Sang-ho; Takahashi, Kazuhisa MD, PhD; Sandella, Danielle MS
Spine:  Post Acceptance: February 1, 2016
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Here’s a crazy study

Posted by Mark Croucher
on February 5, 2016
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My favorite research review of the week!

Swearing as a Response to Pain—Effect of Daily Swearing Frequency

charlotte faceThis article presents further evidence that, for many people, swearing (cursing) provides readily available and effective relief from pain. However, overuse of swearing in everyday situations lessens its effectiveness as a short-term intervention to reduce pain.

Previously we showed that swearing produces a pain lessening (hypoalgesic) effect for many people.20 This paper assesses whether habituation to swearing occurs such that people who swear more frequently in daily life show a lesser pain tolerance effect of swearing, compared with people who swear less frequently. Pain outcomes were assessed in participants asked to repeat a swear word versus a nonswear word. Additionally, sex differences and the roles of pain catastrophizing, fear of pain, and daily swearing frequency were explored. Swearing increased pain tolerance and heart rate compared with not swearing. Moreover, the higher the daily swearing frequency, the less was the benefit for pain tolerance when swearing, compared with when not swearing. This paper shows apparent habituation related to daily swearing frequency, consistent with our theory that the underlying mechanism by which swearing increases pain tolerance is the provocation of an emotional response.

pain journal

December 2011Volume 12, Issue 12, Pages 1274–1281

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Posted by Mark Croucher
on February 4, 2016
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golf swing

Many of our patients are “fond” of golf to put it lightly.  The little ol’ white ball beckons them in the wee hours of the morning.  I myself enjoy the game but I have some things to say about our little addiction.

It’s not that great for your back or your neck for that matter.

Think about the force generated on my lower back as I coil back and then dynamically swing through the ball. Notice that my head position is in the middle, staying still.  My left shoulder is pinned to my neck at my full backswing.  Nice technique but the rotational (torsion) forces on my neck from my shoulder rotation are huge.  The same type of rotational strain on my lower back is tremendous.  No matter how good your technique.

Now imagine how many swings you take before, during and after a round. Then think about the estimate that nearly 100% of people over 60 years old have degenerated (dried, hardened, broken down) spinal discs.  

Just a little food for thought.


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Disc injury and chronic pain

Posted by Mark Croucher
on February 4, 2016
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discArthritis Research & Therapy 2015

A recent study from Arthritis Research & Therapy helps to shed light on a topic that has been of great discussion for many years.  It has been thought to be a general rule that the discs or pads in between the vertebra do NOT have a good blood supply in the inside of the disc.

Also, in healthy discs, the nerves in the area grow AROUND the disc but not INTO the disc.

Why are those points important?  Well…here’s why.


  1. The lack of blood supply is one of the reasons why discs don’t heal well when they are injured or placed under repetitive loads like sitting all day or bending over and over again. These problems lead to damage or degeneration in the discs (hardening, breakdown, tearing, bulging).
  2. The nerves that grow AROUND the disc can then invade INTO the disc after injury.  This is called nerve ingrowth.  The consensus is that these ingrown nerves are VERY sensitive to pressure and give you MORE PAIN than they would in healthy discs.

When these researches speak about the NP they mean the Nucleus Pulposes which is the center gelatin portion of the disc.  When they use the term IVDs they mean the disc (intervertebral discs).

“Our findings demonstrate that nerves are present within a large proportion of NP samples from degenerate IVDs. This study shows a possible link between nerve ingrowth and degeneration of the IVD and suggests that nerves can migrate in the absence of blood vessels.”

So how does this apply to spinal pain management?  We believe that degenerated discs become more painful due in part to the way the problem affects the nerves.  Research has also helped us to understand that spinal manipulation/mobilization can stimulate the nervous system in ways that help alleviate pain. We also believe that many other manual therapies and targeted exercises also stimulate the nervous system and may be why these other interventions reduce spinal pain.

STUDY:  Nerves are more abundant than blood vessels in the degenerate human intervertebral disc – Arthritis Research & Therapy 2015

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Spinal surgery/Chiropractic care

Posted by Mark Croucher
on February 3, 2016
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  • spine-center-lower-back-painsmAre you dealing with chronic back pain?
  • Do you have pain or numbness in your arms or legs?
  • Have you already had spinal surgery?
  • Have you been considering spinal surgery for back pain?
  • Have you tried PT, spinal injections and medication?

If you answered yes, you may be interested in this.  Our patient base is made up of patients suffering with severe and chronic spinal pain (back and neck) and in may cases radiating pain, numbness or tingling in their arms or legs.  The majority of our patients had already been through physical therapy, spinal injections, medications and subsequent spinal surgery prior to coming to our office.  Many of our patients have been referred to our office from local pain management specialists, surgeons and other medical physicians.

Many of these issues start from damage to the discs that reside in between the spinal bones or vertebra.  The discs can tear, bulge or even rupture creating pressure and inflammation that irritates the spinal nerves.  These nerves that exit from your spine control your arms and legs.  That’s where the leg and arm symptoms come from.

I think its important for people to know that chiropractic treatments have been shown to provide relief to patients with this type of chronic back and neck pain.  Our goals are to improve spinal function (ability for bending, transitions from sitting, walking, standing) and reduce the pain associated with those activities.

There are a number of techniques that can be helpful in reducing the symptoms of numbness, pain and tingling into the arms or legs.  Manual therapies and forms of manual and automated spinal traction can provide relief from this type of debilitating condition.

If you’re suffering from these conditions, consider calling our office.



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Lifelong Learning

Posted by Mark Croucher
on February 2, 2016
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dan carlsonDr. Carlson is teaching a class at Christopher Wren Association through The College of William and Mary here in Williamsburg entitled SPINAL INJURY AVOIDANCE CONCEPTS AND. POSTURAL IMPROVEMENT TUTORIAL. January 26th, Feb 2, 9, 16, 23 and March 1st.  Unfortunately the main class has reached maximum capacity but the Lecture Format is still open on March 31st. Contact Christopher Wren Association at 757-221-1506 

The same class will follow at James City County REC center April 5, 12 and 19.  There are some openings still available at the James City County class so call ahead to register!!  Contact Kristen Tolj – Health and Wellness Coordinator at 757-259-4176.

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How does chiropractic work?

Posted by Mark Croucher
on February 2, 2016
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deep thoughtsChiropractors routinely help patients with chronic spinal pain who in many cases have been unresponsive to other medical interventions.   Studies indicate that our treatment can successfully reduce chronic back pain, neck pain and other related issues.   So how the heck does a chiropractic adjustment work?

A recent systematic review published in 2016 in the medical journal Spine attempts to answer the question.  The review suggests that spinal mobilization (primary treatment in chiropractic spinal care) may lead to changes in the central and sympathetic nervous system.  This neurological effect may explain the pain relieving qualities of the treatment.  There are other studies demonstrating a reduction in inflammatory markers and still others that show physical improvements in posture and spinal stiffness.  There are no studies indicating that these treatment move bones back in place.

Mechanism of Action of Spinal Mobilizations: A Systematic Review.
Aguirrebeña IL, et al. Spine (Phila Pa 1976). 2016.
Spine:  Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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Why Instrument Adjusting

Posted by Mark Croucher
on February 1, 2016
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Many people want to know the general difference between instrument assisted spinal manipulation and good ol’ fashioned manual manipulation (the popping – cracking kind).  At our office we primarily use Non-Thrust and Instrument Adjusting Techniques for several reasons. Our opinions are as follows:

1. We feel that these treatments are easier to control with regard to patient comfort and safety.

2. We feel that clinically the treatment outcome is more predictable for patients.

3  We are continually impressed with the research associated with Instrument Adjusting.

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Harvard Medical School on Chiropractic

Posted by Mark Croucher
on February 1, 2016
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Harvard Med Logo

Here is a well done article from Harvard on Chiropractic care.  Enjoy!

Chiropractic care for pain relief

Chiropractic is a health care system that holds that the structure of the body, particularly the spine, affects the function of every part of the body. Chiropractors try to correct the body’s alignment to relieve pain and improve function and to help the body heal itself.mark

While the mainstay of chiropractic is spinal manipulation, chiropractic care now includes a wide variety of other
treatments, including manual or manipulative therapies, postural and exercise education, ergonomic training (how to walk, sit, and stand to limit back strain), nutritional consultation, and even ultrasound and laser therapies. In addition, chiropractors today often work in conjunction with primary care doctors, pain experts, and surgeons to treat patients with pain.

Most research on chiropractic has focused on spinal manipulation for back pain. Chiropractic treatment for many other problems—including other musculoskeletal pain, headaches, asthma, carpal tunnel syndrome, and fibromyalgia—has also been studied. A recent review concluded that chiropractic spinal manipulation may be helpful for back pain, migraine, neck pain, and whiplash.

There have been reports of serious complications, including stroke, following spinal manipulation of the neck, although this is very rare and some studies suggest this may not be directly caused by the treatment.

Spinal manipulation” is a generic term used for any kind of therapeutic movement of the spine, but used more precisely it is the application of quick but strong pressure on a joint between two vertebrae of the spine. That pressure twists or rotates the joint beyond its normal range of motion and causes a sharp cracking noise. That distinctive noise is believed to be caused by the breaking of a vacuum or the release of a bubble into the synovial fluid, the clear, thick fluid that lubricates the spinal and other joints. Spinal manipulation can be done either directly by pushing on the vertebrae or indirectly by twisting the neck or upper part of the body. It should be done to only one spinal joint at a time. Chiropractors and other practitioners accomplish this by positioning the body so the force they exert is focused on one joint while parts of the spine above and below it are held very still. Most spinal manipulation treatments take somewhere between 10 and 20 minutes and are scheduled two or three times a week initially. Look for improvements in your symptoms after a couple of weeks.

In addition, a chiropractor may advise you about changing your biomechanics and posture and suggest other treatments and techniques. The ultimate goal of chiropractic is to help relieve pain and help patients better manage their condition at home.

To go to the Harvard Medical School site to see this article > Click Here

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Posted by Mark Croucher
on February 1, 2016
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December 11, 2013

Statins, Diuretics Linked to Increased Diabetes Risk in Patients with Impaired Glucose Tolerance


By Kelly Young

Diuretics and statins are both associated with significantly increased risks for new-onset diabetes in patients with impaired glucose tolerance at high cardiovascular risk, according to a BMJ study.

Researchers reanalyzed data from a trial of 9300 patients with impaired glucose tolerance who started various cardiovascular drug treatments. After a median follow-up of 5 years, patients who began taking diuretics were at higher risk for developing diabetes than those who did not (adjusted hazard ratio, 1.23). New statin users were also at increased risk (HR, 1.32). Beta-blockers and calcium-channel blockers did not pose a significantly higher risk for incident diabetes.

The researchers calculate that there is one case of new-onset diabetes for every 17 patients treated with diuretics over 5 years, and one case for every 12 treated with statins.

These results “suggest that glycemia should be better monitored when these drugs are initiated in high risk patients,” the researchers conclude.

NEJM watch


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