Posts Tagged ‘chiropractor’

Smoking Is An Influence on Pain and Back Pain

Smoking Is An Influence on Pain and Back Pain Specifically

About 1 in 5 Americans smoke (4), so West Palm Beach is likely to have smokers like anywhere else. Smoking is a leading preventable cause of disease and death in the US, resulting in 438,000 deaths annually. (5) Smoking’s influence on low back pain, reported level of pain and recovery from low back is a popular field of study. For the most part, smoking’s influence on back pain is sizeable enough to quit smoking or not start.

In a large scale review of 81 studies and 40 studies analyzed on the topic of smoking and back pain, the association between smoking and back pain prevalence is reported as modest. However, it was found that both current and former smokers have a higher prevalence and incidence of low back pain than non-smokers. This association is even stronger in adolescent smokers than adult smokers. (6)

Since chronic low back pain is one of the main causes of disability in the community, likely even low back pain in West Palm Beach, researchers studied 73,507 Canadians (aged 20 to 59 years) to report on their chronic low back pain status as well as other factors like smoking. Daily smokers have a prevalence of 23.3% for chronic low back pain versus only 15.37% in non-smokers. Occasional smokers were found to have only a slightly increased change of having chronic low back pain. Daily smoking increases the risk of low back pain in young adults. (7)

Another Canadian study reports that persons with chronic low back pain were more likely to smoke than those without chronic low back pain or arthritis. (8)

A significant association between tobacco smoke and pain is reported in smokers and non-smokers exposed to environmental smoke. This study done in Denmark compared active and passive smoking and the frequency of pain due to the exposure. Daily smokers reported significantly more frequent pain than never smokers. The younger the smoker started smoking increases the probability of frequent pain in daily smokers. (9)

Does Stress and Smoking Influence on Back Pain?

Certainly. A study of 571 individuals who experienced onset of low back pain at 32 and 33 years of age and 5210 individuals who were pain free at that age were compared for risk facts (smoking, psychological distress at 23 years of age, social class, childhood emotional status, body mass index, job satisfaction). Psychological stress more than doubles later risk of low back pain, and smoking modestly influences it. The other factors did not significantly influence low back pain onset.  (10) Smoking influences back pain in West Palm Beach.

Smoking and Exercise in Low Back Pain Patients

The smoking habits and exercise habits of 50 low back pain or leg pain sufferers were compared to 50 asymptomatic persons.

  • 33% of low back or leg pain sufferers smoked.
  • 14% of those without pain smoked.
  • 47% of low back or leg pain sufferers exercised
  • 86% of those without pain exercised.

It is suggested, therefore, that the level of physical activity and general exercise improves strength, mobility and endurance, possibly enough to prevent future back injury. (11)

Research reports the negative health effects of smoking like poor physical fitness and reduced muscle strength. Smokers are found to have reduced muscle strength and fatigability of the lumbar spine extensor muscles, making them possibly more vulnerable to back injuries. This study does report that weakness is reversible with rigorous exercise. (12)


In closing, not smoking is a healthier lifestyle choice than smoking. The evidence that smoking may well negatively impact the incidence of back pain and recovery from low back pain makes not smoking or stopping smoking a worthy goal. Smoker or not, your back pain can be controlled, and we at Moses Chiropractic appreciate the opportunity to help you.


Dr. Gregg F. Moses

Chiropractic Physician

1800 Forest Hill Blvd. Ste. A8-10

West Palm Beach, FL 33406


Spinal Manipulation (chiropractic care) compared to back school and physiotherapy for chronic low back pain

Well a belated Happy New Year to all.  A beautiful day here in S. Florida (specifically West Palm Beach)…about 50 degrees this morning.  A little cold for some, but sure is better than the 20 inches or so they had this weekend across the mid-Atlantic states.  Over the past few weeks I watched my NY Jets over-achieve and make it to the AFC Championship game.  This season concluded yesterday as the NO Saints beat the Colts in a great game.  I was away in Naples, FL two weeks ago.  Dr. James Cox was there speaking on the latest regarding the treatment of neck and back pain with the Cox Technique.  He focused on FBSS, Failed Back Surgical Syndrome.  I want to share a recently published article from Clinical Rehabilitation 24  (1). Jan 2010 p.26-36.  The authors are Cecchi, F; Molina-Lova, R; Chiti, M; Pasquini, G; Conti, AA; Macchi, C.  The title is “Spinal Manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic lower back pain: a randomized trial with one-year follow-up”.

I only have the abstract for this study and I will give some details. 

Objective:  To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.

Design:  Randomized trial with 12-month follow-up.

Setting:  Outpatient rehabilitation department.

Participants:  210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years.

Conclusions:  Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

As a chiropractor I am certainly not surprised that spinal manipulation gave more pain relief, but overall back school and physiotherapy are wonderful adjuncts to chiropractic in the treatment of our patients.  I have read many medical journal since my last blog and have a lot of articles to share.  I hope to do an entry about once a week.  Should anyone have a specific topic they would like more information on, just send me an e-mail and ask.

Gregg F Moses, DC

Cox Decompression – Case Study Cervical Disc Herniation

Once again, welcome to my blog.  I had a great weekend here in South Florida….windy and less hot.  My football team, The New York Jets didn’t lose.  That’s because they didn’t play.  Family time…taking Jake to his tennis lesson.  We also saw a great show at PBCC….theatrical version of the children’s book, Stellaluna.  It was amazing. 

I wanted to share a research article that is very important to me.  I have been a practicing chiropractor since 1989 and in 1999 I became certified in the Cox Decompression Technique.  The Cox Decompression technique was founded by Dr. James Cox.  The technique involves a specialized table, but is also “hands-on” by the doctor to implement the decompression.  It is a gentle, painless, spinal manipulation performed with the spine under distraction- a traction force that separates the vertebrae to increase the size of the nerve and spinal canal openings, drop pressure inside the disc to reduce herniation. 

This case study was published in the Journal of Manipulative and Physiological Therapeutics, June 2008 and authored by Sharina Gudavalli, DC and Ralph Kruse, DC.

Foraminal Stenosis With Radiculopathy From a Cervical Disc Herniation in a 33-Year-Old Man Treated With Flexion Distraction Decompression Manipulation 

A 33-year-old man complained of severe neck and upper pain and spasm, pain radiating down into his left arm with numbness into his fingers.  Cervical spine radiographs showed mild C6/C7 degenerative changes.  MRI revealed a moderate left posterolateral disc herniation at C6/C7.

This patient underwent Cox Flexion Distraction Decompression Manipualtion and adjunctive physiotherapy modalities.  Total treatment was 15 visits over a 10 week period.  This patient had a good clinical outcome utilizing post examination findings and a pain scale.  At 2-year follow up, subjective and objective findings remained stable. 

Although I have not had the time to submit a case study to be published, these are the kind of results we see in the office with the Cox Technique. All cases are different.  Some respond quickly and some not so quick, but I always implement this rule.  If a patient does not have 50% relief of pain within 30 days of care, they will be referred for further testing or consultation.  Dr. Cox has numerous case studies on his website  Our website is  I hope to post about once a week.  I welcome comments and questions.

Gregg F. Moses, D.C.

Cox Decompression Treatment for the Pregnant Patient with Lower Back and Leg Pain

Thanks again for viewing this blog.  I had a great week in the office.  In addition to chiropractic care, we also have full physical therapy and massage therapy.  Pregnant patients with lower back pain are always interesting and sometimes difficult to treat.  Certainly if the patient has leg pain, more caution should be given with the treatment.  We are somewhat limited as to what treatment can be done.  Although many chiropractors do traditional / diversified manipulation for pregnant patients with lower back pain, I choose to do the Cox Decompression Technique.


This article / case study was published in Journal Of Chiropractic Medicine , December 2007 and authored by Ralph A. Kruse, DC, Sharina Gudavalli, DC and Jerrilyn Cambron, DC, MPH, PhD.  I have included the abstract.



The purpose of this report is to describe chiropractic treatment of lower back and unilateral leg pain in a pregnant patient.

Clinical Features

A 26-year-old woman in her second trimester of pregnancy had severe pain in her lower back that radiated to her hips bilaterally and to her right leg. She reported tingling down her right lower leg to the dorsum of her foot. Although no diagnostic imaging was performed, her differential diagnoses included lumbalgia with associated radiculopathy.

Intervention and Outcome

Treatment consisted of manual traction in the side-lying position using a specialized chiropractic table and treatment technique (Cox flexion-distraction decompression) modified for pregnancy. Relief was noted after the first treatment, and complete resolution of her subjective and objective findings occurred after 8 visits.


When modified, this chiropractic technique appears to be an effective method for treating lower back pain with radiation to the leg in a pregnant patient who cannot lie prone.

I hope this article / case study was helpful.  Feel free to contact me by clicking the following link: chiropractor west palm beach.  You can also find a certified Cox Technique practitioner on Dr. Cox’s website

Respectfully submitted,

Gregg F Moses DC

Vitamin D3 / The Epidemiology of Influenza

I recently read an interesting article published in a medical journal, Virology Journal, February 25, 2008, Volume 5. The authors are John J. Cannell, Michael Zasloff, Cedric F. Garland, Robert Scragg and Edward Giovannucci.  The title of the article is “On the Epidemiology of Influenza”.

I thought this was pertinent because of the concern over the H1N1 virus as well as this being onset of the time of year for season influenza.  I will list some of the highlights of this article:

  • A 2006 study concluded that there has been no evidence of a reduction in influenza related mortality in the last 15 years despite the increase of influenza vaccination coverage from 10% to 60%.
  • In a  2007 study, 104 women given vitamin D were 3 times less likely to report cold and flu symptoms than placebo.  800 IU/day of vitamin not only reduced reported incidence, it abolished the seasonality of reported colds and flu.  A higher dose (2000 IU/day) virtually eradicated all reports of colds or flu.
  • Compelling epidemiologal evidence indicates vitamin D deficiency is the ‘seasonal stimulus’, responsible for flu outbreaks.
  • Lower respiratory tract infections are more frequent in those with low vitamin D3 levels.

Of course this is just 1 article, but certainly it makes us look at our vitamin D3 levels.  As always I suggest people speak with their primary physicians, chiropractors and/or do their own research before taking levels of supplements/vitamins higher than the RDA.  That being said the “National Academy of Sciences – Institute of Medicine” recommends the adequate intake of vitamin D3 should be revised upward to at least 2,000 to 4,000 IU/day.

I will keep my eyes open for other published articles that may be of interest.  I know I just started this blog, but I will be discussing many different topics over the upcoming weeks.  If there are specific questions and/or comments, don’t hesitate to contact me at or through my website: chiropractor west palm beach

Welcome to My Chiropractic Blog

Thank you for visiting my blog.  As a chiropractor in West Palm Beach, I have spent over 2 decades treating patients with a variety of neuromusculoskeletal conditions.  These conditions include whiplash, spinal stenosis, failed back surgical syndrome as well as degenerated and herniated discs.  I give a lot of the credit for successful treatment of these conditions to Dr. James Cox, founder of the Cox Technique.  I have studied under Dr. Cox and have been certified in the Cox Decompression Technique since 1999.  This blog will serve to share information, including interesting articles that I read in peer reviewed medical and chiropractic literature.   I hope to also interject some personal thoughts on family and friends (my obsession with Facebook), food, vacation and sports (my love/hate relationship with the New York Jets) and many other topics.  Please check out my website by clicking the following link: Chiropractor West Palm Beach.  Enjoy!