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What does it mean to be a Chiropractic Sport Specialist?

By definition “chiropractic is an evidence-based, non-invasive, hands-on health care discipline that focuses on the musculoskeletal system.” – Ontario Chiropractic Association

Chiropractors treat a large range of maladies related to the spine, pelvis, nervous system and joints. After a thorough patient history and physical exam, a  chiropractor may use a combination of treatments, manipulations, hands on therapies, exercise prescriptions and lifestyle counselling. A chiropractor is indisputably an integral part of our primary healthcare team.

So what makes a Sport Specialist Chiropractor stand out?

Sport specialist chiropractors are highly educated and uniquely trained to provide expert assessment, diagnosis, and management of musculoskeletal conditions. In addition to a health science or kinesiology undergraduate degree and 4-year Doctor of Chiropractic degree, the intensive post-graduate sports sciences fellowship can take an additional 4 years to complete. With over 1500 hours of field work, academic focus on exercise physiology, sport nutrition, sport psychology, radiology, advanced imaging, rehabilitation, sport specific research, acute and chronic injury management, and sport administration training, the sports sciences fellowship provides the most extensive sports specialty training in the chiropractic profession.

 

Dr. Arif Karmali

Strength Training and Knee Pain

With Strength comes stability and with stability always comes less pain.

If you have spent any amount of time in our clinic, this is something you have more than likely heard. Dr Karmali shares a little on what makes stability so important to the health of our joints.

“When it comes to maintaining the long-term health of any joint in our body, stability plays a critical role. Take for example, the knee.
The knee joint is the largest and most superficial joint, primarily operating as a ‘hinge’, allowing for bending and straightening of the leg. These hinge movements are combined with gliding, rolling, and rotation, which add to the functional complexity of the knee. Despite being well constructed, the knee joint is relatively vulnerable mechanically because of the in-congruence of its articular surfaces, which can be likened to two balls laying on a warped tabletop.

With that thought in mind, imagine if we didn’t have any ligamentous or muscular control to hold things together… We wouldn’t have a very good knee and understandably, be more prone to injury or accelerated joint degeneration. It is with this notion that ensuring the integrity of joint-specific ligaments as well as adequate and timely neuromuscular control that we can provide our joints with optimal loading and force dissipation to maintain and even improve their longevity.”

Our Approach to Knee Injections

Joint injections and musculoskeletal (MSK) injections are increasingly common in Calgary and indeed, across North America.  At both Elite Sport Performance as well as our private Knee Clinic, we utilize various injections when clinically indicated.  Joint and musculoskeletal injections can be done either blind or with the benefit of image guidance.  Various studies purport that blind injections into a joint have an accuracy of somewhere around 63% to 75%, while image-guided joint injections enjoy an accuracy of between 95% and 99%.  Unsurprisingly then, the popularity of image-guided joint injections is increasing.  There are still some ‘old-school’ physicians who claim to be able to do a blind injection with a high degree of accuracy, but the statistics do not support this approach.

 

When performing an image guided injection, the practitioner has the option of using a diagnostic ultrasound or a much more expensive piece of equipment called a fluoroscope.  A fluoroscope is effectively a live x-ray exposing the patient to a not-insignificant degree of radiation.  Diagnostic ultrasound, on the other hand, is non-irradiating.  With respect to fluoroscope-guided procedures, a small amount of dye is typically injected so that the physician can confirm that the needle placement is correct.  This is in part necessary because the fluoroscope does not show in great detail the soft tissues in the area in question.  Diagnostic ultrasound, on the other hand, does not require any dye injection and shows in considerable detail the soft tissues surrounding the target to the injective.

 

There is another less palatable reason for a doctor to use a fluoroscope for image guidance rather than a diagnostic ultrasound, and that is the ability to bill Alberta Health Services for a ‘surgical procedure’ for even the most basic injection.  This billing code allows the physician to bill Alberta Health Services over $600 for simply turning on the fluoroscope when a much less expensive, less dangerous ultrasound option exists.  Diagnostic ultrasound procedures are billed at a dramatically lower rate to Alberta Health and can also be utilized within a truly private clinic.  Compounding the disparity between these two procedures is the timeliness with which they can be done.  Image-guided joint injection by a physician using a fluoroscope currently is accompanied by a wait of weeks to months within the city of Calgary.  The same image-guided joint injection using a diagnostic ultrasound can often be done within one or two days.  This represents a significant cost-savings of time for a patient looking to have a procedure done sooner rather than later.  This timeliness, along with the different ethical approach in billing Alberta Health Services so much money for a simple procedure, is why there is quite a difference in pricing for certain injections within the city.

 

Ultimately, it is the patient’s prerogative which route they choose to take,  but consider asking the clinic which method of image guidance they use and ask yourself if costing the public system more than $600 extra really represents good value for you, your family, or your community.  Paying a little bit extra to have the procedure done privately in a timely fashion, using a non-irradiating guidance such as diagnostic ultrasound, can allow you to feel better both physically and morally.  For more information regarding this topic or to learn more about any of the injections that we offer within our clinic, please reach out at (403) 689-9889 or reception@kneeclinic.ca.

Inflammation and OA

Osteoarthritis (OA) was previously considered non-inflammatory. It is now well recognized that inflammatory mediators are produced and can be measured in joint fluids of patients with OA. This inflammation is a major risk factor in cartilage loss, pain, swelling, and stiffness. When management and treatment of OA consists of anti-inflammatory components, patients can improve their function and decrease pain levels. Platelet-rich plasma (PRP) is a cell therapy, that uses one’s own blood through joint injections, to reduce inflammation. Platelets are a high source of concentrated growth factors and inflammatory mediators. Platelets in PRP release many types of anti-inflammatory proteins that signal cells that lead to suppression of inflammation in OA.

 

Goldring and Otero. Inflammation in Osteoarthritis. Curr Opin Rheumatol. 2011; 23

Xie et al. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014; 16