This article was originally published in the March 8th 2016 edition of the Portland Press Herald, seen here
SOUTH PORTLAND — Kudos to Gov. LePage, who has made the opioid drug crisis in the state of Maine a top priority for his administration.
He is working closely with the leadership of the Legislature to come up with creative, innovative solutions to this problem, which is destroying and devastating so many lives. He has formed a task force to advise his administration on possible solutions. He’s proposed requiring Maine doctors to use the Prescription Monitoring Program before prescribing opioids.
Thinking outside the “script” will be needed to solve this epidemic of human destruction. The problem is beyond calamitous – it is the equivalent of a modern plague of “Pharmagedon.”
How bad is it? According to the U.S. Centers for Disease Control and Prevention, 259 million prescriptions for opioid painkillers were written in 2012: almost one prescription for every adult.
As a result, the CDC reported, 46 people die per day in the U.S. from overdosing on prescription painkillers. If any other issue caused this many deaths, there would be no limit to the mobilization of resources to combat it.
Though the United States has 5 percent of the world’s population, we consume 75 percent of the world’s opioids, the U.N. Office on Drugs and Crime has found.
Taking a global view of this epidemic, one could easily ask: For what ailments are opioids prescribed? Ironically, the majority of the prescriptions are for chronic pain from musculoskeletal disorders. They are back pain (30 percent), extremity pain, osteoarthritis, fractures, neck pain and headaches.
In Maine, the majority of health care is delivered by five corporations. They are MaineHealth (Maine Medical Center), Eastern Maine Healthcare (Mercy Hospital and Eastern Maine Medical Center), Central Maine Healthcare (Central Maine Medical Center), InterMed and Martin’s Point. They provide billions of dollars of health care services each year.
What do these corporations have in common? None has alternative health care practitioners on their staff. The only medical center with a chiropractic physician on staff is the Veterans Affairs hospital at Togus.
Why is the public restricted from the opportunity to receive proven alternative health care services when they seek pain relief at the facilities owned by these corporations?
After careful review of the research and evidence, the CDC and American Public Health Association are advocates of conservative, non-pharmacological pain treatment alternatives, including chiropractic services, acupuncture, meditation, yoga, anti-inflammatory diet recommendations and exercise.
Gov. LePage should mandate that a chiropractic physician be part of the triage team to initially evaluate patients seeking pain relief for musculoskeletal disorders. They should be in each emergency room and hospital as a specialist in musculoskeletal disorders. The education and training of doctors of chiropractic make them uniquely qualified, and every study reveals a high level of patient satisfaction.
This proven alternative approach and input to the evaluation of the patient will help direct the type of care the patient should receive. This can range from very conservative care to more invasive care, always beginning with the most conservative approach.
This innovative non-pharmaceutical approach may not be well received by Big Pharma as we work together to try to limit the number of painkillers prescribed. This is a stark contrast to the current approach to pain management. On the fiscal side, hospital administrators may have issues: Will this approach increase or decrease revenue?
A paradigm shift in health care is upon us. The old model is “the more you do, the more you make”; the new one is “the less you care do with outstanding outcomes, the more you earn.”
Chiropractors collaborate with our medical and osteopathic colleagues coordinating care for our mutual patients on an outpatient basis. There are many cross-referrals between the professions. Working side by side will only help the professions understand how each of us looks at and evaluates the patient’s best treatment options.
The health care model of tomorrow will mandate collaboration, integration and innovation, such as at Togus, where doctors of chiropractic are integrated into the Veterans Affairs practice. This non-pharmaceutical approach has proven effective for our veterans in the management of many of their musculoskeletal disorders.
There are many examples of chiropractors and medical doctors working together. Most major colleges have chiropractors on the medical staff; so do all of the major professional sports teams. Chiropractors travel with the PGA and the Olympic team. Congress also has a chiropractic physician on staff.
I believe these innovations, while disrupting the status quo, will eliminate the need for unnecessary opioid prescriptions and the potential for painkiller addiction.
“I have been doing a triathlon every day this summer.” This is what my patient told me one month ago. He returned to my practice for care from his training. He has decided to do the Lobsterman’s triathlon this weekend.
He is a wonderful athlete. He was a high school track star and ran for a Division I college. He won a number of prestigious races in southern Maine.
His family has been associated with my practice for four generations. His grandparents were patients of my father, and now his nieces and nephew have been to see me.
His father and mother are terrific people. His father was a basketball star at a local high school and went on to captain his Division I college basketball team. His father has been ill the last several years. He still affectionately calls me “Roberto,” the nickname he gave me years ago when he would come into the office.
Both of his brothers were outstanding athletes for their high school and college teams. They continue to be in great shape.
This was the first time a patient told me they were doing a triathlon every day. He rides his bike about 15 miles per day before going to his summer job.
At his summer job, he and the other lifeguards will run 3 to 5 miles per day as part of their training. They also will swim each day and practice rescues. All of the lifeguards take their job seriously. Their lives and the lives of the beach goers depend on their training and fitness.
He usually will swim between a third- and a half-mile each day, depending on the tide.
He’s in the shape we all dream of being in. I have cycled with him. He talks during most of the ride while I’m breathing like a freight train trying to keep up.
His chief complaints are neck pain and tightness in his calf. He also has some stiffness in his lower back.
I have found other swimmers to have neck issues, especially if they breathe out of one side. This will cause a muscle imbalance on one side of their upper back and trapezius muscle.
Treating this type of neck pain is not complicated and it responds very well to conservative care. Preventing it from recurring takes work. I ask the athlete to get a swimming coach.
A good coach can make you more efficient in the water. This will place less stress on your body as you propel yourself through the water.
Breathing out of both sides of your swimming stroke makes you more symmetrical. This reduces the stress on one side of your upper body and neck. It’s hard to learn and takes practice.
His calf muscle had a mild strain. He has had this before when he increased the intensity of his running. I performed deep tissue work on the muscle. We reviewed stretching exercises as well.
His lower back showed some joint restriction in his lumbar spine. I used spinal manipulation to restore joint mobility.
I encourage my triathletes to do more swimming and cycling than running. Both of these sports are less stressful on the body than running. They also will maintain their cardiovascular fitness.
I hope you will consider trying a triathlon. You will be glad you did.
Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald. Contact him at:
The tennis season is in full swing. Many of us are playing on clay courts, both green and red clay.
Clay is my favorite surface for tennis. It’s softer and much
easier on your feet and legs than the hard surfaces of indoor and many
outdoor tennis courts.
Because the surface is soft the ball doesn’t come off the court as
fast. This can lead to longer rallies where it takes longer to win a
point. It also results in the games and sets lasting longer, which can
be exhausting if you aren’t in great condition.
I’ve been playing for years with a friend who vacations in Maine.
Whenever he’s here, we play as often as we can. He was coming to
Portland and wanted to play at my club.
Before we played he asked me to evaluate him. He was having pain in
his right shoulder blade area — a big problem, especially when he
served. He was also tight and sore on the top of his shoulder and right
lower back. This had started several months ago.
My evaluation discovered his right shoulder was much lower than his
left. There was muscle spasm on the inside of his right shoulder blade
and trapezius muscle. He also had a very tender rib attachment at his
I also found his pelvis to be unlevel with weakness of his right
gluteus muscle. His cervical spine was also restricted when he tilted
his head to the right. His core strength needed work.
Tennis is a one-sided sport. You will swing the racket hundreds of
times during a match or practice. This creates a lot of stress and
tension on the muscles of the upper back, shoulder and arm. There’s also
a tremendous amount of torque in the pelvis and hips.
I treated him with spinal adjustments to his hips, midback, neck and
ribs. This helped level his shoulders and hips while reducing the muscle
spasm and pain. I showed him a series of exercises to help balance his
muscles and strengthen his core.
The good news was he improved and hit his serve without pain. The bad
news was he won our match. I learned to evaluate and treat him after we
Another player is the head teaching pro of a large New York tennis
facility. A month ago he started to have stiffness and pain in the front
of his right hip.
He was walking with a limp. He could not cross his leg. Playing was
almost impossible. He was very concerned he had degeneration in his hip
and he didn’t want hip replacement surgery.
Pain in the front of the hip with restricted motion is a reason to be worried about degenerative hip disease.
I found his hip to be very tight with spasm of the psoas and anterior
hip flexor muscles. This was restricting his hip motion. His pelvis was
locked on the right side as well.
Years of playing a one-sided sport had taken its toll. I performed
manipulation to the pelvis and deep muscle work to the hip flexor and
psoas. I gave him several exercises to do at home.
He was 50 percent better after three visits. He left for home and
would continue his exercises. He was so pleased he didn’t need surgery.
Maintaining muscle and structural balance is the key to avoiding injuries playing a one-sided sport.
Dr. Robert Lynch is a former president of the Maine Chiropractic
Association and head of the Lynch Chiropractic Center in South Portland.
“Staying in the Game” appears every other Thursday in the Press Herald.
Contact him at:
“I can’t believe the progress I have made.” This is what she said as I entered the treatment and examination room.
The timing was perfect. The Beach to Beacon 10-kilometer road race was the next day. She felt very confident she was now going to have a good race. She told me her goal and she wanted to set a personal record, even though her training was hindered.
She gave me a substantial history of right lower back pain and hamstring issues. It started a year ago, when she ran the Beach to Beacon. During the race she pulled her hamstring.
Prior to last year’s race she was having pain. It was aggravated by lying in bed on one side or the other too long. It would make her hips ache.
The pain was interfering with her running. Sitting at her desk at work also caused pain on her right sit bone, which is part of the pelvic bone.
She had tried a number of different treatments. She had a cortisone shot in her spine, physical therapy, acupuncture and sports massage. She was somewhat better but still in chronic pain.
She feels she is too young to feel this way. She wants to be active.
She can’t remember a single incident that lead to her chronic pain issues. She does give me a history of several sprained ankles.
I examined her and found her to be very fit. She has a slight bow in her legs, the left more pronounced than the right. She had muscle spasm in her right lower back and buttocks muscles. Her pelvis was rotated with a locked sacroiliac joint.
I could feel scar tissue in her right hamstring from when she pulled the muscle last year. I also found substantial loss of range of motion of her right ankle. Neurological testing for disc and sciatic nerve issues were all negative.
My diagnosis was mechanical joint dysfunction of her ankle and pelvis. This was causing motor and muscle imbalance, and it was the cause of her chronic pain.
I needed to restore the motion to her ankle. This change would alter her running gait and put tremendous stress on muscles like her hamstring. I also needed to balance her pelvis.
I manipulated her ankle and got an excellent release. I also used a special table that flexes and distracts the lumbar spine and pelvis. This helped balance her pelvis and unlock her sacroiliac joint.
I also performed deep tissue cross friction massage to breakup the scar tissue in her hamstring. She was given exercises to do at home.
She started care four weeks prior to the race. Her pelvis was more level and balanced. Her ankle range of motion was much better. Her hamstring still had a knot in it from the old pull, but it was less pronounced.
I got an email from her with an update on her results. Even though the day was very humid and her training was limited prior to the race, she broke her personal record. She was very pleased.
She was a little sore after the race. This she expected. She is going to take a week off to recover.
Chronic pain can be so frustrating for athletes and non athletes alike. It interferes with work, play and family life.
There are many causes to chronic joint and muscle pain. Finding the cause and developing a treatment plan can yield tremendous results.
“I have not been able to workout for over a month.” She has not been able to play golf. It is very difficult for her to sit at her desk and work.
Her girlfriend told her she is walking funny. Summer is going by and she wants to be outside enjoying herself.
The pain started while on vacation in the islands. She noticed carrying her purse and luggage was uncomfortable. The pain got worse on the plane. Over the next several days she was miserable.
She tells me the pain is in her lower back going into her buttocks. She also has pain in her mid back, between her shoulder blades. She has no previous history of back pain or injuries.
She did everything she could think of to avoid seeing a doctor. She took over-the-counter drugs for inflammation and pain. She used heat and ice at home. Her friends gave her their unused prescription medications for the pain and muscle spasms.
She was a former worker’s compensation adjuster and had frequently denied chiropractic treatment. Her friend recommended she make an appointment with me for an evaluation. She was skeptical.
She told me she was worried about the cost of care for her condition. She is a self-employed single mother of two. She has to purchase her own health insurance. She has a $10,000 deductible.
My examination reveals a woman that appears much younger than her stated age. She seems to be very fit. Her gait and posture are compromised. She had to swing her hip and leg around to step forward.
There is muscle spasm in her left buttocks, lumbar spine and between her shoulder blades. There is tenderness to palpation over a rib attachment between her mid back and her shoulder blade.
I tested her range of motion. Side bending of her lower back is restricted and she has lost motion in her left sacroiliac. Her reflexes and motor strength are normal. She is not pinching her sciatic nerve.
My diagnosis is mechanical lower back and mid back pain from joint dysfunction in her pelvis, lumbar and thoracic spine. Imaging studies did not appear appropriate at this time.
I recommended a short trial series of chiropractic spinal adjustments. She agreed.
This was her first time to a chiropractor. She was a little nervous and concerned that the manipulation would be uncomfortable. She tolerated my procedures very well.
She scheduled a follow-up appointment in four days.
She was so excited on her next visit.
Her pain was almost gone and she was functioning at a much higher level. “I wish I had come in to see you sooner.”
My examination revealed a significant reduction in her muscle spasm and tenderness. Her joint dysfunction and range of motion returned to normal.
I discharged her from active care with a few simple exercises.
I gave her the green light to return to all her normal activities including golf and going to the gym.
She was also surprised at how affordable the care was that she received. The high deducible for her insurance caused her to delay care and treat the condition herself.
I highly discourage patients from taking drugs that have not been prescribed specifically for them. This can be dangerous.
Many times patients just need a high-touch, low-technology approach to restore their health.