Integrating Complementary and Alternative Medicine into a Chiropractic Practice

Geoff Lecovin, D.C., N.D., L.Ac., CSCS

Education/Training

 BS Human Biology (1989 LACC)  DC (1990 LACC)  MS Nutrition (1992 University of Bridgeport)  MS Acupuncture (1994 Bastyr University)  ND (1994 Bastyr University)  CSCS (2006 NSCA)  CES/PES (2007 NASM)

What is CAM?

Complementary and Alternative therapies that have been shown to be safe and effective.

(NIH) e.g. naturopathic medicine, acupuncture, manipulation, guided imagery, supplementation

Naturopathic Medicine

Naturopathic Medicine

 Four-year graduate level naturopathic medical school  Holistic and nontoxic approaches emphasizing prevention and wellness  Professional board exams to be licensed as a primary care general practice physician

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Philosophy of Naturopathic Medicine

Do no harm Find the cause Treat the whole person The healing power of nature Prevention

Scope of Practice (WA)

             Nutrition and food science Supplements Physical modalities/manual therapy Minor office procedures Homeopathy Botanical medicines/nutritional supplements Hygiene and immunization Contraceptive devices Common diagnostic procedures Counseling and hypnosis Intramuscular and intravenous therapies Prescription drugs (all legend/limited controlled substances) Diagnostic procedures (e.g. lab, imaging, etc.)

Naturopathic Patient Demographics

      Pain/sports injuries/auto & work injuries Family practice Obesity Cardiovascular disease/hypertension/diabetes Wellness NHRT, depression, ADD/ADHD, women’s/men’s health, pediatrics, oncology, fertility

Naturopathic physicians are currently licensed in these states :

               Alaska Arizona California Connecticut District of Columbia Hawaii Kansas Maine Montana New Hampshire Oregon Utah Vermont Washington US Territories: Puerto Rico and Virgin Islands

Acupuncture

Acupuncture

 Traditional Chinese Medicine (TCM)  Neuro-anatomic acupuncture (“dry needling”)

TCM

 The practice of acupuncture dates back nearly 5000 years, where it began in China and other Asian countries.  Over the course of its development, ancient practitioners developed concepts and systems reflecting the religious, medical and cultural beliefs of their time.

Neuro-Anatomic Explanations for Acupuncture Lesions created by inserting sterile needles in the soft tissue activate the body ’ s main systems:     Nervous Cardiovascular Endocrine Immune This promotes homeostasis and stimulates healing.

( Yun-tao Ma, Mila Ma, Zang Hee Cho, Biomedical Acupuncture )

Effects of Dry Needling

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Strengthen tendons & ligaments by inducing local inflammatory reactions Stimulates GTO & muscle spindles inducing muscle relaxation Mechanically disrupts trigger points Treats overactive motor points Provides blood & growth factors, which can increase circulation, disrupt micro-scars and repair tissue Alters neural control via neurotransmitters Stimulates neural reflex mechanisms

Chiropractic, Manual Therapies and Exercise

Beyond chiropractic help

Kinetic Chain

Muscular Kinetic Chain Articular Neural

Muscle Imbalance/Joint dysfunction (upper & lower crossed syndromes)  Altered reciprocal inhibition  Synergistic dominance  Myofascial dysfunction  Arthrokinetic dysfunction

Manual Therapy

     Spinal and extremity manipulation Mulligan techniques Soft tissue manipulation -NMR -Soft tissue release -Gua Sha -Active isolated stretching Modalities Exercise

Corrective Exercise Protocol (NASM)

    Inhibit- self myofascial release with foam rollers Lengthen- stretching Activate- isolated intramuscular strengthening Integrate- full body intermuscular movements

NASM Exercise Model

Case Study: An Integrative Approach

Psychological

Triad of Health

Biochemical Structural

History

 28 y/o female Caucasian presents with headaches 3-5x/wk that started during high school and have progressively worsened. They are 3-6/10 (10 being worst). Massage, chiropractic and heat are temporarily palliative. Stress and working on the computer are provocative. History of minor rear-end collision in high school. Symptoms worsen during menses. Other complaints include low energy and difficulty losing weight.

Review of Systems

        General – NAD, A&O x 3, overweight EENT, cardiovascular, respiratory, gastrointestinal, genitourinary and neurological are unremarkable Musculoskeletal - neck pain & headaches Skin - eczema Psychiatric - high stress job Endocrine - heavy menses Hematologic - history of anemia Allergy/immunologic - seasonal allergies

PMhx/Family hx/Social hx

       PMhx - unremarkable Family hx - mother has hypothyroidism Social hx - single; non-smoker; light drinker Occupation - Microsoft software engineer Sleep – poor (5-6 hrs interrupted) Exercise – occasional yoga Diet - high refined carbohydrate/fast foods; often skips breakfast and/or lunch

Examination/Diagnostic Testing

        Vitals (Ht 5’4”; Wt 137 lb; BP 90/68; P 77 Eyes - 20/20 vision Head and neck - normocephaly. No thyromegaly.

ENT - tender frontal and maxillary sinuses Cardio/Pulm/Abdomen - unremarkable Skin - dry Cervical X-ray – loss of cervical lordosis Blood work - TSH 5.3; D3 22; Ferritin 20 - CBC and Chem within normal limits

Assessment

 Chronic tension headaches  Hypothyroid  Overweight  Iron deficiency  Vitamin D deficiency  Insomnia

Naturopathic Treatment

 Dietary modification  Supplement prescription  Armour thyroid  Systematic relaxation/guided imagery/breathing home exercises

A Balanced Approach to Diet

  Focus on fueling the body with nutrient dense, anti inflammatory foods that satisfy energy requirements Optimize nutrients     Shift balance of omega-3:omega-6 fats Change carbohydrate sources to fruits and vegetables (low glycemic load) Incorporate lean protein sources with every meal and snack Increase phytonutrients and water

(In other cases, it might be indicated to identify potential food sensitivities through food elimination/challenge)

 Broccoli  Cabbage  Carrots  Cauliflower  Dark green leafy veggies (e.g. Spinach, kale, chard, Brussels sprouts etc.)  Green beans  Peppers  Tomatoes

+ healthy fats, including:

 Avocado  Nuts and seeds  Olive & Canola oil

Healthy Plate

Non-starchy veggies Starch

 Corn  Peas  Potatoes  Pumpkin  Squash  Sweet potatoes  Yams  (Brown/wild rice, oats, Quinoa)

Protein

 Beans & lentils  Beef (grass fed)  Poultry (w/o skin)  Dairy (Yogurt)  Eggs  Fish  Nuts & nut butters

The Power of Color

RED

(anthocyanins, lycopenes) - strawberries, cranberries, raspberries, cherries, grapes, beets, peppers, water melon, pomegranates, apples, onions, pink grapefruit

ORANGE-YELLOW

(beta carotene, lutein, zeaxanthin) - carrots, sweet potatoes, yellow potatoes, orange, mangoes, cantaloupe, pumpkin, squash, apricots, corn, banana, turmeric, ginger

GREEN

(beta carotene, lutein)- spinach, chard, kale, avocado, asparagus, artichokes, broccoli. Brussels sprouts, cabbage, green tea

BLUE-PURPLE

(anthocyanins)- blueberries, blackberries, grapes, red wine, eggplant WHITE- garlic, onion, cauliflower

BLACK/BROWN

- Coffee, dark chocolate, nuts, stout beer The Color Code. James A. Joseph, Ph.D., Daniel A. Nadeau, M.D., Anne Underwood

Supplements (Thorne)/Prescriptions

• •       Multiple with iron Iron - 20 mg qd Vitamin D - 2000 IU qd Fish oil (Nordic Naturals) - 1000 mg tid L-Tryptophan - 1000 mg at bed time Armour Thyroid (Rx) - 60 mg away from iron and multiple TSH to be re-tested after 1 month Ferritin and D3 to be re-tested after 12 weeks

Acupuncture Treatment

1. Symptomatic points - local trigger points 2. Paravertebral points - cervical and thoracic 3. Homeostatic points – facial, upper extremity and shoulder region

Chiropractic Treatment

 Soft tissue release/NMR to address shortened muscles (upper crossed syndrome)  Spinal manipulation to cervical/thoracic/lumbar areas of segmental dysfunction  Headache SNAGS (Mulligan)  Home corrective exercises

Home Corrective Exercises

 Self-myofascial release with tennis balls and foam rollers 

Static stretches

 Isolated strengthening - scaption, deep neck flexors  Integrated movements - squat to row

Outcome

         Patient was seen two times per week for one month Headache frequency was reduced to once per week Sleep, energy and feeling of wellbeing were improved Skin hydration improved TSH after one month decreased to 2.1 (thyroid Rx was refilled for 6 additional months) Frequency of visits reduced to once qo wk for four more visits, at which time headaches were minimal Exercise progressed from corrective to strength training 2x/wk, + yoga 1-2 x/wk At 12 weeks, headaches were infrequent. Vitamin D level was 52 and Ferritin level was 68 Next follow-up was scheduled for 3 months

Recommended Resources

    Certifications: NASM - CES and PES Seminars:       NMR training with Peter Levy, DC Mulligan technique Hands on Seminars – trigger point therapy Gaby/Wright – medical nutrition Stuart Taws – soft tissue release Stuart McGill, PhD (books and seminars) Books:        Natural Hormonal Enhancement – Rob Faigin Good Calorie, Bad Calorie – Gary Taubs The Gunn Approach to Pain – Chan Gunn Acupuncture, Trigger Points and Musculoskeletal Pain – Peter Baldry Trigger point manuals, Travell and Simons Biomedical Acupuncture, Yun-tao Ma, Mila Ma, Zang Hee Cho New Rules of Lifting, Schuler and Cosgrove  Internet: www.vitasearch.com, www.nutraingredients.com

Dr. Geoff Lecovin

Evergreen Integrative Medicine www.eimed.com

[email protected]