Inside this Issue
Low Back Pain
I Have a Short Let?
Insurance News
Trigger Points
Positive Thinking
Are You Experiencing the #1 Cause of Low Back Pain?
The most common condition I treat in this office, without question, is Sacroiliac Joint Syndrome. It involves one or both of the joints near the dimples of the lower back which connect the hipbones to the tailbone. These joints are supported by some of the strongest ligaments in our bodies because we use them constantly while walking, bending, twisting, and getting up and down. Despite their strength, sooner or later, constant wear and tear leads to injury.
Sacroiliac injuries can be extremely painful and restricting. Common symptoms of sacroiliac syndrome include pain while getting up after sitting or sleeping, difficulty in activities such as going up or down steps, getting into or out of the car, rolling over in bed, gardening, and twisting activities such as swinging a golf club or baseball bat. Pain occurs primarily in the low back, though sciatica (pain in the leg) frequently accompanies it.
Common signs include a short leg, one hip higher than the other, muscle weakness, spasms, or imbalances in the low back, hip or knee. Disc problems often develop because malfunctioning sacroiliac joints increase the stress on the discs, resulting in bulges or herniations.
Fortunately, sacroiliac problems are easy to identify and generally respond exceptionally well to chiropractic care. They occur in both children and adults. They are nearly as epidemic as cavities in teeth!
Sacroiliac syndrome is clearly the most common condition I see as a Chiropractor. Keeping the sacroiliac joints functioning well with periodic chiropractic adjustments is essential to a healthy, active lifestyle.
I Have A Short Leg?
Having one leg shorter than the other is a relatively common situation that can affect you in more ways that you think. A short leg predisposes you to painful conditions such as:
- Knee pain - Sciatica
- Hip pain - “Restless Leg” syndrome
- Low back pain - “Growing pains” in children
Left untreated, a short leg can result, over time, in disc herniations or severely arthritic hips, as the body is pushed beyond its ability to compensate for the uneven stress.
TWO CAUSES OF SHORT LEGS
Short legs can be grouped into two types, anatomical and functional. An anatomical short leg is a result of uneven bone lengths present at birth or arising from bone trauma during growth. The second type, acquired functional short leg, is caused by muscle imbalances or misaligned joints in the legs or spine. These can be corrected with chiropractic adjustments and exercises.
HOW TO TELL IF YOU HAVE A SHORT LEG
You can, however, discover for yourself if you have a short leg by using the following procedure with the help of a friend. Lay down on your stomach on a bed or bench. The other person cups their hands around the heels of your shoes and pushes your feet towards your hips until the slack is out. Comparing your heels will show whether or not a leg is short.
Another method is simply by comparing where your pant legs fall in a mirror. Many people have found they have been hemming one leg higher than the other.
Chiropractic care is unique in its approach to correcting short legs. Spinal and leg joint adjustments can correct the uneven leg lengths and help provide relief from associated symptoms. Getting into the habit of checking your family for short legs can result in early detection and prevent more serious, painful leg and spinal conditions from developing.
Supporting Research
In one study, people with chronic low back pain were up to 5 times more likely to have a short leg. People with uneven leg lengths tend to have hip pain and arthritis in the long leg side. Chronic knee pain and arthritis occur commonly in the short leg side.
- Manual of Medicine
Uneven leg lengths may be a major contributing factor in the development of degenerative hip disease.
- “Studies in Osteoarthritis of the Hip,” Canadian Medical Association Journal
79% of patients going for back surgery due to herniated discs had a short leg. The majority of them had sciatica pain radiating into the short leg.
Spine Journal
Insurance News
On June 1, 2013, some Highmark insurance plans began requiring treatment plans before covering chiropractic or physical therapy services. Highmark delegated the task to a company called Healthways, based in Virginia. As this is something new, we hope to keep you informed about it and how it affects you, as we gain experience with it.
Two subjects are coming up frequently during the past few months, medical necessity and, appealing denied treatment plans .
Medical Necessity
The term medical necessity is the number one reason we are seeing given by Healthways when denying claims. But what is meant by medical necessity? Well, it depends on whose perspective you look at it from:
1) Most patients: when most people call a doctor or dentist, it is usually because they have a problem they believe requires professional help. To them, that appointment is for a medically necessary condition. For example, you pick up an item in your basement. As you go to twist, you feel a sharp pain in your low back. As days or even weeks go on, the pain persists. You realize it’s not going away on its own. You call a doctor and schedule an appointment.
2) Doctors: When someone calls a doctor’s office, it must be assumed it’s for a condition needing help. The doctor assesses the person’s condition, recommends and provides treatment. The person feels better. To a doctor, a problem that responds to treatment is the criteria used to justify medical necessity.
3) Insurance Companies: Many insurers define medical necessity similar to the way patients and doctors do. However, they also add other criteria. They look at whether a condition is chronic, recurring, how many visits a person has made to the doctor in the past 6 months for any other reasons. They look at what type of doctor treats which type of condition. They look at whether a cheaper treatment option is available. Different insurance companies have different criteria for medical necessity. They tend to keep these secret.
The Bottom Line
It is very difficult for you or us to predict what care Highmark will consider medically necessary. Currently, the best we can do is submit a treatment plan and see how they respond. Hopefully, we will get better at anticipating what care they will approve, as we gain more experience. This can be frustrating for you and us at times. We appreciate your patience, understanding and trust.
Appealing Denied Treatment
Highmark allows you to appeal care denied by Healthways. Your appeal is handled directly by Highmark, NOT Healthways. We have already seen many of you have your care approved as a result of you calling them directly.
You are important to Highmark. You are their policy holders. They appear to take your input and preferences into consideration when handling appeals. Other patients have told them how much Chiropractic helps them function and get timely relief. In response, denials have been reversed.
Your best bet is to call the number listed on the denial letter. You may also file a written appeal, though it is a slower process.
Pre-visit Denial Waivers
If Highmark denies your care and you still choose to continue receiving chiropractic care in our office, you will need to sign a form in advance showing that you understand that they will not pay for your care but want to receive it anyway. Highmark requires this as a condition of our being in-network. We can help you estimate what additional amount you will owe for your care.
Here is a common example for a straightforward chiropractic adjustment for those of you with Freedom Blue or Security Blue:
Your visit cost: $40
Highmark’s allowance:
98940 ( 1 or 2 areas ) $24.81 -$15.19
98941 ( 3 or more areas ) $34.67 -$5.33
Your copay: $20.00
* If Highmark denies your care, you would owe an additional $4.81 (code 98940) or $14.67 (code 98941). This is the amount Highmark pays when your visits are approved. The total cost of your visit would be either $24.81 or $34.67, which includes your copay.
Chiropractic and Physical Therapy
Some people and insurance companies are confused about these two forms of health care. They mistakenly consider them to be one and the same.
Chiropractic’s uniqueness is the way it focuses on keeping your joints in proper alignment and your nervous system functioning without interference or irritation. Its primary tool to achieve this is the chiropractic adjustment. Using hands or a handheld instrument, precise forces are applied to restore proper alignment and movement to misaligned, fixated joints. Because nerves exit your spine between the bones, stress is reduced from nerve tissue as a result.
Physical therapy includes all other physical methods to reduce pain and restore function. It includes ice, heat, ultrasound, electrotherapy, exercise, braces, massage, cold lasers and other modalities.
Chiropractors used physical therapy in conjunction with adjustments before any licensed physical therapists existed.
The two are synergistic in helping achieve the best level of improvement. Chiropractors are trained and licensed to perform all physical therapy procedures. However, by law, we are not allowed to refer to ourselves as physical therapists. Instead, we receive a license to perform “adjunctive procedures.” This implies that physical therapy measures are a separate procedure supplemental to the chiropractic adjustment. The two are synergistic. That is why research has often shown much better results when the two are combined versus when physical therapy alone is performed.
Managing Chronic Conditions
The goal of chiropractic care is to keep your joints, nerves and muscles in the best shape possible, for as long as possible. By the time many people first try chiropractic, however, varying degrees of permanent damage have already occurred in these areas. Arthritic joints, bone spurs, scar tissue, muscle degeneration, irreversible postural abnormalities, bulging/herniated discs, stenosis, etc., are just a few examples!
While chiropractic may be the best, most effective approach for many of these conditions, the fact remains that they are permanent in nature and will likely require long-term management. Without periodic care, these problems tend to get worse with time.
Some people misunderstand why friends and family members continue seeing chiropractors. They view the ongoing care as evidence that the care is not helping. Meanwhile, the truth is quite the opposite. The reality is that chiropractic has been, and is, a god send for many. It helps people maintain a much higher quality of life for more years than would otherwise happen. It often significantly reduces the need for and amount of medication. It can help people avoid unnecessary and even dangerous surgeries. It can prevent loved ones from enduring needless suffering.
So even though many chronic conditions cannot be permanently fixed or relieved 100%, ongoing chiropractic management may be one of the wisest investments a person can make for their present, and future, health and happiness.
Trigger Points: what are they and how do we treat them?
Before you can understand trigger points, you need to understand the nature of muscles. Muscles have 4 basic characteristics:
Excitability (irritability) - the ability to receive and respond to stimuli via nerve impulses.
Contractility - the ability to shorten when a sufficient internal or external stimulus is received.
Extensibility - the ability to be stretched.
Elasticity - the ability to return to normal shape after contraction or extension.
With that in mind, a trigger point will occur if any of these mechanisms are malfunctioning or interrupted. By definition, a trigger point is “a hyperirritable knot within a tight band of skeletal muscle, located in the muscular tissue and its associated covering.”
So, in easier language to understand, a trigger point is the area, or point along a muscle band in which the tenderness reaches its maximum.
When a trigger point is flared up, this may give rise to referred pain , tenderness, a reduction in local blood flow, and skin temperature change.
The best methods for treating trigger points are to
1) free up the nerve supply via adjustment
2) light or deep tissue massage by either a chiropractor or massage therapist and
3) ice/heat at the trigger point with light, sustained stretching until the muscle is relaxed.
~ Finando, Donna, and Steven J. Finando. Trigger Point Therapy for Myofascial Pain . Rochester, VT: Healing Arts, 1999.pps 1-7
“To view and treat a single muscle or muscle group without consideration of the whole is insufficient treatment.”
– The Nature of Muscles and Trigger Points
Positive Thinking
Once you replace negative thoughts with positive ones, you’ll start having positive results – Willie Nelson
Office News
Colleen had her baby! William David Hardy was born July 3, 2013 at 3:55 pm and weighed
in at 9lbs 5oz and was 21 inches long. Mom and baby are doing very well.