​Breathe | June 2016 | Volume 12 | No 2
Common causes of dyspnoea in athletes: a practical approach for diagnosis and management
James M. Smoliga , Zahra S. Mohseni, Jeffrey D. Berwager, Eric J. Hegedus


Dyspnoea during exercise is a common chief complaint in athletes and active individuals. It is not uncommon for dyspneic athletes to be diagnosed with asthma, “exercise-induced asthma” or exercise-induced bronchoconstriction based on their symptoms, but this strategy regularly leads to misdiagnosis and improper patient management. Dyspnoea during exercise can ultimately be caused by numerous respiratory and nonrespiratory conditions, ranging from nonpathological to potentially fatal in severity. As, such it is important for healthcare providers to be familiar with the many factors that can cause dyspnoea during exercise in seemingly otherwise-healthy individuals and have a general understanding of the clinical approach to this patient population. This article reviews common conditions that ultimately cause athletes to report dyspnoea and associated symptoms, and provides insight for developing an efficient diagnostic plan.

​For the Halloween season I prefer the strange to the blunt instrument for entertainment.
Try these animated movies.
 
Spirited Away
Director: Hayao Miyazaki
https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=spirited%20away
 
 
Mirror Mask
https://www.youtube.com/watch?v=swrcKRVgeGI
 

So..... Why do I frequently manipulate your mid back (thoracic spine) when your complaint is headache or low back pain? 

Since it's inception, chiropractors have recognised that the spine affects the nervous system and therefore the body as a whole. The PTs have coined the term "Regional Interdependence" to describe this.

What it comes down to is that we operate as an integral whole. We develop from a single egg cell but for some reason many people, even medical experts continue to treat people in isolated segments.

When I am working with the selective functional movement assessment (SFMA) approach, I frequently correct pain-free dysfunctions elsewhere to improve painful movements that brought the patient in. I may improve hip function to relieve plantar fasciitis or low back pain.
We don't want to ignore where you hurt, but we do want to do everything to improve functional problems that may be making the problem worse or, even causing the stresses that are producing the pain.
​
If you have a stiff forward mid spine that forces you into a forward head position, you have to tighten all the neck muscles to the rear and cock your head up to see straight which can produce headaches.


Regional interdependence and manual therapy directed at the thoracic spine
Amy McDevitt1, Jodi Young2, Paul Mintken1, Josh Cleland2 1University of Colorado, School of Medicine, Physical Therapy Program, Anschutz Medical Campus, Aurora, CO, USA, 2Franklin Pierce University, Physical Therapy Program, Concord, NH, USA

Journal of Manual and Manipulative Therapy 2015 VOL. 23 NO. 3

A cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011 found that there were fewer annual visits to PCPs for back and/or neck pain when the patients had more access to chiropractic care.
 
CONCLUSIONS:
"Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults.”

J Am Board Fam Med. 2015 Jul-Aug;28(4):481-90. doi: 10.3122/jabfm.2015.04.150005.
Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain.
Davis MA1, Yakusheva O2, Gottlieb DJ2, Bynum JP2.

Each patient has individuals needs but it's good to know what the average patient does best with. 

A 2014 study by Vavrek et al aimed at determining the most effective number of chiropractic visits for the treatment of chronic low back pain. They found that 3 visits per week for 4 weeks was more effective than 2 or 6 weeks.

Lost  job productivity is the greatest cost of chronic LBP at $3,815 for patients who received no spinal manipulation. Chiropractic care for 4 weeks at 3/wk saved enough that the total treatment cost was more than compensated for by savings in lost work. The patients treated with spinal manipulation felt better with 22.9 more pain-free days and 19.8 fewer disability days than those who had no spinal manipulation.


J Manipulative Physiol Ther. 2014 Jun;37(5):300-11. doi: 10.1016/j.jmpt.2014.03.002.
Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial.
Vavrek DA1, Sharma R2, Haas M3.

How does the cost of chiropractic care for low back pain compare to your alternatives? 

A study was published in 2016 consisting of 73,326 patients with chronic low back pain.  

"This study found that older multiply-comorbid patients who used only CMT during their cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients in the other treatment groups. Further, costs of care for the episode and per episode day were lower for patients who used a combination of CMT and conventional medical care than for patients who did not use". 
​J Manipulative Physiol Ther. 2016 Feb;39(2):63-75.e1-2. doi: 10.1016/j.jmpt.2016.01.006. Epub 2016 Feb 19.
The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.
Weeks WB1, Leininger B2, Whedon JM3, Lurie JD4, Tosteson TD5, Swenson R6, O'Malley AJ7, Goertz CM8.

​
We will post a series of these studies each day - check back tomorrow for more information!