MONTHLY HEALTH UPDATE
Is Your Foot Causing Your Knee Pain?
Chad Abramson, D.C.
Whole Body Health
Charlie Horses and Management Strategies
At some point in time, most of us have had a "Charlie horse" or muscle cramp. In fact, 50% of
adults over the age of 50 suffer from night cramps. Doctors of chiropractic are often asked by their
patients, "Where do these come from? Why am I having these? What can I do to get rid of them?"
The most common type of muscle cramp is caused by exercise, hence the label "exercise- associated muscle cramps" (EAMC). Though EAMCs are common in both recreational and professional athletes, the actual cause remains unclear. Therefore, treatment is often based on anecdotal studies rather than sound scientific evidence.
With that said, a thorough analysis of previous studies published between 1955 and 2008 concluded that the two most widely discussed theories for the cause of EAMC are 1) dehydration and the resulting electrolyte imbalance/depletion and 2) neuromuscular causes. The authors of the analysis concluded that the actual cause is "…likely due to several factors coalescing to cause EAMC." In other words, it’s sort of like "a perfect storm", as several causes interact to result in the cramp, which is why treatment and prevention strategies for EAMC can vary considerably. The recommended care for acute EAMC is to apply a steady, moderate static stretch to the muscle followed by gathering a proper history to determine if any predisposing conditions exist that can trigger EAMC. Prevention should focus on fluid and electrolyte balance (replacement) and/or neuromuscular training. Specific physical problems that can increase the rate and/or intensity of muscle cramps include conditions affecting the endocrine system (hormonal imbalance), the metabolic system (loss of fluids and electrolytes), and/or the neurological system (such as nerve injury or damage). Common areas for muscle cramping include the calf, front of the thigh (quadriceps), and back of the thigh (hamstrings). A thorough history and physical examination may include a nutritional assessment, which can lead to treatment strategies tailored for each unique, individual patient. Additionally, it’s a good idea to review what medications a patient is taking as they may play a role in the development of cramps. For example, diuretics commonly prescribed for high blood pressure and other heart-related conditions may lead to potassium depletion. Some helpful natural remedies for those with persistent muscle cramping may include a mineral/electrolyte replacement such as calcium, potassium, and/or magnesium. Anti-inflammatory nutritional care such as ginger and turmeric and/or muscle relaxing approaches such as valerian root can also be helpful. Other anti-cramping natural substances include Cassia oil and capsaicin. Riboflavin has been used preventatively with success as well.
Whiplash Injury Prevention – Part II
Last month, we discussed whiplash injury prevention by focusing on the physical
characteristics of crashes. This included information about head restraints, collision speed, seat back
position, body size differences, air bags, and more. This month, we'll focus on the MOST important
aspect of whiplash prevention: driver distraction!
According to a survey of 6,000 drivers conducted by the National Highway Traffic Safety Administration (NHTSA), 20% of those surveyed in the 18-20 years old age group and 30% of those 21-34 years of age claimed texting does not affect their driving.
Of the 6,000 drivers surveyed, 6% reported having been in a crash in the prior year and 7% had been in a near-crash, with men being at a slightly higher risk than women. Young drivers, those 18-20 years old, had the highest incidence of crash or near-crash experiences (23%) compared with all other age groups while interestingly, drivers aged 65 years and older had the lowest (8%). The younger drivers reported almost double the number of crashes (17%) as drivers in their early 20s (9%) and up to four-times more than the other age groups (4-6%). Of the 718 drivers who were involved in a crash or near-crash in the previous year, 6% reported phone usage at the time (4% talking, 1% sending a text or email, and 1% reading a text or email). The young driver (18-20 years old) group, reported the highest cell phone use (13%) at the time of the crash or near-crash (2% talking, 8% sending a text or email, 3% were reading a text or email). The highest incidence of talking on the phone at the time of crash/near-crash was in the age 25-34 years old group (10%). Not too long ago, we reported statistics comparing texting to drunk driving, and the data was sobering. Researchers from the Monash University Accident Research Centre in Australia found that texting severely impaired driving skills, as participants spent 400% more time with their eyes off the road! Hands-free devices are NOT without risks either. Put simply, the brain is distracted when talking, as attention is displaced from the road to the conversation—especially if the conversation is heated! Interestingly, the Texas A&M Transportation Institute reported that voice-to- text offers no safety advantage over manual texting while the AAA Foundation for Traffic Safety reported voice- activated in-car technologies “dangerously undermine driver attention." To summarize, avoid all distractions while driving and keep your eyes on the road!
Neck Pain / Headaches
What Is Torticollis?
Torticollis, also called wry neck or loxia, represents a category of neck
conditions which exhibit a twisting position of the head and neck outside of a normal
neutral position. There are many potential causes for torticollis from sleeping in a
faulty position to an injury to the neck, like whiplash. However, it's commonly labeled
as "idiopathic," which basically means, “We don’t know what caused it."
Torticollis often occurs out of the blue with no obvious cause or history such
as, “When I woke up, I couldn’t turn or move my head!" It can occur at any age and
may disappear on its own in a few days to weeks, but in rare cases, it can persist for
months or years.
Because it can be quite alarming, most people quickly seek healthcare services, which can include visiting a doctor of chiropractic. Once the more serious causes of torticollis are ruled out (such as a severe type of infection like a retropharyngeal abscess or bacterial meningitis, fracture, neoplasm, cervical dystonia, etc.), conservative care can proceed.
If a patient has a family history of torticollis, they may have a more serious form of torticollis called cervical dystonia. This usually begins between 31-50 years of age and if left untreated, it can become permanent.
Chiropractic care 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, your doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Your chiropractor may also use physical therapy modalities and or provide instruction on home-based exercises and other self-management strategies.
Exercises for Hip Pain
There are two types of muscles that help facilitate motion in our hips and lower extremities: tonic
Tonic (postural) muscles are always working or contracting to keep us upright. Therefore, these muscles tend to be tight and short. When we sleep, they contract or shorten and are taut upon waking and need to be stretched on a regular basis. Examples of tonic muscles include the hamstrings and the iliopsoas or hip flexors muscles. Here are two great stretches for these muscles:
Iliopsoas stretch: 1) Stand and take a step forward with the left leg into a front straddled position. 2) Rotate the left side of the pelvis forward so that it becomes square with the right side of the pelvis. 3) Perform a posterior pelvic tilt by flattening the curve in the low back while rocking the pelvis forward to create a strong stretch in the left groin/front of the hip. 4) Lean backwards to the right to further increase the left groin/hip stretch. Hold for five to ten seconds and repeat this on the opposite side. Practice these stretches multiple times a day.
Phasic muscles, on the other hand, only work when needed and tend to be weak. These require strengthening, not stretching. Examples of phasic muscles include the abdominal and buttock muscles. Here are two great strengthening exercises for these muscles:
Abdominal strengthening: 1) Lying on the floor, place your hands behind your low back. Bend one knee/leg while keeping the other straight. 2) Lift your breast bone toward the ceiling one to two inches (2.54 to 5.08 cm) and hold for ten seconds. Repeat multiple times until the abdominal muscles are fatigued.
Buttocks strengthening: 1) Squeeze your buttocks together multiple times a day when sitting or standing. 2) Lie on your back with your knees bent and your feet flat on the floor. Raise your buttocks so it lines up with your trunk while pushing your heels into the floor. Hold for ten seconds and repeat five to ten times.
Depending on the nature of your hip pain, your doctor of chiropractic may recommend further exercises that you can perform at home as part of your treatment plan.
Carpal Tunnel Syndrome
Treatment Option Comparison for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) results from the compression of the median nerve as it
travels through the wrist. Classic symptoms associated with CTS include numbness, tingling, and
weakness in the thumb, index, middle, and ring finger. In non-emergency situations, treatment
guidelines recommend patients undergo conservative care before considering more invasive
procedures, like surgery. This month’s article will look at the differences between standard
medical care vs. chiropractic care to treat CTS.
In a case study series, researchers divided 91 patients with confirmed signs and symptoms of CTS into two groups: one receiving standard medical care utilizing ibuprofen and night splints; and one group receiving chiropractic care including manipulation of the upper extremity bony joints and soft tissues, as well as spinal manipulation. Researchers monitored improvement with self-reports, nerve conduction, and vibrometric sensation testing of the affected hand.
Both treatment groups experienced improvements in comfort, finger sensation, and nerve conduction; however, vibrometric sensation testing revealed greater improvements among members of the chiropractic treatment group (3.05 decibels vs. 1.37 decibels).
The authors of the study point out that chiropractic provides an alternative form of non- surgical care, and patients with CTS should be offered the option, especially for those who cannot take a non-steroidal anti-inflammatory drug (NSAID) due to intolerance like stomach irritation or liver-kidney issues. Personal preference is also important in the decision making process for CTS.
Other CTS treatment options often offered by doctors of chiropractic include work modifications, ice therapy, and nutritional options such as ginger, turmeric, boswellia, bromelain, fish oil, and others. There are also CTS-specific stretching exercises that can be done multiple times per day at home and work. The treatment plan for the CTS patient will often include several of these options in order to achieve a satisfying outcome.
Low Back Pain
What to Do for Chronic Low Back Pain
Low back pain (LBP) is a very common problem that many, if not most of us,
have had at some point in life. In fact, about 80% of adults experience LBP in their
lifetime, and it’s the leading cause of job-related disability and missed work days.
According to the National Institutes of Health, more than 25% of adults have had a recent
episode of LBP.
Men and women are equally affected by LBP, which can occur abruptly following a specific incident (such as over lifting), or it can develop slowly over time due to wear and tear. Studies show a sedentary lifestyle during the week can set the stage for developing LBP, especially when it's followed by strenuous weekend workouts.
Although about 80% of acute LBP (lasting a few days to weeks) resolves with self-care or short-term management, about 20% of those with acute LBP will still have persistent symptoms after a year. So what can be done to manage chronic LBP and prevent disability?
One study looked specifically at maintenance spinal manipulative therapy (SMT) to determine its effectiveness in managing chronic LBP, which they defined as LBP that persists for more than six months. Researchers randomly assigned sixty patients to receive either 1) 12 treatments of sham SMT for one month; 2) 12 treatments of SMT for one month but no treatment thereafter; or 3) 12 treatments for one month followed by SMT twice a month for the following nine months.
The research team found that groups two and three experienced significantly lower pain and disability scores than the sham treatment group at the end of the first month. However, only the third group experienced more improvement in regards to pain and disability at the ten-month evaluation. In the absence of continued SMT, the second group's pain and disability scores returned back to near pre-treatment scores. The authors concluded that SMT is effective for chronic nonspecific LBP, but to obtain long-term benefit, patients should continue to receive care on an ongoing basis.
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10222 19 th Ave SE, Suite 103, Everett, WA 98208
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.