727 Route 481

Monongahela, PA 15063



March 2011

Inside this Issue

Shoulder Pain

The Permanence of Soft Tissue Injuries

Magnesium and Sudden Death

Maintenance Visit Policy

Insurance News

Office Hour Changes

Fat Burning Tip

Shoulder Pain

Shoulder pain is a very common ailment that affects most people sooner or later in life. It is probably the 3 rd or 4 th most common condition treated in the office, after neck and back-related conditions.

Why So Common?

Healthy shoulder function involves proper co-ordination of approximately 20 different muscles. The shoulder is a ball-and-socket joint, true, but has a very shallow socket into which the head of the humerus bone fits. The shoulder is designed to be very flexible and allows all sorts of movements. However, it sacrifices stability in order to accomplish this. Though the shoulder bones are held together by ligaments, the main stability of this joint comes from your muscles. Since it is involved in so many daily activities, shoulder injuries are rampant.

The 2 Most Common Causes of Shoulder Pain

Shoulder pain most frequently is caused by localized injury around the joint or, is referred from irritated nerves in your neck or upper back.

  1. Local injury occurs when you overstretch or overload your shoulder muscles and/or ligaments. Partial tearing and inflammation result. You may experience pain with certain shoulder movements, notice your shoulder feeling weak or have dull, aching pain. Normal daily activities can be significantly affected, such as reaching overhead, fixing your hair or getting dressed. You are probably familiar with the term, Rotator Cuff (RC). The RC refers to 4 important, thin muscles that guide shoulder movements. These are commonly injured and known simply as rotator cuff injuries.
  2. Referred pain is also a very common cause of shoulder pain. It occurs when nerves are irritated or inflamed as they pass through openings between the bones in your upper back and mid to lower neck. This happens as a result of automobile collisions, sports injuries, poor posture associated with sitting at your computer, improper neck support while you sleep, among many other common daily stresses on your spine. With referred pain, it is possible to have full use of your shoulder and experience no additional pain when moving it. The pain is often sharper, electric-like, radiating pain that may “shoot” down your arm into your hand. Shoulder pain with numbness in your fingers is probably coming from your spine.

Chiropractic Treatment

Chiropractic care delivers good to excellent results for both types of shoulder problems. If the pain is linked to misalignments in the spine, chiropractic care can retrain the muscles and ligaments to hold the joints in better alignment. This reduces tension and allows the irritated nerves to settle and heal.

Other therapies may speed healing and recovery, including electrical therapy, hands-on “trigger point” muscle therapy, icing your neck or back, and paying attention to the way you sleep and hold your spine throughout the day.

Local injuries require treatment to the affected shoulder muscles and ligaments. They may also include electrical and muscle therapy, wearing a sling, icing your shoulder, exercising with tubing or bands, stretching and modifying the way you carry things or watching your shoulder position when lying down.

Sometimes shoulder pain is caused by both spinal and local injuries and a successful outcome requires that both be treated.

Healing Times

These vary substantially depending on the:

· cause of your pain

· your regular activities

· the severity of the injury

· how long you have had the injury

Maximum pain relief usually takes anywhere from 1 to 3 months of care. Initially, your visits may need to be 2-3 times per week, gradually reducing in frequency as your symptoms and your objective findings allow. It is often necessary to follow through with periodic checkups and care to maintain your shoulders in top condition after maximum healing is achieved. (See the following article: “The Permanence of Soft Tissue Injuries”)

Stubborn Cases

Chronic shoulder problems can be very difficult to treat. Most noteworthy are FROZEN SHOULDERS and CERVICAL STENOSIS.

· “Frozen” shoulder - without timely treatment, muscles can heal stiff and inflexible. Scar tissue infiltrates them and results in permanent loss of mobility. Chiropractic treatment can improve your level of pain and give you better use of your shoulder. However, you may need to see an orthopedist for a procedure called manipulation under anesthesia (MUA). While you are anesthetized, the orthopedic attempts to break up scar tissue and restore more normal flexibility to your shoulder.

· “Cervical stenosis” is a condition in which neglected joint injuries progressively deteriorate until there is no longer enough room between 2 bones to allow a nerve to pass through freely. Chronic misalignment, locking and abnormal movement of a joint leads to osteoarthritis --a degenerative state caused by excessive, premature wear-and-tear on a joint. The disc between 2 bones thins and bulges, joint surfaces become rough and uneven, and bony spurs may form as the body attempts to “shore up” the weak, stressed areas. The result is overcrowding or encroachment of the tunnel the nerve passes through.

Conservative, chiropractic care is effective in many advanced cases of stenosis. If your pain is severe, you may require strong pain medication from your medical doctor as well as your chiropractic care. Occasionally, stenosis is so bad that surgery may be your only option. A trial of 2 to 4 weeks of intensive chiropractic treatment is usually long enough to see whether or not you will respond to conservative care.

MRIs and Rotator Cuff Tears

MRIs are highly advanced imaging tests which can provide in-depth details of your shoulder’s condition. They can pinpoint tears in muscles and tendons, isolate the involved tissues, show swelling of bursas (fluid-filled pouches that buffer tendons as they rub over bones) and pick up bony spurs that result from chronic shoulder irritation.

Some people assume that RC tears require surgery. In fact, only a small percentage do. The most important factor is how you are responding to conservative care over the first 2 to 6 weeks. The body will heal the tear with scar tissue. As long as your pain is decreasing and your use of your shoulder is significantly improving, surgery is optional.

Physical Therapy

Medical doctors, due to their training and beliefs, typically refer their shoulder pain patients to physical therapy. MD’s are not knowledgeable about chiropractic’s effectiveness in helping people with shoulder pain.

Physical therapists are usually good at treating local shoulder injuries. They are typically limited, however, when the cause is coming from the spine and nerves. Chiropractic’s advantage is its ability to sort between the two and offer a combined approach.

Cortisone Shots and Medications

These are commonly used to reduce pain, swelling and muscles spasms. While often effective in giving welcome relief, they do not address the underlying problem. If shoulder and/or spinal problems are not addressed, it is highly likely that ongoing degeneration will continue. Shoulder pain may reappear months or even years later. If degenerative changes advance, it can be more difficult to return your shoulder to normal function.

Summing it up

Keeping your shoulders feeling good requires a healthy neck and upper back, good posture, strong and flexible shoulder muscles and, proper co-ordination and balance between them. Daily habits which stress your spine or shoulders need to be identified and modified. Periodic chiropractic evaluation of your spine and shoulders can detect and treat abnormalities early and help keep your shoulders feeling their best!

The Permanence of Soft Tissue Injuries

Most “soft tissue” (e.g., ligaments or muscles) injuries cause permanent changes which result in ongoing flare-ups or recurrences of your original symptoms. The reason is because they heal with scar tissue rather than new ligament or muscle tissue. Scar tissue is used to “ patch up an injured area. However, it is weaker, less flexible and more pain-sensitive than the original tissue. Even with the best healing and recovery, an injured area is likely to give you trouble on-and-off for years to come. This happens with professional athletes, as well, who are stronger and in far better condition than the average person. Some of the most common soft tissue injuries are sprains and strains to your neck, back, shoulders, knees and ankles.

Soft Tissue Injuries Do Better With Chiropractic Intervention

Soft tissue injuries, like broken bones, will heal on their own, regardless of whether you seek outside help. However, as with broken bones, professional care can do much to assist the healing process, get you back to your normal activities faster and, minimize the chances of long-term pain and disability.

Chiropractic care is a highly effective, safe and natural treatment for soft-tissue injuries. Chiropractic adjustments help realign injured joints and restore normal movement to the affected area. Without them, your body is forced to compensate by increasing or decreasing muscle tension around the injured body part. It adapts to the problem, which further stresses the body and perpetuates new problems, sometimes far from the original injury site. This can lead to premature breakdown of joints and discs from the uneven distribution of stress in your body.

Long-Term Results Usually Require Long-Term Care

To maintain your chiropractic results, periodic adjustments and muscle therapy – combined with regular exercise – are usually necessary. How often you need adjusted varies from person-to-person and injury-to-injury. The interval between your visits can be as long as 3 to 6 months or as short as a week. This depends on how severe your injury was, your work, stress levels, nutritional status, age, postural habits and fitness level. Getting more involved and taking proactive steps to stay well can significantly improve your long-term results.

Although soft-tissue injuries are permanent in nature, chiropractic care is a long-term solution to help keep you in your best possible condition for years to come!

Magnesium and Sudden Death

Sudden heart attacks account for more than half of all heart disease deaths. Researchers tracked 88,000 women for 26 years to see if their magnesium intake was linked to sudden death. It was. Those consuming more than 345mg a day had a 34% lower risk than those consuming 260mg or less. And women with the highest blood concentrations of magnesium had a 77% lower risk of sudden cardiac death than those with the lowest concentrations.

Good food sources of magnesium are leafy greens, beans, whole grains and nuts. Supplemental powdered magnesium is available in the office.

Source: Nutrition Action Health Letter Jan/Feb 2011

Maintenance Visit Policy

We offer a maintenance chiropractic care visit at a discounted fee to encourage you to keep feeling your best and minimize the risk of you experiencing flare-ups or relapses.

The potential benefits you may receive from choosing maintenance care are:

  • Fewer, milder flare-ups
  • Slow or stop the progression of spinal decay/osteoarthritis
  • Prevent premature hip and knee degeneration associated with having one leg shorter than the other or a misaligned pelvis
  • Reduce or eliminate nerve interference resulting from poor spinal function

  • Keep your joints in optimal alignment and moving properly
  • Feel better on a regular basis
  • Improved quality of life; keeping your body in good alignment and function lets you do more of what you want to do!

The three conditions that apply to maintenance care are :

  1. Maintenance visits must be scheduled 3 or more weeks in advance . If you must change it due to a serious situation or emergency (e.g. death in the family, car breaks down, etc.), let us know and we can reschedule it. Maintenance visits rescheduled for other reasons will be at the regular office visit fee. The discounted fee is an incentive for you to commit to better care of your spine and health.
  2. Maintenance visits may not be submitted to your insurance company . By definition, insurance companies do not cover maintenance care.
  3. Maintenance visits must be paid for in full at the time of service . If the service is not paid for, then you will be charged for a regular office visit.

Some of you believed that you had to commit to coming in every 3 weeks to receive the discount. This is not the case. A maintenance visit needs to be scheduled a minimum of 3 weeks in advance to qualify. You are not locked in to any commitment.

A maintenance visit is intended to be a chiropractic version of a dental check-up or cleaning. Its purpose is to keep you feeling good once your maximum improvement level is reached at the end of your relief/corrective phase of care.

With insurance coverage dwindling to cover mostly traumatic-induced crisis care only, this is a way for you to enjoy the benefits of ongoing chiropractic wellness care at a more affordable fee.


Multiple Copays

This continues to be the most confusing issue with insurance. We all wish it was simple, like it used to be. 20 years ago, almost everyone had a $100 deductible. Once you paid that, your insurance paid 80% of additional charges and you paid the remaining 20%. Those days are gone.

Insurance plans have created a dizzying array of coverage packages. In an attempt to keep this simple, I will stay focused on multiple copays.

Some plans have no copays; others require only one copay, no matter your condition or treatment. Then there are those plans which may involve multiple copays. Unfortunately, they don’t spell it out to you when you enroll. It is hard to tell from your insurance card if you have multiple copays. It may appear you only have one. The only way to know is to research your benefits online, call member services, or contact us.

Here are some general guidelines that may tip you off to the possibility of 2 copays for a visit:

· Your FIRST VISIT . You may have 1 copay for the evaluation of your condition and a 2 nd copay for any treatment rendered that day.

· A spinal and non-spinal complaint on the same visit . For example, you have neck pain and heel pain. Each will often have a separate copay.

· Your main problem does not involve the spine . If you are treating only for a foot/ankle/heel problem, a shoulder condition, or carpal tunnel syndrome, even a typical $40 visit could be split in two. One copay for the exam and assessment each visit and, a 2 nd copay for the treatment.

It gets even more involved than that!

Know that you still benefit from being able to treat different problems in one stop . The alternatives are seeing different doctors for each condition or treating separate complaints on separate visits. These would usually still involve 2 copays in the end.

Is there someone you care about who is having a problem you believe Dr.Wohar may be able to help them with?

Feel free to take one of our referral packets

located in the waiting room!

It has information about our office,

Chiropractic in general, and our website,

which may help them take that first step and call .

As always ,

We appreciate your confidence and trust in referring others to our office. Thank you!

Upcoming Dates of Office Hour Changes

Saturday, March 12 th – OFFICE CLOSED

Fat-burning Tip

Exercising twice in one day is more effective at burning fat than one, longer workout. This finding comes from a University of Tokyo study. It showed that 10% more fat was burned post-exercise after exercisers did two 30-minute workouts versus a longer 60-minute workout.

Source: SELF fitness

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