Pain Relief Chiropractic: Recent Episodes
William Holdsworth
Providing listeners with research-based information regarding musculoskeletal topics with an emphasis on chiropractic. New episodes Monday-Thursday.
Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.
It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!
In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.
The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).
Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.
Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!
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When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself.
One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, “The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.”
This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve.
Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. That’s why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible.
The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. That’s why it’s important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) sooner rather than later.
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The term whiplash associated disorders (WAD) describes a constellation of symptoms that includes (partial list) pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain-fog. The condition is associated with accelerations/deceleration events like car accidents, sports collisions, or slip and falls. Such injuries are classified into four categories: WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury – muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain, with 29-40% recovering within a little more than three months and about 23% still not having recovered after one year.
A 2016 systematic review generated treatment guidelines for patients with WAD and/or neck associated disorders (NAD) in the context of both a recent injury and for cases in which pain has persisted for longer than three months. Importantly, these guidelines were formed with input from several types of healthcare providers, including doctors of chiropractic, medical doctors, and physical therapists.
For recent-onset neck pain (0-3 months), the authors recommend multimodal care (multiple types); manipulation or mobilization; range-of-motion home exercise or multimodal manual therapy (for grades I-II NAD); adding supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD).
For persistent neck pain (more than 3 months), the review recommends multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).
The term, “multi-modal care” is defined as a grouping of manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). Multi-modal care may also incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Doctors of chiropractic often take a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash associated disorders.
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As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches?
To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors.
The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, ≥60 years old.
While most patients experienced significant improvement in both stages of the study, some did not. Patients with more severe cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which underscores the importance of seeking care for CTS as soon as symptoms develop. Furthermore, participants who continued to overuse their hands at work or who did not modify their work procedures or workstation to reduce the forces applied on the hands and wrist were less likely to report significant improvements at the one-year point. Interestingly, age was not found to be a significant risk factor, which is surprising, as past studies have reported that being age over 50 is a risk factor.
Not only are doctors of chiropractic trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counseling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.
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As screens (televisions, computers, and smartphones/tablets) become an increasingly important part of daily life, many people gradually take on a more slumped posture, which can place added strain on the neck and shoulders, raising the risk for neck pain and headaches. Luckily, it’s possible to improve forward head posture, rounded shoulder posture, and scapular instability with neck-specific exercises and chiropractic care.
In a 2018 study, patients with forward head posture performed either scapular stabilization or neck stabilization exercises for 30 minutes three times a week for four weeks. Participants in both groups experienced improvements related to their craniocervical angle and muscle activity around the upper back and neck, with greater results reported by the scapular stabilization group.
Several studies have shown similar results for improving forward head posture using both scapular and neck stabilization exercises. In another study, high schoolers with forward head posture performed scapular and neck stabilization exercises and exhibited good posture up to four months later.
A 2019 study looked at the effect of a six-week intervention featuring manual therapy and/or stabilizing exercises on 60 women with neck pain and forward head posture. Participants in both the manual therapy/stabilization exercise-combo group and the stabilization exercises-only group reported better outcomes with respect to head posture, pain reduction, and improved function, but the results were best in the combined treatment group. The authors concluded that manual therapy adds a meaningful role to a structured exercise program that addresses scapular and neck instability and forward head and rounded shoulder posture.
Doctors of chiropractic often incorporate exercise training in their treatment recommendations, especially when postural issues may contribute to the patient’s symptoms, like neck pain and headaches.
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While doctors of chiropractic enjoy helping their patients get better, the preference is to avoid injury in the first place, and if that’s not possible, to reduce the risk for serious injury. This is especially important when it comes to car accidents, as whiplash associated disorders (WAD) injuries can persist for months to years and greatly reduce one’s ability to carry out their normal activities.
One of the most important steps you can take is to focus on the road while driving and eliminate distractions, which includes not texting while driving. In one study, researchers observed that even using hands-free functions increased the risk a driver would drift into another lane, drive too closely to the car in front of them, and be less responsive to changing road conditions. Other common distractions include fiddling with the radio, eating, reading (yes, people do this!), talking with other passengers (especially if you turn your head to look at them), and driving while intoxicated, while under the influence of legal/illicit drugs or medications, or while tired.
Strategies to stay safe on the road include taking regular breaks (if driving a long distance), keeping your eyes moving (check mirrors frequently), not speeding or driving faster than road conditions allow, following traffic rules, using your signals, avoiding night and bad weather driving, heeding caution signs, and keeping your car properly serviced (including making sure there is enough air in your tires and that your tires are in good condition). Additionally, it’s important to respond quickly to vehicle recalls. As they say, “An ounce of prevention is worth a pound of cure!”
Sometimes it’s not always possible to avoid an accident. Wearing a seatbelt can reduce the risk you’ll be ejected from the vehicle in the event of an accident (which almost certainly results in fatality) or suffer more serious injuries. Making sure your head rest is properly adjusted can also reduce your risk for a serious head/neck injury.
Automobile manufacturers continue to implement safety improvements in their vehicles. For example, a review of data between 1995 to 2016 supports that vehicle safety design improvements reduced the frequency of rollover crashes from 7% to 3.5% when comparing 1995-1999 vs. 2010-2016 model year vehicles, respectively. Starting in 1997, General Motors (GM) introduced high retention seats in their new model cars, SUVs, vans, and light trucks. A recent study compared the 1991 to 2000 Fatality Analysis Reporting System (FARS) data to the 2001-2008 FARS data to evaluate the impact of high retention seats. The data show that in rear impacts, high retention seats reduced the fatality risk from 27.1% to 16.6% and the risk of serious injury by 70.2%.
If you’re involved in a car accident, even a low-speed collision, it’s important to be evaluated by a doctor of chiropractic to ensure any soft-tissue injuries that result are properly treated as soon as possible in order to reduce your risk for ongoing pain and disability.
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Carpal tunnel syndrome (CTS) has long been recognized as an occupational disease, and though the incidence of many other occupational diseases has decreased over time, CTS appears to be becoming more prevalent.
A 2019 study looked at the impact/benefit of wrist-specific exercises and oral enzyme therapy on automotive assembly line workers with CTS (excluding those treated previously or who had a positive history of hormone replacement or current pregnancy, inflammatory joint disease, trauma to the affected hand, polyneuropathy, other relevant conditions).
Participants in the exercise group performed the following exercises at home for nine weeks:
- Deep “push & pull”: Massage the palm-side of the wrist using the thumb from the opposite hand for 30 seconds.
- “Prayer Position”: Place the palms together in front of your chest; press the fingers slowly against each other for five seconds and release for five seconds; press the palms together and then slowly lower the hands toward the floor. Repeat as tolerated, gradually increasing reps.
- Neuromobilization: Stand sideways to a wall; place the palm of the left hand on the wall, fingers pointing back to a “10 o’clock” position. Start with the elbow bent and slowly straighten it while bending the head sideways toward the wall (left). Slowly bend the elbow and bend the neck/head to the right. Repeat six to eight times with each hand.
The enzyme group took oral enzymes (which are known for their anti-inflammatory, anti-edematous, and analgesic effects) that included 2,000 mg pancreatin, 900 mg bromelain, 1,200 mg papain, 480 mg trypsin, 20 mg chymotrypsin, 200 mg amylase, 200 mg lipase, and 1,000 mg of rutin for nine weeks divided into two doses a day.
Compared with a third group that continued their usual activities, participants in both the enzyme and exercise groups reported improvements with their CTS symptoms. Nerve conduction velocity tests also revealed improved function in the median nerve.
Doctors of chiropractic commonly utilize a multi-modal approach when treating CTS, which often include manual therapies, nutritional recommendations, exercises, activity/modifications, and overnight wrist splinting.
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While tinnitus is commonly associated with a ringing sound in the ears, it can also involve a buzzing, hissing, or whistling noise. The sound can be intermittent or constant and can change in volume. The noise often intensifies in a quiet room when background noise is absent, such as at night, which can interfere with sleep. Approximately 50 million adults in the United States are affected by tinnitus, and up to 90% of people with tinnitus have some degree of noise-induced hearing loss. Though tinnitus can be due to many different causes, trauma-induced tinnitus from motor vehicle collisions is common.
Studies have demonstrated that an 8 mph (12.87 kmph) rear-end collision can result in 4.5g of neck acceleration, which can cause a sprain/strain injury to the neck that can lead to the cluster of symptoms that characterize whiplash associated disorders (WAD) such as neck pain, back pain, mental fog, headache, balance disturbance, depression, anxiety, tinnitus, and more.
Additionally, this process can also accelerate the head, essentially slamming the brain against the inside of the skull, followed by a rebound into the opposite side of the skull. This can lead to bruising on the brain, which is commonly called a concussion but is more formally known as a mild-traumatic brain injury (mTBI). This type of injury shares many symptoms with WAD, including tinnitus. If symptoms persist, the condition is known as post-concussive syndrome (PCS).
This has led researchers to speculate that WAD and mTBI often co-occur, and treatment to address cervical spine dysfunction commonly observed in WAD patients may also help patients with PCS. In a 2015 study involving five patients with diagnosed PCS, researchers observed that when the patients received manual therapy treatment to address cervical spine dysfunction, they reported improvements in several symptoms associated with PCS.
Doctors of chiropractic are highly trained to manage cervical spine dysfunction, a common sequela following a motor vehicle collision. Frequently, the many symptoms associated with WAD, including tinnitus, improve once the dysfunction is managed through manual therapies applied to the muscles and joints in the neck. If you are suffering from the aftermath of an MVC, please see your chiropractor!
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Osteoarthritis (OA) is the most common form of arthritis and is caused when the smooth cartilage surface of an articulating/moving joint wears away until there is bone-on-bone contact that results in both loss of movement and pain. Although OA most commonly affects the joints under the greatest load (the hips and the knees), it can occur in any moving joint, including those that make up the shoulder.
Because cartilage lacks a direct blood supply, it relies on a process called diffusion in which nutrients are absorbed into cartilage when it’s compressed by movement. Anything that restricts the movement of the joint (like inflammation or injury) can slow or cut off its supply of nutrients, placing the tissue at risk for injury and degeneration.
When a patient presents for care involving OA of the shoulder, chiropractic treatment will generally focus on improving the motion of the affected joints with manipulation, mobilization, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counseling, and home-based exercises.
Here are some additional ways to self-manage osteoarthritis of the shoulder:
- Stay Active: Movement/exercise is the BEST way to keep joint cartilage nourished and healthy. Many people can manage the pain often without medication by simply pacing themselves and by staying active.
- Eat a Healthy Diet: Keep your diet balanced and emphasize foods that reduce inflammation or swelling like omega-3 fatty acids (fish oil), ginger, turmeric, Boswellia, and more.
- Reduce the Load on the Joints: This includes losing weight, as well as modifying job/lifestyle activities that routinely place force on the affected joints.
- Get Plenty of Sleep: Several studies show that getting too little or too much sleep each night can lead to poor outcomes. Aim for seven to nine hours of restful sleep.
- Use Hot/Cold Packs: This is a great way to reduce inflammation.
- Supplements: Consider glucosamine and chondroitin.
Generally, the more advanced the case, the longer it will take to achieve a successful outcome, if at all. That’s why it’s important to seek care sooner rather than later when you experience pain in the shoulder or any other part of the body.
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When someone is diagnosed with carpal tunnel syndrome (CTS), there seems to be an automatic assumption that surgery is imminent or at least inevitable. However, treatment guidelines for CTS that are intended to be followed by ALL healthcare professionals ALWAYS recommend an initial course of non-surgical treatment, NOT jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed, and many patients are not given an option for anything other than surgery.
The following is an excerpt from a 2017 Washington State CTS treatment guideline:
All of the following criteria must be met for surgery to be authorized:
- The clinical presentation is consistent with CTS
- The EDS [electrodiagnostic studies] criteria for CTS have been met
- The patient has failed to respond to conservative treatment that included wrist splinting and/or injection
Medical-based non-surgical care for CTS includes: neutral position wrist splints worn at night and (in certain cases) at times during the day (studies report that 30-70% of patients respond favorably within several months of initial wrist splint use); glucocorticoids injections into the carpal tunnel (these can provide short-term relief with about 50% of patients requiring surgery within one year); and forearm and wrist exercises.
Doctors of chiropractic often use a combined approach based on the patient’s unique case, which can include wrist splints and exercise training (as described above) along with manual therapies like manipulation and mobilization on the wrist and elsewhere along the course of the median nerve; physical therapy modalities such as laser therapy, ultrasound, and pulsed electromagnetic field; nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia; and ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions.
Studies show that, in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery (though without the potential side effects associated with going under the knife), which underscores the importance of seeking care for CTS as soon as possible.
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In the face of musculoskeletal pain, it’s common to restrict activity. Unfortunately, doing so can weaken the muscles and joints in the affected area, which can prolong pain and elevate the risk for future injury. Patients with osteoarthritis of the knee often fall into this trap. So, what type of exercises are best for improving knee strength in the presence of knee osteoarthritis?
First, let’s define two types of muscle activity that can occur during exercise: eccentric and concentric. During a bench press, when you’re pushing the barbell upward, the muscles in the chest shorten in a concentric motion. As you lower the bar downward, your pectoralis muscles lengthen, which is an eccentric motion.
A 2019 study that involved 54 seniors with knee osteoarthritis investigated which of the two phases builds better strength for the knee – the concentric/muscle shortening phase or the eccentric/muscle lengthening phase of muscle activity. The participants were split into three groups: CNC RT (concentric resistance), ECC RT (eccentric resistance), or CON (control group – no exercise/wait-list group). The two exercise groups received four months of supervised exercise training using traditional weight machines with proper set-ups and instructions that emphasized the concentric or eccentric phase of the exercise.
Each week, participants completed questionnaires to measure knee pain and disability. The researchers also recorded the maximum weight each subject could lift with respect to knee flexion, knee extension, and the leg press.
The results showed that BOTH exercise groups experienced strength increases in comparison to the control group, with the eccentric resistance group achieving greater gains on the leg press and knee flexion exercises, but not for knee extension. Both exercise groups also reported less pain and disability than the control group. The authors concluded that both types of resistance training effectively improved leg strength, pain, and function, and they recommend that the mode an individual emphasizes should be based on personal preference, goals, tolerance, and equipment availability.
This study is a great example of the many benefits that exercise can offer for an elderly population suffering from knee osteoarthritis. Doctors of chiropractic often prescribe exercises for patients with knee pain in addition to providing manual therapies, modalities, orthotics (knee braces and foot orthotics), as well as dietary and nutritional counselling for inflammation reduction and pain management purposes. Before throwing in the towel and jumping to a total knee arthroplasty (replacement), you owe it to yourself to seek less invasive management strategies FIRST.
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The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain?
A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexion—tucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in improving muscle performance, disability, and pain intensity over the course of a three-month time frame.
After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a “wait list” group who served as controls.
Here’s where it gets more interesting… At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group! This study supports the need for specific neck exercises to reduce pain and disability and improve function.
When the deep muscles are injured, it’s common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since there’s research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest.
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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Let’s discuss what causes CTS, its symptoms, how it’s diagnosed, and how it’s treated…
Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.
Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms.
Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patient’s symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” (flicking the fingers to “wake them up”) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.
Treatment: All treatment guidelines recommend conservative, non-surgical care prior to surgery unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. THIS IS WHERE CHIROPRACTIC SHINES! Besides “usual” non-surgical care (night splinting, anti-inflammatory measures, exercises, and ergonomic modifications), chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel, which reduced pressure on the tunnel’s contents. Chiropractors also perform manual therapy based on neurodynamic techniques, which a 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.
It’s important to note that patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait months or even years. If you experience the symptoms associated with CTS, seek care sooner rather than later!
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Experts estimate that whiplash associated disorders (WAD) from motor vehicle collisions (MVCs) affect about 300 for every 100,000 people in the Western each year. Suffice it to say, that’s a lot of people!
Crash tests have demonstrated that the risk for whiplash is much greater when the backrest is leaned backward and/or when a headrest is lacking (in older cars) or is too low in relation to the head. The key is to prevent the head from extending backward over the top of the seat, which can lead to more severe soft tissue injuries in the neck. While it’s not always possible to anticipate an MVC, past research has shown that looking forward at the time of the collision may reduce WAD injury/severity risk.
On the topic of necks, individuals with thinner necks have a greater risk for injury, which may explain why woman are more often affected by WAD than men. However, regardless of whether you are male or female, staying fit and keeping the neck muscles strong is important. It’s been suggested that individuals with a history of neck pain are more likely to experience more severe whiplash injuries, as are those in poor general health. There are conflicting studies that report that seat belt use may increase the risk for WAD, but after reviewing multiple studies, the consensus is that seat belts save lives, so buckle up!
In many cases, WAD patients may miss work, especially if they have a job with high physical demands. Patients with more severe injuries may miss up to twenty-five days of work, while those with minor injuries may still be out for up to ten days. One study found that about 31% of the 800 cases the researchers looked at took no time off work, 52% returned to work after only four days off, and 90% returned within thirty days off. About 4.9% of the patients in the study were still not working after twelve weeks.
Several factors suggest a WAD patient may experience a slower or more limited recovery: a history of neck pain; loss of neck motion measured post-MVC; increased sensitivity to cold stimulation; high pain levels post-MVC; less severe crash-type; dizziness, arm pain or numbness; low back pain; and poor expectations of recovery.
The good news is that treatment guidelines have consistently recommended spinal manipulation— he primary form of treatment provided by doctors of chiropractic—for managing whiplash-related injuries.
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A 2009 study that monitored over 8,800 elderly French adults found that an individual’s blood pressure can fluctuate with the seasons. In particular, the researchers observed that as temperatures fell, both systolic and diastolic blood pressure could rise to unhealthy levels, but they were unable to determine why.
However, a study published just five years later may have solved the mystery. The solution has to do with the molecule nitric oxide. Nitric oxide is a vasodilator, meaning that it causes the walls of blood vessels to relax and expand, with a resulting reduction in blood pressure.
Researchers have discovered that nitric oxide is stored in the dermal vasculature at levels much greater than are found circulating in the bloodstream. When exposed to long-wave ultraviolet (UVA) rays, the skin releases some of that stored nitric oxide into the bloodstream. Because individuals tend to spend less time in the sun during the winter months, there are fewer opportunities for the skin to release nitric oxide into the blood, dilate blood vessels, and moderate blood pressure. This may also help to explain why stroke and blood vessel rupture (aneurism) are more common in the winter months among the elderly.
How can one maintain healthier levels of nitric oxide in their bloodstream when it’s not convenient to spend time in the sunshine? The answers may be found in diet and exercise.
A 2018 study found that eating leafy greens and root vegetables and drinking beetroot juice effectively increased nitrate plasma (blood) levels for the purpose of enhancing exercise performance.
In 2020, researchers observed that schoolteachers in South Africa with greater physical fitness levels had higher levels of nitric oxide in their blood, as well as lower systolic and diastolic blood pressure readings. The research team concluded, “These results may suggest that even moderate physical activity could increase nitric oxide synthesis capacity, which in turn may mitigate the development of cardiovascular disease in this population.”
The take home message is that to maintain a healthier blood pressure, consider getting plenty of sunshine, eating leafy green and root vegetables (or drink beetroot juice), and exercising!
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One of the symptoms commonly associated with whiplash associated disorder (WAD) is headaches. The current research suggests that up to 50% of patients who experience whiplash-associated headaches may continue to suffer from them for up to a year or more, and many of those will continue to have headaches as late as five years following their whiplash injury event. There are many potential causes for WAD-related headaches, which can include cervical injury, jaw dysfunction (TMJ), psychological distress (depression and anxiety), brain structure abnormalities (concussion), and/or overuse of headache medications.
To address these potential causes of whiplash associated headaches, treatment may include the following:
MANUAL THERAPIES: Mobilization and manipulation, which are commonly used by doctors of chiropractic, have been demonstrated to be effective for reducing pain and improving function for many conditions, including WAD and headaches of cervical origin. Treatment may also involve massage and physical therapy modalities, depending on the patient’s needs.
EXERCISE: A review of research published between 1990 and 2015 found that craniocervical, cervicoscapular, and posture correction exercises can be helpful in the treatment of whiplash-related headaches.
STAY ACTIVE: Try to carry on with normal activities within pain tolerances, as movement is needed to keep soft tissues healthy and to ensure a continuous supply of nutrients to the cervical disks. Don’t use a cervical collar to immobilize the neck unless directed to do so by your doctor.
NUTRITIONAL SUPPORT: There are several vitamins and supplements that have been shown to reduce inflammation and/or reduce pain. These include flavonoids, curcuminoids, omega-3 fatty acids, taurine, and vitamin D. Adopting an anti-inflammatory diet can also aid in the healing process.
Doctors of chiropractic frequently use a combination of these approaches when managing WAD patients to help reduce pain and disability and assist the patient in returning to their normal activities as soon as possible.
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With many sports requiring overhead movements that can place the shoulder at the extreme end of its range of motion, it’s not surprising that shoulder injuries are so common among athletes. For instance, up to 50% of NCAA college football players have some history of shoulder injury, which comprises about 10-20% of total injuries in the sport. When looking at collegiate quarterbacks, one study found that shoulder injuries accounted for more than half of injuries among players in the position. When it comes to sport-related shoulder injuries, these are the three most common (and to complicate matters, they often co-occur):
1) SLAP (or labrum) tears: Superior (top) Labral tear from Anterior (front) to Posterior (back) tear is a term used to describe a torn piece of cartilage located along the rim of the socket. The labrum adds depth to the cup, which helps to stabilize the ball in the socket. Individuals with a SLAP tear will often report a loss of motion and power, a feeling like their shoulder could pop out of socket, and a deep ache that is hard to pinpoint when attempting overhead movements.
2) Shoulder instability or dislocation: With contact sports, there’s the opportunity for a collision that can dislocate the ball of the shoulder joint (the end of the humerus bone) from the shoulder socket. Because the muscles in the front of the shoulder tend to be larger and stronger, the dislocation will more often occur in that direction. Symptoms can include a severe, sudden initial pain followed by short bursts of pain as well as swelling and a noticeable deformity in the appearance of the shoulder.
3) Rotator cuff tears (RCTs): This is common in sports that require repetitive overhead motion like baseball (especially among pitchers), swimming, and tennis. Symptoms include a deep, hard to locate ache, weakness, and reduced range of motion (especially overhead or to the back).
In general, early/prompt care yields the best results. While there are instances when a prompt surgical procedure is warranted, treatment guidelines typically emphasize non-surgical therapies first with surgery only after all other options have been exhausted.
Chiropractic management of these conditions will often involve a multi-modal management approach that includes manual manipulation and mobilization to the shoulder’s multiple joints, the neck, and the mid back; specific shoulder exercise instruction; physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field, and more); and nutritional recommendations.
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Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued?
The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.
In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.
The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.
A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time.
While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.
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Neck pain is one of the most common complaints that drive patients to seek chiropractic care. Sometimes the cause of injury is a known traumatic event, but in many cases, neck pain is the result of wear and tear from poor posture—forward head posture in particular.
The head, which weighs 10-11 lbs. (4.5-5 kg), typically rests above the shoulders. When an individual’s head leans forward to look at a computer screen or to look downwards at their smartphone/tablet, the muscles in the rear of the neck and upper back/shoulders need to work harder to keep the head upright.
Experts estimate that for each inch (2.54 cm) of forward head posture, the head feels about 10 lbs. heavier to the muscles that attach to the back of the head and neck. To illustrate this, pick up a 10-pound object like a bowling ball and hold it close to your body. Then, hold it away from your body with your arm outstretched and feel how much heavier it seems and the strain it places on your body to maintain that position for even a short time.
In the short term, forward head posture is something the body can manage, but over time, the muscles can fatigue and the strain can injure the soft tissues in the back of the neck, shoulders, and upper back. To adapt, some muscles may become stronger (and some may atrophy), the shoulders can roll forward, the cervical curve can straighten, etc. Researchers have observed that forward head posture can also reduce neck mobility, especially with rotation and forward flexion movements. While these changes can lead to several negative health issues, neck pain is perhaps the most obvious and common.
When a patient presents for chiropractic care for neck pain, postural deficits will likely need to be addressed to achieve a satisfactory outcome. This can be achieved with manual therapies to restore proper motion in the affected joints and with exercises to retrain the muscles that may have become deconditioned. Additionally, a patient will need to develop better postural habits, especially when interacting with their electronic devices. While the process can take time, the good news is that it’s possible to reduce forward head posture, which can also lower the risk for neck pain recurrence.
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When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.
Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.
To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.
In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.
For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).
To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.
To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.
For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system. Be safe, and do these in a corner to prevent falling!
Make these exercises a habit. Consistency will help improve low back function and you’ll reduce your risk for a future episode of low back pain!
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While neck pain is most commonly associated with whiplash associated disorder (WAD), patients often report jaw or temporomandibular joint (TMJ) pain following a car accident, sport injury, or slip and fall.
Common symptoms associated with temporomandibular disorders (TMD) include pain in the jaw joint area (in front of the ear), neck and shoulder pain, ear area pain with chewing or yawning, a “stuck” or locked feeling, and clicking, popping, or grating sounds with jaw movements. Patients with TMD may also feel like their teeth don’t fit well together, or report toothaches, headaches, dizziness, and tinnitus (ringing in the ear).
An MRI (magnetic resonant imaging) study of TMD following a WAD injury revealed joint effusion or swelling and/or disk displacement in more than half of the participants, along with alterations in the thickness of the lateral pterygoid muscle (LPM) that helps open the mouth. Studies have shown that rear-end collisions can result in trauma to the muscles in the area of the TMJ, along with its joint capsule and fibroelastic disk. Post-traumatic muscle imbalance can then perpetuate the problem, leading to chronic TMD.
A 2018 study found that patients with TMD following a whiplash injury (wTMD) had higher pain intensity scores, worse exam findings, worse function, and greater muscle atrophy in the LPM than patients whose TMD resulted from another cause. The patients with wTMD were also more likely to be affected by stress and headaches than the other TMD patients.
The authors concluded that TMD is a common WAD-related injury, and MRI findings of disk displacement and LPM alterations are often found together. They also point out that TMD from whiplash appears to involve a different mechanism than TMD from other types of trauma or no trauma.
Doctors of chiropractic are trained in the assessment and treatment of WAD, including TMD, which often involves a multi-faceted approach that includes manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more).
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Carpal tunnel syndrome (CTS) is a condition that we typically associate with overuse activities, especially occupations that require fast, repetitive hand work such as typing, sewing, and packaging. However, the hormonal changes that occur in pregnancy can also lead to swelling or inflammation in the wrist, and subsequently, the symptoms associated with CTS.
A 2019 study involving 382 women in the third trimester of pregnancy revealed that 111 (23.03%) experienced the signs and symptom consistent with mild-to-severe CTS. Further analysis showed that the women who were older, left-handed, and had gestational diabetes mellitus were more likely to have severe CTS symptoms.
It makes sense to assume that pregnancy-related CTS would resolve once a woman has given birth, but another study suggests this isn’t always the case. In one long-term study, researchers monitored the status of 45 women who presented with CTS during their pregnancy. One year following the birth of their child, only 40% of the participants reported that their symptoms (pain, tingling, numbness) and function had improved. Half of the women reported no change in their symptoms or function and a small portion said their condition worsened (13.3% symptoms, 4.4% function). Nerve conduction testing showed no problems in 17.8% of participants, with the rest experiencing some degree of nerve interference.
At the three-year mark, 51% were symptom-free, while 49% were still symptomatic but less so compared to their situation at the start of the study and at the one-year follow-up.
In conclusion, although many women who develop CTS during pregnancy will experience improvement over time, almost half will continue to report symptoms and functional impairments up to three years after the birth of their child. Doctors of chiropractic offer a non-surgical, effective combination of management strategies that can be easily and safely applied during pregnancy and after delivery. Because CTS can be highly disruptive to sleep and cause other quality-of-life issues, women with the condition should strongly consider chiropractic care during pregnancy and after if symptoms or problems persist.
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It’s estimated that up to 50% of whiplash associated disorder (WAD) patients will develop chronic symptoms such as neck and upper back pain, headache, dizziness, emotional and cognitive disturbance, referred pain, and physical dysfunctions. Fibromyalgia (FM) is a condition that is also characterized by long-term, persistent symptoms such as chronic widespread musculoskeletal pain, sleep disturbance, cognitive disturbance, fatigue, and physical dysfunctions. Both WAD and FM patients share similar chronic, debilitating signs and symptoms. Why is this so?
In one study, researchers evaluated cognitive loss, central sensitization, and health-related quality of life (QoL) in chronic WAD patients, FM patients, and individuals without any known chronic conditions to serve as a control group. Participants in both the WAD and FM group exhibited significant cognitive impairment, central sensitization, and decreased health-related QoL, suggesting that brain injury plays a significant role in each condition.
In WAD injuries, the mechanism of injury causing cognitive loss (the brain’s inability to process information) appears to arise from the brain slamming into the inside of the skull. In a classic rear-end collision, the brain first hits the back of the brain casing followed by the rebounding into the front of the skull, causing a concussion.
A 2011 study found that among 58 women who had been admitted to the emergency room for a whiplash injury, three met the clinical criteria for FM three years later. Another 2011 study found that among 326 WAD patients with persistent neck pain lasting longer than three months, up to 14% met the criteria for FM. Based on these findings, it’s clear that the whiplash process could be a strong contributing factor for developing FM. Indeed, a 2015 study that looked at the health histories of 939 FM patients identified trauma as a precipitating factor in 27% of cases.
While we typically associated whiplash with motor vehicle collisions, such injuries can also occur in sport collisions, physical assaults, and falling. It’s possible that a greater percentage of FM cases may be due to trauma the participant simply wasn’t able to recall. Emotional trauma and post-traumatic stress disorder have also been associated with an elevated risk for FM. The disease process for FM isn’t entirely understood, and in cases when the cause is not known, it’s possible the condition could be the result of a cumulation of factors, including WAD.
Nonetheless, it’s clear that chronic WAD and FM are potentially debilitating conditions and seeking treatment after a trauma, such as a motor vehicle collision, is important for mitigating the risk for chronic symptoms. The good news is that both FM and WAD patients respond very favorably to chiropractic care! Doctors of chiropractic are trained to examine, diagnose, and treat those presenting with FM and WAD. Studies have reported that the inclusion of spinal manipulation enhances recovery in acute and chronic WAD, as well as FM.
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Alzheimer’s disease (AD) is the #1 cause of dementia, representing an imminent threat to our senior population. It is one of mankind’s cruelest afflictions that causes patients lose their memory, personality, and eventually self-care skills. According to the Centers for Disease Control and Prevention (CDC), about 6 million people currently have AD with projections of this doubling in the next two decades. The 2015 Framingham Heart study reported that 1 in 5 women and 1 in 10 men will develop AD.
Though researchers have observed an association between beta-amyloid plaque build-up in the brain and AD, well-funded studies have failed to determine that beta-amyloid plaques are the cause of the disorder. Interestingly, two studies published nearly 40 years ago concluded that the virus that causes cold sores (HSV-1) may play a role in the development of AD. This suspicion was bolstered by a 2014 study that detected the virus in the brains of AD patients, particularly in the parts of the brain related to memory. Neuroscientists propose that the plaque build-up commonly seen in AD patients may a consequence of the immune system trying to battle the presence of HSV-1 in the brain.
This finding suggests that AD could potentially be treated, or even prevented, by therapies that target HSV-1. Dr. Robert Rubey notes that as far back as 1968, researchers have known that HSV-1 requires the molecule arginine for replication, which can be blocked by the presence of the amino acid L-lysine. Double-blinded studies have demonstrated L-lysine is effective at both preventing or decreasing/reducing the severity of HSV-1 outbreaks.
Dr. Rubey concludes that AD is a disease process, NOT an aging process. The importance of preventing viral reactivation leading to brain inflammation/damage is key in preventing AD. In 2010, Dr. Rubey speculated that supplementing with 1,500mg of L-lysine twice a day combined with a low-arginine diet (reduced intake of nuts, seeds, grains, and tofu) may protect against AD. However, more research is needed in this area before firm recommendations can be made.
Doctors of chiropractic often recommend anti-inflammatory diets and supplements for both aiding the recovery process from musculoskeletal injuries and living a healthier lifestyle.
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The shoulder is one of the largest and most complex joints in the body. It’s actually three joints—the AC or acromioclavicular joint (the collar bone/acromion of the shoulder blade joint), the glenohumeral joint (the ball-and-socket joint), and the scapulothoracic joint (the shoulder blade/rib cage “joint”)—all of which involve the scapula to some degree.
The rotator cuff is made up of four muscles, three of which sit on the back side of the scapula and rotate the arm outward (external rotation) and one in front that rotates it inward (internal rotation). The trapezius muscle is made up of three parts: the upper part pulls the shoulder blade up and in, the middle portion pulls the shoulder inward, and the lower section of the muscle pulls the scapula down and inward. The chest muscles rotate the arms inward. There is also a “bursa” or a fluid-filled sac that cushions, lubricates, and protects the rotator cuff tendon attachments. The “labrum” attaches to the rim of the “socket” or cup, to give it more depth and stability for the ball to sit in.
While this arrangement gives the shoulder a wide range of motion, it also makes it less stable and more vulnerable to injury. There are many injuries that can affect the shoulder, with one of the most common being tearing of the rotator cuff tendons (called “tendinitis” or “tendinopathies”), which often lead to a bursitis, or swelling of the bursa sac, resulting in shoulder impingement (pain raising the arm). In fact, over half of people in their 80s have tearing of the rotator cuff.
There are many exercises that help return function to the shoulder in both non-surgical and post-surgical cases. Exercises are aimed at restoring motion, strengthening weak muscles, and stabilizing the shoulder. However, studies show that the best results are achieved when scapula stabilization exercises are included in the treatment process.
One GREAT exercise for stabilizing the scapulae is called the Push-Up Plus (PUP). This is performed by positioning yourself into a push-up position (either toes or knees—you choose based on strength) with your hands shoulder width apart, elbows locked straight, and the fingers pointed outward (thumbs at 12 o’clock). Instead of dropping the chest to the floor, PUSH the middle of the back upward toward the ceiling. Hold the position for three seconds and SLOWLY return to the start position. Repeat five to ten times and gradually increase reps as you’re able.
There are several variations of this. For example, rotating your fingers inward increases activity in the rotator cuff muscles (the most important muscle group for shoulder stabilization) and reduces activity in the chest muscles (pectoralis major) and scapula elevators (levator scapula). You can also alter this by raising your feet to different heights, as the higher the feet, the greater the serratus anterior muscle activity! Your doctor of chiropractic can advise you on which shoulder stabilization exercises may provide the most benefit for your unique case.
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In addition to spinal manipulation, doctors of chiropractic often use other conservative therapies to reduce pain and improve function in patients with neck pain. When it comes to neck conditions involving herniated disks, radiating arm pain (“radiculopathy”), strains, facet syndromes or sprains, and myofascial pain, cervical traction is one such option.
As part of the initial new patient examination, a chiropractor may use their hands to gently pull on the patient’s neck while in sitting and/or supine (lying on the back) positions. If this feels good, then cervical traction may be warranted either in the office, with an at-home unit, or both. However, cervical traction is not advised if there is instability in the spine/ligaments, vertebral artery insufficiency, rheumatoid arthritis, osteomyelitis, discitis, neoplasm, severe osteoporosis, untreated hypertension, severe anxiety, cauda equina syndrome, or myelopathy.
There are various forms of cervical traction devices, so treatment may be performed while the patient is in a standing, sitting, lying horizontal, or inclined either prone or supine position, and the traction force can be continuous or sustained vs. intermittent or pulsed. Variables include body/head weight and the associated friction against the traction table in lying down types of units, and the angle can often be varied with most types of traction units.
There are pros and cons to different types of traction units. Lying down traction may allow for better relaxation vs. sitting, but more weight may be needed due to the friction of the body on the table. Generally, when hold times are longer (especially with sustained traction), less weight is used. Some doctors advocate starting at 5 lbs. (~2.67 kg) for 15 minutes with a sitting device (sustained traction) and gradually increasing the weight to maximum tolerance while keeping the time constant at 15 minutes.
There are a number of theories on why traction relieves pain: it forces rest through immobilization and by supporting the weight of the head, it pulls apart or opens the facet joints, it improves nutrition to the joint cartilage, stretches ligaments, it decreases the pressure inside the disks, it reduces pressure on nerve roots (by widening the holes through which they travel), it improves head posture, and/or it stretches the neck muscles to improve blood flow and reduce muscle spasm.
The bottom line, if you have neck pain and manual traction applied to the cervical spine provides pain relief, then your doctor of chiropractic may choose to incorporate this therapy into your treatment plan, either in the office, at home, or both.
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It’s common for the elderly to have multiple chronic conditions, all of which can impact their ability to live a vibrant, independent lifestyle. While it may not be possible to avoid adverse health conditions in our later years, it appears there are steps we can take now to give ourselves the best possible chance to maintain good health for as long as possible.
In an April 2020 study published in the Journal of the American Medical Association, 32 researchers from around the world collaborated to investigate the association of a healthy lifestyle with years lived free of major chronic diseases like type 2 diabetes, coronary heart disease (CHD), stroke, cancer, asthma, and chronic obstructive pulmonary disease (COPD). The data set for the study included 116,043 adults (average age 43.7 year) whom researchers followed for an average of 12.5 years.
At baseline, the investigators looked at four lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) and assigned a scoring system for each factor (0=poor; 1=intermediate; 2=optimal) for a total score of 8.
During the course of the study, 15% of participants developed at least one chronic disease. The research team’s analysis showed that every one-point increase in an individual’s healthy lifestyle score translated to an increase of .96 chronic disease-free years in men and .89 chronic disease-free years in women.
Compared to individuals with a score of 0, those with a score of 16 benefited from an average of 9.4-9.9 additional chronic disease-free years!
The findings showed that maintaining a healthy weight (BMI or body mass index of ~25), not smoking, avoiding excessive alcohol consumption, and getting regular exercise dramatically increased the odds of reaching age 70 without chronic disease.
Doctors of chiropractic frequently encourage patients to live a healthy lifestyle because not only can it add years to your life, as this study suggests, it can add life to your years.
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A study published in 2019 found that nearly half of whiplash associated disorders (WAD) sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce their risk for chronic WAD symptoms?
The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn’t become more severe. This is one reason why cervical range of motion is reduced when the neck is injured.
You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck.
The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature.
The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines.
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Osteoarthritis (OA) is the leading cause of knee pain and disability in the elderly population. While treatment to address knee OA will often focus on the knee itself, a patient may also need to change their footwear. Why is that?
During normal walking, joint loading is NOT evenly distributed, and the distribution most often greatest on the medial (inner) side of the knee. This greater load can cause wear and tear over time and lead to thinning of the smooth, slippery cartilage surfaces on the medial side of the joint, which eventually leads to bone-on-bone contact, the end-stage of OA. By changing where joint loading occurs on the knee, it’s possible to slow this process and potentially delay or even prevent the need for a knee joint replacement.
This can be accomplished through either a change in footwear or adding an insole or orthotic to an existing shoe. On the footwear front, an OA patient may need to avoid clogs, barefoot shoes, high heels, and extra-rigid/stiff shoes. Rather, walking or running shoes or, for more formal occasions, a shoe with a shock-absorbing sole and padded collars that’s not too rigid may be a better choice. A well-trained employee at a specialty shoe store can help identify which shoes will work best for your situation.
One study investigated the use of lateral wedges both with and without custom arch supports for people with medial knee osteoarthritis (OA) and pronation (rolled in feet). Each of the 26 participants wore one or the other for two months and switched to the other option after a two-month “washout” or rest period. The researchers concluded that the lateral heel wedge WITH foot orthotic/arch supports provided the best benefit to the participants with respect to performance on a timed stair climb test. Another study found that adding a mobility shoe reduced medial joint loading to an even greater degree.
For the knee OA patient, chiropractic treatment may also include specific exercise training, weight management/nutrition, manual therapies, modality use (electrical stim, magnetic field, laser, ultrasound, and more), and the use of a knee brace—all in the effort to reduce pain and improve mobility.
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Of all the potential contributing factors for carpal tunnel syndrome—diabetes, thyroid dysfunction, inflammatory arthritis, pregnancy, birth control usage, and obesity—perhaps the most well-known is participating in jobs and activities that require fast, repetitive hand movements that can place increased pressure on the median nerve as it passes through the wrist. What can someone do if they begin experiencing tingling and numbness or pain and weakness associated with carpal tunnel syndrome without giving up their livelihood or their hobby?
First, understand that when the wrist is bent, the pressure on the contents of the carpal tunnel can increase substantially, especially when inflammation is present, which can affect the median nerve. So, if an activity frequently leads to numbness, tingling, or painful sensations in the hand and wrist, look for ways to maintain more neutral wrist posture. This may also involve using tools with a more ergonomic, wrist-friendly design. For the carpal tunnel syndrome patient, a doctor of chiropractic may also recommend wearing a splint overnight to keep the wrist from bending during sleep.
It’s also important to take frequent breaks (every 30 minutes, for example) to allow the affected wrist and hand to rest. Or if possible, switch to a different activity for a short time before returning to the task that places the greatest strain on the wrist.
Here are three great exercise options to improve finger, thumb, wrist, and forearm flexibility, which may stretch the soft tissues in the wrist and increase activity tolerance:
- Thumb-finger “push-ups”: Place the pads of your fingers and thumbs together in front of you and keep the fingers straight, spread apart, and pointing down. Push the hands together (try to touch your palms) and then push them apart by flexing your fingers and repeat. This stretches all five digits and the palm/forearm muscles ALL at the same time.
- Shake ‘em out: …as if you’re shaking your wet hands to dry them. Continue this for as long as one to two minutes every hour.
- Wall-stretches: Place your palm on a wall, elbow straight, fingers pointed down and push your palm flat into the wall as far as you can. Reach over and pull your thumb back off the wall with your other hand and hold for 20-30 seconds. Switch hands and repeat the stretch. This can be repeated two to three times per hand every hour.
Of course, consult with your doctor of chiropractic so that he or she can take a look at your patient history and examine the entire course of the median nerve to identify any other factors that may contribute to your carpal tunnel syndrome-associated symptoms.
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Neck pain is the second most common reason patients seek chiropractic care, and it’s particularly a problem with office workers. One study estimated that neck pain affects 42-69% of those who work in office environments. Many such individuals will experience recurring episodes of neck pain, and at least one in six may develop chronic, ongoing neck pain. While chiropractic offers a safe and effective way to manage neck pain, are there any steps an office worker can take to reduce the risk for neck pain in the first place?
According to one study, taking a daily walk may be an effective neck pain prevention strategy. In the study, which included 387 office workers without spinal symptoms in the previous three months, researchers asked participants to wear a pedometer and note any spinal pain symptoms over the next year.
Of the 367 participants who completed the study, 16% reported the onset of neck pain. The results showed that for every 1,000 steps a participant averaged each day, their risk for neck pain fell by 14%. The authors concluded that increasing daily walking steps is protective for the onset of neck pain in those who work sedentary jobs, and managers should formulate and test strategies to encourage walking to reduce the incidence of neck pain among employees.
What about other forms of exercise? A meta-analysis of data from two randomized control trials that included over 500 participants showed moderate-quality evidence that participating in a workplace exercise program can reduce the risk for developing a new episode of neck pain by up to 68%. In the first trial, participants performed stretching and endurance training twice a day at work and twice a day at home. The second trial involved a combination of strength, stabilization, aerobic, and body awareness exercises that included health information, ergonomic training, and stress management training three times a week for one hour over a nine-month time frame.
While it’s not possible to completely avoid a condition like neck pain, the evidence suggests that regularly engaging in physical activity may substantially lower the risk. For those who do develop neck pain, it’s important to seek chiropractic care as soon as possible, which may lead to a faster resolution of symptoms and reduce the risk for both neck pain recurrence and chronic neck pain.
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While under chiropractic treatment, it’s not uncommon for a patient to report improvement for an issue that seems unrelated to their chief complaint. For example, a patient with a temporomandibular disorder may experience an improvement in their jaw symptoms following treatment to the neck or upper back. Or treatment to improve hip function may also benefit the ankle or knee. In this article, we’re going to look at how treatment for low back pain may help a patient who also has urinary incontinence (UI) issues.
There are many potential causes for UI, but one contributing factor is weak pelvic floor muscles. Thus, it makes sense that treatment to address impaired pelvic function may benefit some UI patients. A 2018 Cochrane systemic review concluded that pelvic floor muscle training (PFMT) is more effective than either a sham treatment (placebo) or no treatment for some individuals with UI.
This is where back pain comes into play. It’s estimated that back pain will affect more than 80% of us during our lifetime. We often adjust how we perform everyday activities to avoid pain, both consciously and unconsciously. These abnormal movements can place added stress on other parts of the body. In the case of the lower back, altered function in the hips and pelvis is common.
A November 2019 study published in the Journal of Craniovertebral Junction & Spine concluded that individuals with lumbar degenerative disk disease, spondylolisthesis, and failed back surgery syndrome are more likely to exhibit abnormal spino-pelvic alignment. Overtime, these individuals can develop secondary conditions in the hip or pelvis, which can impair the function of soft tissues, including muscles, in the region. Or likewise, injury to the hips/pelvis can lead to dysfunction in the lower back, which may be why the patient sought care in the first place.
Doctors of chiropractic are trained to review a patient’s case history and conduct a thorough examination on the whole patient in order to identify contributing factors for the patient’s chief complaint. Hence the importance of noting all symptoms, even those that seem unrelated or may be embarrassing. If a low back pain patient’s history notes UI and the examination identifies abnormal pelvic posture, then treatment will likely address improving function in both the pelvis and low back to achieve a successful outcome.
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Multiple studies have shown that hyper-pronation (HP), or too much rolling-inwards of the ankle, can have effects on the body far beyond the foot. For example, abnormal motion of the ankle can lead to slight changes in how the knees and pelvis move as you carry out your normal daily activities, placing added strain on these structures and increasing the risk of injury in both the short and long term. These faulty movement patterns can also lead to improper motion and a higher risk for injury above the hips, including in the lower back.
In one study that involved patients with low back pain (LBP), researchers found that improving both ankle pronation (with foot orthotics) and lower limb weakness (with exercise) resulted in improvements in knee, hip, and low back function.
Foot orthotics often include a pronation-correcting wedge that is thicker on the inside and tapers narrow to the outside to correct the rolling-in effect of the ankle. One study measured the effects that a 5º heel wedge had on the lower limb up to the thorax, noting significant 3-dimensional kinematic changes occurred on the hip, pelvis, and thorax. However, over-correction (at 10º), had detrimental effects on proper motion elsewhere in the body, which underscores the importance of getting an accurate prescription when fitting foot orthotics. Likewise, other studies have demonstrated that a forefoot orthotic may also be required to ensure proper biomechanics while walking.
A study that included 213 high school and college cross country runners (107 male, 106 female) found that 37 (17.4%) wore foot orthotics. Of the 37 orthotic users, 17 (54.8%) wore them for exercise-related leg pain, of which 15 of the 17 reported benefits. Another study compared the load on the Achilles tendon during running both with and without foot orthotics and reported that running with foot orthotics was associated with significant reductions in Achilles tendon loading compared to running without orthotics.
These studies clearly support the MANY benefits foot orthotics have on the whole body or structure, which facilitate both the short- and long-term management of conditions like low back pain! Doctors of chiropractic frequently fit foot orthotics for lower extremity complaints, as well as LBP.
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For patients with chronic low back pain (cLBP), treatment guidelines recommend a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to avoid an initial surgery unless it’s absolutely indicated. That means, unless there is loss of bowel or bladder control or retention (which represents a medical emergency) or if there is progressive neurological motor and sensory loss, one can safely avoid surgery and conservatively manage the condition.
Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up!
Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone.
The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care.
The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone.
The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.”
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Low back pain (LBP) from a herniated disk often leads to surgical intervention. However, there are patients with this painful malady who can successfully “ride it out” and repeat MRI imaging six to twelve months later often fails to show little, if any, evidence of the original herniated disk that was initially very obvious. How is this possible?
The proposed theory is that there must be some unique interplay between molecular signals that might explain why some herniated disks heal themselves while others do not. Researchers at Vanderbilt University Medical Center are investigating this and published a report on their progress in the January 2016 issue of the Journal of Clinical Investigation.
LBP affects 60-80% of Americans during their lifetime, and there are upwards of 300,000 surgeries for herniated disks annually in the United States alone. A disk can herniate when its outer fibers tear or give way, allowing the semi-fluid center to leak out. If the herniated disk material hits the nerve root exiting the spine, the classic sciatica, or pain down the leg, can result.
Dr. Dan Spengler states that about 50% of patients with disk herniation will improve within six weeks, and the actual herniated material may completely resorb over time. What troubles Dr. Spengler and other researchers is why this doesn’t occur with everyone.
Looking specifically at the molecules that are frequently present when disks herniate, researchers have identified a group of proteins called matrix metalloproteinases (MMPs). Certain MMPs have the ability to act like “Pac-Man” and literally chew through other proteins making it highly suspect that MMPs may be at the forefront of why some disks resorb while others do not! Additionally, when a disk herniates, bleeding occurs and white blood cells—specifically macrophages, which are immune system cells in our blood that ingest foreign materials and bacteria—also flood into the area.
What most surprised the authors was the interplay between the macrophages and the MMPs. They found that when the blood/macrophages and one of two specific MMPs interacted in a very specific manner, disk resorption occurred and they were even able to replicate this process in a lab. They concluded the following, “These enzymes are more complicated and interesting than we originally thought. Rather than being big bulldozers, they’re a fine pair of scissors that cut certain things.”
The TAKE-HOME MESSAGE here is unless you are having progressive neurological loss (meaning muscle weakness or sensory pain that is progressing, and/or especially bowel or bladder weakness), there is NO RUSH to run and have surgery! Doctors of chiropractic can offer natural, non-invasive treatments to manage pain while you let your body manage the herniation!
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Previously, we discussed how herniated disks can resorb all by themselves, especially large herniated disks. But what about a damaged nerve—can it self-repair too?
First, it’s important to realize that damage can occur when enough pressure is applied to any living tissue. The anatomy of our nerves includes many micro-structures such as the blood vessels that bring needed oxygen to the several layers of the nerve. If the nerve is deprived of oxygen long enough, there can be damage to its infrastructure, similar to a heart attack damaging the heart muscle.
A pinched nerve results in symptoms that include numbness, tingling, weakness, and in some cases, burning sensations. There are three stages of nerve damage that can be simplified into mild, moderate, and severe, and the ability for nerves to regenerate depends largely on the amount of damage and the length of time that has passed before treatment is sought out.
Generally speaking, it has been well reported that the nerves that make up the peripheral nervous system (the nerves outside of the brain and spinal cord) have the ability to regenerate, while those within the central nervous system (CNS) generally do not. However, there is hope. Researchers have begun to identify the molecular mechanisms that can promote axon regeneration in CNS injuries. Much of the knowledge and insight derived from these studies comes from the experimental use of fruit flies, as is referred to as “Drosophila models of axonal regrowth.”
The activation of an important receptor (called “insulin-like growth factor 1 receptor or IGF-1R) appears to be an essential step for axonal regeneration to occur in adult CNS neurons. Studies utilizing Insulin-like Growth Factor-1 (IGF-1) as a form of treatment in animal models after a brain injury found IGF-1 to be “neuroprotective” in the early stages of brain injury, and blood levels are often elevated soon after an injury.
In a study of 45 patients who suffered traumatic spinal cord injuries, researchers detected higher levels of IGF-1 blood serum levels in those who had clinically documented neurological resolution as compared to lower levels that were found in those who did not have neurological remission.
Unfortunately, researchers need to identify some of the missing pieces of the CNS-injury recovery puzzle before a consistent and predictable outcome can be expected for people who have sustained a serious spinal cord injury.
Doctors of chiropractic are trained to identify injuries to peripheral nerves as well as to the spinal cord and they can also work closely with other experts who manage the more significant neurological injuries, all in the quest of getting you back on the road to as much recovery as possible!
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According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes that roughly follow a 24-hour cycle, responding largely to environmental light and darkness. Most living things possess this trait including animals, plants, and many microbes.
So how does this relate to low back pain? Recent studies reveal that the intervertebral disk (IVD)—the “shock-absorbers” located between our vertebrae in our spine—contain intrinsic circadian clocks that are regulated by age and cytokines and are linked to degeneration. This means we have a 24-hour rhythm producing various changes in an organized way throughout the day in each of the disks in our spine!
Researchers have found at least 600 genes with 24-hour patterns of expression representing several essential pathways associated with disk pathology. In experiments on mice, scientists have observed that when the normal expression of these genes is disrupted, disk degeneration may occur. The study concludes, “These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.”
So what can we do about this? These findings support an important concept that improves overall health, quality of life and longevity: our sleep habits! We know our circadian rhythms influence sleep-wake cycles, hormone release, body temperature, and many other important bodily functions and are linked to various sleep disorders.
Researchers have linked abnormal rhythms with obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder (SAD), to name a few. We also know how we feel when we fly from California to New York and the alarm rings at 7am in NYC but our biological clock says 4am!
The importance of sleep cannot be overstated. Longevity is shortened when sleep duration is altered (either too little OR too much sleep) and we know quality of life is negatively affected in swing-shift workers. Now, we’ve learned that the cells in our disks also have a circadian rhythm, and alteration of that rhythm can lead to disk degeneration resulting in low back pain!
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Wry neck, also known as torticollis, is a painful condition in which the top of the head usually tilts to one side while the chin rotates to the opposite side. Torticollis can have several causes from infection (cold, flu, or otitis media, for example) to sleeping in a draft; however, the cause is usually unknown (idiopathic).
In a typical case, torticollis may resolve itself within four to six weeks, but with chiropractic care, cervical function can return to a more normal state much faster, often within a week. Chiropractic treatment for torticollis often includes stretching, in which manual cervical traction, spinal mobilization, and myofascial release techniques help to restore the lost range of motion and faulty posture. Once enough motion has been restored, a doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Chiropractors may also use physical therapy modalities and/or provide instruction on home-based exercises and other self-management strategies.
There’s a type of torticollis called congenital torticollis in which an infant is born with torticollis that either developed in utero or during the birth process. Current guidelines support prompt treatment for congenital torticollis versus taking a wait-and-see approach. One study found that treating infants with gentle manual therapy approaches at one month of age led to higher success rates than waiting until they were six months or older when substantially more care was needed to restore full range of motion with lower odds of success.
There is a less common but more serious type of torticollis called cervical dystonia, sometimes referred to as spasmodic torticollis, which is characterized by involuntary contraction of muscles in the neck that twist the head in a variety of directions. Cervical dystonia can occur at any age, but it’s more common among middle-aged women. While there is no known cure for the condition, there are case studies showing that cervical dystonia may respond to chiropractic treatment. In one such case study, a 59-year-old woman with an eleven-year history of cervical dystonia experienced a dramatic improvement in function (from 3/10 to 9/10 on a scale of 0 to 10, 10 being full function and 0 being no function) following a treatment regimen that included cervical spinal manipulation, reflex therapy, eye exercises, and vibration therapy.
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People with migraines know all too well about that throbbing, pulsating, and nauseated feeling that accompanies their headaches and the associated disability that often results. The underlying cause of migraine headaches is still not well understood, but genetics (family history), chemical imbalances in the brain (serotonin, in particular), environmental factors (weather, allergens), and hormonal changes appear to play a part. Because medications to manage headaches can come with potentially serious side effects, especially with prolonged use, many patients opt for non-pharmaceutical treatment approaches to reduce the frequency and intensity of their migraines…
A 2018 survey of 4,356 American adults with a history of migraines found that common symptoms associated with migraines include sensitivity to touch (32%), food cravings (28%), and hallucinations (18%), which include sound and smell. The most common foods to trigger a migraine were chocolate at 75%, cheese (especially aged cheeses) at 48%, citrus fruit at 30%, and alcohol (especially red wine) at 25%. Other foods that may be triggers include cured meats, monosodium glutamate (MSG), aspartame (and other artificial sweeteners), snack foods, fatty foods, dairy products, food dyes, coffee, tea, cola, and nuts.
According to a 2019 study, people who suffer from migraines are often deficient in magnesium (Mg), a mineral naturally found in spinach, nuts, and whole grains. Magnesium is also important in regulating blood pressure, blood sugar (glucose), and muscle and nerve function. A meta-review of previous study findings revealed that migraine patients who received a Mg supplement reported reductions in both headache frequency and intensity. Other benefits included a decrease in hospitalization during pregnancy, and at a higher dose, a lower incidence of type-2 diabetes and stroke!
Another nutritional anti-migraine option includes the use of fever few (Tanacetum parthenium) for both prevention and treatment of migraine headaches. Other benefits of fever few include fever reduction, irregular menstrual cycles, arthritis, psoriasis, allergies, asthma, tinnitus, dizziness, and nausea/vomiting. There is also research support for the use of riboflavin (vitamin B-2), melatonin and coenzyme Q10 by migraine patients.
Doctors of chiropractic often manage their migraine headache patients using a multi-modal approach that includes cervical spinal manipulation and mobilization, physical therapy modalities, home exercise training, nutritional counselling (including supplementation advice), and other conservative treatment approaches based on the patient’s specific needs.
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Mechanical neck pain—neck pain without neurological compromise, often without a specific cause—is associated with a loss of mobility, poor activity tolerance, increased pressure pain sensitivity (or hypersensitivity to a normal stimulus), and increased joint position sense error (JPSE—difficulty reproducing the same movement when repeated multiple times). Patients with mechanical neck pain often seek treatment from doctors of chiropractic. Let’s look at how high-velocity, low-amplitude (HVLA) manipulation—the primary form of treatment used by chiropractors, commonly referred to as an adjustment—helps these patients…
In a 2018 study involving 54 patients with mechanical neck pain, participants received either HVLA cervical thrust manipulation or a sham cervical thrust manipulation. Evaluations conducted immediately following treatment showed that patients in the HVLA group experienced improvements with regards to JPSE (specifically neck rotation and extension), pressure pain threshold, and disability. (A related study showed that patients who received HVLA cervical thrust manipulation experienced an immediate 41% improvement in JPSE.)
A week later, the participants in the HVLA group continued to experience improvements related to disability. Again, this was after just a single treatment. Typically, doctors of chiropractic administer a series of HVLA manipulations one to three times per week for one to two weeks followed by a re-assessment to determine if care should continue (at the same frequency or at a reduced frequency) or if the patient should be released from care and advised to return for care on an as-needed or maintenance basis.
Chiropractors often combine several treatment approaches when managing patients with mechanical neck pain and other musculoskeletal conditions to both reduce pain and improve function. A partial list of commonly applied services include the following: HVLA manipulation (thrust with cavitation), mobilization (non-thrust), soft tissue therapies (massage, vibration, muscle release techniques, trigger point therapy, myofascial release, and more), home and/or in-office exercise training, nutritional counseling, physical therapy modalities, and more. Chiropractic HVLA manipulation has strong research support as being a VERY affective management approach for patients with either acute or chronic neck pain!
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For the last two months (Part 1 and Part 2), we’ve discussed the importance of sleep and its effect on low back pain (LBP). Last month, we offered 9 ways to improve sleep quality, and this month we will conclude this topic with 11 more. Sleep deprivation has been called, “…an epidemic” by the Centers for Disease Control and Prevention. To achieve and maintain good health, we must ensure restorative sleep! Here are additional ways to do that (continued from last month):
- Avoid snacks at bedtime …especially grains and sugars as these will raise your blood sugar and delay sleep. Later, when blood sugar drops too low (hypoglycemia), you not only wake up but falling back to sleep becomes problematic. Dairy foods can also interrupt sleep.
- Take a hot bath, shower, or sauna before bed. This will raise your body temperature and cooling off facilitates sleep. The temperature drop from getting out of the bath signals to your body that “it’s time for bed.”
- Keep your feet warm! Consider wearing socks to bed as our feet often feel cold before the rest of the body because they have the poorest circulation. Cold feet make falling asleep difficult!
- Rest your mind! Stop “brain work” at least one hour before bed to give your mind a rest so you can calm down. Don’t think about tomorrow’s schedule or deadlines.
- Avoid TV right before bed. TV can be too stimulating to the brain, preventing you from falling asleep quickly as it disrupts your pineal gland function.
- Consider a “sound machine.” Listen to the sound of white noise or nature sounds, such as the ocean or forest, to drown out upsetting background noise and soothe you to sleep.
- Relaxation reading. Don’t read anything stimulating before bed, such as a mystery or suspense novels, as it makes sleeping a challenge.
- Avoid PM caffeine. Studies show that caffeine can stay active in your system long after consumption.
- Avoid alcohol. Though drowsiness can occur, many will often wake up several hours later, unable to fall back asleep. This can prohibit deep sleep, the most restoring sleep (~4th hour).
- Exercise regularly! Exercising for at least 30 minutes per day can improve your sleep.
- Increase your melatonin. If you can’t increase levels naturally with exposure to bright sunlight in the daytime and absolute complete darkness at night, consider supplementation.
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On the last podcast, we discussed the relationship between sleep deprivation and low back pain (LBP) and found that LBP can cause sleep loss AND sleep loss can cause LBP. It’s a two-way street! This episode, we will look at ways to improve your sleep quality, which in return, will reduce your LBP. There are many ways we can improve our sleep quality. Here are some of them:
- Turn off the lights: Complete darkness (or as close to it as possible) is best. Even the tiniest bit of light in the room can disrupt your internal clock and your pineal gland’s production of melatonin and serotonin. Cover your windows with blackout shades or drapes.
- Stay cool! The bedroom’s temperature should be around 70 degrees Fahrenheit (about 21 degrees Celsius). At about four hours after you fall asleep, your body’s internal temperature drops to its lowest level. Scientists report a cooler bedroom mimics your body’s natural temperature drop.
- Move the alarm clock. Keeping it out of reach (at least 3 feet or about 1 meter) forces you to get out of bed and get moving in the morning. Also, you won’t be inclined to stare at it during the night!
- Avoid loud alarm clocks. It is very stressful on your body to be suddenly jolted awake. If you are regularly getting enough sleep, an alarm may even be unnecessary.
- Reserve your bed for sleeping. Avoid watching TV or doing work in bed, you may find it harder to relax and drift off to sleep.
- Get to bed before 11pm. Your adrenal system does a majority of its recharging between the hours of 11 p.m. and 1 a.m. and adrenal “burn-out” results in fatigue and other problems.
- Be consistent about your bed time. Try to go to bed and wake up at the same times each day, including weekends. This will help your body to get into a sleep rhythm and make it easier to fall asleep and get up in the morning.
- Establish a bedtime routine. Consider meditation, deep breathing, using aromatherapy, or essential oils, or a massage from your partner. Relax and reduce your tension from the day.
- Eat a high-protein snack several hours before bed to provide the L-tryptophan needed for melatonin and serotonin production.
There are other “tricks” that ensure a good night’s rest that we will continue with tomorrow as this is a VERY important subject and can literally add years to your life and life to your years.
Low back pain (LBP) can arise from a lot of causes, most commonly from bending, lifting, pulling, pushing, and twisting. However, there are other possible causes, including sleep. This not only includes sleeping in a crooked or faulty position, such as falling asleep on a couch, in a chair, or while riding in a car, but also from the lack of sleep. So the question is, how much sleep is needed to feel restored and how much sleep is needed to avoid low back pain?
It’s been shown that lack of sleep, or chronic sleep loss, can lead to serious diseases including (but not limited to): heart disease, heart attack, heart failure, irregular heartbeat, high blood pressure, stroke, and diabetes. Sleepiness can also result in a disaster, as was the case in the 1979 nuclear accident at Three Mile Island, the oil spill from the Exxon Valdez, as well as the 1986 nuclear disaster at Chernobyl. With sleep deprivation, our reaction time is slowed down, and hence, driving safety is a major issue. The National Highway Traffic Safety Administration estimates that fatigue causes more than 100,000 crashes per year with 1,500 annual crash-related deaths in the United States alone. This problem is greatest in people under 25 years old. Job-related injuries are also reportedly more frequently, especially repeat injuries, in workers complaining of daytime sleepiness—which also results in more sick days. It’s also well published that sleep plays a crucial role in thinking and learning. Lack of sleep impairs concentration, attention, alertness, reasoning, and general cognitive function. In essence, it makes it more difficult to learn efficiently. Also, getting into a deep sleep cycle plays a critical role in “consolidating memories” in the brain, so if you don’t get to a deep sleep stage (about 4 hours of uninterrupted sleep), it’s more difficult to remember what you’ve learned. An interesting study (U. of Pennsylvania) reported that people who slept less than 5 hours/night for 7 nights felt stressed, angry, sad, and mentally exhausted. As shown in another study of 10,000 people, over time, insomnia (the lack of sleep) increases the chances for developing clinical depression by 5-fold. Other clinical studies have published many other negative effects of sleep deprivation, some of which include aging of the skin, forgetfulness, weight gain, and more.
Regarding low back pain, what comes first? Does LBP cause sleep interference or does sleep deprivation cause the LBP (or both)? It’s been shown that sleep loss can lower your pain threshold and pain tolerance, making any existing pain feel worse, so it works both ways. Specific to LBP, in a 28-year, 902 metal industry worker study, sleep disturbances (insomnia and/or nightmares) predicted a 2.1-fold increase in back pain hospitalizations with one and a 2.4-fold increase with both sleep disturbance causes (insomnia and nightmares). Other studies have shown patients with chronic LBP had less restful sleep and more “alpha EEG” sleep than controls. Similar sleep pattern differences using EEG (electroencephalogram – measures brain waves) have been shown when comparing chronic LBP patients with vs. without depression compared to controls (non-LBP, non-depressed subjects).
So the BOTTOM LINE is: talk to your chiropractor about how chiropractic helps reduce LBP, stress, and facilitates sleep. There are also nutritional benefits from Melatonin, valarian root, and others that he or she can discuss. Now, go to bed and get a good night’s sleep!
www.PainReliefChiroOnline.com
Have you ever had leg pain and immediately blamed your lower back? Many patients (and unfortunately, many doctors) conclude such pain to be “sciatica” or a “pinched nerve.” When this diagnosis is wrong, it can lead to an inappropriate type of treatment which can delay more appropriate care, or worse, may result in death due to a missed diagnosis of a blood clot.
Here’s a news flash from September 15, 2008:
*WASHINGTON - Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.”
“It’s a silent killer. It’s hard to diagnose,” said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. “I don’t think most people understand that this is a serious medical problem or what can be done to prevent it.”*
Blood clots make headlines when seemingly healthy people collapse after prolonged sitting, such as long airplane flights or being in similarly cramped quarters. Former Vice President Dick Cheney suffered one after a long trip in 2007. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the Iraq invasion.
According to the Surgeon General’s 2008 campaign, there are about 100,000 deaths associated with blood clots each year. Risk factors include increasing age (especially over 65), recent surgery or fracture, falls, car crashes, prolonged bed rest, smoking, obesity, pregnancy, and hormone replacement drugs—including birth control pills. Other less controllable causes can include genetic conditions so it is important to tell your doctor if a relative has ever suffered a blood clot.
The Surgeon General 2008 campaign warns that people with these factors should have “a very low threshold” for calling a doctor or even going to the emergency room if they have symptoms of a clot.
Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.
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You’ve probably heard of a friend or loved one whose back pain resulted in a spinal fusion surgery, but you may not understand what prompted surgery over non-surgical approaches, including chiropractic care.
Simply put, spinal fusion is a surgical technique that aims to eliminate excessive motion (instability) in the spine by fusing two or more vertebrae together. Fractures related to trauma are a common reason for spinal instability, but excessive motion can also be caused by conditions such as spondylolisthesis (when one vertebra slides forward on another) and age-related disk degeneration.
When is a fusion necessary? The short answer is after every non-surgical option fails to result in a satisfactory outcome. The long answer is when there is progressive neurological loss or deficit, cauda equina syndrome, failed non-surgical care, failed prior surgical care, x-ray evidence of instability with neurological signs, and unremitting pain that affects one’s quality of life. Treatment guidelines are not always followed, as many patients consult with a doctor of chiropractic only after they’ve already been advised that their lower back condition requires surgery.
The good news is that most conditions of the lower back can be managed with non-surgical chiropractic care, especially early on. With any musculoskeletal injury, it’s almost always best to seek care right away when the symptoms may be milder. Ignoring an injury may cause it to worsen and/or lead to the formation of scar tissue in the affected area and secondary problems elsewhere as the body attempts to compensate for mobility impairments. Conditions like chronic back pain can still respond well to chiropractic care, but keep in mind, it may take longer to achieve a successful outcome.
However, there are times when surgery is necessary. Surgery may include decompression of the nerve without fusion, but in cases of spinal instability, fusion may be needed, which is determined on a case-by-case basis. There are always risks associated with surgery, which is why it’s so important to exhaust non-surgical options first. When appropriate, your doctor of chiropractic can help facilitate in the referral process for a surgical consultation.
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In recent decades, several studies have identified risk factors for early death such as reduced cardio-respiratory fitness (CRF), obesity, smoking, diabetes, heart disease, pulmonary disease, etc. Of all the causes listed, poor CRF appears to be the leading risk factor for early death. If CRF is so important, can walking help? If so, how many steps do we really need to live longer and better?
For years, experts have suggested walking 10,000 steps per day to live a long and healthy life, but there isn’t much research to support this claim. A 2019 study looked at how many steps a group of 18,289 elderly females took over a seven-day period and compared that data with their health outcomes four years later. The researchers associated a reduced mortality risk with more steps taken per day, up until about 7,500 steps per day. Compared with participants taking 2,700 steps per day, those averaging 8,400 steps per day were 58% less likely to die during the course of the study.
In a similar study involving 4,840 middle-aged adults, researchers compared daily step count data collected during 2003-2006 with health outcomes a decade later and identified an association between steps taken per day and a reduced risk for early death.
Neither study concluded that a fast or slow walking speed played a role in overall mortality risk. However, several studies have linked a faster walking speed with better cognitive health and a reduced risk for disability. A thirteen-year study that compared members of a running club with those who didn’t run found that those who regularly jogged were less likely to experience physical impairments or a premature death.
These studies suggest that getting up and moving your body can improve your cardio-respiratory fitness and reduce the risk of early death. Additionally, staying active may be associated with a better quality of life. Other ways to prolong life include avoiding excessive alcohol consumption, not smoking, maintaining a healthy weight, preserving/building muscle mass, and eating a healthy diet. If you develop musculoskeletal pain that interferes with daily function, seek treatment from your doctor of chiropractic as soon as possible so that you can resume your normal activities pain-free.
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Whiplash associated disorders (WAD) is a collection of symptoms commonly associated with motor vehicle collisions. Because WAD can have such a negative effect on one’s quality of life, it makes sense to take steps to reduce the risk for a car accident. Let’s look at some of the modern technologies that our automobiles may include to lower the chances that a crash occurs:
- Hands-Free / Voice Controls: Cell-phone distractions are the underlying cause of many vehicle collisions, especially texting while driving. In fact, studies suggest that texting while driving may be as dangerous as driving while intoxicated. If you must make a call while driving, use a hands-free option. Fiddling with the radio can also be distracting, so use voice commands or steering wheel functions to change the station, if your car has them.
- Adaptive Cruise Control: This feature accelerate/deaccelerates your vehicle depending on what the car ahead of you is doing. This feature can reduce the stress of long highway drives and eliminates the need to constantly turn on/off or change your cruise control. Some systems will allow your car to stop and start in busy stop-and-go traffic.
- Lane Departure Warning/Lane Keeping Assist: This warns you when you drift out of your lane by vibrating the steering wheel, beeping, and/or giving a visual warning. Many vehicles also have an auto-correction steering feature that keeps you in your lane, provided there are line markings on the road for the sensors to detect. This feature is not meant to steer for you, but it can be particularly helpful, such as when driving at night on a winding road.
- Backing Up/Forwards Safety Features: These include a rear camera and a warning beep if unseen cross traffic is near. Your vehicle may also have an emergency brake assist feature where the vehicle automatically brakes to avoid a crash. Some vehicles also have a collision avoidance system that works when driving the car forward by detecting another car, a pedestrian, or some other obstacle and stops the car or steers the car out of harm’s way. The Insurance Institute for Highway Safety REQUIRES this feature in order to earn its highest safety score.
- Blind-Spot Warning: This feature is usually located on your side mirrors, which illuminate when a vehicle is approaching from the rear of your vehicle and remains lit until the vehicle passes. Many systems will also sound an alarm if you attempt to change lanes or activate your turn signal. More advanced systems can also brake or steer the vehicle back to the center of your lane.
There are many other features such as antilock brakes, traction control, electronic stability control, advanced safety belt features, brake assist, and more. While chiropractic care is an effective way to manage many of the soft tissue injuries associated with motor vehicle collisions, the best outcome is to completely avoid a crash in the first place!
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Groin pain syndrome is a term used to describe groin pain without clinical evidence of hernia or hip pathology. Though the condition is thought to affect between 2% and 20% of athletes, there is not a lot of conclusive research on its cause or the best way to treat it. Most of the published research on those with groin pain without hernia or hip joint pathology are case studies (primarily of professional male athletes), making it difficult to establish agreed upon treatment guidelines, as these types of studies are considered to be of low quality and do not apply to the general population.
Understanding the anatomy of the trunk and pelvis helps us appreciate why physical activity applies tremendous strain to this region. First, the pubic joint is in the front/midline of the pelvis, the sacrum or “tail bone” is in the back, and ilium (or “wings” of the pelvis) make up the sacroiliac joints. These joints only partially move as we walk, run, twist, jump, etc. while the hip joints move freely. The muscles arising from the legs connect to multiple places on the pelvis and spine.
With groin pain syndrome, there is a significant amount of tension directed at the pubic joint by the muscles, tendons, and ligaments (collectively called “soft tissues”) during intense athletic activities (and sometimes regular daily life). These soft tissues also provide shock absorption and add structural support to the pubic joint.
Researchers speculate that groin pain syndrome is caused by the significant difference in strength of the opposing muscle forces from above (abdominal muscles) and below (adductors) leading to strain/sprain and eventually pubic joint pathology (osteoarthritis). Because of this high level of force, injury to the labrum that lines the rim of the hip joint may occur simultaneously resulting in two separate injuries or pain generators, making it easy to overlook the often more subtle, less known groin pain syndrome. Degeneration or joint arthritis can result in both the pubic joint and hip joint, again, adding to the confusion and differential diagnosis.
One case study that involved three soccer players with groin pain syndrome reported that all three athletes experienced satisfactory outcomes after an eight-week course of conservative treatment that included manual joint and soft tissue manipulation. Another study that looked at outcomes from NFL players who underwent either conservative or surgical treatment for groin pain syndrome found no difference in performance between the two groups, though the data suggests that players who underwent surgery for groin pain syndrome may have had shorter careers than those in the non-surgical group.
Doctors of chiropractic are trained to identify all potential causes for a patient’s musculoskeletal condition and to offer conservative treatment options to reduce pain and restore function so the patient can resume their normal activities.
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Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy that affects roughly 4-5% of the general population and about 10% of working adults. The chiropractic treatment approach for the CTS patient typically involves many of the same therapies as those used for conditions like neck and back pain, such as joint manipulation, mobilization, specific exercises, and nutritional recommendations to reduce inflammation. In some cases, patients with neck and back pain can benefit from traction. Could the CTS patient also benefit from traction applied to the wrist?
Back in 2004, the Journal of the Canadian Chiropractic Association reported on a case series concerning four patients with confirmed CTS who underwent a mechanical traction treatment protocol that involved between five and twelve five-minute treatment sessions over a three-month time frame. The results showed an improvement on nerve conductive tests that persisted up to one year following the conclusion of treatment.
In a study published in October 2017, researchers assigned 181 CTS patients to receive either mechanical traction (two treatments a week for six weeks) or usual medical care. The criterion used by the investigators for a successful outcome was whether or not the participants had elected to undergo carpal tunnel release surgery within the following six months.
According to the research team, 43% of the participants in the usual care group had undergone surgical carpal tunnel release in the allotted timeframe compared to just 25% of the patients in the mechanical traction group. The authors concluded that mechanical traction appeared to be an effective conservative treatment option for the CTS patient. Treatment guidelines recommend that patients exhaust all non-surgical treatment options before considering surgery, unless warranted otherwise.
However, as with any musculoskeletal condition, it’s important to identify all contributing factors of a patient’s chief complaint. In the case of a patient with suspected CTS, there may or may not be median nerve compression at the wrist. Similarly, median nerve compression can occur elsewhere along the course of the nerve from the neck into the hand. There may also be non-musculoskeletal causes for inflammation in the carpal tunnel that would need to be addressed in conjunction with other healthcare providers in order for the patient to achieve a satisfactory outcome.
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When individuals use their smartphone, they often adopt an awkward posture in which their head rests forward of their shoulders. This forward head posture, or “text neck,” places added strain on the muscles in the back of the neck, shoulders, and upper back, which can lead to musculoskeletal pain. Researchers are now looking into how electronic tablet use affects posture and can elevate the risk for pain in the neck, shoulders, and upper back.
In a 2018 study, University of Nevada, Las Vegas researchers reviewed survey data from 412 university students, staff, faculty, and alumni regarding their electronic tablet use and associated musculoskeletal symptoms. The research team found that 55% of frequent tablet users reported at least moderate levels of neck and shoulder pain, which is a rate higher than the general population. Furthermore, 10% of the daily tablet users in the survey cited severe neck and/or shoulder pain associated with tablet use. However, only about half (46%) said they stopped using their device when experiencing discomfort.
The researchers added that regular tablet users, especially younger individuals without a dedicated workspace, often used their device in awkward positions, such as sitting with their legs folded on the floor or laying on their stomach or side while looking down at their device. Such postures can place excessive stress on the neck, shoulders, and upper back, leading to musculoskeletal discomfort.
The research team also found that women were over two times more likely to experience pain related to tablet use (70% vs. 30%). While this may partially be explained by women being more likely to sit on the floor with their legs crossed while using their tablet (77% vs. 23%), the researchers hypothesize that a primary driver of the disparity may be in the anatomical differences between men and women. Women often have more slender necks and less muscle mass/strength. Their shorter arms and narrower shoulders may also result in more extreme postural strain while typing on their device.
These findings concern researchers because tablets are becoming more popular for personal, school, and business use, which may place a larger burden on the healthcare system in the years to come. To reduce the risk for musculoskeletal pain associated with tablet use, experts recommend sitting in a chair with back support; placing the screen slightly below eye level; using an external keyboard; typing with the elbows bent at 90 degrees; taking mini breaks to stretch; and performing forward posture correction exercises. If you continue to experience pain associated with tablet use, consult with your doctor of chiropractic.
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Scoliosis is a condition that affects about 3% of teenagers, though the cause is typically unknown. In most instances, the degree of spinal curvature is mild (10-15º curve), but in some cases, the curve may continue to increase as the child grows.
Visible signs of adolescent idiopathic scoliosis include the following: uneven shoulders, one shoulder blade “sticking out” (more prominent) than the other; an uneven waist or a hip higher than the other; and/or a prominent rib cage, usually on the convex side of the curve.
When the curve is small, there are often few if any symptoms. However, if the curve worsens, the child may experience complications, which may require treatment. Complications associated with scoliosis primarily occur in those with larger curves and involve heart and/or lung problems due to the spine shortening and rib cage distortion as the curve progresses, making it more difficult for the heart to pump or for the lungs to expand. Due to changes in spinal biomechanics, individuals with scoliosis may also report chronic back pain and other musculoskeletal conditions.
Scoliosis is diagnosed following a routine patient history and physical examination, as well as standing x-ray of the lower and middle back in order to more accurate determine the degree of spinal curvature. In mild cases, treatment may not be required; however, if the condition worsens or in more severe cases, standard medical treatment may include wearing a back brace or possibly even surgery.
Does chiropractic offer a treatment approach for scoliosis? In a study published in January 2017, researchers reviewed the case history of 60 scoliosis patients treated in a chiropractic setting. The patients received a combination of chiropractic spinal manipulation and exercise approaches including cantilever, postural weighting, fulcrum block, and rotatory torso therapy ball exercises. The results showed successful outcomes in 90% of the cases with 52% of patients experiencing a curve correction and curve stabilization in 38% of the patients. This adds to previous studies and case reports on the effectiveness of both therapeutic exercises and manual therapies for the management of scoliosis.
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Primary dysmenorrhea (PD) is a very common gynecological disorder affecting 84.1% of women during childbearing age. The most common symptoms of PD include lower abdominal pain that can radiate to both thighs and/or to the low back. Other symptoms include tiredness, headache, nausea, constipation, and diarrhea. The condition precedes menstruation (in the absence of any organic pathology) and lasts approximately 48-72 hours. Primary dysmenorrhea is the most common reason for absenteeism from work or school, thus interfering with quality of daily life, which is associated with many direct and indirect costs.
There have been MANY proposed interventions for PD reported in the scientific literature. Most common are non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives, as both work similarly—they affect the cause of pelvic pain, which is reportedly mediated by the hormone-like fatty acid called prostaglandin factor 2x. However, both approaches carry negative side effects such as bleeding in the gut and hormone issues such as bloating and edema, respectively. Thus, the demand for new and alternative approaches with less associated risks has increased.
Spinal manipulative (SM) techniques for PD has been previously studied and proven to have positive benefits on pain perception and menstrual cramps, as well as affecting plasma (blood) levels of some chemical pain mediators. However, there appears to be a lack of agreement on where spinal manipulation should be applied. One study recommended that SM should be applied to the lumbosacral region (L5-S1) for symptom reduction in dysmenorrhea.
A more recent study found that “global pelvic manipulation” (GPM) performed on both sides of the pelvis to mobilize the sacroiliac joint (SIJ) and L5-S1 facet joint resulted in improvements related to low back pain and pressure pain thresholds in the SIJ, with a significant increase in serotonin.
Doctors of chiropractic specialize in the use of spinal manipulation therapy and are trained in many different techniques of lumbo-pelvic manipulation. For those struggling with PD, including a chiropractor as a member in your healthcare “team” makes perfect sense!
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Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss?
A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.
Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain.
Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.
Up to six weeks after the conclusion of care, the researchers reported that patients in the chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP—reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.
This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of LBP.
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When people say, “My shoulder hurts,” they often point to different areas in the vicinity of the shoulder such as the base of neck, the collar bone, the scapula (shoulder blade), the chest, and/or their arm. The challenge with the shoulder is that it’s anatomically comprised of three joints: the glenohumeral joint, or GHJ (ball-and-socket); the acromioclavicular joint, or ACJ (collar bone and scapula); and the scapulothoracic joint, or STJ (shoulder blade and rib cage). Some researchers even argue that the sternoclavicular joint, or SCJ (collar bone and sternum), should also be considered part of the shoulder.
From a musculoskeletal standpoint, the list of conditions that can cause shoulder pain is quite lengthy (and NOT all-inclusive): avascular necrosis (the bone dies due to lack of blood flow), nerve injury (neck and/or peripheral), thoracic outlet syndrome, fractures in/around the shoulder, bursitis, shoulder dislocation, frozen shoulder, impingement, arthritis (several types), rotator cuff injury, sprains, tendinitis or rupture, and labral tears (cartilage rim around the socket).
One of the most common causes of shoulder pain is impingement, which may occur with many of the above-mentioned conditions. This is technically referred to as “subacromial impingement” (SAI), which is essentially a reduction of the normal gap between the ball and socket, thus limiting the amount of room the joint has to function. Classic symptoms include pinching and pain when trying to put a coat sleeve on or raising the arm horizontally.
To complicate matters, conditions elsewhere in the body can also refer pain to the shoulder. In 2018, a study noted instances in which athletes failed to respond to routine treatment for shoulder pain but experienced improvements in pain and function when treatment addressed dysfunction in the cervical spine. Non-musculoskeletal conditions can also result in shoulder pain, such as gall bladder disease, which classically refers pain to the right scapula/shoulder blade. Other abdominal organ conditions that can refer pain to the shoulder include pancreatitis, an ovarian cyst, an ectopic pregnancy, as well as post-surgical referred pain. A heart attack classically refers pain to the left shoulder and left arm but may also include the abdomen, jaw, and/or mid-back. A lung condition such as a blood clot (pulmonary embolism), infection (like pneumonia), or lung cancer or tumors may also refer pain to the shoulder.
Doctors of chiropractic are trained to evaluate the whole patient and identify contributing factors for the patient’s chief complaint. In instances in which a non-musculoskeletal issue is suspected, the patient may be referred to the appropriate healthcare provider. However, a combination of manual therapies (manipulation/mobilization), exercise, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying outcome in most cases of shoulder pain.
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When it comes to neck pain, many patients seek out chiropractic care. In fact, there are several studies demonstrating that manual therapies performed by doctors of chiropractic can offer significant benefits for non-specific or mechanical neck pain as well as neck pain arising from injuries related to sports, car accidents, and falls. What are some of these manual therapies?
Spinal manipulative therapy (SMT) involves moving the head and neck to a firm end-range of movement followed by a fast, thrust aimed at specific joints that are fixed, subluxated (partially out of position), and tender. The thrust is described as a “high-velocity, low amplitude” (HVLA) movement, and it’s also called “an adjustment”, which is more unique to the chiropractic profession. Joint cavitation (the “cracking” sound) often occurs as gas (nitrogen, oxygen, carbon dioxide) either forms within or is released from the joint.
Spinal mobilization (SM) is a low-velocity, low amplitude movement that is typically slow and rhythmic, gradually increasing the depth of a back-and-forth movement, often combined with manual traction. Here, joint cavitation is less common.
Exercise training that focuses on strengthening the deep neck flexor muscles and other exercises that are specifically designed for each individual patient based on their specific needs can result in better treatment outcomes compared to a generalized, non-specific exercise program. Studies in which SMT/SM and exercise are combined report better long-term outcomes than SMT/SM alone, but SMT/SM typically out-performs exercise therapy alone.
Physical therapy modalities (PTM) can include ultrasound, interferential, low and high volt, galvanic current, diathermy, lasers (class 3B and IV primarily), ultraviolet, ionto- and phono- phoresis, pulsed electro-magnetic field, hot/cold, and more.
Muscle release techniques (MRTs) include massage therapy, myofascial release, trigger point therapy, muscle energy techniques, active release therapy, gua sha, and many more.
Cervical traction devices can be used either in the office or at home, depending on the patient’s needs; however, it’s common for both approaches to be used. The obvious benefits of home traction include the ability to repeat its use multiple times a day, and it’s generally more cost effective. Types include static traction that can be applied sitting or supine (on the back) and intermittent traction, which is typically performed supine and is computerized, and hence, is often limited to in-office use only.
Which approaches are used in the course of care depend on the preference of the patient as well as the treating chiropractor. It’s important to discuss your preferences with your chiropractor when seeking care.
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When patients present with low back pain (LBP), they are frequently nervous and worried about whether they’re going to respond to the treatment—especially when it comes to getting out of pain and returning to their normal activities. A variety of studies have shown chiropractic care to be an effective option for the LBP patient, and though there is no “crystal ball”, there are some tests that doctors of chiropractic can perform during an examination that can help predict outcomes!
In fact, a meta-analysis of data from 43 studies published since 2012 suggests that centralization and directional preference, which may be present in 60-70% of LBP cases, offers important prognostic clues. Directional preference means that it’s possible to move the body in a manner that feels better to the patient. Centralization implies that it’s possible to move in a way that reduces the range of the pain to a specific region.
Here’s an example… Let’s say an LBP patient presents with radiating leg pain from their lower back with numbness and tingling in the leg and foot. The focus is to find a movement that REDUCES the leg pain/numbness, so their doctor of chiropractic asks the patient to bend forward, backward, and sideways, and to rotate their torso, looking for which direction is preferred, i.e., directional preference. When pain decreases AND centralizes (the leg pain disappears), then extension is the directional preference.
When centralization occurs, this is a favorable prognostic sign indicating that improvement can be expected. Likewise, when all positions or directions increase leg pain, this is a poor prognostic sign, meaning this is likely a more challenging case.
This helps doctors better advise patients about their condition and what to expect from care in both the short and long term so the patient can make REALISTIC goals and timely plans. Over or under reassuring patients is simply not appropriate! Directional preference also allows providers a means of determining what type of treatment to emphasize. For example, if the patient feels better bending backward and leg pain disappears, the provider will approach treatment and exercise recommendations from that direction.
Patient education is an important part of treatment, and educating patients on how this process can predict treatment outcome instills trust and places realistic goals in perspective so patients know what to expect. This improves compliance with care and confidence for both the healthcare provider and the patient.
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Since falls are a major cause of serious injury, especially for older adults, here’s a simple way to objectively measure and improve your sense of balance…
First, stand in a place where you can catch yourself from falling (like behind a chair or in a corner). Place your feet side by side for ten seconds. Then, place the heel of one foot next to your big toe for ten seconds. Finally, rest the forefoot fully in front of the other (like standing on a tight rope) and wait ten seconds. If this process presents no issues, you can proceed.
Stand on one foot/leg for up to 30 seconds with your eyes open. Next, switch legs and repeat the process. Switch back to the first leg, get your balance, and start a 25 second timer. Close your eyes and see if you can maintain your balance for the full 25 seconds. If you must open your eyes and put your foot down, keep track of your time and try the exercise up to three times in a row to see if you can improve. Repeat this on the opposite leg.
The 25-second “cut-off” for “eyes closed” is published as the “norm” for those up to 59 years old. If you are 60-69 years old, the norm drops to ten seconds and if you are 70-79, the norm is only four seconds! This means we NORMALLY lose our sense of balance with age, but that doesn’t mean you should accept it, as retraining your balance system is feasible with the proper exercises.
First, practice the test described above, as it is also a great exercise for improving balance. Other balance challenges can include the use of a balance or rocker board, walking like you’re on a tight rope, walking backward, hopping in place, and stepping up and down on one or two steps. The important thing is to work these exercises into your daily routine. Many of these balance challenges also work well as a great “mini-break”, especially if you have a desk job.
Re-test your balance skills once one or two weeks and see if you can improve your time. You will be surprised how quickly and how much you can improve your balance skills and how much steadier it can make you feel in your everyday activities. Fall prevention starts with knowing your current abilities, and re-testing keeps you motivated!
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Patellofemoral pain (PFP) is commonly associated with running, jumping, squatting, and walking up/down stairs. It’s thought that PFP is caused by excessive rubbing between the back of the patella and groove, or track, that it rides in. Besides overuse, additional causes for PFP pain include muscle imbalance or weakness or direct trauma. The condition is most common in adolescents and young adults, usually due to overuse and/or misalignment, the latter of which is often referred to as poor “patellofemoral tracking.” This can eventually lead to arthritis, which is more commonly seen in older adults with PF pain.
Past research has demonstrated that issues in the foot can increase the risk for musculoskeletal pain in other parts of the body, including the knees. In a 2018 study, researchers examined the effect of knee-targeted exercise vs. a combined approach that included knee- and foot-focused exercise with foot orthotics (shoe inserts to correct pronation or the rolling inwards of the ankle and foot) in patients with patellofemoral pain.
Participants were instructed to perform terminal extension quad exercises that emphasized COMPLETE extension (straightening) of the knee. This exercise can be done sitting or lying on the back with a rolled-up towel behind the knees (with or without an ankle weight) and fully flexing the quad muscles for three to five seconds and repeating the process ten to twenty times, as tolerated.
The results revealed a significantly greater improvement in the group that included foot care, supporting the conclusion that better outcomes are achieved by combining foot exercise and foot orthotics with knee exercises. The authors reported that the benefits were still present four months after the conclusion of care but not a year, suggesting the importance of continuing exercise and foot orthotic use.
Doctors of chiropractic routinely perform posture assessments when examining patients with knee pain in order to identify dysfunction in the hip or feet that may contribute to their chief complaint.
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We previously discussed how walking backward can strengthen the low back extensor muscles, which can aid in both the treatment and prevention of back pain. According to a study published in the January 2019 issue of the journal Cognition, walking backward (or even watching a video simulating backward motion) may also improve one’s memory.
The study involved 114 people who participated in experiments focused on recalling images, word lists, and even details from a crime scene. Before the recall stage of each experiment, participants were instructed to walk forward, backward, sit still, watch a video that simulated forward or backward motion, or imagine walking forward or backward.
The results revealed that participants performed better in nearly every instance when they either physically walked backward, watched a video that simulated walking backward, or simply imagined doing so. Further analysis revealed that this memory boost lasted an average of ten minutes. While it’s unclear how walking backward benefits memory, psychologist Dr. Daniel Schacter of Harvard University hypothesizes that people may associate backward movement with the past, which may trigger a memory response.
When a crime has occurred, detectives will perform a cognitive interview with witnesses that involves walking them through the crime. Including a backward walking component to the process may allow witnesses to recall more details about the event, which may help solve the case.
Future studies will aim to uncover why this technique improves memory recall and if motion-based memory aids such as this can be applied to patients with cognitive impairments, either from dementia or brain injury.
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Musculoskeletal conditions drive millions of patients to doctor’s offices each year, with back and hip pain being among the most common. Because the hip and low back neighbor one another in the body, these conditions often overlap, with only one of the two being diagnosed. This can lead to inadequate treatment, unnecessary costs, and unsatisfying outcomes for the patient with prolonged pain, disability, and mental health distress.
In some cases, a problem elsewhere in the body can refer pain to another region. For example, dysfunction in the upper neck could result in symptoms in the wrist and hand that could appear to be carpal tunnel syndrome. Or an issue in one area, like the foot, can change a patient’s gait and lead to a problem with the knee. It’s possible that the patient may only seek care for their knee pain, as their foot may not have obvious symptoms for concern. With the hip and low back, both scenarios can occur, which is why it’s important to focus on the whole patient and not just the area of chief complaint.
That’s why doctors of chiropractic consider the whole patient when they present for conditions like hip pain or back pain, starting with a thorough patient history. This includes asking the right questions, in which we frequently use the acronym LMNOPQRST, which stands for: Location, Medical History (or Mechanism of injury), New, Other Symptoms (or, Onset), Provoking/Palliative, Quality, Radiation, Severity, and Timing. These questions MUST be asked for each complaint.
The remaining history of Past, Family, and Social histories and, a Review of Systems allows the doctor of chiropractic to consider other potentially important aspects of the patient’s past such as prior injuries, accidents, surgeries, current medications, genetics, social aspects (smoking, drinking, exercise habits, sleep quality) and more, which can give clues to the current presenting complaints. The use of pain diagrams and questionnaires helps quantify the amount of suffering and serve as good outcome tools to determine treatment success.
The examination includes observing the patient walk and move (with or without distress), their posture, and their affect (is their condition all-consuming); palpating or feeling for painful structures and performing movements that both increase and relieve their pain; measuring patient’s range of motion; determining what position is favored or “best” vs. “worst”; and nerve function tests to look for impairments with regards to sensation, strength, and reflexes.
Each part of the examination is considered in order to arrive at the correct diagnoses so that treatment can accurately focus on healing and improving the function of the ailing parts.
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A quick look around any airport, mall, or auditorium/theater will reveal that poor posture is common. There’s forward head posture, rolled forward shoulders, and uneven/misaligned heads/shoulders/pelvis-hips. Some people even limp or shuffle while walking. Research shows that when a person adopts an abnormal posture, it can place added strain on various areas of the body, which can elevate the risk for musculoskeletal pain, including neck pain. The good news is that when combined with chiropractic care, at-home exercises are great for improving a patient’s posture, which can also reduce their risk for future episodes of neck pain. Let’s look at some of the studies that support the use of at-home exercise and posture training for neck pain…
- For older adults with a bent forward posture due to rounding of the mid back (“hyper kyphosis”), a six-month study that included 99 seniors revealed that a one-hour, three times a week exercise program resulted in both improved spinal curvature and self-esteem.
- Among two groups of young adults with rounded shoulder posture, researchers found that shoulder stabilization and shoulder stretching exercises (40 mins, three times a week for four weeks) benefited patients in different ways. This suggests that combining these exercises may be the best approach to improve balance, strength, flexibility, and posture.
- In another study that included young adults with rounded shoulder posture, researchers reported that patients experienced better results when scapular stabilization exercises were combined with abdominal bracing exercises.
- Teenagers with forward head and protracted shoulder posture exhibited improved posture when specific neck and shoulder exercises were incorporated into their physical education program for sixteen weeks.
In 2008, the Neck Pain Task Force recommended exercise for the management of neck pain, including neck pain associated with a whiplash injury. A 2016 literature review published in the journal Spine added to that recommendation by noting that exercise is also effective for grade III whiplash and neck pain (and injury that includes loss of neurological function). Interestingly, the review did not find one form of exercise to be superior to another, suggesting that combining several forms of exercise may be the best way to achieve the most satisfying outcome for the patient.
Doctors of chiropractic are highly skilled in manual therapies, exercise training, and functional assessments – all of which have been found to successfully improve outcomes for patients with persistent neck pain. As with most conditions, prompt treatment yields the best results, so don’t delay in starting your chiropractic management program!
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There are many conditions that affect the hand and wrist: tendonitis (strains), ligament injuries (sprains), as well as carpal tunnel syndrome (CTS). A contributing factor for these conditions is inflammation caused by overuse and repetitive motions. That’s why your doctor of chiropractic recommend taking mini-breaks (30 seconds to one minute) throughout a busy workday to give the wrist a chance to rest. The following exercises are also helpful for self-managing wrist pain (in addition to chiropractic care):
- SHAKE: As if to dry off your wet hands, shake your arms and hands vigorously.
- FIST/BEAR-CLAW/FAN: This three-step exercise includes making a firm fist, then a bear-claw (bending only the ends or tips of the fingers/thumbs), and lastly, opening the hand wide and fanning or spreading the fingers out.
- THUMB-FINGER “O’s”: Make an “O” by touching the tip of the thumb to each of the four fingertips. Vary the speed and pressure. Mix it up.
- WRIST BENDS (OPTION #1): Sit or stand, elbow straight, palms up, and bend the hand toward you (fingers pointing up). Bend the wrist back so the fingers point down. Hold each position for about five seconds and repeat five to ten times. Repeat on your opposite hand to add pressure to the end-range stretch (to “super-stretch”).
- WRIST BENDS (OPTION #2): Repeat Exercise 4 but with the palms down.
- TENDON TETHER: Hold the arm out in front and bend the elbow 90°, palm facing you. Bend the wrist back so the palm faces upward. With the other hand, pull down on each finger while slowly straightening the elbow until the elbow is fully extended (arm straight) and hold for five seconds. REPEAT on each finger and thumb (both hands).
- WRIST RESISTANCE: Rest the forearm on the arm of a chair (elbow bent 90°) palm down, with the wrist and hand extended off the end of the arm (an edge of a table works too). Place the other hand across the knuckles (to form a “+” sign). First, raise the bottom hand against the resisting/top hand slowly through the full range of motion (ROM) and then reverse it by slowly lowering the hand while STILL RESISTING as you move back down toward the floor (full ROM). Repeat five to ten times slowly and repeat on opposite side. Perform the same exercise with the palm up and repeat on both sides.
- HAND SQUEEZE: Hold a soft rubber ball or a pair of balled up socks and slowly squeeze to a maximum tolerance and SLOWLY release it. One repetition should take at least five seconds. Repeat five to ten times with each hand.
When exercising, THINK ABOUT what you are doing (visualize the movement in your head) to enhance the neuromotor response for the best results. Your doctor of chiropractic can train you on these and many other exercises to facilitate CTS/wrist injury recovery.
www,PainReliefChiroOnline.com
It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?
If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.
A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.
The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.
The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.
The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.
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The ability to take out a small device and check email, take photos, interact with friends, play games, and answer almost any question seemed like a great idea when smartphones and social media debuted over a decade ago; but in recent years, several studies have looked at the downsides associated with heavy social media and device use.
For example, a 2018 study found that people who use social media platforms for extended periods of time are more prone to make risky decisions. Another study revealed an association between heavy social media use and an elevated risk for physical ailments. Most people are aware of the term “text neck”, which results from spending so much time looking down at the phone that it changes a person’s posture for the worse. Other studies have linked social media use with poor mental health, especially among teens and young adults. One study even suggests that the more someone uses social media, the more likely they are to consult with a plastic surgeon to “improve” their appearance.
The Cleveland Clinic’s Dr. Joseph Rock notes that these issues associated with social media/device use may be due to both how social media changes the brain and the effects of sedentary activity on the mind and body. After all, if you’re staring down at your phone all day, you’re probably not moving your body enough.
One of the big problems with social media is that it produces feelings that keep luring people back for more—to the point where they have difficulty coping if they’re not glued to their device. The best way to determine if you’re using your device too much is to ask family and friends what they think, and if the answer is consistently “too much”, that’s a good indication of a problem. Dr. Rock recommends a “cold turkey” approach to test the addiction intensity. He warns, though it will be initially uncomfortable, it does gradually improve.
Not only will you find yourself spending more time having face to face conversations and smelling the roses, but you’ll probably increase your physical activity levels and take on a healthier posture. If you’re still experiencing some neck/shoulder discomfort, your doctor of chiropractic can show you some exercises that can help retrain your body to sit up straight, which can take a lot of pressure off your neck and upper back.
Posture Exercises:
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https://youtu.be/yqjgCxbOgyY
https://youtu.be/Lo4LdBetr1k
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https://youtu.be/wOO7wbjux3E
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Losing excess weight and keeping it off can be a challenge. Hopefully, these eight tips can help make it easier to win the battle of the bulge…
- FOOD JOURNAL: A study published in the journal Obesity reported that in a 142-obese person group, those who consistently logged their meals and held online group sessions about weight-loss strategies lost an average of 10% of their body weight within six months. This process reportedly took participants just 15 minutes per day.
- WHEN TO EAT: It’s not just WHAT we eat but also WHEN we eat that can make a BIG difference. One study showed that a “time-restricted feeding” (TRF) group (eating breakfast 90 minutes later and dinner 90 minutes earlier than usual) felt more energetic, shed more weight, and experienced greater improvements in their blood sugar and blood lipid readings than individuals who continued to eat on their normal schedule.
- SELF-CONTROL: Before reaching for another serving, rate your satiety on a 0-10 scale (10=feeling stuffed) and aim for a score of 4-6/10 maximum to avoid feeling like you ate too much. Studies suggest that exercising this rating method can reduce the risk you’ll consume excess calories at mealtime.
- WHAT TO EAT: When the urge to eat junk food strikes, think about eating a healthy food choice instead of an unhealthy choice. A KEY to success with this recommendation is to have healthy choices pre-prepared so it is easy to grab when the urge for a snack strikes.
- READ & FOLLOW THE LABELS: Restrict the volume of food to the serving size that is printing on the packaging. For example, when it comes to a bowl of cereal, many people fill the bowl to the brim, which may actually be three servings, not one. One study reported that when participants followed this simple instruction, they consumed an average of 300 fewer calories per day.
- FRONT-LOAD YOUR CALORIES: Studies show that individuals who consume more of their daily caloric intake earlier in the day tend to be less likely to feel hungry during the day and crave sweets than those who eat a light breakfast and a large supper.
- BE BEVERAGE AWARE: Be mindful of what you drink as well as what you eat. Many beverages such as sodas, juices, iced tea, and milkshakes are full of sugar and/or high in calories. Drink water instead. Staying hydrated is very important to ensure proper metabolic functions as well. Drinking a full glass of water before eating will also reduce the volume of food consumed.
- EAT MORE PROTEIN: Avoid processed/fast food as these stimulate dopamine in the brain which may increase cravings for such foods. Eat nutrient-dense foods rich in protein and fiber (chicken, fish, lean meats, and non-starch veggies) instead.
www.PainReliefChiroOnline.com
Some of us have been around long enough to remember when wearing a seat belt was optional, and some of us are even old enough to remember when car manufacturers weren’t even required to install them in the first place! Nowadays, not only is it the law in most jurisdictions for all passengers to fasten their seat belt but our cars will obnoxiously beep if we forget. This is for good reason because according to the Centers for Disease Control and Prevention (CDC), seat belts can reduce the risk for injury and save lives in the event of a car accident. However, despite this obvious statement, MILLIONS do not buckle up when traveling in a motor vehicle.
In 2016 alone, 23,714 vehicle occupants (drivers and passengers) died in automobile collisions, of which more than half were not wearing a seat belt at the time of the accident. Let’s dispel some of the myths associated with seat belt use and misuse…
MYTH: Seat belts are uncomfortable and can restrict one’s movement and ability to operate a vehicle.
REALITY: You can adjust the seat belt properly for body size and height.
MYTH: If you are a good driver, you don’t need a seat belt.
REALITY: You can’t control the OTHER DRIVERS.
MYTH: Airbags are enough. I don’t need my seat belt.
REALITY: Airbags are designed to work in coordination with seat belt use, and they may not help you in a roll-over crash.
MYTH: If I brace myself for the impact, I’ll be fine.
REALITY: Studies have demonstrated that the whiplash process can occur faster than the brain can react to it.
MYTH: I’d rather be thrown away from the vehicle.
REALITY: There isn’t a bed of pillows outside the car waiting for you. The chances for survival when ejected from the vehicle are extremely low.
So always make sure to wear a seat belt. If you do experience a collision, the injuries you sustain will certainly be less serious than you’d suffer without a restraint.
www.PainReliefChiroOnline.com
Shoulder pain is a VERY common problem, especially among individuals over 40 years old. Experts estimate that between 16-30% of the population has experienced shoulder pain in the last month, with subacromial impingement syndrome (SIS) being one of most likely diagnoses made by clinicians.
Why is SIS so common? The short answer is because the ball and socket part of the shoulder joint is shallow to allows for a wide range of motion but at a cost of reduced stability. Factors that can increase one’s risk for SIS include increasing age, overhead work, repetitive microtrauma, hypoxia (lack of oxygen), type III acromion shape (a hooked-shaped “roof” over the ball and socket joint), spurs off the acromioclavicular joint and/or front part of the acromion (the roof of the joint), and ligaments becoming calcified.
These risk factors can cause wear-and-tear of the rotator cuff muscle tendon, which can lead to a muscle tendon rupture (partial or complete) over time. In turn, this results in a high position of the humeral head (the ball part of the joint), which when it shifts upwards, causes pinching of the subacromial bursa, especially when the arm is raised, resulting in bursitis. Lying on the affected shoulder is often uncomfortable and a common complaint of SIS. In fact, finding ANY comfortable position in bed can be a challenge! Overhead work is often prohibited due to pain.
The diagnosis of SIS is made using a combination of a thorough history, physical examination, and imaging studies (x-ray, MRI, CT, diagnostic ultrasound). Imaging facilitates the differential diagnosis, which includes spurs, tears, assessing the acromion shape, and more.
Interestingly, a 2019 review of previously published studies concluded that surgery has little benefit for impingement (SIS) in the middle-aged patient. Instead, it’s advised that patients seek a multi-modal, non-surgical treatment approach often utilized by doctors of chiropractic that may include:
- Patient education with respect to the cause of their pain, the realization that progress may be gradual and take three to six months or longer, and the importance of performing a home exercise program.
- Exercises to reduce the high position humeral head (ball), regain range of motion without impingement, strengthen the rotator cuff and surrounding muscles, restore scapular and clavicular function and stability, and reduce pain to regain function.
- Manual therapies (manipulation and mobilization) to the shoulder’s multiple joints.
- Physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field) to facilitate healing and reduce pain and inflammation.
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Most people have heard about carpal tunnel syndrome (CTS) as it’s the most common of the peripheral neuropathies or pinched nerves in the extremities, but few have heard of pronator teres syndrome.
Carpal tunnel syndrome occurs when the median nerve is pinched or compressed while passing through the wrist. However, the median nerve originates in the neck and must pass through several anatomical regions before reaching the wrist and ultimately the hand. One of these areas is the elbow where the median nerve passes between the two heads of the pronator teres muscle. The good news is that pronator teres syndrome is much less common than CTS. The bad news is that it can produce similar symptoms in the hand and can even co-occur with CTS.
That’s why when a patient seeks chiropractic care for carpal tunnel syndrome symptoms like pain, numbness, tingling, and weakness in the hand, a doctor of chiropractic will examine the entire course of the nerve to identify where the median nerve is pinched. This can include the wrist, the forearm, the elbow, the shoulder, and even the neck. Chiropractors will also review a patient’s history for non-musculoskeletal conditions that may be associated with an elevated risk for CTS, such as type 2 diabetes, which may necessitate co-managing care with other healthcare professionals.
Once the potential musculoskeletal causes are identified, which may include pronator teres syndrome, treatment can proceed. In most cases, doctors of chiropractic will utilize manual therapy techniques such as joint manipulation and mobilization to improve joint motion, along with soft tissue manual release methods to relax tight, tender muscles. A chiropractor may also use physical therapy modalities such as pulsed ultrasound, electromagnetic field, electrical stim, and/or the use of therapeutic lasers. Additionally, patients may be advised to temporarily modify their job function, make ergonomic changes to their workstation, use a nighttime splint to keep their wrist in a neutral posture during sleep, or make dietary changes to reduce inflammation (which may include using herbal supplements like ginger, turmeric, and Boswellia).
Most studies show that the best outcomes or results are obtained when conditions like pronator teres syndrome and CTS are caught early in the mild to moderate stage of the condition. Waiting too long can result in scar tissue formation around the nerve making satisfying results more difficult to obtain regardless if management is non-surgical or surgical.
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Experts estimate that headaches affect half the population, with up to 25% of headaches originating from the cervical spine or neck, which is referred to as a cervicogenic headache (CGH). There are many studies that demonstrate the effectiveness of chiropractic management for CGH, often involving a multi-modal treatment approach to address biomechanical dysfunction in the cervical spine that may contribute to or cause a patient’s headache. These treatment options include…
- SPINAL MANIPULATION THERAPY (SMT): There are multiple methods or techniques of spinal manipulation to improve joint movement that can be sub-divided into two types: high velocity, low amplitude (thrust) where joint noise (called cavitation) occurs; and low velocity, low amplitude (non-thrust) where joint cavitation is not common. Some refer to the later as “mobilization.” Doctors of chiropractic often use both, but ultimately, the decision is decided by provider and patient preference.
- EXERCISE: On its own, exercise does not appear to be as effective as spinal manipulation, but when exercises—especially those targeting the deep flexors—are combined with SMT, the benefits last longer and are more satisfying in the long term.
- OCCIPITAL NERVE FLOSSING: Tension on the occipital nerve as it exits the skull can exacerbate CGH symptoms. Nerve flossing can reduce this tension. While lying on the back with the chin tucked in, the chiropractor lifts the patient’s head and moves the chin toward the chest to stretch the muscular attachments at the base of the skull (which often pinch the nerves that cause headaches) while the patient bends the elbows to touch their collar bones. As the chiropractor lowers the patient’s head, the patient extends their elbows and wrists/hands and lowers the arms toward the floor. This is frequently repeated five to ten times (depending on tolerance).
- ACTIVITY (ERGONOMIC) ADVICE: Here, your chiropractor assesses your work and hobbies, looking for ways to reduce the load on your neck and upper back. Forward head posture is VERY common and once identified, he or she can teach you ways to correct the faulty posture—often by making simple adjustments to the activity.
- HOME CERVICAL TRACTION: Traction works by stretching the vertebra and muscles. Though this can be done in the office, you can do it at home much more frequently. An over-the-door unit works well. Typical treatment time is 15 minutes. Gradually increase the weight to a maximum comfortable point (10-15 lbs. / 4.5-6.8 kg) is a common threshold of tolerance). The “KEY” is to RELAX to get the best effect.
Bottomline: If you suffer from headaches, then it may benefit you to consult with a doctor of chiropractic to determine if your headaches may be caused or exacerbated by dysfunction in the neck. If so, then your chiropractor will have a variety of treatment options available to reduce the frequency and intensity of your headaches.
www.PainReliefChiroOnline.com
For the patient with low back pain, guidelines recommend seeking treatment in the acute state of the condition instead of waiting for it to become chronic. While it’s generally easier and faster to achieve a satisfactory outcome in the earliest stages of a back pain condition, there’s another reason: to reduce the risk for additional injury. To see how this is the case, let’s look at the effect low back pain has on walking.
In a February 2020 study, researchers examined the lower limb kinematics (function) in 40 subjects, half of whom had chronic back pain, using a special seven-camera system that tracked the movements of the pelvis, hip, knees, and ankle joints during walking. The data show that individuals with chronic low back pain had significantly altered movement in all three joints of the lower extremities.
Another recent study used a marker-based motion capture system to examine the spinal kinematics of 22 adults (half with chronic low back pain) while walking by breaking down the spine into four sections: upper and lower lumbar (UL and LL) and thoracic (UT and LT). This experiment also revealed significant movement differences between the two groups.
Using a sophisticated assessment method called statistical parametric mapping (SPM) to capture a 3D analysis of subjects (20 with vs. 20 without low back pain), yet another study identified altered movement patterns among those with low back pain.
These studies demonstrate that individuals with back pain exhibit altered walking kinematics, which may be a response by the body to avoid pain. But doing so may place added stress on other parts of the body, like the hips, knees, and ankles, which could lead to secondary conditions. On the other hand, there’s the possibility that pre-existing dysfunction in the lower extremities resulted in abnormal motion which led to a lower back condition.
Either way, these findings underscore the importance of examining the whole patient to identify any and all issues that may contribute to their low back pain, something which doctors of chiropractic are trained to do in order to achieve the best possible outcome for each patient.
www.PainReliefChiroOnline.com
A 42-year-old female patient presented with neck pain that had been present for two months. The pain came on gradually and without a specific cause. Her vocation is answering the phone for a busy mail order shoe store. She works 40 hours a week, 5 days per week. Her neck pain worsens with work, especially by the end of he eight-hour shift. Other pain producers include driving more than 30 minutes, reading more than 30 minutes, and washing her hair with the head back. Her pain improves when she rests her head on a chair or pillow, moves her head in circles, takes 600 mg of ibuprofen (repeated 3x/day), and after a hot shower. She describes the pain as an ache with intermittent sharp pain that is becoming more frequent, “…when I move the wrong way.” There is no shooting pain into her arms or hands.
Sound familiar? People with neck pain present to chiropractic offices around the world every day; however, each patient is different and every person is unique and each case must be individually managed. For example, some patients “hate doctors” or are extremely anxious about going to any doctor. This might stem back to a prior “bad experience” with a healthcare provider at a very young age or perhaps even a more recent event. Nonetheless, the approach used in this type of presentation may be best if it is very methodical, reassuring, and fully explained. A “low-force” type of manipulation may be best suited for this type of person as “cracking” of the neck may be too frightening for them. On the other hand, a different patient may not be happy unless there is a “good crack” and will not be satisfied until a chiropractic adjustment is performed.
It is equally important in both cases that a patient get a complete explanation regarding:
- What is the condition causing the symptoms?
- What can be done to treat it (that is, “what are my treatment options”)?
- Will the proposed treatment “fit” into their busy schedule, financial situation, and philosophy about healthcare?
Providing answers to these questions will usually aid in achieving the best results, as the patient will understand the issues most important to them and will have confidence that those issues are understood and appreciated by the doctor. In either case, management for this particular patient may include:
- Modifying the workstation by switching to a headset rather than pinching a phone between the neck and shoulder.
- Evaluating the patient at their workstation to check for proper posture at the desk, proper computer monitor positioning, etc. and making modifications as needed.
- Teaching the patient cervical range of motion exercises and other stretches that can be done at the workstation multiple times a day that only take a minute or two to perform.
- Cervical traction (if this “feels good” when tested during the exam).
- Use of a cervical or contoured pillow.
- Neck/upper body-strengthening exercises.
- The use of ice as needed.
- An anti-inflammatory diet (for example, a gluten-free diet).
- Nutritional supplementation, as indicated. Of course, most of the time, all of these approaches do not have to be included, but are options.
www.PainReliefChiroOnline.com
Neck pain can arise from many different sources with a similar clinical presentation, which can make it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome (TOS). Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.
TOS can arise from either blood vessel compression, nerve compression, or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle), and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm, and hand (usually affecting the 4th & 5th fingers). It’s the job of your chiropractor to run different tests to figure out where the primary pinch or pinches are located so he or she can treat the right area.
The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle, and so on can also result in pinching of the nerves and/or blood vessels.
Purses, backpacks, carrying golf clubs, a mailbag, and the like can also cause a pinch. A seat belt injury from a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.
A slouchy, slumped posture where the shoulders roll forwards can cause TOS. Large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as food servers, carpenters, and electricians can also increase TOS risk.
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Dr. Wil Holdsworth of Pain Relief Chiropractic located in Newton Andover New Jersey discusses a weight-loss plan where you can eat whatever you want and still lose weight.
As desktop computers, laptops, tablets, e-readers, and smartphones take greater importance in our lives, more and more people are consulting with healthcare providers for musculoskeletal conditions like neck pain. Why is this the case, and are there things that can be done to reduce one’s risk for neck pain in today’s modern world?
When using electronic devices, it’s common for individuals to lean forward and/or look downward. When the head rests in front of the neck and shoulders, the muscles in the back of the neck must work harder to keep the head upright. Over time, forward head posture (FHP) can lead to inflammation and injury in the back of the head/neck, shoulders, and upper back resulting in pain and disability. Past studies have shown that up to 60% of neck/shoulder pain patients have FHP, which suggests that taking steps to reduce FHP may have a dramatic effect on the prevalence of neck pain in the general population.
The following exercises can help improve one’s posture, thus reducing the risk for neck pain (they also benefit patients with neck pain):
- Stretch the pects, or chest muscles, by grasping a door jam and rotating your body away.
- Shoulder external rotation strengthening. Lay on your side, elbow bent, and lift/rotate a LIGHT dumbbell toward the ceiling and slowly lower it.
- “Flies”.Strengthen the interscapular muscles by laying prone and raising the arms up toward the ceiling (like you’re flying), squeezing the shoulder blades together.
- Chin Tucks. Tuck your chin and nod the head to strengthen the deep neck flexors.
- Neck Stretches. Pull your neck to the side, look up, and turn toward your pulling hand, followed by looking down and turning away from your pulling hand.
Staying physically active can also reduce your risk for neck pain. In a year-long study involving 367 sedentary workers, those who increased their daily step count by 1,000 steps cut their risk for neck pain by 14%! So, if you work in an office, set a timer to remind yourself to get up and walk around and/or perform the above exercises (at least #4 and #5, which can be done from your seat). Breathing exercises and meditation can also reduce neck muscle tension.
In addition to using manual therapies like mobilization and manipulation to treat patients with neck pain, doctors of chiropractic frequently recommend home exercises like those listed above to improve forward head posture and strengthen the neck muscles to not only reduce neck pain but also to reduce the risk for neck pain recurrence.
www.PainReliefChiroOnline.com
Low back pain (LBP) and posterior pelvic pain (PPP) are very common complaints during pregnancy. In fact, current estimates show that two-thirds of expectant mothers will experience back pain during pregnancy and one in five will report pelvic pain. These afflictions can have a significant impact on a woman’s quality of life and her ability to carry out everyday tasks. So, where does chiropractic care fit into this picture? While some pain conditions associated with pregnancy may be related to changes in certain hormones, there is evidence that the growing fetus shifts the center of gravity forward in a woman’s body. This shift can greatly affect the biomechanics of the body and place added strain on the lumbar and sacroiliac joints, giving rise to pain in those areas. A landmark 2014 study looked at the effect of chiropractic treatment on 115 pregnant women with LBP/PPP. In a nutshell, 52% improved with respect to pain and disability after just one week of care, 70% after one month, 85% after three months, and 90% after six months. Interestingly, the patients who had LBP/PPP prior to pregnancy tended to have higher pain scores at the conclusion of the study than those without a previous history of LBP/PPP. This finding supports the theory that women who have a history of LBP prior to pregnancy are particularly good candidates for chiropractic care early in their pregnancy. Also, due to a common link between persistent LBP after pregnancy and pre-pregnancy LBP, chiropractic care post-partum may be equally important. This study included many chiropractors in various locations, and treatment was not standardized to any one specific method or technique. That being said, high-velocity, low-amplitude spinal manipulative therapy was the most common approach utilized and is the “standard of care” utilized by most chiropractors around the world. As further research is conducted, it seems clear that the use of SMT during pregnancy will become “the norm”.
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In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.
In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.
With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.
For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.
The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.
For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more—including in-office or at-home traction, if warranted.
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The term “intermittent fasting” (IF) describes a variety of eating patterns in which an individual restricts calories for a given timeframe, which typically ranges from twelve hours to several days on a recurring basis. The current research suggests that IF optimizes physiological function, enhances performance, and can slow the aging and disease processes. But how does it do that?
- Autophagy: This is the body’s natural process that removes old, broken down dysfunctional cell parts and proteins, including cells that may become cancerous. Researchers believe that reducing the energy needed to process food allows the body to utilize those resources for autophagy, which may improve longevity and overall quality of health.
- Cancer Prevention: Though additional research is needed to better understand how IF can prevent cancer, researchers have observed that fasting results in a significant reduction of insulin growth factor (IFG-1), which has been linked to prostate and breast cancers.
- Immune Boost: Fasting stimulates stem cells to produce new white blood cells, which helps fight off infections and toxic stress such as during chemotherapy treatment.
- Decreases Insulin Resistance: Consuming carbohydrates causes the pancreas to produce insulin, a hormone that helps balance blood sugar levels. Though restricting calories benefits insulin sensitivity, IF does the same thing only better.
- Reset Your Taste Buds: Prolonged fasts can reset your urge to eat by increasing your sensitivity for sweet and salty tastes, thus reducing the urge to consume unhealthy, processed foods.
- Liver Health: Liver cells regenerate in the absence of food, which means that fasting may promote liver regeneration.
- Mental Focus: The current research suggests that fasting is associated with increased focus and clarity. Try delaying your first meal of the day to see if it benefits your early work activities.
- Metabolic Boost: Research shows that fasting can boost one’s metabolism by 14% within three days, which can aid in weight loss.
- Reduces Hunger: Fasting is associated with a reduction of ghrelin, a hormone released by the stomach that increases appetite.
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It’s common for individuals with low back pain to avoid any movement they feel may worsen their condition. Over time, this behavior can lead to deconditioned back muscles, setting the stage for either prolonged back pain or later recurrence. That’s one reason why treatment guidelines recommend patients continue to be active during the recovery process. But what about physical activity before back pain occurs? Does exercise reduce one’s risk for back pain in the first place?
In a 2019 study, researchers reviewed data concerning 4,246 Finnish men and women (average age 34 years) and found that those who routinely engaged in five or more sporting activities and/or endurance sports (especially running and cycling) were less likely to have radiating or non-radiating back pain. Meanwhile, those who focused on strength training only had a reduced risk for radiating back pain. The authors concluded that participating in a diversity of sporting activities, especially endurance sports, may be best for reducing the risk of both radiating and non-radiating low back pain.
Another study that analyzed data concerning 4,022 men approaching middle age revealed a clear relationship between lower physical activity levels and a greater risk for chronic low back pain. This finding persisted even after researchers controlled for obesity, which is also a risk factor for back pain.
A 2020 study that utilized data concerning 7,565 older men came to a similar conclusion. In the study, researchers calculated each participant’s total physical activity levels and found that the more one moved during the day, the lower their risk for chronic low back pain. The data show that even intermediate levels of physical activity cut the risk for chronic low back pain by as much as 25%.
The findings of each of these studies suggest that staying physically active can reduce one’s risk for low back pain during each phase of adulthood, especially with the utilization of endurance exercises. If you’re suffering from back pain and have become inactive, your doctor of chiropractic can help identify simple exercises you can perform at home to increase your physical activity levels and help you get out of and stay out of pain.
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With all the hype about cholesterol, where does the truth lie? On one hand, some doctors recommend EVERYONE be placed on a statin (cholesterol lowering medication) regardless if their cholesterol levels are high or not. On the other hand, some experts report that statins are unnecessary and cholesterol is both essential and good for us. So, where does the current research fit into this picture?
Let’s look at a July 2015 Harvard School of Public Health publication that reported “….it would be cost effective to treat 48-67% of all adults aged 40-75 in the [United States] with cholesterol-lowering statins. By expanding the current recommended treatment guidelines and boosting the percentage of adults taking statins, an additional 161,560 cardiovascular-related events could be averted.” The authors of the report start their discussion by recognizing the “new cholesterol treatment guidelines have been controversial” and seek to weigh the pros and cons of their recommendation. They point out that on one side, “there is strong evidence that statins reduce the risk of heart attack and stroke” and on the other, they report that “…more people would be at increased risk for negative side effects, such as memory loss, type 2 diabetes, and muscle damage.”
Of interest, in November 2013, the American Heart Association and others recommended that statins be prescribed for people with a 7.5% or greater risk of heart attack or stroke over a 10-year period (down from 10-20% or higher in previous guidelines), including many with no existing cardiovascular issues. An article in the July edition of Journal of the American Medical Association (JAMA) reports the 7.5% was acceptable in terms of cost-effectiveness, “…but more lenient treatment thresholds of ≥3.0-4.0% would be “optimal…and would avert an estimated additional 125,000-160,000 CVD-events.”
The opposing camp regarding cholesterol management says that inflammation is at the core of heart disease and stroke, NOT cholesterol. Moreover, RAISING the amount of cholesterol-rich foods in our diet is reportedly WISE since only a small amount of our body’s cholesterol actually comes from diet and most is produced by the liver. Cleveland Clinic’s cardiologist Dr. Steven Nissen says we NEED cholesterol, a theory that is now embraced by the new 2015 Dietary Guidelines Advisory Committee (DGAC), as they have taken a TOTAL about-face compared with their 2010 recommendations (which had “stood” strong since the 1960s). The DGAC are now stating that “cholesterol is not considered a nutrient of concern for overconsumption.”
Other researchers say lowering dietary cholesterol is likely causing far more harm than good. Our cell membranes, as well as activity that goes on INSIDE our cells, our liver (cholesterol is a precursor to bile acids needed to digest the fat we eat), our digestive system, and our brain (which contains 25% of the cholesterol in our body) REQUIRE adequate cholesterol levels. Low levels of HDL cholesterol have been linked to several brain-related malfunctions including depression, stroke, Alzheimer’s disease, violent behavior, and suicide. Also, cholesterol provides insulation for our nerve cells and plays an important role in the production of hormones (particularly testosterone, progesterone, and estrogen). Cholesterol is also important for the production of vitamin D, as when sunlight hits our skin, the cholesterol in the skin is converted into the vitamin.
Obviously, we have a choice: limit / reduce our cholesterol or embrace it. Which camp appeals to you the most?
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Some of you may have heard about how a modified form of boxing is helping patients with Parkinson’s disease (PD). If you haven’t, it’s been observed that people with Parkinson’s disease (PD) who engage in this boxing-like exercise routine can enhance their quality of life and even build impressive gains in posture, strength, flexibility, and speed. Proponents of the program report that regardless the degree of severity of PD, participants have a happier, healthier, and higher quality of life.
But must it be boxing? Maybe not. A report presented at the International Congress of Parkinson’s Disease and Movement Disorders in San Diego in June 2015 found that patients with Parkinson’s disease who began regular exercise early into the PD process had a much slower decline in their quality of life when compared with those who started exercising later. The researchers found just 2.5 hours per week of exercise is needed to improve quality of life scores. According to the report, it didn’t matter what exercise the participants did — simply getting up and moving for a total of 2.5 hours/week was reportedly enough (that’s only 20-25 minutes / day)!
Looking beyond Parkinson’s, other chronic conditions also benefit from adding exercise into a person’s lifestyle. Studies show that regular exercise as simple as walking helps reduce one’s risk for memory loss, and it slows down functional decline in the elderly. Incorporating aerobic exercise into one’s lifestyle can also improve reaction time in people at ALL AGES. Exercise has also been shown to improve both physical and emotional well-being in those afflicted with Alzheimer’s disease with as little as 60 minutes/week of moderate exercise! Patients with multiple sclerosis (MS) have also reported less stiffness and less muscle wasting when using exercise machines, aquatic exercise, and/or walking.
Research has shown just 30 minutes of brisk exercise three times a week can help reduce depressive symptoms in patients with mild-to-moderate depression. In a study involving teenagers, those who engaged in sports reported a greater level of well-being than their sedentary peers, and the more vigorous the exercise, the better their emotion health! In kids 8-12 years old, physical inactivity is strongly linked to depression. Even anxiety, stress, and depression associated with menopause are less severe in those who exercise! So LET’S ALL GET OUT THERE AND EXERCISE!!!
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Often referred to as a “sinful indulgence,” chocolate is usually not thought of as a healthy food choice. However, in the last 20-30 years, there has been growing evidence that there are indeed health benefits associated with chocolate consumption! Let’s take a closer look!
Chocolate is made from tropical Theobroma cacao tree seeds. The earliest use of chocolate dates back to the Olmec civilization in Mesoamerica (1200 - 400 B.C.E.), the precursor to the Mayan and Aztec cultures (currently the states of Veracruz and Tabasco). Following the 15th/16th centuries, chocolate became extremely popular in Europe. Today, millions indulge daily on this unique, rich, and sweet-tasting food with the average American consuming around 4.5 kg (close to 10 pounds) per year!
So what is it in chocolate that makes it so good? The answer includes its richness in flavonoids and flavanols (such as anthocyanidin and epicatechins). In general, the darker the chocolate, the greater the amount of flavonoids and flavanols. These substances are thought to have antioxidant properties, which help neutralize free radicals—nasty things that can damage cells all over the body. Inflammation as well as pollution, UV exposure, and cigarette smoke all increase free radical production. This leads to oxidative stress, which is closely associated with heart disease, cancer, arthritis, stroke, immune deficiency, and more!
Studies have shown that chocolate can reduce both blood pressure and the chance for stroke! Cocoa flavanols are reportedly helpful in reducing inflammation and relaxing blood vessels, which lowers blood pressure, lowers total cholesterol, and increases the “good guy blood fat” or high-density lipoproteins (HDLs). All of this adds up to a reduced risk of heart disease and stroke!
A study published in 2012 looked at the association between chocolate consumption and the risk of stroke in a population of over 30,000 men in Sweden over a ten-year time frame. They found that moderate consumption of chocolate may lower the risk of stroke—“moderate” meaning about 63 grams/week (there are about 43 grams of chocolate in an average chocolate bar). Another study found that fruits and vegetables also lower the risk of stroke as did drinking four cups of black tea per day.
Getting back to chocolate, there may also be a link between eating chocolate and improved cognitive (brain) function. So not only is it smart to eat chocolate, but it may also MAKE YOU SMARTER! This correlates well with an association between dementia prevention and chocolate consumption. Harvard Medical School scientists suggest that two cups of hot chocolate a day may keep the brain healthy and prevent memory decline in older people. Another active ingredient in chocolate is lavado, in which a 2014 study found may reduce or block damage to nerve pathways found in Alzheimer’s disease patients.
Of course, there are “down sides” to eating chocolate. One is the sugar and calorie issue with the negative side effects of obesity, tooth decay, and diabetes. Another is an increased risk of forming calcium oxalate kidney stones, as chocolate / cocoa are high in oxalate. To gain the benefits of cocoa without the worry of sugar and calories, you can purchase cocoa-rich powders and supplements that can be added to beverages. So ENJOY your chocolate, but remember moderation, like in so many other things in life, is “KEY!”
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In general, exercise is good for everyone. In fact, exercise seems to benefit EVERY system of the body, AND it’s one of the BEST ways to relieve stress. So back to the question, should you include push-ups in your exercise program?
The short answer is yes…and no! To best answer this question, we must FIRST assess what shape you’re in BEFORE jumping into any exercise, and push-ups are no exception.
Push-ups are likely one of the oldest forms of a strengthening exercise on record. The beauty of push-ups is that they can be done anywhere and don’t require any special equipment. However, if an individual is not strong enough to perform a push-up, then injury to the shoulders, elbow, wrist, neck, and low back can occur. So, how does one determine where and how to start?
One typically does NOT enter a gym and throw as many plates on a barbell as they can find and start doing bench presses! Nor should one assume he or she can get on the floor and start doing traditional push-ups. You must “wean” into the exercise in order to determine your ability.
FIRST, start in a standing position and lean against a wall with your feet one to two feet (.3 - .6 meters) away from the wall. Pretty easy, isn’t it? In fact, it’s probably too easy, so move your feet further away from the wall and try different distances until you feel a good resistance in your chest, arm, and back muscles.
Gradually increase the load by leaning against a counter top, chair seat, and eventually, the floor. Start with the knees bent and resting on the ground—the so-called “girl push-up” (no offense ladies)! Notice the increased load on your wrists, elbows, shoulders, neck, and back?
Once you’re comfortable with your progress, move to the more traditional “on your toes” push-up. You can also increase the challenge by moving your hands inward and keeping your elbows more tucked into your sides. This is now becoming quite challenging, isn’t it?
But what if you feel pain somewhere? MODIFY the push-up by reducing the load as noted above. You may find it necessary to NOT go all the way down to the floor with your chest but maybe half way or three-quarters down if you have shoulder problems, for example.
A push-up also strengthens the core, as it’s essentially a front plank. Side planks from the knees first and then feet can be added for additional core strengthening. A “push-up with a plus” is another modification particularly good for the scapular stabilizing muscles. Here, you push up beyond the normal “up” position as high as possible until you feel your shoulder blades (scapulae) spread apart.
Whether you’re trying to get in shape after a long winter or after pregnancy, the benefits of push-ups is you can do them anywhere and at anytime. Your push-up options are almost endless! The KEY to a happy life is being healthy, and exercise is KEY to a happy, healthy life!
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High-intensity interval training (HIIT) is characterized by 30-60 second bouts of high-intensity output followed by a very low-intensity exercise (like walking or slow pedaling) which allows one’s heart rate and breathing to recover before the next high-intensity segment.
Studies have shown HIIT can produce similar results as low-intensity aerobic exercise, but with significant differences in intensity, duration, and energy output. HIIT participants can experience improved maximal rate of oxygen uptake (VO2max), improved skeletal muscle capillarization, increased enzymes of fat metabolism, and improved insulin sensitivity—all of which result in better overall health-status and physical performance.
Three separate studies report that HIIT can reduce one’s body fat percentage using durations of only nine total minutes high-intensity activity per week—without controlling food intake! A 2016 study looked at even shorter weekly time durations and included both male and female participants to see what differences exist between the sexes.
The study involved 24 men (average age 38) and 17 women (average age 41) who performed HIIT three mornings a week using a cycle ergometer followed by a blood sample draw over the course of twelve weeks. Their routine consisted of a two-minute warm-up (moderate intensity) followed by four bouts of 20 seconds at maximum effort (set at 175% of the workload attained in the VO2max test) separated by two-minute recovery bouts using very low-intensity cycling (~20% VO2max).
After the three-month study, the participants experienced a lower body fat percentage (average 1%), higher rates of fatty acid oxidation (average 13%), and a greater VO2max (average 9%). Women had greater gains in their VO2max than men, while men lost more fat than the women. Keep in mind the participants only engaged in high-intensity activity a total of 240 seconds per week!
The “TAKE HOME” message is that if you don’t enjoy spending 30-60 minutes per day doing aerobic exercises, then HIIT may be something to consider, as it can produce similar (sometimes even better) results in less time.
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Here are a few ways to improve your sleep quality in spite of a busy lifestyle:
1) SET A SCHEDULE: Set a time for BOTH going to bed AND getting up in the morning, preferably at the same times each day—even on weekends.
2) EXERCISE: Try to get 20-30 minutes of exercise every day (but NOT just prior to bedtime). FIRST thing in the morning is often the best time—before we can “talk” ourselves out of it!
3) AVOID CAFFEINE, NICOTINE, & ALCOHOL: These stimulate the brain and keep us awake. Caffeine sources include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smoking promotes light sleep and early morning waking from nicotine withdrawal. Alcohol also interferes with deep sleep and REM sleep—especially when consumed before bedtime!
4) RELAX BEFORE BED: Take a warm bath, read (but not an action-packed book), and/or perform relaxation exercises before bedtime, as studies have demonstrated these to help one fall asleep.
5) SLEEP UNTIL SUNRISE: Try to wake up with the sun or turn on very bright lights in the morning. This helps “set” the body’s biological clock and exposure to morning sunlight can help people fall asleep later that night.
6) GET OUT OF BED: If you can’t sleep, do something like read, watch TV, or listen to music until you feel tired. Anxiety about NOT being able to sleep contributes to insomnia!
7) CONTROL ROOM TEMPERATURE: Keep the temperature comfortable. If the room is either too hot or too cold, it may prevent you from both falling asleep and also reaching deep, restful sleep when you do finally clock out.
8) SLEEP AIDS: These can include sleep supplements such as valerian root, melatonin, chamomile tea, and/or kava starting with a low dose and gradually increase it as needed.
Other “lifestyle” tips on getting a higher quality sleep include: 1) keep noise and light to a minimum (use earplugs, window shades, or an eye mask); 2) avoid large meals two hours before bedtime; 3) avoid afternoon naps; 4) stop mentally taxing tasks one hour pre-bedtime; and 5) avoid emotional discussions/thoughts right before bedtime.
This list is certainly finite and could go on much longer. The BOTTOM LINE is that if you need help, your doctor of chiropractic can offer a LOT of benefits and when necessary, can work with primary care physicians and sleep specialists—all in the quest of getting you to sleep!
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This certainly is a provoking question! Interestingly, there appears to be some fairly convincing evidence that intermittent fasting can have a dramatic effect on both diabetes management (and possibly play a role in preventing the condition) in addition to increasing longevity. In 2013, researchers looked at this approach in a British Journal of Diabetes & Vascular Disease article entitled, “Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease?”
The study’s authors reported that intermittent fasting helps reduce the risk of heart disease as well as type 2 diabetes AND obesity, as it provides a method to help people manage their weight. They reported generally good compliance and described intermittent fasting as a “clinically relevant therapeutic approach.”
There are several options for intermittent fasting such as fasting on alternate days or not eating for 16 hours (last meal at 8PM and first meal the next day at 1PM, for example). Another option is to simply cut out one meal on days when you observe that your weight has increased.
Not only can intermittent fasting reduce one’s risk for developing diabetes but it may also help diabetics better manage their condition, as this form of fasting improves blood sugar and insulin levels in addition to insulin sensitivity. The research also shows that intermittent fasting can reduce inflammation and improve blood pressure and blood lipid levels. ALL of this, unlike most medications, comes with a low risk of adverse effects and is highly cost effective!
There is also evidence to support the addition of chromium to the diet in order to help prevent and/or control diabetes. According to the National Institutes of Health, chromium is known to enhance the action of insulin—the hormone that keeps our blood sugar levels from soaring out of control. Your doctor of chiropractic can help you establish a program of both chromium intake and fasting.
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Since ancient times, as far back as the days of Hippocrates (the father of medicine), people have taken cold baths in the belief it could both treat serious illness and maintain one’s good health.
In a 2016 study conducted by a team of Dutch researchers, a group of roughly 2,800 participants were split into four groups: three of which were asked to take a 30, 60, or 90 second shower every day for a month while the last group avoided cold showers to serve as a control group.
Nearly 80% of participants completed the study, of which two-thirds continued to take regular cold showers after their initial 30-day commitment had ended. Outcome assessments revealed those in the experimental groups experienced an increase in quality of life as well as a 29% reduction in sick days from work that researchers did not observe in the control group. Some participants even noted their cold showers increased their energy in a manner similar to drinking a caffeinated beverage. Of note, the results were consistent across all three groups, suggesting a 30-second cold shower was just as beneficial as a 60- or 90-second cold shower.
Presently, the authors of the study can only speculate on why the study participants benefited from cold showers. Possible explanations include: the shivering induced by cold exposure increases hormones in the body that can affect the immune system; cold exposure creates some type of neurological benefit; or the effect among participants was entirely psychological, as they had volunteered for a study about how cold showers might improve one’s health.
Lastly, the researchers even speculate that routine cold showers may affect the body in the same manner as engaging in regular physical activity, thus improving the participants’ fitness levels. They write, “In the present trial, reduction of sickness absence of a routine cold shower (29%) was comparable to the effect of regular physical activity (35%).” Of course, more research is necessary to understand why frequent cold exposure has been historically observed as having healthy benefits.
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If someone said that suboptimal breathing patterns and problems associated with posture and trunk stability are related, what would you say? Sounds pretty far-fetched, doesn’t it?
There are many factors that can result in both faulty respiration and poor posture including poor exercise tolerance (being “out of shape”), dyspnea (shortness of breath), poor chest expansion, poor neuromuscular control of core and pelvic floor muscles, diaphragm issues (hernia, muscle shortness, poor pressure output), increased lumbar lordosis, and low back pain. This is because several of the muscles that help control posture and stabilize the core—such as the thoracic diaphragm, transverse abdominus, and the pelvic floor muscles—are also involved in the breathing process.
One of the most critical and overlooked factors is the ability to maintain an optimal zone of apposition (ZOA) of the diaphragm. This refers to the dome, or “umbrella” part, of the diaphragm and its attachments to the lower rib cage. The ZOA is important because it is largely controlled by the abdominal muscles and plays a role in how much air you can take in while breaking, or maximal respiration.
When the ZOA is decreased or not optimum, the result is inefficient breathing (less air in and out) and reduced activation of the transverse abdominus muscle (important for BOTH respiration and low back stabilization). A suboptimal ZOA can be the result of a combination of increased curve in the low back (hyperlordosis), long abdominal muscles (a large belly), long hamstring muscles (forward pelvic tilt), and/or a weak pelvic floor.
The following is a therapeutic exercise that promotes optimal posture and finely tunes the neuromotor control of the deep abdominals, diaphragm, and pelvic floor: 1) Lie on your back and put your feet on a wall with both the knees and hips bent at 90 degrees. 2) Place a small (4-6 in, or 10.16-15.24 cm) ball between your knees. 3) Place your right arm above your head and place a balloon in your mouth with the left hand. 4) INHALE through the nose and simultaneously perform a posterior pelvic tilt (flatten your low back into the floor/mat) while pulling downward with your heels (as if to bend the knees – don’t push into the wall) and gently squeeze the ball with your knees. 5) Inhale through the nose and exhale or blow slowly into the balloon, then pause for three seconds by pressing the tongue to the roof of the mouth (to prevent blowing into the balloon). 6) Without pinching the neck of the balloon and while keeping your tongue placed on the roof of the mouth, inhale again through your nose (without the balloon deflating).
Relax and repeat the sequence four more times. When blowing into the balloon, do not strain your neck or cheeks. After the fourth breath in, pinch the balloon neck and remove it from your mouth and let the air out of the balloon.
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Omega-3 polyunsaturated fatty acid (omega-3-PUFA) consumption has been linked to reduced inflammation, a lower risk for heart attack and stroke, and even improved outcomes for patients with carpal tunnel syndrome. Here’s a benefit that may come as a surprise: ANXIETY relief!
Anxiety is the most commonly experienced psychiatric symptom, and it’s reported that it will affect one in three individuals in their lifetime. Anxiety is characterized as an inappropriate or exaggerated fear leading to distress and impairment and is often accompanied with other psychological disorders, including depression, and is associated with a lower health-related quality of life and increased risk of all-cause mortality.
Classic treatment options include cognitive-behavioral therapy (CBT) and pharmacological treatments, mainly with selective serotonin reuptake inhibitors. A common problem with treatment is potential medication side-effects (sedation and/or drug dependence), as well as time-consumption and cost factors. This often leads to a reluctance to engage in treatment, which is why these findings regarding a nutritional approach to managing anxiety are so important.
In a recent meta-analysis of data from 19 clinical trials that involved 2,240 participants from 11 countries, researchers uncovered evidence that participants who consumed omega-3 fatty acid supplements reported significant clinical improvements in anxiety signs and symptoms.
Interestingly, the researchers noted that the anti-anxiety benefits of omega-3-PUFAs were stronger in those with clinical anxiety compared with those whose conditions were classified as subclinical or borderline. The research team also observed that participants who were given a higher dose (>2000 mg/day) obtained the best anti-anxiety benefits.
Vitamin D, the “sunshine vitamin”, has also been found to improve mood, especially during the winter months. Moreover, people with low vitamin D levels (70% of Americans) may be more likely to experience anxiety.
Hence, a combined daily supplement of >2000 mg of omega-3-PUFAs AND 2000-5000 mg of vitamin D may help manage anxiety signs and symptoms.
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Curcumin, a chemical found in turmeric that gives mustard and curry their yellow color, has long been known for its anti-inflammatory and anti-oxidant capabilities. Because of its prevalence in Indian cuisine, some researchers suspect that reduced inflammation in the brain from frequent curcumin use may explain why senior citizens in India have a lower prevalence of Alzheimer’s disease and better cognitive performance than older adults from other backgrounds.
In a 2018 study published in the American Journal of Geriatric Psychiatry, UCLA researchers examined what effects an easily absorbed curcumin supplement had on memory in individuals with AND without Alzheimer’s disease. The study utilized a double-blind, placebo-controlled study that included 40 adults (age 50-90) who had mild memory complaints. The patients were randomly assigned to one of two groups receiving either a placebo or 90 mg of curcumin two times a day for 18 months. Outcome measures used in the study included standard cognitive tests performed initially and again at six-month intervals, and curcumin blood levels were measured initially and again after 18 months. Positron emission tomography (PET) scans were utilized in 30 of the 40 subjects to determine the levels of amyloid and tau in the brain tissue at the start and after 18 months.
The curcumin group experienced significant improvements in memory and attention skills while members of the placebo group did not. Participants in the curcumin group also performed 28% better on memory assessments and reported mild improvements in their mood. Moreover, their brain PET scans showed significantly less amyloid and tau signals in the amygdala and hypothalamus, parts of the brain associated with memory and emotional functions.
The only reported side effects were mild abdominal pain and nausea, which affected four of the curcumin group participants. The authors are planning a larger study that will include people with mild depression to see if curcumin can also serve as an anti-depressant. It will also allow researchers to assess whether curcumin’s memory enhancing effects will vary according to people’s genetic risk for acquiring Alzheimer’s, their age, or the extent of their cognitive problems.
These preliminary results are exciting, as it appears that taking curcumin could provide meaningful cognitive benefits over the years. Doctors of chiropractic frequently council patients on diet and supplementation through the use vitamin, minerals, herbal formulas, and more, of which turmeric/curcumin is a common recommendation, especially given it anti-inflammatory benefits for musculoskeletal conditions.
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Deep slow breathing (DSB) has been widely used for managing various diseases of the heart and lungs as well as for psychiatric disorders including anxiety, depression, and stress-related conditions. There appears to be some research to support DSB as being helpful for pain management, but the results have been inconsistent. However, a 2012 study suggests that how you “think” while practicing DSB may be the key for reducing pain…
In the study, researchers monitored sixteen healthy adults as they performed DSB while in both a relaxed and distracted state. In the relaxed state, participants were instructed to focus only on taking slow, deep breaths while in the distracted state, participants had to actively manage their deep breathing in pace with instructions on a computer screen. In order to reduce any carry-over effects, the active/distracted portions of the study were spaced six months apart and participants were advised to avoid practicing DSB or meditation or to seek any outside education on the topic.
Interestingly, in both circumstances, participants experienced similar reductions in negative feelings (tension, anger, and depression). However, the researchers only observed improvements with respect to pain thresholds, autonomic activity (skin conductance or sympathetic tone), and thermal detection for cold and hot stimuli when participants were relaxed.
Hence, it appears to be important that focused concentration on inhaling and exhaling or “thinking about” each breath in DSB and removing distracting thoughts is KEY to achieving increasing sympathetic arousal and improving mood processing. These findings may help to explain why mindful mediation, or mindfulness, benefits patients and why Eastern disciplines such as yoga, Qi-Gong, and Tai Chi are associated with reduced pain and improved mood.
Doctors of chiropractic often advise patients to reduce stress as part of management process for chronic pain conditions, with DSB being a great choice. This study shows that when done in a relaxed state, not only can patients experience mood-related benefits but they may also be able to reduce the effect of pain on their daily lives so they can perform their usual work and life activities.
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In today’s world, consumers are inundated with contradicting news about foods that are good for them and foods that can be detrimental to their health. Rice is one such food. Is it good for you? Is it bad? Let’s find out…
In a 2019 study, researchers in India randomly assigned 169 overweight adults (aged 25-65 years) to consume meals that included white or brown rice twice a day, six days a week for three months. The research team used blood testing to measure glucose, insulin, HbA1c, insulin resistance, lipids, and inflammation. The results showed that those who consumed white rice had test results that suggested a higher risk of type 2 diabetes, while those who ate brown rice had blood test results that indicated less inflammation and a reduced diabetes risk.
In 2012 and 2014, Consumer Reports raised concern about the arsenic levels in US rice. In order to determine if rice consumption is associated with an increased risk for cancer, researchers evaluated data from several long-term databases that included dietary and health information involving 45,231 men and 160,408 women who were cancer-free at the start of the study and tested every four years for 26 years.
Overall, the data show that 10,833 men (23.9% of men) and 20,822 women (12.9% of women) developed cancer. Comparing participants who ate <1 serving of rice per week vs. those who ate ≥5 rice servings per week, there was NO significant difference or associations between those who did vs. those who did not get cancer, regardless of the type of rice, cancer type, BMI, smoking status, or ethnic background. Additionally, rice consumption was not associated with cardiovascular disease, which is another leading cause of death in the developed world.
Another interesting study reported that cooking brown rice under high water pressure increased the water absorbency of brown rice without nutrient loss.
Other studies have found that fermented brown rice and rice bran appears to reduce the risk of cancers of the colon, liver, stomach, bladder, esophagus, and lung. In animal models, fermented brown rice/rice bran was also observed to reduce tumor size, though this finding has yet to be confirmed in human subjects.
Doctors of chiropractic often encourage patients to live a healthy lifestyle, which includes eating more of the foods that are good for us and less of the foods that are not. So far, the science suggests that eating white rice in moderation may not hurt you and consuming brown rice may offer some additional benefits.
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Since the late 1980s, researchers have embraced the biopsychosocial model (BPS) to understand both the causative and prognostic factors associated with neuromusculoskeletal disorders, which includes back pain. In order to achieve the best possible outcomes for patients with back pain, it’s important to understand the role that factors outside of the biomechanical injury model play in both the injury and recovery processes. Unfortunately, there’s a lot of misinformation out there that can be detrimental to the patient.
In one study that included 130 low back pain (LBP) patients with persistent or recurring back pain, participants answered questions about the cause of their LBP, including what they’ve learned since receiving care. Their answers revealed that such patients see their LBP as: 1) due to the body being like a broken machine; 2) permanent; 3) complex; and 4) very negative. Nearly 9 in 10 patients (89%) indicated they learned these beliefs from healthcare professionals.
The study’s findings indicate that healthcare providers may be in the best position to educate patients about their condition. However, responses from 103 primary care physicians (PCPs) suggested that they considered biomechanical risk factors to be the most important short-term and long-term factors for a sudden episode of acute LBP.
When it comes to giving yourself the best possible chance of recovery from LBP, here are some things to keep in mind in addition to utilizing non-surgical treatments that are recommended by current guidelines, of which chiropractic care is an excellent choice: 1) Research has demonstrated that depression, anxiety, and self-limiting beliefs about future ability to work or do physical activity are psychosocial factors that are associated with poor outcomes. 2) Insufficient sleep and smoking are also lifestyle behaviors that can slow one’s recovery from injury, which includes low back pain! 3) Because movement is necessary to diffuse nutrients into cartilaginous tissue, it’s important to stay active during the recovery process to maintain joint health. Physical activity also keeps the muscles from deconditioning, especially the deep muscles that control posture.
Doctors of chiropractic are trained to approach treatment from a biopsychosocial perspective and to consider all factors that affect the patient’s chief complaint and quality of life. Through patient education, spinal manipulation, mobilization, exercise training, the use of modalities, and more, chiropractors can greatly help those struggling with back pain and other musculoskeletal conditions!
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In the past, patients may have been prescribed bed rest by their family doctor for low back pain. These days, treatment guidelines recommend staying active during the recovery process. Why the change?
There are two types of muscles in the back: the superficial muscles and the deep muscles. The superficial muscles are used to perform motions like bending and twisting. These muscles are strengthened by exercise that places stress on the muscles, like lifting weights. The deep muscles help stabilize the spine and maintain posture, and physical activity helps keep them in shape.
When a person goes on bed rest, the muscles in the back will weaken and begin to atrophy. As activity is resumed, the body will recruit the superficial muscles to help stabilize the back. Because the muscles are not adapted for this function, the superficial back muscles will tire more easily, and in the presence of deep muscle weakness, normal movement will be impaired. This can place abnormal stress on the structures in the spine and other parts of the body, increasing the risk for additional musculoskeletal injuries.
Bed rest can also affect the disks that act as “shock absorbers” in the spine. In one study, researchers recruited 72 middle-aged adults and assessed their physical activity levels in the preceding years based on how many days they engaged in strenuous activity every two weeks: active (9 to 14 days), moderately active (1-8 days), or inactive (0 days). About one in five (21%) were classified as active, half (53%) were described as moderately active, and the remainder (26%) were inactive. The researchers also performed an MRI on each participant and gathered information on low back pain-related pain and disability.
The results clearly showed that physically inactive individuals were more likely to have back pain, reduced function, loss of disk height, and fat build-up in their back muscles. The research team concluded that getting regular, regimented exercise throughout life is important for reducing the risk of back pain.
There are very specific exercises that help strengthen the deep, low back stabilizing muscles. Doctors of chiropractic regularly prescribe exercise to address an acute flair-up of LBP and to help prevent future occurrences.
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Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency, and duration of their headache pain. This is because the cervical spine / neck is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.
A study in the October 2009 issue of The Spine Journal reported on the benefits obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least three months of headache pain has been present. This new study compared two different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last four weeks, and the amount of medication utilized. Data was collected every four weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) as a control treatment.
The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.
The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, and a natural, holistic approach to the management of chronic headaches is accomplished.
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If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain (LBP) patient FIRST see a chiropractor before any other type of doctor? That is in fact, what should be done, based on a 2009 report!
On October 20, 2009, a report was delivered on the impact on population, health, and total healthcare spending. The authors found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.” Authored by an MD and an MD/PhD and commissioned by the Foundation for Chiropractic Progress, the findings are clear: chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.
The study reviewed the fact that low back and neck pain are extremely common conditions consuming large amounts of healthcare dollars. In 2002, 26% of surveyed US adults reported having back pain during the previous three months, 14% had neck pain during that time period, and the lifetime prevalence of back pain was estimated at 85%. LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more. Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared with spending from just a little over a decade before in 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications. Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.
In a review of the scientific literature, the authors noted that chiropractic care is at least as effective as other widely used therapies for low back pain. Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain. Other studies reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, and fewer hospitalizations and surgical procedures compared to those with no chiropractic coverage. The authors then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, and manipulation plus physiotherapy-led exercise for low back pain care. They found utilizing chiropractic care was associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”
When combined with exercise, chiropractic care was also found to be very cost-effective when compared with exercise alone. This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.” When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared with other approaches. It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!
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Infantile colic (IC) is a distressing common childhood condition that affects 5-20% of infants. The condition is characterized by excessive crying, fussing, and irritability during the first five months, often with no obvious cause.
Over the last fifty years, researchers have sought to understand the cause of infantile colic. Some hypotheses include formula intolerance, an immature gastrointestinal tract, food allergies, intestinal cramping, and excessive gas, as well as psychosocial causes, such as maternal anxiety and/or maternal-infant bonding issues. Because the cause of IC has proven elusive, there are few treatment options available to parents.
In an effort to find a solution, many sleep-deprived mothers and fathers seek out complementary and alternative medicine (CAM) approaches, which includes chiropractic care. A 2019 study looked at the available research regarding CAM and infantile colic and found the following approaches showed promise to alleviate symptoms of colic (however, larger studies are needed to confirm these findings):
Fennel is an herb from the carrot family that is a rich source of thiamine, riboflavin, niacin, vitamin B6, vitamin C, calcium, iron, magnesium, manganese, phosphorus, potassium, and zinc. While there is some evidence that a mixture of water and fennel can help alleviate colic symptoms, it’s unclear how fennel benefits the colicky baby.
Probiotics seem to be most effective in breastfed infants with colic while more research is needed regarding babies with IC who are on a formula diet.
One study showed that gentle chiropractic manipulation reduced daily crying time in colicky infants by nearly 1.25 hours a day. When all serious diagnoses have been excluded, it has been suggested that it may be appropriate to utilize a four-to-six treatment trial to determine the effectiveness of gentle chiropractic care for a colicky infant.
While many doctors of chiropractic have received training on using gentle treatment approaches on pediatric patients, some may prefer to refer the care of babies and small children to chiropractors who specialize in caring for this population.
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Headaches are a common complaint among patients with whiplash associated disorder (WAD) following a motor vehicle collision, slip and fall, or sports injury. While in some cases, the cause of WAD-associated headache can be a concussion or traumatic brain injury (TBI), in many instances the underlying cause of WAD-related headaches can be injury to the neck. How is this possible?
Past research has demonstrated that irritation of the nerves that pass through the top of the cervical spine (C1, C2, and C3) can lead to tension-type or cervicogenic headaches, especially when the C2 nerve is involved. These nerves exit the spine and travel through a thick group of muscles located at the top of the neck/base of the skull or “suboccipital” region.
In a 2019 study, a group of anatomists discovered the close relationship of the greater occipital nerve (C2) and a muscle called the obliquus capitus inferior (OCI) and sought to determine how the C2 might get “pinched” in injuries such as whiplash.
The authors studied 20 cadavers and found three patterns. The nerves either travelled loosely around the muscle (Type I), were incorporated in the dense muscle fascia (Type II), or travelled directly through a myofascial sleeve within the muscle (Type III). Among the 40 C2 nerves (there is a left and right), the research team found seven instances of Type I, thirty-one instances of Type II, and two instances of Type III. Because of the intimate relationship between the OCI and C2 nerve, it’s understandable that during the whiplash process, the stretching of C2 nerve combined with the contraction of the OCI could set the stage for injury to the nerve.
Doctors of chiropractic frequently find that WAD patients have a great deal of tenderness in the suboccipital region and respond well to upper cervical spinal manipulation and mobilization. When these muscles are more relaxed, neck pain and headaches often improve. Similarly, exercises that focus specifically on this region help the patient self-manage headaches and neck pain, which reduces the need for medications, many of which have negative side-effects.
One such exercise is called the cervical brace. This is done by kneeling on all fours and is broken down as follows: 1) “poke” your chin/head straight down toward the floor; 2) in a smooth scooping motion, tuck your chin down (chin-to-chest); 3) and then scoop your head back up to neutral keeping the chin tucked. Repeat in a smooth scooping motion (avoid doing it “steps”). Repeat until your neck feels loose. You may notice some painless popping, crunching sounds as you do the exercise. As modifiers, try it sitting or standing, with or without resistance applied to the forehead.
Studies show neck pain and headaches arising from WAD injuries respond very quickly to chiropractic care. Please consider chiropractic care FIRST in your post-WAD management process!
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Hip pain is a VERY common problem among older adults that can affect their ability to remain independent. While it’s common to assume that hip osteoarthritis (HOA) is responsible for the prevalence of hip pain in the aging population, the Framingham Osteoarthritis Study (FOS) found this isn’t always the case.
The authors of the FOS reported that the presence or absence of HOA on x-ray correlated poorly with hip pain. Of the participants with frequent hip pain, only 15.6% had x-rays showing HOA. On the other hand, only 20.7% of the men and women with x-rays that showed evidence of HOA had frequent hip pain! If only about one-in-six patients with hip pain have HOA, where is their hip pain coming from?
A common cause is bursitis. The bursae are fluid-filled sacs located near joints and muscle tendon attachments that cushion and protect the area. Bursitis is an inflamed bursa and is usually the result of trauma̶—repetitive over time or after a one-time macro-traumatic event, like a sports injury.
Hip synovitis (HS) is an inflammatory condition of the hip’s synovial membrane (SM) that is located within the joint capsule. The function of the SM is to lubricate and nourish the cartilage and bones inside the joint capsule. The SM is what causes a joint to rapidly swell after an injury (think knee or ankle injury with LOTS of swelling). Due to the deep nature of the hip joint, swelling is not visible from the outside.
Hip synovitis can result from trauma, such as a labral tear where the thin ring of cartilage or labrum (located on the rim of the hip socket) tears. The labrum cushions the hip joint and acts like a rubber seal or gasket that helps hold the ball into the hip socket. Sports and slip-and-fall injuries can cause labral tears.
Other causes of hip pain include arthritis (several types), injury (bursitis, synovitis, dislocation, fracture, labral tear, inguinal hernia, sprains, tendinitis, or strains), pinched nerves (sciatica, femoral nerve pinch), cancer, and more.
What do chiropractors do for hip pain? The first step is to establish an accurate diagnosis using the patient’s history, a thorough examination, and diagnostic tests such as x-rays or even an MRI, when warranted. If infection or certain types of arthritis are suspected, a patient may be referred out to their medical physician for blood tests.
If the cause is musculoskeletal in nature, treatment may include manipulation, mobilization, and soft tissue therapy of the hip and nearby joints, including the pelvis and low back. Patients may also receive nutritional and exercise recommendations to reduce inflammation and aid the healing process.
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Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy—or pinching of a nerve outside of the spine—affecting between 3-6% of the population. While we usually focus on how carpal tunnel syndrome is managed, in this article we’re going to focus on why CTS is one of the costliest musculoskeletal disorders.
The symptoms associated with CTS (pain, numbness, tingling, and weakness) tend to come on gradually and worsen over time. Because of this, many CTS patients delay seeking care, often only consulting a doctor when their condition severely limits their activities. Generally, the longer a musculoskeletal condition persists, the more care that may be needed in order to achieve a satisfactory outcome for the patient.
The type of care sought by the patient is also a major factor in the ultimate cost for CTS treatment. In one study that monitored 120 women with diagnosed CTS for one year, the researchers found that those treated with manual therapies—such as those provided by doctors of chiropractic—reported similar improvements at the one-year mark as participants who underwent a surgical procedure, with an average cost savings of $2,800.00 per patient. The patients in the manual therapy group also required fewer visits with healthcare providers and missed fewer days of work for recovery.
Work absenteeism is another major cost associated with carpal tunnel syndrome. One report found that the average CTS patient can miss up to 27 days of work per year. The same study also reported that up to 18% of CTS patients leave their job within 18 months. It’s estimated that when healthcare costs, reduced productivity, missed work, and the potential for lost income due to changing careers are considered, the typical carpal tunnel syndrome case may have an overall cost on society of between $47,000 and $119,000! That’s not to mention the impact CTS can have on one’s hobbies, ability to carry out daily tasks, and relationships with friends and loved ones.
With all this in mind, what can be done to reduce the impact CTS could potentially have on you? While there are some risk factors beyond our control such as genetics or biology (women are three times more likely to develop CTS than men, for example), there are some steps that can be taken to reduce the risk for the condition. First, understand that CTS is generally caused by inflammation in the carpal tunnel that places pressure on the median nerve as it travels through the wrist. Some modifiable causes of inflammation in the wrist can include conditions like diabetes, obesity, awkward hand postures, prolonged exposure to vibrations, and both forceful and repetitive hand motions.
If you feel numbness, tingling, or pain in the hand or wrist, don’t just flick your hand until it resolves and go on with your life. The sooner you seek care, the less likely the condition will have a major effect on your ability to carry out your usual activities, including work! Treatment guidelines recommend trying non-surgical approaches first, of which chiropractic care is a highly effective option.
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Migraine headaches can have a serious impact on one’s quality of life and their ability to carry out their daily activities, both at home and at work. While chiropractic care has been demonstrated to be effective for tension-type and cervicogenic headaches, what does the literature say about its effect on migraines?
The first thing to understand is that while migraines may not necessarily be caused by cervical dysfunction, it’s becoming increasingly clear that issues in the neck may play some role in the migraine headache process.
For example, in a 2019 study published in the European Spine Journal, researchers examined the neck of 52 female migraineurs and 52 women without a history of neck pain or headaches and found that participants in the migraine group were significantly more likely to exhibit cervical dysfunction.
Another 2019 study, this time published in the journal Cephalagia, reported that migraine patients with concurrent neck pain had significantly more migraine-related disability than those without neck pain. Other studies have shown that individuals with migraines are more likely to have trigger points in the cervical muscles.
So, can chiropractic treatment to improve cervical function benefit migraine patients? A review of data from six randomized control trials that included a total of 667 migraine headache patients who received spinal manipulative therapy (SMT) concluded that SMT is “an effective therapeutic technique to reduce migraine days and pain/intensity.”
What can a migraine patient expect when they visit a doctor of chiropractic? First, the patient will undergo a thorough examination to determine which locations in the cervical region to apply treatment, usually by examining the degree of joint “play” or restriction, point tenderness, and localized muscle guarding using static and motion palpation methods. The treatment approach will typically include a combination of spinal manipulation, mobilization, specific exercises, modalities, and nutritional recommendations, depending on the patient’s needs and preferences.
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It stands to reason the more an intervertebral disk herniates, the more it will compress the spinal nerves, leading to a greater likelihood for surgical intervention. But what if that isn’t the case?
The current standard treatment of lumbar disk herniation (LDH) involves FIRST the initial use of non-surgical care for at least six weeks. If that fails, a surgical consult can be considered. Exceptions to this rule include the presence of a red flag or a dangerous, potentially life-altering or life-ending condition like infection, fracture (unstable), cancer, and/or cauda equina syndrome (pinched cord altering bowel and bladder control)—all of which are (thankfully) NOT common.
In a study that involved 368 LDH patients who underwent at least six weeks of non-surgical care, researchers observed that 91.3% did not undergo surgery within the following year. A review of MRI findings of the patients who did vs. did not have a surgical procedure showed no difference with respect to what percentage of the spinal canal was inhibited by LDH (31.2% vs. 31.5%). The research team concluded that percentage of canal occluded by LDH does not predict which patients will fail non-surgical care and require surgery.
This finding is important because many spine surgeons still use the size of the lumbar disk herniation to determine if a patient is a candidate for surgery.
While the findings from the previously mentioned study suggest that 9 in 10 LDH patients can avoid surgery, is there any data to indicate which LDH patients might not respond well to surgical care if they do choose that route? A 2019 study investigated this question and reported that the persistence of leg pain may be a key factor. The authors reviewed 556 patient files over a three-year time frame and found that moderate to severe leg pain at early post-surgical follow-up correlated with higher disability scores over time. This group of patients was more likely have both a history of smoking and chronic back pain. This makes some sense as smokers often face a greater risk for post-surgical complications (many surgeons won’t operate on smokers if they can avoid it) and a history of chronic back pain suggests other factors may be responsible for the patient’s current pain and disability, not just the LDH.
The good news is that treatment guidelines support chiropractic care as a non-surgical option for the LDH patient through a combination of spinal manipulation, mobilization, specific exercises, modalities, and nutritional recommendations.
The omega-3 fatty acids DHA and EPA can reduce the risk for cardiovascular issues and even ease depressive symptoms, but can these healthy fats also help keep our minds sharp as we age?
In one study, researchers from the University of Pittsburgh School of Medicine monitored the diets of 260 healthy, cognitively normal older adults for ten years and found that participants who consumed blackened or broiled (but not fried) fish at least once a week had healthier brains over time. In fact, a comparison of MRIs revealed that these weekly fish consumers had greater gray matter volume in the areas of the brain responsible for memory (4.3%) and cognition (14%).
Previous research has shown that people who eat more seafood have a reduced risk for blood clots and white-matter abnormalities, both of which could impair brain function. Omega-3 fatty acids promote neuron growth in the brain, improve cerebral blood flow, and reduce cellular inflammation. Researchers have also observed that adults with lower blood levels of the omega-3 fatty acids DHA and EPA in late middle age had smaller brain volumes and cognitive dysfunction as older adults compared to their peers with higher blood levels of the omega-3 fatty acids. An analysis of data from the Framingham Study cohort revealed that participants with the highest DHA levels had a 47% reduced risk for all-cause dementia and 39% lower risk for Alzheimer’s disease.
In one systemic review, researchers found that omega-6 fatty acid levels are also important for brain health. Essentially, the investigators found significant evidence that cognitive decline and dementia were more likely in those who had higher omega-6 fatty acid serum levels. This is noteworthy because fast foods are often high in omega-6 fatty acids. According to the Centers for Disease Control and Prevention, 36.6% of adults in the United States consume fast food on any given day!
While some degree of cognitive decline is anticipated with age, these findings suggest that eating a healthy diet that’s high in omega-3 fatty acids and low in omega-6 fatty acids can help keep the mind sharp.
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The hip is a very important region of the body, especially since our upright, weightbearing activities rely on a properly functioning hip joint. With the expansive growth of youth athletic programs, the incidence of hip-related injuries and the associated disability has markedly increased. But is there a difference between young male and young female hip injuries?
We’ve all observed the rapid rate of growth that occurs from age five to age seventeen, with bone growth reaching maturity around age sixteen for females and eighteen for males. Prior to skeletal maturity, the growth plates remain open in the long bones of the body, which adds to the complexity and challenge in diagnosing and treating hip injuries in this age group.
Studies show that hip injuries account for approximately 5-9% of all athletic injuries. According to a study that looked at data from 121,047 pediatric visits at a sports medicine clinic between 2000-10, the most common hip injuries for males were labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). For females, the leading hip injuries included labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%).
The five most common sports that caused hip injuries were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%). Among adolescents (age 13–17 years), the data show that hip injuries were significantly more common in females than males. Studies have shown that young female athletes, especially in post-puberty ages, exhibit different landing and pivoting movements than males, which may help explain why adolescent females may be more at risk for hip injuries than teenaged boys.
Doctors of chiropractic are trained to diagnose and treat musculoskeletal injuries—including those of the hip joint—in patients of all ages. The key is to manage such conditions as early as possible to help patients get back to sporting activities and reduce the risk for future injuries in the hip and neighboring regions of the body.
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Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.
In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.
After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.
If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.
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Carpal tunnel syndrome (CTS) is a disorder caused by compression of the median nerve that alters the nerve’s function (neuropathy), leading to pain and numbness/tingling (paresthesia) primarily on the palm-side of the wrist and hand. While factors like hormonal changes and repetitive motions are known to increase the risk for CTS, there might be a genetic component to the condition.
It’s known that conditions that can elevate the risk for CTS—like diabetes, thyroid disease, rheumatoid or osteoarthritis, and obesity—can run in families. Additionally, the data show that having a family member with CTS raises the risk that you too can develop the condition, but it’s not entirely clear to what extent genetic traits are responsible versus shared environmental factors among family members.
In 2007, at the 74th Annual meeting of the American Academy of Orthopaedic Surgeons in San Diego, Harvard professor Dr. David Ring and colleagues presented their evaluation of 117 previously published studies to determine the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors. Their analysis revealed that genetic risk factors were two times stronger than the evidence supporting occupational risk factors, such as overuse.
Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or of unknown cause, further supporting genetics as the primary factor. Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there may be epigenetic factors or environmental changes to genes based on certain foods eaten or certain activities might increase a person’s risk beyond their genetic makeup. As of 2015, no epigenetic factors have been identified in idiopathic CTS.
The good news is that even if you have a family history of carpal tunnel syndrome, you can reduce your risk for developing CTS by managing any conditions or activities that can contribute to inflammation along the course of the median nerve. This includes maintaining a healthy weight, eating a low-inflammation diet, getting regular exercise, taking frequent breaks from repetitive tasks involving the hand, reducing exposure to awkward hand postures and vibratory forces, etc. If you are experiencing CTS-related symptoms in the hand and wrist, a thorough examination by a doctor of chiropractic can help identify potential causes and help you manage the condition so you can return to your normal activities as soon as possible.
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In the United States: 1) seniors represent over 13% of the population but consume 40% of prescription drugs and 35% of over-the-counter drugs; 2) on average, people 65-69 years old take nearly 14 prescription drugs per year, and those 80-84 take an average of 18; 3) 15-25% of drug use in seniors is considered unnecessary or inappropriate; 4) adverse drug reactions & non-compliance are responsible for 28% of hospitalizations of the elderly; 5) 36% of all reported adverse drug reactions involve an elderly person; 6) annually, 32,000 seniors have hip fractures related to medication-related problems.
Regarding pain control, let’s look at opioid use and the impact it has on our overall health. One recent study investigated problems associated with chronic low back pain (cLBP) and its effect on daily function. The authors specifically focused on the sleep patterns in patients with cLBP and then looked to see if there were differences between those taking opioid vs. non-opioid medication.
The study compared ten healthy “controls” and 21 cLBP patients where six were taking non-opioid meds and fifteen were taking an opioid medication. Using questionnaires and sophisticated sleep study equipment, the researchers found that patients in both cLBP groups—regardless of medication type—had significant sleep and wake disturbances, decreased sleep quality, increased symptoms of insomnia, increased fatigue, spent more time in bed, took longer to fall asleep, and had higher variability in other measurements compared to the control group.
However, those taking opioids (>100 mg morphine-equivalent/day) had distinct abnormal brain activity during sleep unlike the others. It’s well known that sleep disturbance can gravely affect our overall health and longevity, and the use of opioids only makes sleep problems worse!
When compared with a placebo, opioid side effects include: constipation, nausea, somnolence, dizziness, itching, and vomiting. Medications to treat the primary opioid side effect of constipation (such as Movantik) have their own side-effects when compared to a placebo including abdominal pain, diarrhea, nausea, flatulence, vomiting, headache, and sweating. These side-effects may prompt yet another medication to try to counteract the above, thus creating a dangerous vicious cycle!
As a disclaimer, we realize that many people HAVE TO take certain meds to stay alive or to achieve an acceptable quality of life.
The “take-home” message here is to minimize the amount of medication taken as much as possible making sure the benefits truly outweigh the risks! For conditions like musculoskeletal pain, consider non-drug, non-surgical options like chiropractic care. Many studies show chiropractic care is not only highly safe but it can get patients out of pain fairly quickly. Additionally, the benefits may persist long after treatment ends, something that doesn’t typically happen if you cease taking a medication for such conditions.
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Running is one of the most popular forms of exercise, largely because it can be done almost anywhere at any time and it doesn’t require much in the way of equipment (other than a pair of running shoes). While there is a common belief that running always leads to osteoarthritis (OA) of the knee, the current research suggests that running may reduce the risk for knee OA and it can also improve pain and disability in patients who have developed the condition. Here are four tips for reducing the risk of experiencing a running-related injury so that you can reap all the benefits this activity has to offer…
Tip #1: Practice good form. Avoid running like you’re on a tight rope or balance beam (crossover gait). Practice walking, and then slowly run while keeping your feet apart (about the width of your pelvis). A crossover gait is bad because it increases foot/ankle pronation (rolling in), knee valgus stress (knock-knee affect), hip internal rotation (turns in), hip adduction stress (pulls on the outer thigh and impinges the hip), and low back extension (too much arching)—ALL of which can lead to injury in multiple body regions, including the knees!
Tip #2: Wear the “right” shoes for your foot. Dip your foot in water and look at your footprint on the floor. If your foot looks wide, you have a flat, pronated foot and a “motion control” shoe (designed for the low or no arched foot) is recommended. Avoid stiff soled shoes as they reduce the ability to feel the ground, leading to new or further injuries. If your footprint looks skinny, a “cushioned” shoe designed for the high arched foot is ideal as it absorbs the shock caused by the lack of pronation. If your footprint is between skinny and wide, a “stability” or “neutral” shoe designed for the normal arched foot is ideal. If you’re not sure, consult with a representative at your local running store. Many businesses that cater to runners have equipment on site to help identify the best shoe for you. Also, remember to replace your shoes every 250 miles REGARDLESS of your foot and shoe type!
Tip #3: Avoid progressing too fast. The tendency is to want to get into shape NOW! This can lead to overtraining and places too much stress on the body, which can result in injury. Practice the 10% rule. If you ran ten miles in total last week and you want to increase your total distance, try adding 10% to each run so you achieve a total of eleven miles this week.
Tip #4: Strengthen your legs and hips with these exercises: 1) Posterior lunge - Stand and reach back with your left leg while squatting down as if to touch your left knee to the floor while bending your right knee (arms out front for balance). Go as far down as you COMFORTABLY can, keeping the right knee behind your toes. Repeat on the other side. Go slow, start with a half or quarter lunge to avoid injury! 2) Advanced Clam - Lie on your side, raise the upper leg and rotate the hip in and out slowly. 3) Side Plank Leg Raise - Lie on your side, legs straight (advanced) or bent (easier), and raise the pelvis off the floor (elbow under the shoulder), then raise the upper leg toward the ceiling.
If you feel as though running is causing pain or worsening existing pain, then consult with your doctor of chiropractic. He or she can examine your body and mechanics and provide conservative treatment to help make sure your next run is as pain free as possible.
www.PainReliefChiroOnline.com
Kinesiophobia, the fear of movement, is a common occurrence for patients with chronic low back pain (cLBP). Unfortunately, self-restricting one’s daily physical activity can result in muscle weakness and atrophy. This can lead to further inactivity and more muscle weakness, and subsequently, poor tolerance of normal activities of daily living, work absenteeism, and depression. When the muscles around the low back or lumbar spine become atrophied and weak, the risk for acute flair-ups of low back pain (LBP) increases, leading to more dysfunction and distress.
Studies have reported that when comparing the muscles in the front of the lumbar spine (the “flexors”) to those behind the spine (the “extensors”) in individuals with cLBP, greater amounts of atrophy and weakness occur to the extensors. The lumbar multifidus (MF) muscles are crucial for maintaining stability of the lumbar spine, while the erector spinae (ES) superficial extensor muscles are known as “global stabilizers”, which are designed to produce gross movements and to counterbalance when lifting external loads.
When treating patients with cLBP, doctors of chiropractic commonly prescribe rehabilitation/exercise programs to improve motor control, muscle strengthening, stretching, and aerobic capacity. One such exercise that may be recommended is walking backward. Compared with walking forward, studies have shown that walking backward can lead to better results with respect to cardiovascular fitness and MF muscle activation (which as noted previously, are often weaker in cLBP patients).
Additionally, walking backward works the lower limb muscles to a greater degree while reducing stress on the patellofemoral joint (the kneecap). This is important, as knee pain can commonly co-occur with low back pain, especially in patients who are overweight/obese. Walking backward also stretches the hamstrings, which are often short/tight in cLBP patients.
So not only can walking backward benefit patients who already have back pain, but adding this activity to your exercise regimen may also reduce the risk for low back pain in the first place!
www.PainReliefChiroOnline.com
The sciatic nerve is made up of five nerve roots that exit the spine in the lower back (L4 to S3) and then merge into one nerve that travels through the buttock and into the leg. At the back of the knee, the nerve divides into two nerves, the tibial and common peroneal, that travel into the inner and outer lower leg and foot.
When the sciatic nerve is compressed or pinched, a patient can feel pain, tingling, numbness, and even weakness in the hip, buttock, and leg. For individuals under the age of 60, the most common cause of sciatica is a herniated disk. For older adults, the most likely causes of sciatica are spinal stenosis (a narrowing of the openings of the spine the nerves travel through) and spondylolisthesis (when one vertebra slides forward on the neighboring vertebra).
Normally, a nerve root moves freely in and out of the spine through holes located between each vertebra called intervertebral foramen (IVF). Movements or exercises such as hamstring stretches or punting a football create tension on the sciatic nerve and pull the nerve roots out of the IVFs. Similarly, when we stand up straight and look down at our feet, this pulls the spinal cord upward and the nerve roots move into the IVFs.
When managing sciatica, chiropractors will utilize a technique called nerve flossing. Like flossing teeth, the back and forth motion of the dental floss is conceptually the same action as the back and forth motion of the five nerve roots that merge into the sciatic nerve. To pull the nerve roots out of the IVF, extend the head/neck upward and then flex the foot/ankle upward as well (toes toward the nose). To pull the nerve back into the IVF, point the foot/ankle downward while the head/neck flexes forward (chin to chest). Repeat multiple times as long as pain or other symptoms do not worsen. The idea behind this is to free up the nerve root by reducing adhesions in the IVF.
Nerve flossing is usually performed first by a doctor of chiropractic to make sure it is well tolerated and safe so that the patient can perform the exercise at home several times a day. Studies show that this method helps reduce tension on the sciatic nerve while also stretching the hamstrings, which are often tight in patients with low back pain.
Using functional MRI, researchers have observed that music activates the visual, motor, and coordination centers on both sides of the brain. Research also shows that music affects deeper brain areas involving memory and emotion—more than almost any other stimulus. Additionally, music engages less used neural connections in the brain, strengthening them to potentially restore or improve impaired/lost functions.
The American Music Therapy Association (AMTA) notes that music therapists work with older adults to help with dementia, children and adults to reduce asthma episodes, hospitalized patients to reduce pain, children with autism to improve communication skills, premature infants to improve sleep patterns and increase weight, people with Parkinson’s disease to improve motor function, and more.
One of the most publicized music therapy cases involved Congresswoman Gabby Giffords. After a near-fatal head injury, Giffords suffered from aphasia, the inability to speak due to damage of the language pathways located on the left side of the brain. By layering words on top of melody and rhythm and with a lot of practice, new neuropathways were formed, allowing her to regain the ability to speak. Her music therapist, Meaghan Morrow, compared the process to a freeway detour, describing the brain’s ability to form new roads or paths around damaged areas (a process called “neuroplasticity”) so the information can reach the same part of the brain that the damaged freeway once provided.
Dr. Oliver Sacks’ book Musicophilia describes the role of music therapy in managing Parkinson’s disease, which spurred the book and film “Awakenings.” In his book, Dr. Sacks cites an 1871 article by neurologist Dr. John Hughlings Jackson entitled, “Singing by Speechless Children.”
In previous months, we’ve discussed how walking backward can improve memory recall. Other research has found that trying new things or performing activities in a different way can create new pathways in the brain, which may improve brain health. So next time you drive to the store, take a different route. Tomorrow, try holding your toothbrush or your hairbrush with your other hand.
Of course, continue to get regular exercise, eat a healthy diet, get plenty of sleep, avoid smoking, abstain from excessive drinking, and get regular chiropractic care to keep your mind and body in the best shape possible to give yourself the best chance of a long and happy life!
Not only are blueberries delicious and easily attainable at the supermarket but they are also incredibly good for you. But don’t take our word for it, let’s look at what researchers say…
A 2019 review looked at findings from eleven studies that involved blueberry interventions. The researchers found that blueberries benefit memory and executive function in both children and adults, and blueberries can improve psychomotor function in seniors, including those with mild-cognitive impairment. The authors also reported that blueberry intake reduces risks for developing metabolic syndrome (heart disease, stroke, and type-2 diabetes), cancer, cardiovascular disease, and cognitive decline.
In a 2018 study involving 215 older adults, researchers observed that those with the greatest cognitive impairments who consumed a daily 600mg polyphenol-rich grape and blueberry extract for six months experienced significant improvements with respect to episodic memory.
Not only are blueberries low in calories (only 84 calories per cup) but just one cup of blueberries contains four grams of fiber, 24% of the recommended daily allowance (RDI) of vitamin C, 36% of the RDI of vitamin K, and 25% of the RDI of manganese.
Blueberries are antioxidant rich, which can protect the body from the free radicals that are known to damage cells and contribute to aging and diseases, like cancer. These antioxidants can also reduce oxidization of LDL (“bad”) cholesterol, which is a risk factor for heart disease.
There is research that suggests regular blueberry intake is associated with lower blood pressure and a reduced risk for heart attack.
Blueberries can improve insulin sensitivity and glucose metabolism—both of which can reduce the risk for diabetes and may even benefit diabetics.
Much like cranberries, blueberries contain anti-adhesive substances that can help keep bacteria from sticking around in the bladder and causing a urinary tract infection.
If you regularly exercise (you do, don’t you?), then the good news is that blueberries may reduce soreness and aid in muscle recovery following a strenuous workout.
BOTTOM LINE: Eat blueberries!
Whiplash associated disorders (WAD) describes a constellation of symptoms that can arise following a motor vehicle collision (MVC), sports collision, or slip and fall. The typical initial treatment approach for WAD is non-surgical care, but what does the research say is the best non-surgical approach?
To start, most (if not all) studies on WAD center around the concept of preventing chronicity of WAD. In other words, the GOAL of care is to restore function and get the patient back to their normal lifestyle (work and play), which has been emphasized as being most important, even more so than pain resolution, though the two often go hand-in-hand. What are the best treatments in the initial stages—acute (less than two weeks) and sub-acute (two to twelve weeks)—of healing that can best reduce the risk of a patient developing chronic WAD (over twelve weeks)?
To answer the question, researchers reviewed studies from a 30-year time frame (1980-2009) and published their findings in a five-part series.
The first article in the series offered an overview and summary of the entire work. The second focused on the acute stage which included 23 studies that met the inclusion criteria. The researchers concluded that EXERCISE and MOBILIZATION treatment approaches had the strongest research support—two services STRONGLY EMBRACED by chiropractic.
The third article in the series focused on the subacute stage (2-12 weeks), which included 13 studies. The authors described research support for “the use of interdisciplinary interventions and chiropractic manipulation” but stated that the level of evidence was not strong for ANY treatment approach in the sub-acute stage. Investigators concluded that more research was needed with respect to this stage of care.
The fourth article in the series centered on the chronic stage (more than three months), of which 22 studies were included. Here, EXERCISE programs were reported to offer relief, at least over the short-term, while nine studies supported effectiveness for an interdisciplinary approach. Manual joint manipulation and myofeedback training were also reported as useful for pain relief.
The authors also stated that there was strong evidence to suggest that immobilization with a soft collar was not only ineffective but may impede recovery.
Do you see the “theme” of this research series? Services offered by chiropractic (exercise training, manipulation, and mobilization) are recommended at each stage of WAD recovery!
The American Sleep Association reports that 50-70 million adults in the United States (US) have a sleep disorder. Poor sleep is associated with several adverse health outcomes, including an elevated risk for musculoskeletal pain.
Though the exact mechanisms are not fully understood, the current research suggests the relationship between musculoskeletal pain and sleep disturbance is bi-directional. That is, individuals with a sleep disorder are more likely to develop a pain condition and people with pain are more likely to have trouble sleeping.
Chiropractic care has been studied in many populations where sleep deprivation is common—particularly in patients with fibromyalgia, a condition characterized by sleep disturbance, fatigue, and pain in several sites across the body. One such study published in 2000 reported that fibromyalgia patients who received 30 chiropractic treatments experienced substantial improvements with respect to pain intensity, fatigue, and sleep quality.
In a systematic review, researchers identified 15 studies that associated chiropractic care with benefits for patients with insomnia. For low back pain and neck pain, which are two of the most common sleep interfering chronic conditions, chiropractic management not only helps but it is RECOMMENDED as a first levels of care in clinical guidelines worldwide.
Chiropractic offers the following to help with sleep troubles: manual therapies such as manipulation, mobilization, and soft-tissue work that can help relax the nervous system; nutritional approaches, including the use of supplements like melatonin, L-theanine, 5-HTP (5-hydroxy-tryptophan), and valerian root; weight management (obesity is a risk factor for insomnia); and education/advice on sleeping position, napping, relaxation methods (breathing exercises, mindful meditation), no “screen-time” prior to bed, pillow placement and size, and more.
TAKE HOME MESSAGE: Chiropractic care helps manage pain arising from MANY conditions. Pain interferes with sleep. Sleep is NECESSARY to avoid chronic, disabling conditions (like FM) and maintain a high quality of life, so seek chiropractic care FIRST and sleep well tonight!
Several studies have found that a treatment approach that combines specific exercises with spinal manipulation, mobilization, and nutrition is often ideal for reducing pain and improving function in patients with low back pain. But how does your doctor of chiropractic know which low back exercises to recommend and which to avoid? The answer: it depends.
Because each patient is unique (age, health status, fitness), it’s clear that exercise prescriptions need to be individually tailored to be safe and to avoid injury. Perhaps one of the most important tools your doctor will take into consideration is the concept of directional preference. That is, which position helps your back feel good or bad? From a sitting position, first slump and slouch and then ask yourself, “Does this feel good, bad, or no different?”
Next, sit up straight and arch your lower back and ask the same question. Do you prefer one over the other? If so, the position in which you feel BEST is YOUR directional preference.
Using that concept, let’s say you feel best slumped and slouched, which is quite common. What are the “BEST” exercises for this flexion directional preference (FDP)?
- While laying down and facing upward, pull one knee to the chest followed by the other, repeating five to ten times each (staying within reasonable pain boundaries).
- While laying down and facing upward, flatten and “push” the arch of your lower back into the floor by rocking your pelvis forward and hold three to five seconds, repeating five to ten times.
- While sitting, bend forward and try to touch your toes. Repeat multiple times a day as needed.
If you feel best in the arched sitting posture, then the ideal exercises for you may be those that utilize the extension directional preference (EDP):
- While sitting or standing, place your hands behind your back, and arch your back over your hands (as far as comfortably allowed). Hold for three to five seconds, repeat five to ten times.
- Sit up as arched as your can and try to hold that position as long as possible when doing sitting tasks (computing, driving, etc.).
- Do a “saggy push-up” (also called a “Cobra,” or prone press-up) by keeping your hips on the floor while doing a push-up, arching the low back.
You can improvise and make up your own exercises using this concept, but while some discomfort is to be expected, avoid sharp lancinating pain. If you don’t have a directional preference and feel good in both positions, do ALL of the above! Your doctor of chiropractic can help monitor and train you in these and many more exercises as part of your treatment plan to reduce back pain and improve back function.
While the anatomy of the shoulder allows for a wide range of motion and movement, it comes at the cost of a less stable joint, especially for those who routinely perform activities that require lifting the arms. This is likely why shoulder pain is one of the leading reasons patients seek chiropractic care, trailing behind low back and neck pain. The most common cause of shoulder pain is from tearing of the rotator cuff muscles (RCMs), particularly muscles that rotate the shoulder outward.
The “typical” rotator cuff tear patient is typically over 50 years of age with shoulder pain that has slowly worsened over time. A 2018 study found that as many as 96% of people over age 50 have RCM abnormalities, of which MANY are asymptomatic or non-painful. The study also reported that 24% of a random sample of 46 young people with an average age of 23 years old with no symptoms and no history of past injury, had degenerative changes in the RCMs. This finding supports the notion that rotator cuff injuries may occur early in adulthood and progress slowly until the symptoms drive a patient to seek care.
In a study involving 167 patients with rotator cuff tears, researchers observed no difference in outcomes one year after participants received either conservative care or surgery. This led the authors to recommend that non-surgical care, such as chiropractic care, should be considered as the PRIMARY method of treatment for rotator cuff tears of non-traumatic origin.
One study looked at impingement syndrome in a case series of four patients who received multimodal chiropractic care that included shoulder manipulation, shoulder girdle exercises, and ultrasound. In all four cases, the patients reported complete resolution of their shoulder pain and disability with five treatments. When researchers followed up with the patients four to eight weeks later, the participant’s symptoms had not returned.
A systematic review of data from 200 articles found evidence for the following non-surgical treatment options—which are commonly provided in chiropractic clinics—for shoulder pain: exercise training (specific favored over general), manual therapy, laser, extracorporeal shockwave, pulsed electromagnetic field (PEMF), transcutaneous electrical nerve stimulation (TENS), myofascial trigger point therapy, acupuncture, and microwave and light therapy.
For a patient with a rotator cuff tear, conservative chiropractic care is an excellent option for reducing pain and improving function in the affected shoulder!
A myofascial trigger point (TP) is a hyper-irritable area in skeletal muscle that is commonly detected by palpating (feeling with the fingers). Although more sophisticated ways exist for locating TPs—ultrasound, microdialysis, electromyography, infrared thermography, and MRI—palpation remains the most utilized due to its simplicity, efficiency, and low cost. For patients with migraine and tension-type headaches, TPs are commonly found at the base of the skull/upper neck, paraspinal neck muscles, the upper trapezius, and/or the levator scapulae musculature.
In one study that included 34 headaches sufferers (20 had migraine headaches without aura and 14 had tension-type headaches) and 34 non-headache controls, researchers looked at what happened when they used a specific technique to recreate the effect of a trigger point on muscles in the upper neck and in the arm.
When the researchers stimulated the upper neck, 8 of the 14 (57%) members of the non-headache control group, all 14 TTH subjects, and 19 of the 20 migraine sufferers reported headache-related symptoms. On the other hand, when the same technique was used on the arm of each participant, none reported headache-like symptoms.
The authors concluded that the high incidence and accuracy of headache reproduction from upper neck stimulation supports the importance of evaluation and treatment of trigger points in the upper neck region in those with TTH and migraine headaches. Doctors of chiropractic commonly perform manual techniques to the upper neck region and train their headache patients in identifying and self-managing TPs located in the upper neck muscles.
Several methods can be used to self-treat TPs in the upper neck region. Perhaps the easiest approach is to reach back with your thumb to the muscle attachments along the base of the skull and apply deep (but tolerated) pressure, feeling for areas that are most sensitive and sliding the thumb up/down and across the sore TP until it becomes less tender. Work the left side with the left thumb and vice versa. Doing the same with small head movements—up/down, left/right rotations, etc. helps.
Another method is to sit in a straight-back chair, slide down so that you cradle your upper neck over the top edge of chair back and then roll your head left to right. When you find a sore TP, add a nodding type of head motion while “digging in” over the chair-back edge (within tolerance) until it loosens and hurts less.
If you suffer from headaches, your doctor of chiropractic can train you in these and other effective exercises and render treatment to improve cervical function that can be highly effective at reducing both the frequency and intensity of headaches.
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When people suspect they have carpal tunnel syndrome (CTS), it’s typical that their first thought is that their condition will require surgery and a lengthy recovery. While surgery may be warranted in emergency situations, treatment guidelines encourage patients to seek non-surgical options first. So how do non-surgical approaches like manual therapy interventions —provided in a chiropractic setting—compare with surgery to treat CTS?
In 2018, a team of European researchers reviewed data from ten studies that compared the effectiveness of surgery vs. non-surgical care for the treatment of CTS. While the results favored non-surgical approaches at three months and surgery at six months, the available data show no difference in outcome one year later. Thus, the research team concluded that conservative treatment should be preferred unless otherwise indicated.
If both surgery and non-surgical options produce similar outcomes at the one-year mark, can CTS improve on its own?
In one study that involved 22 patients (19 of whom had CTS in both hand), researchers incorporated a twelve-week waiting period into the experiment to see if symptoms worsened, stayed the same, or improved. Questionnaires completed by the participants who abstained from manual therapy interventions showed that their symptoms worsened during the twelve-week non-treatment period.
The treatment phase of the study involved six sessions twice a week for three weeks and incorporated manual therapies to address the soft tissues of the hand and wrist and the carpal bones. The patients reported that treatment resulted in improvements with respect to both pain and function. This led the researchers to recommend manual therapy interventions as a valid non-surgical treatment approach for CTS.
Doctors of chiropractic specialize in manual therapy techniques and employ these regularly for many neuromusculoskeletal conditions, including CTS and related conditions that may contribute to a patient’s hand and wrist symptoms—something that a carpal tunnel release procedure cannot address. To achieve optimal results, it’s important to seek PROMPT assessment and non-surgical treatment for CTS.
It’s common to see older adults with a slumped posture, and though there are many possible reasons for this, perhaps the most common cause is a condition called spinal stenosis.
The Mayo Clinic notes that spinal stenosis can result from wear-and-tear that narrows the spinal disks. This narrowing can place pressure on the nerve roots as they exit the spine prior to traveling down into the legs. The symptoms—which can include pain, numbness/tingling, and weakness—typically come on gradually and may worsen over time. The spinal stenosis patient may feel more comfortable by leaning or bending forward as this posture opens the holes in the spine (the foramen), taking pressure off the nerves.
Because spinal stenosis is a condition caused by wear-and-tear, some individuals may be at more risk than others, especially those with a history of spinal/disk injury, heavy labor, poor nutrition, or obesity.
The good news is that patients with spinal stenosis can benefit from non-surgical approaches!
In a 2019 randomized trial involving 259 seniors with spinal stenosis, researchers compared the effectiveness of three approaches: medical care (including epidural steroid injections), group-based exercise, or manual therapy (spinal mobilization performed by a doctor of chiropractic) with individualized exercise (stretches and strength training).
While participants in the medical care and exercise-only groups reported some benefits, the research team noted that the patients in the manual therapy plus individualized exercise group experienced greater improvements with respect to pain, function, and walking ability.
The “take-home” message here is that in all three measured outcomes—pain, function and walking ability—the chiropractic approach did the BEST! If you suffer from spinal stenosis and its associated symptoms and walking limitations, PLEASE consider chiropractic not only as an option but perhaps as this study points out, the BEST option!
Neck Manipulation Facts
References:
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- Lazarou J, Pomeranz BH, Corey PN; Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-analysis of Prospective Studies; Journal of the American Medical Association; Vol. 279; No. 15; April 15, 1998; pp. 1200-1205.
- Giles GFL, Muller R; Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation; Spine; July 15, 2003; Vol. 28; No. 14; pp. 1490-1502.
- Wolfe MM, Lichtenstein DL, Singh G; Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs; The New England Journal of Medicine; June 17, 1999; Vol. 340; No. 24; pp. 1888-1899.
- Terrett AG; Misuse of the literature by medical authors in discussing spinal manipulative therapy injury; Journal of Manipulative and Physiological Therapeutics; May 1995; Vol. 18; No. 4; pp. 203-210.
- Weban A, Beck J, Raabe A, Dettmann E. Seifert V; Misuse of the terms chiropractic and chiropractor; J Neurol Neurosurg Psychiatry; May 2004; Vol. 75; No. 5; p. 794.
- Weban A; Inappropriate use of the title ‘chiropractor’ and term ‘chiropractic manipulation’ in the peer-reviewed biomedical literature; Chiropractic and Osteopathy; August 2006; Vol. 22; Vol. 14; p. 16.
- Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE; Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation; Cureus; February 16, 2016; Vol. 8; No. 2; e498.
- Cassidy, J David DC, PhD; Boyle, Eleanor PhD; Côté, Pierre DC, PhD; He, Yaohua MD, PhD; Hogg-Johnson, Sheilah PhD; Silver, Frank L. MD; Bondy, Susan J. PhD; Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study; Spine; Vol. 33(4S); February 15, 2008; pp. S176-S183.
- Kosloff TM, Elton D, Tao J, Wade M Bannister WM; Chiropractic Care and the Risk of Vertebrobasilar Stroke: Results of a Case–control Study in U.S. Commercial and Medicare Advantage Populations; Chiropractic & Manual Therapies 2015; Vol. 23; No. 19; pp. 1-10.
- Chaibi A, Russell MJ; A Risk–benefit Assessment Strategy to Exclude Cervical Artery Dissection in Spinal Manual Therapy: A Comprehensive Review; Annals of Medicine; March, 2019; Vol. 19; pp. 1-10.
- Moser N, Mior S, Noseworthy M, Cote P, Wells G, Behr M, Triano J; Effect of Cervical Manipulation on Vertebral Artery and Cerebral Haemodynamics in Patients with Chronic Neck Pain: A Crossover Randomised Controlled Trial; BMJ Open; May 28, 2019; Vol. 9; No. 5; pp. e025219.
- Kranenburg R, Tyer R, Schmitt M, Luijckx GJ, van der Schans C, Hutting N, Kerry R; Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid and Intracranial Arteries: A Systematic Review; Journal of Orthopaedic & Sports Physical Therapy; July 2019 [epub].
There has been great debate over the years about the pros and cons of drinking coffee. The confusion is justified, as one study will report on the negative affects while the next will highlight its beneficial attributes. So here we go again, but this time, the focus is on whether or not the compounds found in coffee can help you live longer.
In a 2017 study published by the International Agency for Research on Cancer and the Imperial College London, researchers surveyed 520,000 people from ten European countries and concluded that drinking coffee does appear to promote a longer lifespan. According to the study, other significant health benefits associated with coffee consumption include lower mortality rates from liver and digestive disease in both men and women; decreased mortality from cancer, circulatory disease, and cerebrovascular disease (stroke) in women; and a reduced suicide rate for men. Coffee consumption also lowers inflammatory markers and other negative biomarkers in the blood, giving us some insight on how the compounds in coffee may promote longevity.
The other study, this one funded by the National Cancer Institute, included a diverse set of subjects, as the survey included more than 185,000 adults from various ethnic backgrounds. The authors of this study also concluded a link between coffee consumption and living longer.
Regarding the dosage of coffee required to achieve the most benefits, the European study found the more coffee consumed, the better. They observed that participants who consumed three cups a day had better protection against all-cause death than those consuming less, especially when compared with the non-coffee drinkers. Also, because the researchers surveyed people from many different parts of Europe, it didn’t appear to matter what brand of coffee the participants consumed, how it was prepared, or the serving style.
The United States-based study echoed many of the same findings as it reported that individuals consuming two to four cups a day had an 18% lower risk of early death in comparison with the non-coffee drinkers, regardless of the ethnicity, coffee type, or preparation style.
Not to burst your bubble about the health benefits of coffee, but moderation is still recommended regarding your daily indulgence. Nutritionists also warn that adding heavy cream and sugar may nullify many of the health benefits of black coffee plus add unnecessary calories to your diet.
Look for future research to focus on determining which compounds found in coffee provide the most benefit and if they can be consumed as a supplement for people who are not coffee drinkers.
Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!
Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!
Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!
This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.
Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!
Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain! So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
“I woke up this morning with an excruciating headache. I thought the top of my head was going to blow off!”
“I notice as the day goes on, tightness in my neck worsens and I get a headache usually by 2-3pm.”
“I don’t know if I can do my work with my headaches.”
Statements like these are common on case history forms patients fill out when they seek chiropractic care for their headaches. Many patients ask, “...what is a headache?” The National Institutes of Health (NIH) describe four types of headache: vascular, muscular contraction or tension, traction, and inflammatory.
The most common form of vascular headache is the migraine. Migraine sufferers usually complain of severe pain on one or both sides of the head, nausea or vomiting, and sometimes visual changes. There is often a heightened sensitivity to light or noise prompting migraine sufferers to lay in a dark, quiet room until the migraine passes. Women are more likely to suffer from migraines than men and the severity of symptoms can be so extreme that all activity must be stopped until it passes.
The next most common type of vascular headache is the toxic headache produced by a fever. Other vascular headache types include “cluster” headaches, which are characterized by repeated episodes of intense pain that start in one spot and spread out. These may only last a few minutes to an hour but carry a very high level of pain and activity intolerance. Another common type of vascular headache is that resulting from high blood pressure.
Muscle contraction or tension headaches involve tightening of the facial and neck muscles. These often start in the neck and radiate over the top or to the sides of the head. The muscles in the neck are usually extremely tight and tender and often, moderate pressure applied with the finger or thumb to these muscles will prompt radiating pain into and/or over the top of the head. This can also result in significant activity intolerance but usually not as severe as migraine or cluster headaches.
Traction and inflammatory headaches result because of other conditions that range from a sinus infection to a stroke. These types of headaches can serve as a warning sign of a more significant or serious condition. Another example is meningitis as well as other conditions affecting the sinuses, spine, neck, ear, and teeth.
The NIH suggests, when headaches occur three or more times a month, that “… preventive treatment is usually recommended.” Certainly, in some cases, medication may be indicated but only after ruling out a more serious condition and after exhausting less invasive treatments that carry fewer side effects.
The American Chiropractic Association recommends:
Avoid long time periods of staying in one position (computer, sewing machine, reading, etc.) and take stretching/neck range of motion exercise breaks every ½ to 1 hour;
Exercise – walking, low impact aerobics;
Avoid teeth clenching (due to straining the temporomandibular – TMJ, or jaw joint);
Drink lots of water – stay hydrated.
Chiropractic care may include spinal manipulation (adjustments), nutritional advice (dietary suggestions, vitamin/mineral options such as a B complex), exercise, posture retraining, and relaxation techniques.
Disclaimer
This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.
As we grow older, stretching becomes a more important part of our routine, especially when hip pain is present. Whether you are about to engage in a sport, a job, weight lifting, or errands, it’s best to prepare your muscles for activity. With that said, stretching can be broken down into two main types: static (or passive) and dynamic (or active) stretching.
The available research notes that static stretching (stretching while holding one position, like reaching for your toes) has recovery benefits and is most effective at the end of a workout/competition. However, it can reduce performance when done beforehand, as it relaxes muscles, reduces blood flow and muscle strength, and decreases central nervous system (CNS) activity.
Active warm-ups or dynamic stretching have the opposite effect—they boost blood flow and activate the CNS, which enhances strength, power, and range of motion (ROM) resulting in BOTH immediate and long-term benefits. A 2014 systematic review of 31 studies reported that dynamic stretching that included sprints and plyometrics (movements against resistance) enhanced power and strength performance when compared to static stretching—which did not reduce strength. In a 2010 systematic review of 32 studies investigating active warm-up before engaging in a sport, researchers found that an active warm-up improved performance by 79% across all criteria investigated.
But what about the hip? A 2019 study compared static stretching vs. dynamic stretching of the hip joint with no-load (DSNL), with a light-load (DSLL, 0.25kg), and with a heavy-load (DSHL, 0.5kg) in an elderly population (63.2 ± 7.13 years). Participants stood sideways behind a chair (for balance), and swung one leg, as able. Researchers measured hip flexion and extension range of motion before the test, immediately after, and 60 minutes later. Compared to static stretches, all three types of dynamic stretches improved hip ROM more effectively at all time points, with DSNL being the most effective.
Here are a few hip-specific dynamic stretch options: 1) Standing Hip Circle: Stand on one leg, raise the opposite knee to 90º (thigh parallel to the floor); move the knee outward (open your hip), and make wide circles for 30 seconds/side or to fatigue (start gradually). 2) Lunge: Step forward with the right foot, lower the back knee toward the floor (as able); pause and repeat on the other leg. 3) Half Squat: From standing, slowly bend the knees until the thighs are parallel to the ground while bracing the core and maintaining a neutral low back curve.
Disclaimer
This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.