“Pain” is usually the number one reason a patient presents to our office. Let’s face it. No one ever wants or enjoys pain. Even the elite athletes who claim they enjoy it typically only enjoy the adrenaline rush pain presents but they do not want to live with it. So naturally, as providers, our number one obligation to the patient is to provide pain relief. When it comes to low disc bulges, I am usually tasked with finding the fastest route to relief.
There is no quick fix for a disc bulge. There are only solutions for pain relief caused by the bulge, but these options are limited and usually very temporary.
What is the best for discogenic pain?
First off what is “discogenic pain?” Discogenic pain is any pain caused by the intervertebral disc. More often than not, a disc has bulged or herniated and is applying pressure to one of the spinal nerves causing the pain.
When it comes to pain relief no country is better than the United States. We are the number one consumers of pain medications in the world. In fact, we consume 50% of all the world’s prescription medications, yet we only make up 5% of the world population. WE LOVE OUR PILLS. This has long been the disconnection between immediate pain relief seekers and chiropractors. At this point, the best relief for pain caused by disc bulges is medicine that typically comes with side effects and temporary efficacy.
However, if a person is in enough discomfort, I have learned that they will typically forgo the risks of injury and side effects for quick pain relief. There are a number of injectable medications that can provide almost instant pain relief. Torodol tends to be the common “go-to” for hospitals and urgent care clinics. For discogenic pain, the relief tends to be moderate at best and never with full resolution.
What is the best non-drug relief for low back disc pain?
Spinal traction has proven to be the most effective method of relieving discogenic pain in the low back. Even compared to medication, this modality has been the standard of care for physical medicine practitioners such as chiropractors, physical therapists, and even neurosurgeons. Typically sciatica and other radicular pain is caused by compression of a nerve by another source like a bulging disc. Decompressing the area allows the disc to retract away from the nerve and provides instant relief.
How long does traction relief last?
Traction is typically only effective for a short term, however, repetitious treatment with long axis spinal decompression has been proven to provide lasting relief from low back and neck discogenic pain. Gravity is constantly compressing our spine and it is our worst enemy after a decompression treatment! Repeated treatments over a short course of time provides amazing relief with out the lasting side effects.
So if someone asks if there is a quick fix for disc bulges, I typically refer them to our Nurse Practitioner for short term relief while we initiate decompression therapy to solve the true nature of their pain.
Once viewed as a waste of money vitamins are changing the landscape of health care. It only took a pandemic, pharmaceutical companies, and desperation to live to convince us that supplementing vitamins or consciously seeking them out in our diet is essential for survival. If you’ve been to our office then the chances are high that you’ve been asked about your vitamin D intake and typically one of our providers has told you that you should be taking it. Not because we want to sell you something! In fact, we don’t give a crap where you get it, just get it in your body! Sometimes our patients have heard this from other doctors and ask “do I really need to take vitamin D?”
Most people in the United States, especially in the Pacific North West, need to supplement with vitamin D especially during the winter months from October to March.
In a study published by Forrest & Stuhldrreher, it was discovered that 42% of the healthy population was deficient in vitamin D. Up to 81% were deficient in certain subpopulations.
Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.
What Happens if You Don’t Take Vitamin D?
Clinically low levels of vitamin Dare defined as less than 20ng/mL, although some other texts define it as less than 30ng/mL. These lab values were determined in the 1930s when we began fortifying milk with vitamin D to eradicate a harmful bone disease called rickets. One must be reminded that this was the decade immediately following “The Great Depression” which was certainly the reason for the onset of the condition in the first place due to the lack of nutritious food. Within a decade the FDA had nearly eradicated the condition through a simple supplantation process.
Vitamin D Deficiency Symptoms
There are a large number of symptoms associated with low vitamin D however http://www.ecowatch.com has created a pretty good starter list that I like to follow.
Getting sick or infected often
Fatigue & tiredness
Bone & back pain
Depression
Impaired wound healing
Bone loss
Hair loss
Muscle pain
Can Vitamin D Prevent COVID-19?
I will keep this short and to the point. In a study conducted on Covid-19 patients, it was found that 94.27% of them were deficient in Vitamin D.
How Do I Prevent Low Vitamin D?
Harvard Medical School determined that anyone living north of the 37th parallel needs to supplement with vitamin D during the winter months (October to March). This is because the UVB radiation from the sun is not potent enough during these months to convert vitamin D to its active form in the body. IF YOU LIVE IN A NORTHERN STATE YOU MUST SUPPLEMENT WITH VITAMIN D. The European countries have known this for centuries and have even supplied their populations with krill oil and fortified milk to prevent the onset of disease.
Can Chiropractic Help With My Low Vitamin D?
If you are suffering from any of these symptoms, it is time to get to your doctor or chiropractor.
If you are suffering from any of these symptoms it’s time to get to your doctor or chiropractor immediately. We are trained and licensed on ordering blood work and blood panels as well as treating blood-related disorders TO A CERTAIN EXTENT. There are a plethora of conditions that should be seen by a specialist far beyond a family medicine provider as well. Your chiropractor is able to make that referral if they find a uniquely abnormal value in your labs.
How Much Vitamin D Should I Be Taking?
The recommended daily allowance is between 600 and 800 IU however clinically, across the country, we have learned that is not sufficient to address this worldwide deficiency. Medical doctors around the world are prescribing 50,000 IU a week for some patients. I recommend between 5,000-10,000 a day. It is a fat-soluble vitamin as we get fatter in America due to poor eating and exercise habits we will need to continue to adjust our supplementation levels. So when asked “Do I really need to take vitamin D?” The answer is more than likely “Yes, you’re probably already deficient.”
I would be filthy rich if someone gave me a dollar for every person that comes into our office with low back pain that radiates down their leg (sciatica). Probably one of the most common reasons someone visits our office or any chiropractic clinic is for sciatica. Low back pain that shoots into the butt and down the leg, sometimes all the way to the foot can be the most debilitating pain a person will ever experience. “I’ve tried stretching, hot tub, ice, ibuprofen and some old muscle relaxers I had left over and nothing touches it” us a phrase that should be painted on the wall of all my treatment rooms. It’s almost as though every sciatica patient is given that scripted phrase.
Yes, chiropractic treatment has been proven to be one of the most effective options for treating sciatica. And this isn’t coming from your local chiropractor alone. This has been proven by many medical studies. However, the most comprehensive assessment was done by “Spine” which looked at 51 different studies and compared the results.
“There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.” – The Spine Journal Volume 18, Issue 5, P866-879, May 01, 2018
What is Sciatica?
Pain stemmed by irritation of the sciatic nerve is commonly called “sciatica.” This nerve is the largest in the body and starts in the lumbar spine. Originating from the L4, L5, S1, S2, S3 spinal nerves the sciatic nerve traverses through the gluteal muscles and down the leg. It controls many of the muscles it passes by such as the glutes, hamstrings, and calf muscles. It is not uncommon to have weakness of these muscles in conjunction with sciatica pain.
What Triggers Sciatica?
Sciatica is one of the most frustrating conditions to treat as a health care provider. It can be caused by a number of different condition however the most common reason is impingement of one of the spinal nerves listed above. L5 nerve root is the most commonly affected nerve when assessing sciatica and is usually triggered by a lesion of pathology of the intervertebral disc between the last lumbar vertebra and the sacrum or tail bone. These discs can be damaged for a variety of reasons from heavy lifting, to pathologic conditions, to prolonged wear and tear.
Are Chiropractors Good for Sciatica?
One of the most searched questions of Google is “are chiropractors good for sciatica?” And like many of my other posts I will simply say it depends on the chiropractor. Most chiropractors are quacks. Yes I am a chiropractor and I just told you that most of my colleagues practice pseudoscience with unproven results that are often unreproducible. I spend hours educating patients to avoid chiropractors with quick fix techniques and especially those who are resistant to the idea of medicine as an adjunct therapy for treating sciatica. This condition can be extremely complex and if the patient is unresponsive to chiropractic treatment after 3-4 weeks then the patient must be referred for either advanced testing like MRI or to another provider. I want to scream at the top of my lungs when a patient seeks me out for a second opinion because they have been treating with their family chiropractor for 3 months and there “sciatic pain just won’t seem to go away doc”. These are the quacks I am talking about.
How do Chiropractors Adjust Sciatica?
This question makes me chuckle as we typically don’t “adjust the sciatic nerve”, but this is another one of those highly searched questions on Google so here we go. As we discussed above sciatica is caused by impingement of the sciatic nerve most often by a disc but sometimes by a vertebral misalignment or peripheral entrapment like a muscle spasm or soft tissue injury. A chiropractor MUST PROPERLY ASSESS, TEST AND DIAGNOSE SCIATICA TO DETERMINE THE CAUSE OF THE SYMPTOMS BEFORE THEY EVER LAY A HAND ON YOU! This is a theme I see all too often in my office. The patient has never been given a diagnosis and the chiropractor is over there cracking away on their spine when all too often that is the last thing the patient needs.
Treatments like spinal decompression and light adjusting are the most effective treatment modalities for treating sciatica. If diagnosed and treated properly a chiropractor is one of the safest and most effective options for treating sciatica
How much does “it” cost? This is the most awkward question presented to a doctor, but certainly one that must be addressed at some point during care. It is up to us as business owners and health care providers to understand that everything does have a price and what a person values when it comes to their health is entirely subjective. I know how much a visit in my office costs; however, when I meet a new person in a public place the answer is not always so simple. The best answer. I can produce is the cost of chiropractic care can vary from $29-$400/visit or sometimes even more.
Like every other healthcare profession, the cost of chiropractic care varies for a variety of reasons in Boise and the surrounding Treasure Valley. Reputation of the provider, how busy the office is, is insurance involved and the depth of evaluation and treatments offered, are just a few of the vast differences in cost. Like most other professions, you will find that the majority of practices will be very close in cost with only a couple of practices creating the “outliers” in the range.
Typically when presented with this question I typically defer to my staff who understands out pricing structure, the patient’s insurance benefits and readapted to answering questions far better than I am when it comes to the cost of chiropractic care in Boise.
Quality of Care
The biggest determining factor in the cost of chiropractic care in our city is the quality of care. Do you want to just get your back “popped” or do you want met o utilize my 8 years of education and provide you a diagnosis, appropriate treatment, and accurate prognosis? If you just want your back popped then you can do that for $29 at a couple of places around the valley, but you put a lot of risk on the line if you choose this approach.
People will spend $50 on a dinner or $200 on a pair of designer shoes, but when it comes to their healthcare, many would prefer the cheapest option available assuming all healthcare is the same and equal. These are my favorite from patients– The soccer mom that woke up on Monday with a kink in her neck rushes to the cheapest place in town, is in and out of the office in 10 minutes, then presents to my office on a Tuesday now with pain shooting down her arm. Now I get it, soccer moms and everyone else in today’s society are very busy with little time for inconveniences, but had that Starbucks touting, Lululemon model spent just a little more time vetting her choice she may have prevented the lengthy and painful treatment in front of her aching neck and arm.
If you want fas-food then expect that quality. Now don’t get me wrong, I love the quarter pounder too, but when it comes to my body I will pay for the steak dinner. This is more likely to be better for my body than that quarter pounder in the long run.
Reputation of the Doctor
This one is a big determining factor and it usually correlates with the next topic “how busy is the office?” I will tell you right now that if you want to see. a well-known chiropractor, you are going to pay more than you would for the new kid, fresh out of school. As professionals, we spend our lives honing our craft. Some more than others will spend countless hours researching the latest medical journals, treatment modalities, and tech to improve patient outcomes. Obviously better outcomes and quality of care will produce amazing reputation allowing the doctor to set their prices however they want. The popularity of a clinic is directly related to patient outcomes and marketing efforts. You can have one without the other so it is important to read Google Reviews and also reach out on social media. Chances are one of your friends has seen the doctor you’re considering and they will provide an organic opinion of their experiences. Relying solely on Google, Yelp, and Facebook reviews is naive as these reviews can be bought and paid for.
How Much Does a Chiropractor Cost Without Insurance?
Insurance regulations guide this answer if the clinic accepts any kind of insurance and with the rising costs of healthcare, education of the doctor and overhead most offices cannot afford to be “cash only.” If they accept insurance then legally, they can only offer around 20% reduction in costs and services. Private insurers want to make sure that they are not paying more than the soccer mom who showed up with a crisp $100 bill and if the doctor is offering huge discounts to cash paying patients while charging insurance companies more than they are practicing fraudulently. If they are cash only practice plan on $29-$400. Remember you get what you pay for.
How do Chiropractors Charge?
We charge just like all other providers. Since we are covered by every major insurance including Medicare and Medicaid, we follow similar billing practices using Current Procedural Terminology (CPT coding) A typical chiropractic visit will consist of 3 codes typically.
The Exam: Depending on how complex your problem is this can range from $50-$250
The Imaging: Diagnostic imaging is it’s own world when it comes to billing but it usually only required on the initial visit X-Ray $50-$200 depending on medical necessity MRI $600+
Treatment: This is where costs can really vary. A typical adjustment will be $30-$100 in Boise but if they use other treatment modalities then plan on another $50-$150
The complexity of questions like “how much does a chiropractor cost in Boise” is why I usually defer to my billing staff. One of my mentors told me “Travis does’t make medical decisions for patients based on what you think they can afford. Present them with the most cost-effective treatments that are NECESSARY and let them make the choice. It’s not your health nor your checkbook!” To this day, that is what I practice and may be the reason our office is the Best in Idaho for the last 3 years.
This is the age-old question that continues to evolve as healthcare evolves. Ask any of my patients and they will tell you Dr. White jokes about not being a “real doctor”. Is this what I believe? Obviously not, but I’ve brushed off the nasty stereotypes about the chiropractic profession and have developed my own light hearted way of approaching this question.
Chiropractors are “doctors” and hold a doctorate degree (DC) requiring eight years of schooling after graduating high school. Most states list chiropractors in their state laws under the term “physician” or “chiropractic physician”, and most chiropractic physicians have a much larger scope of practice than you will ever see in their professional settings.
So why have chiropractic physicians been mocked and ridiculed for so many years by other healthcare providers, governing boards, and even the general public? Trust me this is a question I face daily and here are some of the best answers I have found over my decade of being in practice.
Overall lack of understanding As the old saying goes, “you don’t know what you don’t know.” I have found this to mostly be the case when I ask patients, other doctors, and even friends if they know what chiropractors do. Very few understand what chiropractors do or can articulate it in a way that doesn’t sound quacky even to my ears. “They crack backs.” “They re-align the spine.” or my favorite “I don’t really know, but I feel like I need one.” That last one instills a lot of blind trust in me and our practice but also shows that we have done a horrible job of educating the public as to our capabilities.
Many people are astonished that I went to a 4-year university and have pre-medical degree as well as another 4 years of chiropractic school. They are even more caught off guard when I explain to them that the first 2 years of medical school and first 2 years of chiropractic school are essentially identical. If you look at the image below you will see we have similar course loads when it comes to the didactic learning.
Lack of science This is probably the second biggest reason chiropractors are laughed at. This was once true. Chiropractors were once notorious for outrageous claims of curing many medical conditions by simply manipulating the spine or associated joints with no sound proof other than anecdotal experiences. This is why “many doctors hate chiropractors.” Healthcare as we know it circulates around sound scientific evidence obtained through randomized peer-reviewed studies and until the mid 1980’s very few of these studies existed for chiropractic medicine. There are now thousands of studies funded and researched by reputable medical schools and chiropractic universities. Many of these studies have even been published in “strict medical” journals like JAMA, Pain Medicine, The Lancet, and Spine.
Inconsistent practice and treatments If you have a doctor that claims he can waive a crystal over your spine and cure your diabetes I would tell you to run. This is a true claim by a chiropractor I know. How could a profession gain any kind of respect or validation from other healthcare professionals and a very skeptical general public with egregious claims like these? Slowly we are being reigned in from being the mavericks we once were but this has taken time and collaboration of new chiropractic physicians focused on bridging gaps and joining the world of science and leaving the world of snake oils. When my patients indicate they are nervous about coming to a chiropractor, my immediate response is “don’t worry I’m not one of those quacky chiropractors, in fact I am probably the most medically minded chiropractor you will meet.” The fact that I have to tell them this means we have a long way to go still.
No diagnosis As Peter Griffin would say, “this really grinds my gears.” Why would you spend $200k to receive a degree that gives you the authority and comprehensive education to properly diagnose any and all medical conditions then not diagnose? Our practice is entirely referral based because we take the time to diagnose what other chiropractors and health care providers wont. All too often patients are receiving treatment elsewhere without ever knowing what their medical condition is. This creates confusion for the patient as well as their other health care providers. I always joke that my license and education allow me to diagnose anything from a hangnail to malignant cancers, but typically I stick to my lane.
Chiropractors try to do too much There is a reason that there are multiple specialties in the medical profession. It’s because medicine is so highly complex that no single person possesses the knowledge to cure all medical ailments. So why do chiropractors try to fix every condition? Google lists some of the most commonly asked questions about chiropractors “can a chiropractor write a prescription?” In some states chiropractors can write prescriptions which I expect will continue to become more accepted across state boards as the need for primary care providers grows. We certainly have a lot of the required education including pharmacology, pharmacokinetics and pathology, but ongoing certification and training is a must if this is to happen. Chiropractors need stop waiving supplements and herbs around like they are miracle drugs and refer to the appropriate medical providers when complex systemic conditions present to their clinics.
When chiropractors refuse to refer to more specialized providers, we tend to see questions like, “has a chiropractor ever killed someone?”. The answer is “yes” and if you read the malpractice claims and lawsuits, it is typically due to negligence and/or stepping outside of their scope. I have had two patients present to my office with active CVA (cerebrovascular accident or stroke.) Had I not taken the time to assess the patient properly, I most certainly would have been their cause of death, but both patients were immediately rushed to the ER because that is what our training has taught us. I have found multiple myeloma, malignant melanomas, lupus, osteosarcoma, and a plethora of other diseases that were missed by other providers and these patients are always referred to the appropriate medical specialist. When we “stay in our lane” addressing neuromusculoskeletal conditions and provide treatments backed by peer reviewed studies we gain the respect of other providers and a public that is far more educated than ever before.
So, when I am asked, “are chiropractors real doctors?” I typically respond yes, but only if they act like “real doctors.”
Hello everyone! My name is Molly Gulden and I am the brand and marketing director here at White Chiropractic. I have been with the clinic since February of 2021, starting out as a receptionist on Fridays. The amount of growth that I have experienced, and still continuing to experience at White Chiropractic is amazing! If you told me in February that I would have gone from just a Friday receptionist to performing shockwave therapy on patients to being the marketing and brand director, I would not have believed you.
My Experience w/ the Practice
When first getting into the chiropractor realm, I honestly did not know much about what chiropractors do. I always thought they just cracked backs, and it was just an extra medical expense that was unnecessary. After being a part of the practice I have learned the importance of spine health, strength exercises, and tune-ups. I personally have struggled with bad posture my whole life, which has always created a sharp pain in my neck and upper back. With just one adjustment, I felt an instant relief of pain that I had been experiencing for as long as I could remember. I cannot express how thankful I am for Dr. White for not only solving my back problem but for the education on proper posture so that I could have a long-term solution to what I was experiencing.
In regards to shockwave therapy, I was introduced to the machine here at the practice in March. Being the designated shockwave therapy specialist on Wednesdays, I have seen so many injuries and have dealt with many patients that were coming to the clinic with long-term pain. It is such a good feeling seeing that these patients are able to get relief and solutions to their injuries with the shockwave therapy that I was performing on them. I’ve seen people who were never able to even raise their arm above their shoulder now being able to do that after treatments. This past week, in particular, a patient of mine finally got to a point where she had the most knee flexion in years! The most rewarding thing is being able to help patients relieve the pain that they have carried with them- whether that be the pain they have had for a day or years!
Personal Life
I’m just three weeks away from graduating with my Bachelor of Science in Communication Studies, with a Digital Media emphasis, as well as minors in Business and Public Policy! I’m getting this degree from Eastern Oregon University located in La Grande, OR. I spent 2.5 years there running cross country and track, doing the 5k and 10k! Distance running is my absolute favorite. When COVID-19 hit and our track season got delayed, I decided to move back to Boise to get settled down and figure out what career path I wanted to pursue since I was on track to graduate early. That is when I landed here at White Chiropractic! I’m seriously so so blessed that I get to work my dream job, along with having the sweetest co-workers. In my free time, I love to explore local coffee shops, read, listen to podcasts, and watch my favorite lifestyle YouTubers. Wintertime is coming up and I cannot wait to hit the slopes as well! I also love all things design-related. Oh and cooking! There is just something so special about cooking a meal with someone. It hits different.
Let’s Wrap it Up!
Anyways, I hope that everyone is enjoying the blog posts and will enjoy the future ones too! If you guys have any health-related topics for Dr. White, leave them in the replies on any of our blog posts and we will be sure to do them. We want to make this a space for people to get their questions answered, and also a place for education so that we can rid of the bad stigma around chiropractors as a whole. Make sure to give this post a like and tune in next Thursday for another blog post:)
Sarah came into the office yesterday as she normally does every couple of weeks. She’s an avid golfer who prefers and relies on regular care to stay at the top of her game. We are just one of her tools in her arsenal of providers so when she mentioned that she has been experiencing shoulder pain in the top and front of her shoulder I told her we might be able to help. “You can do that? I thought you guys only cracked backs”.
Shoulder pain plagues between 16%-21% of the population and is the third leading cause for musculoskeletal pain.1 It often goes undiagnosed and untreated as patients fear the possibility of surgery, cortisone injections or other invasive procedures. After working with the Minnesota Twins baseball team during my residency I developed a love for evaluating and treating this complex joint. What patients didn’t realize was I suffered from my own right shoulder pain developed from an old weight lifting injury in high school.
Empathizing with our patients and understanding the burden a shoulder injury puts on one’s life I began developing a conservative treatment program that is EFFECTIVE, CHEAP, and DURABLE. The most important tool in our lineup is a piece of a new technology called acoustic wave therapy (AWT) or extracorporeal shockwave therapy (ESWT). FDA approved and usually only available in high-end orthopedic clinics the device has exploded into the sports medicine world as a miracle machine. Couple this with a home exercise program developed by our physical therapists the outcomes are inevitable. Since implementation, we have seen complete resolution of pain in 95% of our patients.
After a couple of tests and 2 x-rays in house we determined that Sarah was likely suffering a labral tear. Before ordering an expensive arthrogram to confirm the diagnosis and referring her to a surgeon we applied our shoulder protocol. She reported immediate relief after yesterday after her first treatment of AWT and will likely have complete resolution after her 5th treatments for well under a thousand dollars.
I love seeing the look on our patient’s faces after their first treatment. I can’t always tell if its relief from the pain or surprise that a “chiropractor” does more than just crack backs. So, I guess when it comes to shoulders. Yeah, we can do that.
1 Shoulder pain: diagnosis and management in primary care. BMJ. 2005 Nov 12; 331(7525): 1124–1128
