Category Archives: Uncategorized

Questioning Efficacy of Knee Arthroscopy

The knee is the largest joint in the body with knee pain affecting millions of Americans. Meniscus cartilage tears and degenerative osteoarthritic wear affect nearly 1 in 2 people. Arthroscopic surgery, one of the most common treatments, may be no better than less invasive therapies for degenerative meniscal tears, and may exacerbate the osteoarthritis. Two landmark studies in 2002 and 2008 concluded these findings. Less invasive alternatives include lifestyle modification, medication, active physical therapy rehab with a home exercise program, passive physical therapies, hyaluronic acid injections (Hyalgin, etc), and platelet rich plasma (PRP) injections. Clinicare is able to provide combinations of all of these procedures.

Victory over imbalance and vertigo

For over a decade, Clinicare has been actively treating balance and dizzyness patients, which are usually seniors, many of who have had one or multiple falls. Technically described as “Vestibular Rehab”, these symptoms account for about a third of all healthcare visits, the second most common complaint seen in doctors visits, and at some time in a persons life will affect 70% of this nations population. 2013 direct medical costs of falls were $34 billion. Causes are multiple and include function of the inner ear (vestibular system); neurologic including the brain stem and cerebellum (central nervous system); the musculoskeletal system including the back, hips, ankles and legs; the nerves of the neck, back and legs (spinal and peripheral nerves); age; health status; etc. Common focuses is on multiple issues of the vestibular ear system and include diagnostic terms such BPPV, Meniere’s disease, acoustic neuroma, labyrinthitis, and others. Our experience is that most patients do not fall into a simple single textbook diagnosis but have multiple causes involved. We believe our experience as a group of providers with multiple backgrounds working in a unique group setting offers the most hope for patients recoveries. Treatment often involves cardio type rehab exercise, specific eye (oculomotor brain) and head (vestibular) movements and exercises, cranial osteopathic and chiropractic manipulation and other passive physical therapy. Please see the video on our website for an example.

Shoulder Diagnostic Ultrasound Advantages Over MRI

While MRI remains the gold standard for musculoskeletal imaging studies, there are several advantages of using diagnostic ultrasound before going to MRI/MRA. The March 2015 issue of Radiology Today quoted from Medscape that to diagnose full thickness rotator cuff tears ( common in both sports injuries and Medicare aged patients), the diagnostic accuracy is high and similar in both, but ultrasound is less expensive, can easily use motion in real time, and can be used at the point of care to perform the diagnosis. “Therefore, when considering accuracy, cost, and availability, US is likely the best option in most settings” For these reasons Clinicare uses ultrasonography both as a diagnostic tool and for guiding injections and other procedures. Both Dr Silver and Kaliakin have had extensive training in this modality and Dr Kaliakin has taught this subject since 2001.

Exploring the Link Between Joint Pain and Weather Changes

Researchers have established that changes in barometric pressure and other weather conditions, affect inflammation and joint pain. These changes can aggravate pain in these joints. Inflamed osteoarthritic joints, including neck, back, and extremities, have edema in the surrounding joint that  contracts or expands in a minute amount but enough to decrease or increase pain. Stormy weather represents low atmospheric pressure increasing joint expansion and pain while sunny weather, high pressure, contacts the joint edema, decreasing pain. Similarly a blown up ballon will expand the higher it rises and contract the lower it descends.

Co-Managed Care Gaining opularity for Back Pain Care

A new study, “Perspectives of Older Adults on Co-Management of Low Back Pain by Chiropractic Doctors and Medical Physicians”, confirms that patients are interested in receiving co-managed treatment for their back conditions and that the two professions encompass complimentary strengths. Although co-management is currently uncommon, the collaboration offers a unique opportunity for first rate care at a desirable cost.

The above follows Clinicare’s unique position of Medical, Chiropractic and Physical Therapy providers truly working together, in house, with the majority of our patients, if they wish to do so.

Clinical Significance of Lumbar Spine MRI Findings

In a resent article by Debra Rate DC, DACBR, describes much conflicting data with the following observations:

1.Not all MRI abnormalities have a clinical significance regarding disc displacement and patient symptoms.

2. The type or size of disc herniation may correlate poorly with clinical signs and symptoms.

3. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms.

4. There is strong tendency to treat disc lesions seen on MRI, but these findings may not be the cause of the patients symptoms.

5. Agressive treatment of disc herniations have created enormous cost increases but have not improved outcomes accordingly or disability rates.

6. Increase in treatment has created a huge use of MRI for evaluating back pain, less than 50% considered appropriate, and association of adverse outcomes including unnecessary surgeries and increased costs.

2007 Harvard Back Surgery Study

1. 62% of all personal bankruptcies in 2007 are due to unpaid medical bills.

2. 78% of these had insurance.

3. Medical Industrial Complex, AMA, HMO’s, Big Pharma and AHA were never brought before Congress like Wall Street was.

4. 60 million surgical procedures in US 2006, 1 out of 5 Americans.

5. Medical care- 3rd leading cause of death, 225,000/ year.

6. 100,000 die from surgical complications, far more than auto accidents.

7.WHO- US #1cost, #72 population health, #37 health care delivery, 48 million uninsured.

8. Back pain #8 in top 10 diseases, $40 billion annual treatment costs, $100 to 200 billion total costs per year.

9. Back pain a leading cause of work illness.

10. Overwhelming evidence that Chiropractic management is more cost effective than medical management of back pain and should be in first place as treatment option.

11.Statistacally patients are 78-100% satisfied with chiropractic care.

12. Per AHCPR, surgery helpful in only 1 in 100 cases.

13. “Spinal manipulation is preferred initial treatment for acute low back pain and should only be done by a professional with experience.”

14.”Medicine has a limited understanding of the condition.”

15. Medical resistance still exists to this data primarily from the North American Spine Society which consists primarily of spine surgeons.


Arthritis statistics

50 million americans affected by all types of arthritis.

67 million projected by 2030.

4 pounds of weight taken off the knee for every pound of weight loss.

1 in 3 people with arthritis who are limited in their ability to work.

50% of people over age 65 with an arthritis diagnosis.

45 years of age at which arthritis becomes a risk factor for both men and women.

992,100 arthritis related hospitalizations each year in the US.

Soccer and Brain injuries

“What we’ve shown here is compelling initial evidence that there are brain changes that look like traumatic brain injury (seen on MRI), which are associated with heading a soccer ball at high frequency. …controlling the amount of heading that people do may provide an approach for preventing brain injury as a consequence of heading.” Michael Lipton MD, PhD. Albert Einstein College of Medicine, published in RADIOLOGY.

Sitting is the New Smoking.

From British Journal of Sports Medicine, Oct 2012

1. Every hour of watching TV, presumably while sitting, cuts about 22 minutes from a lifespan.

2. Estimated that smokers cut their life span by 11 minutes per cigarette.

3. Fundamental message is to take micro-breaks, get up from sitting and move around