Epidural Steroid Injection Vs. Spinal Manipulation

Spinal Injections and Chiropractic care for symptomatic disc herniations

Did you know that there are over 25,000 spinal nerve root injections given in the U.S. each day? This equates to over one million per year in the U.S. alone! These epidural steroid injections (ESI) carry the most common side effects of infections, dural punctures, bleeding, and nerve damage. There is additional research that suggests a 21% increase of vertebral fracture after ESI. A nerve root injection is the injection of steroids, local anesthetic, and/or saline that is performed under fluoroscopy into the epidural space with the intentions to decrease inflammation and improve healing in that region.

Researchers found that both chiropractic manipulation and nerve root injections improved symptomatic MRI confirmed lumbar disc herniations. The groups were split into a chiropractic manipulation group and a nerve root injection group. Pain levels were measured prior to the start of the therapy and again one month post-treatment. After one month, 76.5% of the chiropractic manipulation group found improvement in symptomatology as compared to 62.7% of the nerve root injection group. However, 60% reduction was found with spinal manipulation; whereas, 53% reduction in pain was found with nerve root injections. With nerve root injections, 5.9% of patients found worsening symptoms and with spinal manipulation, 2% of patients found worsening symptoms after one month of treatment.

Already received an injection? Theres more!

A study from 2004 found that chiropractic care following nerve root injections resulted in 76% of these patients having improvement after one treatment procedure. The researchers found that nerve root injections are proposed to address the inflammatory and central components of spinal pain. Spinal manipulation is proposed to address the biomechanical and neural aspects of the pain syndrome. Spinal manipulation is a safe and effective, non-surgical procedure to address low back pain with radiculopathy both before and after nerve root injections.

Sources:Spinal manipulation postepidural injection for lumbar and cervical radiculopathy: a retrospective case series.

Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections.

How your neck pain can kill you!

In talking with some patients, I’ve come to realize not many people understand the importance of a chiropractor being a portal-of-entry provider (meaning, you don’t need to have your MD write a script for you to see a chiropractor). This is a valuable commodity, especially if you have insurance, of which you can take advantage.

First of all, let’s talk about why this is an excellent option.

From a chiropractor’s perspective:

We endure the same amount of schooling as a other medical professionals at a doctorate level, except we focus more on the biomechanical aspect. This is important because a chiropractor can rule out red flags or deadly conditions and/or refer you to the appropriate provider.

From a patient’s perspective:

(Most of) You have insurance to take care of any of the health-related problems. Take advantage of it! Why live with neck pain/headaches when you can have your condition treated effectively and be pain-free? Also, it’s always a good idea to have anything that isn’t normal examined by a professional to make sure it’s not a bigger problem than you think.

So how can neck pain kill you?

Essentially there are two ways that we will discuss, which I’m going to call non-diagnosis and misdiagnosis. Non-diagnosis is leaving a neck condition untreated until it is too late. These are the red flag conditions in which chiropractors are trained to diagnose and refer to a specialist such as beginning signs of stroke, tumor, cancer, etc. Misdiagnosis is essentially a condition that is diagnosed wrong. Although misdiagnosis can happen in any office or with any provider, some are more extreme. Of these most extreme, I’ve seen many of patients that had common, successfully treated-with-chiropractic conditions that have undergone risky operations because of misdiagnosis. The American Chiropractic Association created a graphic to depict the risks of death with commonly used prescriptions/surgeries versus the risk of stroke with neck manipulation.

neck pain; neck; pain; chiropractic; risk of death Now, would you rather go to a surgeon and have surgery for something that can be treated by a chiropractor in 4-12 visits, or would you rather go to a chiropractor and be referred to a surgeon for a condition that absolutely needs surgery?

If you decide to choose conservative, choose chiropractic that works and please give us a call at (570) 621-4390.

Why do joints crack when they’re adjusted?

The age old of question of “why do my joints crack/pop when they get adjusted?” is answered with this study! The most popular belief was the theory that tiny gas bubbles are “popped” and the gases are released from the joint. This study demonstrates the reverse! The popping is the rapid development of bubbles inside the joint. Picture a deflated air bag in between each joint. When it is manipulated a certain way, this air bag is rapidly inflated. This makes a lot more sense then “your joints create bubbles that pop when we apply a specific force.” As mentioned by the author, this study supports the other recent study that cracking your knuckles does not cause, and actually helps slightly prevent, arthritis.

So, basically, chiropractors are helping massage the cartilage inside each joint. Although I haven’t found any research to support it, it makes sense why restricted joints are restricted – there’s no “air bag” or extra cushion between the joints.

If you’ve never had a chiropractic adjustment or are suffering from any type of injury or pain, stop by and check us out! We gladly accept walk-ins or feel free to give us a call to set up an appointment today!

New Year, New You

Along with the New Year, most people make resolutions to eat healthier, lose weight, or just become more active. Unfortunately, these efforts frequently remain efforts rather than evolving into results. So why do most efforts fail?Here are some tips and tricks to help you with your diet and exercise goals.


Let’s start by talking about the major two things to avoid during this time. Then, check out the additional pointers to help you change your diet and avoid falling off the wagon!


These foods include canned foods, foods with a laundry list of ingredients that you cannot pronounce, anything with high fructose corn syrup, and anything with bleached flour. Some might call these all the stuff that tastes good. The reason we try to avoid these foods is because they are composed of harmful ingredients that can create inflammation in your gastrointestinal tract which increases inflammation throughout the body. The other reason is because they are usually simple carbs and empty calories. This means you’re taking in a lot more calories than you can use, so the body stores these calories into the fat cells.


One of the best things you can do when trying to lose weight is by just eliminating sugar intake. I know some of you are saying, hey, shouldn’t that be considered processed foods? I wanted to separate it to talk about how just eliminating excess sugars can help you LOSE WEIGHT. This is the same premise as the processed foods, which are chock full of sugars and simple carbs. Some condiments have sugars added to them. Generally, if it has less than 5g of sugar per serving, you should be okay to use it. If you want to lose weight, eliminate excess sugar. After about two weeks you will notice you’re not craving it anymore and you will notice an increase in energy and mood!

Some additional pointers:

Small changes go the distance– when trying to remodel your diet, small changes make the biggest impressions and last longer.

Keep a diet diary– just by writing down everything that enters your mouth, you can easily see that you may not be eating as healthy as you thought!

Fruits are naturally sweet desserts– having a craving for something sweet? Try fruits as a snack. They are made up of complex carbs that don’t digest as easily and are naturally sweet. This helps curb the sweet tooth.

Still hungry? Add more veggies, protein, or good fats– fiber in veggies and complex macromolecules like proteins and fats can help you feel full longer.

If you have any additional questions or concerns, feel free to contact me.


So what things will help you meet your exercise goals and prevent you from falling off of the wagon?


This may seem like a no-brainer, but, without fail, many people cut their resolutions short because of injury. We tend to fall into a sedentary lifestyle, especially, around the holidays. Muscles tighten, joints get achy, and our bodies adapt to these changes. Then we make a resolution and the next day we’re out there training for a marathon or training to lift a bus. We forget that before you can run, you need to (re)learn how to walk. Some keys to injury prevention are warming up before work outs, working on mobility and stretching, and a progressive workout regimen.

See your chiropractor

We spend 4 years (after college) studying movement patterns, injury prevention, and treatment methods to improve function and pain. Chiropractors are the biomechanical specialists in the medical world and can make sure the joints are moving properly, muscles aren’t inhibiting your efforts or at risk of injury, and your movement patterns aren’t altered. Pain is often the last indicator your body gives when something is wrong. Ignoring that is like ignoring your smoke detector even after you smell smoke – it doesn’t make sense!

Some additional pointers:

Set minor goals and major goals for the future – I love to sign up for 5K races for the spring, summer, and fall because it helps me train. Setting minor goals gives you something to work towards and keep you on track.

Don’t forget to lift weights – Compound movements mimic our natural movements so it makes sense to train that way. Furthermore, muscles burn calories. By lifting weights, you won’t get bulky or big (unless you train that way and intake huge amounts of calories), but you will look and feel better.

Mobility!– Don’t forget to stretch and warm-up. This is key for injury prevention. I prefer to use a foam roller to work out my tight muscles, especially on my rest days.

Pain alters movement -Soaking in Epsom salts can help reduce muscle tension and relieve delayed onset muscle soreness. Biofreeze is also a great product for pain relief. When topically applied, it helps create a cool sensation over the area which helps you reduce pain and prevent altered movement patterns.

If you have any additional questions or concerns, feel free to contact me.

Spine, Low back pain

Do I need an MRI?

Since starting practice, I’ve seen a lot of patients with low back pain and neck pain (some with radiation into the arms or legs). A popular question by those that are concerned about their condition is: do you think I need an MRI? Luckily, my second job gives me access to widely accepted, best available guidelines. Here are the guidelines regarding low back pain and MRI:

Spine, Low back painLumbar Spine:
Unequivocal objective findings that identify specific nerve compromise on the neurologic examination are sufficient evidence to warrant imaging in patients who do not respond to treatment and who would consider surgery an option. When the neurologic examination is less clear, however, further physiologic evidence of nerve dysfunction should be obtained before ordering an imaging study. Indiscriminate imaging will result in false-positive findings, such as disk bulges, that are not the source of painful symptoms and do not warrant surgery. If physiologic evidence indicates tissue insult or nerve impairment, the practitioner can discuss with a consultant the selection of an imaging test to define a potential cause (magnetic resonance imaging [MRI] for neural or other soft tissue, computer tomography [CT] for bony structures).
ACOEM Guidelines, Chapter 12 (Low Back Complaints) (2004), pg 303

Simply put, not necessarily. In our thorough examination, we determine our clinical opinion of whether or not an MRI is needed. The guidelines suggest that neurological examination (muscle strength, sensation testing, reflex testing, and orthopedic tests) is sufficient to determine necessity of an MRI AFTER a trial of (conservative) treatment. Conservative treatment includes medications, physical medicine (chiropractic, physical therapy), and a therapeutic exercise treatment plan. The guidelines also warn of imaging resulting in false-positive findings, such as disc bulges, that are NOT the source of painful symptoms. Too many times, MRIs are performed that reveal degenerative disc disease or disc bulges. It is important to note that these are secondary findings and do not indicate the source of the pain.

With this being said, there are specific criteria that may indicate an immediate MRI or referral to orthopedist for a consult. These criteria include: red flag conditions, subacute and chronic radicular syndromes, and nonspecific low back pain. Red flag conditions are acute LBP during the first 6 weeks if they have demonstrated progressive neurologic deficit, cauda equina syndrome, significant trauma with no improvement in atypical symptoms, a history of neoplasia (cancer), or atypical presentation (e.g., clinical picture suggests multiple nerve root involvement)-a mouthful! So simply put: any history of cancer, presentation of symptoms not commonly seen in our practice, rapidly decreasing strength, numbness in the entire groin area from low back to lower stomach, or bowel/bladder changes. Subacute and chronic radicular syndromes are pains shooting to the legs for at least 4 to 6 weeks in whom the symptoms are not trending towards improvement. And nonspecific low back pain is select chronic LBP patients in order to rule out concurrent pathology unrelated to injury. Basically, that means patients with long-standing low back pain that have no idea how it came about and may have history of infection, family history of cancer, etc.

So you have low back pain that may be sending pain down one or both of your legs; what do you do? First and foremost, don’t panic! At Revive Chiropractic, we commonly see patients that had pain for a long time that are waiting for it to go away and it doesn’t After a thorough diagnosis, we determine if the patient is a candidate for chiropractic care. In the rare occurrences of something that raises a red flag or fits the criteria, we gladly help the patient take the next step into their road to recovery by referring to the appropriate physician or for further imaging (MRI, CT scan, X-Ray). For the majority, we will start care on the first visit. Generally, we will see a change within the first week of treatment, which lets us know we’re on the right track.

The criteria for treating neck pain are very similar to low back pain. If you have low back pain or neck pain with or without radiation into the extremities, we can help! If you’re in the Pottsville area of Schuylkill County, call today to schedule an appointment at Revive Chiropractic (570) 621-4390.

Benefits of Chiropractic Care

Seven Year Study about the Benefit of Chiropractic Care

Benefits of Chiropractic Care

Two chiropractors and one medical doctor performed a study to analyze clinical and cost utilization data from 1999 to 2005. These physicians compiled random patient surveys and independent physician association-incurred claims and descriptively analyzed them for clinical utilization, cost offsets, and member satisfaction. They compared patients with a medical doctor as a primary care physician (PCP) to patients with a chiropractor as a PCP. Overall, 70,274 member-months (the total number of participants who are members for each month) were examined, and patients using a chiropractor as a PCP yielded the following results (as compared to patients using a medical doctor as a PCP):

  • 60.2% decreased in-hospital admissions
  • 59% decreased hospital days
  • 62% decreased outpatient surgeries and procedures
  • 85% decreased pharmaceutical costs

Importantly, the data compared between chiropractor PCP patients and medical doctor PCP patients shows drastic differences in the previously mentioned areas. The decreases noted in all these areas means decreased out-of-pocket expenses as well as decreased expenses for insurance companies. The incentives to decreasing costs to the insurance companies may mean lower premiums or extended coverages with the current premiums. Additionally, the data indicate improved health in the patients seeing chiropractors in that there are less prescribed drugs being taken, surgeries performed, hospital stays, and admissions to hospitals.


For more information, visit our Contact page or give us a call!