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Friday, March 30, 2012

Chiropractic Care Is Effective For Fibromyalgia


Brought to you by: Mendez Chiropractic Center

For years, chiropractic has been considered as alternative medicine. Even so, chiropractic is becoming more and more accepted by the mainstream medical community. Twenty percent of American adults have used chiropractic at some point of their lives. Medical doctors and surgeons now work closely with chiropractors. Most people that use chiropractic have reported good improvement with pain reduction and better function.

Chiropractic is based on the idea that symptoms and illness can be caused by imbalance to the body's skeletal structure and nervous system. Chiropractors look at the body as a whole, rather than just treating symptoms. They see all systems of the body as being connected and affecting each other. All systems of the body rely on a properly functioning nervous system. It is well known by health care professionals that the nervous system is the master system in the body and literally controls every cell and organ in the body.

When there is proper balance to the skeletal and nervous system of the body, persons are more likely to have health and wellness. They are more likely to have a higher quality of life. Even a slight imbalance to the skeleton and nerve system can result in pain and illness. Chiropractors are specially trained to locate and correct imbalances to the skeletal structure. Through special adjusting techniques, they can realign misaligned spinal bones and restore proper function to the nervous system.

Fibromyalgia is a condition that results in several tender points throughout the body that often result in neck pain, back pain and pain in the limbs. To help reduce these symptoms, many people with fibromyalgia are seeking chiropractic care. Specific chiropractic adjustments help to restore proper motion and function of the musculoskeletal system. Problems of the musculoskeletal system are known to trigger symptoms associated with fibromyalgia. Many people suffering from fibromyalgia have significant pain reduction with chiropractic adjustments.

Fibromyalgia is thought to involve turmoil to the central nervous system. This is known as central sensitization which results in hypersensitivity to the nervous system. When there is interference to the nervous system, a person's overall health and wellness is adversely affected. Chiropractors are well trained to help remove interference to the nerves making them a great option for fibromyalgia sufferers.
Chiropractors help correct imbalance to the nervous system by performing specific hands on adjustments to the spine. When bones of the spine become misaligned, it can result in pressure on nerves.

Chiropractors correct the alignments to help remove the pressure on the nerves. As motion and function improve, fibromyalgia sufferers experience significant reduction in pain. Other problems of fibromyalgia such as depression, fatigue and sleep problems also diminish.

Wednesday, March 28, 2012

7 Key Reasons To Seek Chiropractic Care

Chiropracticis a health care profession that focuses on disorders of the musculoskeletal system and the nervous system. Those that use chiropractic care regularly recommend it highly for a variety of reasons. Here are the seven best reasons to find a chiropractor when you aren't feeling your very best.

1. Chiropractic Has Been Proven Safe

Chiropractic is one of the safest therapies available if you are suffering from any neuromusculoskeletal issues such as back, neck, joint, or head pain.

What exactly does safe mean? If you want to talk numbers, then the risk of injury is 1 in 286,000,000, or 0.0002%. Compare that to standard treatments such as medication and surgery where the risk of injury is 1 in 1428. That's right - chiropractic manipulation is that much safer, and as you'll learn later in this report, more effective as well.

The most common issue involving chiropractic isn't an injury at all. It is simply some mild soreness after adjustment. Think about how your muscles feel if you've done something you don't normally do. You feel sore because your muscles, bones, and ligaments have moved in ways they are not used to moving. This is what happens during a chiropractic adjustment but on a minor scale. Any soreness you feel will be gone within 24 hours and most patients feel immediately better with no soreness whatsoever.

Why is chiropractic so safe? There are four main reasons:

Chiropractors have years of schooling with coursework that includes classes on all aspects of the spine.
Chiropractors have been trained, doing clinical work long before becoming licensed.
Chiropractors continue their education long after graduation, completing courses yearly in order to maintain a license to practice.
Finally, and most importantly, a chiropractor's basic philosophy is that the body is capable of healing itself. The purpose of a chiropractor is simply to remove the subluxations, or blockages, that occur in spine so that the body can do its job.
Chiropractic is so safe that agencies unassociated with chiropractic tout its benefits. For instance, the Agency for Health Care Policy and Research (AHCPR), part of the US Department of Health and Human Services, found that complications are rare. Not only that, they suggest that chiropractic should be used before surgery is considered. And finally, they state that prescription drugs are not recommended for most back pains.

2. Chiropractic Has Been Proven Effective for Pain
If you have pain, chiropractic may be just what you need. Studies in the United States and other parts of the world show that chiropractic manipulations are effective. One study in California found that chiropractic was effective 86% of the time for general lower back pain.

But what of acute lower back pain? A report released by the Agency for Health Care Policy and Research recommended chiropractic as the best treatment for this ailment. A study from the University of Pittsburgh Medical Center and the Jefferson County (Missouri) Rehabilitation Centre showed that there was immediate improvement when chiropractic was used to treat acute low back pain.

Study after study has been conducted and study after study has concluded that spinal adjustment is superior to other treatments for acute pain. But chiropractic is beneficial to more than just general, chronic, or acute lower back pain.

Patients of chiropractic seek help for neck pain or discomfort as well. In fact, 19% of patients report neck pain at the first consultation. This pain is usually caused by accident or injury but can also be brought on by every day living.

The modern medical treatment for neck pain is either immobilization or physical therapy. However, studies have shown that spinal adjustments are more effective. For instance, a study done in the Netherlands observed patients receiving one of the three treatments. They found that spinal adjustments improved overall physical functioning more than the other treatments.

Beyond the back and neck, patients often seeks chiropractic care for headaches, including migraines. For chiropractic patients, migraines are often reduced or resolved without using pain killers or other prescription medications. A study was published by chiropractic doctors at University of Odense and the Nordic Institute of Chiropractic and clinical Biochemist in Denmark showing that spinal adjustments and soft tissue therapy allowed for steady improvement.

Many people understand the role of chiropractic in the back, neck, and head because chiropractors are seen as "back doctors." However, chiropractic has proven effective for many other conditions such as carpal tunnel syndrome, fibromyalgia, infantile colic, and much more.

For pain associated with a variety of conditions, chiropractic is proven effective, often more effective than modern medical treatments. Coupled with the safety of chiropractic, it should be your first choice when dealing with pain.

3. Chiropractic is Less Invasive and Drug Free

If you go to a medical doctor due to neck and back pain, you are likely to be given nonsteroidal anti-inflammatory drugs, known as NSAIDS. Although these drugs are given out regularly, they do have significant risks t hat are far greater than the typical issue, soreness, seen with chiropractic.

NSAID risks include:

Allergic reactions, some of which can be life threatening
Hives or rashes
Increased risk of heart attack
Increased risk of stroke
Gastrointestinal issues such as bleeding or ulcers
Cancer
Another typical treatment is bed rest. But this, too, can cause problems such as muscles atrophy, heart and lung weakness, bone loss, and blood clots.

Let's not forget surgery. Surgery is used for neck and back pain whenever painkillers and bed rest don't work and the risks of surgery are great. They include:

Breathing issues due to anesthesia - a patient can quit breathing entirely
Blood loss leading to transfusions
Cardiovascular risks such as heart attack or stroke
Scar tissue
Pain
Infection
Blood clots
Lung collapse
Injury to other areas of the body
Paralysis
Numbness and tingling of parts of the body
Swelling and bruising
And even death
Chiropractic has none of these risks because it is not invasive. There is no cutting on the body and there is no medication prescribed. To avoid the risks associated with NSAIDS and surgery, chiropractic is an excellent choice.

4. Chiropractic is Less Disruptive to Your Lifestyle

Chiropractic is done on an outpatient basis and has easy recovery, often less than 24 hours of minimal soreness. Consider this in comparison to the recovery of surgery.

After any surgical procedure, the body needs time to repair tissues damaged during the surgery so that the body can return to normal. Surgical recovery is a process that can take time, often long periods of time requiring medication and bed rest. In fact, pushing yourself too hard after surgery will cause setbacks and make your recovery time longer.

Chiropractic, on the other hand, has limited recovery time. At most, chiropractic patients may feel some mild soreness in the area of the manipulation. This soreness is typically gone in a matter of hours, not days or weeks as with surgery.

Additionally, surgical patients that are older, out of shape, overweight, or generally in poor health will take far longer to heal and be ready for every day life. Although different factors will dictate how quickly you are pain free, the ability to resume your lifestyle happens quickly with most patients, often with as little as one manipulation.

5. Chiropractic is Less Expensive

In August 1999, Blue Cross/Blue Shield (BCBS) of Kansas presented a study titled "Lumbago Treatment." When viewed per treatment episode, chiropractic was shown to be more cost effective than anesthesiology, neurosurgery, neurology, registered physical therapy, orthopedic reconstructive surgery, physical medicine and rehabilitation, and rheumatology.

Why so cost effective? Medical doctors and physical therapists rely on:

Referrals
Prescriptions
Surgery
MRIs
CT scans
Hospitalization
Over 50% of the charges are simply for diagnostic procedures and not for actual pain relief.

On the other hand, the majority of chiropractic expense comes from office based treatment with less than 10% of costs arising from diagnostics, typically in the form of spinal x-rays.

A study in the May 2007 Journal of Manipulative and Physiological Therapeutics showed that chiropractic resulted in a 60.2% reduction in hospital admissions, 59.0% reduction in hospital days, 62.0% reduction in outpatient surgeries and procedures, and 83% reduction pharmaceutical costs when compared with conventional medicine.

By reducing these items, overall costs associated with chiropractic care are significantly less than that of traditional medical care.

6. Chiropractic Helps With Injuries Due to Accidents

Chiropractic is beneficial in treating various injuries such as sprains, pulled muscles, and joint problems due to auto, sports, work, and everyday injuries. The most common injuries due to accidents are:

Whiplash
Lower back misalignment
Upper back and neck misalignment
Repetitive motion injuries
Whiplash is the sudden movement that causes distortions to the neck. This type of sudden movement often happens during a car crash, even one at very low speeds. Although you may not initially feel any pain, the vertebrae that move out of place will eventually cause problems with the nerves and cause you pain from misalignment or subluxations. Medical doctors prescribe pain meds and bed rest for whiplash, which may be good for a day or two, but not for the long run. There is no way to remain in bed indefinitely nor is it possible to function regularly on pain medications. A chiropractor will help you with the cause of the problem rather than help you manage the symptoms.

Lower back misalignment can happen suddenly or over a long period of time. For instance, you can improperly lift something heavy resulting in immediate back pain, or you can simply have poor posture that results in back pain over time. The misalignment causes subluxations that can be corrected using chiropractic.

Lower back pain is made up of several different low back problems including:

Vertebral subluxations
Injured discs
Muscle strain
Ligament sprain
Scoliosis
Sciatica
And more.
The ability to correct injuries holds true for the upper back and neck as well.

Repetitive Motion Injuries are a fast growing source of pain in the United States often associated with the workplace, particularly sitting at a computer terminal for long periods of time. Repetitive motion injuries cause less oxygen to get into the muscles and this causes scar tissue to develop. Chiropractic releases the subluxations causing the pain.

So, whether your pain is from a car accident or merely sitting incorrectly at work, chiropractic is a way for you to feel better fast.

7. Chiropractic: Because You Live, Move, and Breathe

Because you are alive and move about, you are sure to cause a misalignment of your spine at one time or another. Simple movements such as sitting or bending can cause problems. So can walking, running, stretching, and lifting. In fact, any movement can create a subluxation and subluxations cause pain when left alone. So, if you move, then you can benefit from chiropractic.

Whether you are out running every day or see yourself more as a couch potato, chiropractic can be beneficial to you. It is the most effective natural healthcare available. And, as you've learned, it is safe, effective, non-invasive, inexpensive, and great for any injuries you may have. If you live, move, or breathe, you should have a doctor of Chiropractic as a member of your personal health care team.

Monday, March 19, 2012

How to Improve your Sleep


Brought to you by: Mendez Chiropractic Center

An old Chinese proverb states, "Only when one cannot sleep does one know how long the night is." Anyone who's ever experienced an occasional bout with insomnia—and that's most of us—can relate to this all too well.

In fact, surveys have shown that between 40 and 60 percent of the general population has trouble sleeping. Daily stress and worries, pressures from job and family, body aches and pains caused by uncomfortable beds or pillows, and a host of other issues can keep a person from getting enough quality sleep.

Sleep is critical to good health and functioning, so lack of it is a serious matter. "Sleep is one of the most important functions of the brain," says Frederick R. Carrick, DC, PhD, president of the American Chiropractic Association's Council on Neurology. Through it, our bodies recharge and renew for the next day's challenges.

As wellness experts, doctors of chiropractic can provide patients with a different approach to their sleeping problems-without the use of sleeping pills, which leave many people in a mental haze the next morning. To start, here are a few helpful tips they would recommend for the sleepless in Seattle (or any city, for that matter):
Exercise regularly. Exercising in the morning is best, but if you must exercise in the evening, do so at least two or three hours before bedtime. Any later, and your increased heart rate can interfere with your sleep.

Limit your intake of caffeinated beverages such as coffee, colas and tea-try to avoid them altogether late in the day and near bedtime. In addition, for each cup of caffeinated beverages you drink each day, drink an equal amount of water.

If you have trouble sleeping and then get thirsty, drink tap water at room temperature (cold water may disturb the digestive system).

Eat an early dinner. Eating after 6 p.m. may interfere with sleep as your body works to digest the food you've eaten.

Go to bed at the same time each night and get up at the same time each morning. The routine will help your body know when it is time to rest.

Keep your bedroom at a cool, comfortable temperature and try to make it as dark as possible when you're ready for bed.

Creating a comfortable place to sleep by choosing the correct mattress and pillow is also essential to getting the quality sleep that your body needs to function at its best.

A mattress, for instance, should support the body's weight evenly and allow the spine to stay in its natural alignment. Choosing the right one is a personal matter. "There are a wide variety of comfort preferences. It's very subjective," says Brian Darcy, operations manager for Springwall, the manufacturer of premium-quality Chiropractic® sleep sets that ACA has endorsed for the past 38 years. Give your mattress a good trial run before you buy it. Darcy recommends lying down on a mattress for a minimum of three to five minutes to get a good feel. Sitting on it simply won't do.

Useful mattress facts...
A mattress should provide uniform support from head to toe. If there are gaps between your body and your mattress (such as at the waist), you're not getting the full support that you need.

If you do have back pain and your mattress is too soft, you might want to firm up the support of your mattress by placing a board underneath it. But do this just until the pain goes away; such firmness is not good for "routine" sleeping.

Every few months, turn your mattress clockwise, or upside down, so that body indentations are kept to a minimum. It's also good to rotate the mattress frame every so often to reduce wear and tear.

If you're waking up uncomfortable, it may be time for a new mattress. There is no standard life span for a mattress; it all depends on the kind of usage it gets.

Be aware that changes in your life can signal the need for a new mattress. For example, if you've lost or gained a lot of weight, if a medical condition has changed the way you sleep, or even if you have changed partners, it could mean that it's time to find a new mattress that will accommodate those changes and help you sleep more soundly.

If you're not in the market for a new mattress, and your current mattress is too firm, you can soften it up by putting a 1- to 2-inch-thick padding on top of it - usually available at mattress and bedding stores.


Next, pillow talk... 
After investing in a quality mattress, don't forget to choose an equally supportive pillow, advises Peter Mckay, DC, who is in private practice in San Diego and also works as a consultant for Innovative Choices, the maker of the Therapeutica Pillow-another ACA-endorsed product. "People will spend thousands of dollars on a mattress and then skimp on a pillow that doesn't support their head and neck properly," he observes. A good pillow will keep the cervical (neck) section of the spine aligned with the thoracic and lumbar (chest and lower back) sections. "[The sections] move together and should be supported together."
When choosing a pillow, be selective. When lying on your side, your head and neck should remain level with your mid and lower spine. When lying on your back, your head and neck should remain level with your upper back and spine. In other words, your pillow should not be so thick that it causes your head and neck to be propped up or angled sharply away from your body.

Be wary of pillows that are made out of mushy foam materials. The weight of your head can displace this kind of foam, leaving little support. Choose firmer foam and materials that press back and support the head.

If you find yourself sleeping on your side with one hand propped under your pillow, that's a clue that you're not getting the support you need from that pillow.

There is no such thing as a universal fit when it comes to pillows. Find one that is consistent with the shape and size of your body.


Chiropractic Care Can Help...
If you continue to experience pain and discomfort at night or have difficulty falling asleep, visit your doctor of chiropractic. Doctors of chiropractic are trained to treat spinal problems that can interfere with a restful night's sleep. They can also offer nutritional and ergonomic advice that can help improve the quality of your sleep.

Tuesday, March 13, 2012

Improving Creative thinking through Chiropractic

Brought to you by: Mendez Chiropractic Center

Creative thinking is one of the greatest human assets in that it initiates new thoughts and world changing ideas. Creativity is the ability to generate ideas of both novel and useful form to a particular social setting. Innovative thoughts inspire excitement and unlock the depths of human potential. New research has shown that chiropractic adjustments significantly improve the creative thought process.

Life is dull, bland and stale without the ability to be creative. The unrestricted human mind has the ability to solve problems with new ideas that build off of the latest technology of the day. In fact, nearly every problem mankind has ever faced has been solved by a new, more creative way of thinking and living.

Real World Implications for Creative Thinking

Professional athletes have big incentives to perform at an elite level every time they participate in their sport. Business people, doctors, scientists and others have incentive to perform at their highest level every time they step foot into their specific arena. The ability to think quickly and innovatively is one of the characteristics that allows these individuals to have extraordinary success in their field. These characteristics also allow these professions to evolve to a higher level.

Therapies and ergonomic aids such as caffeine, herbs, and medications have been used for many years to help individuals perform better in their particular field. Performance aids that benefit the individual with very low risk of danger, side effects or addiction are valuable commodities.
A recent study showed that chiropractic adjustments positively affected creative thinking. The pilot study was published in the June 2010 edition of the Chiropractic Journal of Australia.

This study used the "alternative uses test" to measure creative abilities pre/post adjustment. The alternative uses test has the individual write down as many uses for a specific object as possible during a ten minute period. An example would be to name all the different ways one could use a newspaper, a chair, or a shoe.

Pre-testing using the alternative uses test was performed in the beginning on all ten research participants. Then each of these participants was assessed for subluxation. Subluxation is "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health."

Following the assessment the subjects were administered a chiropractic adjustment. The adjustment is defined as, "A maneuver in a specific vector, velocity, intensity of force and point of application that is intended to assist the body in restoring normal tone by correcting subluxation in whole or in part." After the adjustment, the subjects performed another version of the alternative uses test.

Chiropractic Improved Real World Creative Tasks

The subjects were then interviewed two to eight days later after the adjustment to measure lasting effects on creativity. Six of the ten participants experienced a significant post-adjustment improvement in their performance on the alternative uses test. The follow up interviews showed an even stronger result. Seven of the ten individuals indicated they had new directions in a real world creative task. Six individuals claimed to have renewed energy towards a creative project they had already planned. Meanwhile, none of the subjects interviewed said they noticed less energy or creative thinking since the adjustment.

This study indicates that a majority of individuals had improvement in real world creative tasks for two to eight days post adjustment. With the profound implications that the results suggest, it seems appropriate to allocate substantial research dollars to look more in-depth at the ability of chiropractic adjustments in improving creative thinking.

Monday, March 5, 2012

Carpal Tunnel Syndrome - What Can You Do For It?


Brought to you by: Mendez Chiropractic Center

Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?”  As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like CTS:

1. A thorough history  is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive.  Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
2. A Physical Exam  to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
3. Treatment  can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
4. Home Therapies  are the main topic for this Health Update. What can YOU do for CTS?

Here are some of the things that you, the CTS sufferer can self-manage:

  A Carpal tunnel splint  is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.

Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as:

A. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand)
B. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand).
C. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch!
D. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times.
E. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table-- elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times.
F. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed.
G. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down.
H. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the door frame, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.

  Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.

Low Back Pain: Why Is It So Common?


Brought to you by: Mendez Chiropractic Center




This question has plagued all of us, including researchers for a long time!  Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back?  To properly address this question, here are some interesting facts:

1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that      requires treatment of some sort at some time in life.
2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5. About 2% of the US workforce receives compensation for back injuries annually.
6. Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common?  One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30.  That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.

Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more.  Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “bio-psychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.