MONTHLY HEALTH UPDATE
Do Coffee Drinkers Live Longer?
Chad Abramson, D.C.
Whole Body Health
Are Probiotics Necessary? (Part 2)
As discussed previously, probiotics can benefit patients with gut complications such as
enteritis, constipation, and irritable bowel syndrome (IBS). Probiotics may also help decrease
allergic inflammation, treat nonalcoholic fatty liver disease (NAFLD), and fight immune
deficiency diseases. Ingesting probiotics can improve calcium absorption and bone calcium
accretion to treat osteoporosis in postmenopausal women. They may even have a role in the
management of obesity and type-2 diabetes.
Most probiotics are oligosaccharides and can be synthesized or obtained from natural sources including asparagus, artichoke, bamboo shoots, banana, barley, chicory, leeks, garlic, honey, lentils, milk, mustards, onion, rye, soybean, sugar beets, sugarcane juice, tomato, and wheat. Foods rich in probiotics include kefir, kimchi, yogurt, sweet acidophilus milk, miso, tempeh, sauerkraut, aged soft cheese, and more.
Some probiotics include an ingredient called a "prebiotic." This is a non-digestible carbohydrate that acts as food for both the probiotic and the good bacteria already residing in the gut. Prebiotic stimulates the growth and/or activity of one or a limited number of genus/species in the gut, making the probiotic more effective and longer lasting.
Here are some of the various types of probiotics...
1. Lactobacillus naturally occur in our digestive, urinary, and genital systems and can
treat a wide variety of diseases and conditions.
2. Bifidobacteria are found mostly in the colon. They help improve blood lipids and glucose tolerance and can alleviate IBS and IBS-like conditions such as pain, bloating, and urgency.
3. Saccaromyces boulardii is the only yeast probiotic. It’s used to treat C-Dif (an antibiotic complication), traveler’s diarrhea, acne, and more.
4. Streptococcus thermophilus helps prevent lactose intolerance.
5. Enterococcus faecium supports the intestinal tract.
Are there side effects? Generally, side effects are rare and if they occur, they tend to be mild and usually relate to the digestive system and include symptoms such as gas or feeling bloated.
Whiplash Injury – A "Must Read" About Important FACTS!
Whiplash-associated disorders (WAD) is defined as "an acceleration-deceleration mechanism
of energy transfer to the neck." WAD may result from rear-end or side-impact motor vehicle
collisions (MVCs), diving and other sports-related injuries, as well as from falls, assaults, and more.
Because many bones and soft tissues may be involved in WAD, there are a variety of clinical signs
and symptoms associated with the disorder.
In 1995, the Quebec task force coined the term WAD and broke it down into five divisions: WAD 0 includes no pain or exam findings; WAD I includes neck pain, stiffness, or tenderness as the only complaint with no exam signs; WAD II includes pain, stiffness, or tenderness with exam findings such as decreased range of neck motion and/or point tenderness of the neck; WAD III includes all of WAD II plus altered nerve function (sensory deficits and/or muscle weakness or altered deep tendon reflexes); and WAD IV includes fracture or dislocation with or without spinal cord injury.
WAD is usually seen in rear-end, low-impact collisions with about 90% of cases occurring at speeds of <14 mph. In a rear-end collision, the trunk of the body is initially forced back into the seatback followed by hyperextension of the neck and head, which then recoil forwards—all within about 600 msec, which is much faster than the 1,000 msec needed to voluntarily brace our muscles. Studies support that the source of neck pain arises more often from injured joints than injured muscles. In about 60% of cases, neck pain is due to injury of the small facet joints, which are located on the sides of the neck, especially at levels C2-3 and C5-6. This can give rise to upper neck pain and/or headache (from C2-3), and/or lower neck pain radiating to the shoulder blades (C5-6) or worse, into the arms.
Fortunately, most acute WAD injured patients recover within three months. Unfortunately, about 40% do not improve and are then classified as having “chronic whiplash” (cWAD). Risk factors for WAD developing into cWAD include the following: 1) rapid and severe onset of neck pain and stiffness symptoms; 2) neurological deficit with arm pain (WAD III); 3) headaches; and 4) when urgent hospital admission is necessary. Older patients, those with pre-existing neck or low back pain, and individuals with slender necks have an elevated risk for a poor recovery. Depression, anxiety, and mood disorders are common in those with cWAD as well.
Neck Pain / Headaches
What Treatments Work Best for Neck Pain?
Experts estimate that up to 70% of people will experience an episode of neck pain in their
lifetime. Though there are many potential forms of treatment available, little has been published
comparing the various treatment options available to the neck pain patient.
A 2012 study that involved 272 neck pain patients compared three treatment options: chiropractic, medication, and exercise. After twelve weeks of treatment, the patients who received either chiropractic care or exercise instruction reported the greatest reduction in pain. The researchers followed up with the participants for up to a year and found that the patients in the chiropractic and exercise groups continued to report less pain than those in the medication group, and these benefits persisted until the end of the study. The researchers concluded that participants from both the chiropractic care and exercise therapy groups had more than double the likelihood of complete pain relief than with the patients in the medication group.
Quality studies on the short- and medium- term benefits of exercise and manual therapies applied to the cervical spine for patients with neck pain have been published since the 1980s. However, the benefits over the long term are not as well documented. With this in mind, a 2002 study followed 191 patients with chronic neck pain for two years comparing spinal manipulation (SM) with and without one of two types of exercises: low-tech (and low cost) rehabilitative exercise (LTEx) or high-tech MedX (machine assisted) rehabilitative exercises (HTEx).
The research team randomly assigned the 191 patients to eleven weeks of one of three treatments: SM only; SM + LTEx; or SM + HTEx. The investigators evaluated the patients at the start of the study, again after five weeks of treatment, and finally following the conclusion of the treatment phase of the study at eleven weeks. They followed-up with the patients three, six, twelve, and 24 months later as well.
The results showed that SM + LTEx and SM + HTEx were both superior to SM alone at both one- and two-year time points. Overall, the patients in the SM + LTEx group reported the greatest pain reduction and satisfaction with care. This finding is even more important, as the care delivered to the SM + LTEx group costs less than care involving specialized, more expensive equipment.
It’s clear that chiropractic care that includes spinal manipulation and/or mobilization with exercise training yields the best long-term outcomes. Add to that the use of soft tissue therapies such as myofascial release, active release technique, and various modalities, and chiropractic is CLEARLY the best choice for patients with acute or chronic neck pain.
Hip Exercises to Help Knee Pain - Seriously?
The hip and knee are anatomically very close to one another. Functionally, there are several
muscles that attach above the hip and below the knee joint. Hence, depending on the position and/or
activity, the same muscle can move the hip and/or the knee. This close relationship crosses over in
dysfunction as well, as patients with knee pain move differently, and the hip joint is ultimately
affected. But which one is the real culprit, the chicken (hip) or the egg (knee)?
In a quest to answer that question, one study asked patients with patellofemoral pain (PFP)
and without hip pain to perform either knee exercises or hip exercises. Each group consisted of nine
men and nine women. The knee exercise group performed quadricep or knee strengthening exercises
while the hip exercise group engaged in hip strengthening exercises. The specific hip exercises
included hip abduction (outward resistance) and hip external rotation muscle strengthening exercises.
Both groups performed their exercises three times per week for a total of eight weeks. All
participants experienced improvements in pain and function; however, the patients in the hip exercise
group reported greater improvements than those in the knee exercise group. These results persisted
for the next six months.
Why did hip exercises help patients with PFP knee pain MORE than knee-specific exercises? Weight-bearing dynamic imaging studies (x-rays) have shown that patients with PFP knee pain frequently have a lateral or outward displacement of the knee cap as well as lateral tilt due to femur/hip internal rotation (IR) rather than just abnormal patella motion due to muscle imbalance (the "old" theory).
Other recently published biomechanical studies have reported that persons with PFP demonstrate excessive internal rotation and adduction (inwards positioning) of the hip that isn’t generally observed in pain-free subjects. Further, those with PFP tend to have weak hip abductors, extensors, and external rotator muscles than pain-free individuals.
Chiropractic care focuses on whole body care, and patients are often surprised that doctors of chiropractic frequently treat hip, knee, ankle, and foot conditions. Posture and gait assessments, which may be included in an initial patent examination, frequently reveal abnormal movement patterns, leg length discrepancy, pelvic rotation, and lower lumbar spine dysfunction that may contribute to a patient's chief complaint. Often, treatment must address these issues for the patient to achieve a successful outcome.
Carpal Tunnel Syndrome
What Isn't Carpal Tunnel Syndrome?
Numbness in the hand is a common problem that we’ve all had at one time or another,
and unless it becomes frequent, we usually don’t worry too much about it. When it starts to
wake us up at night, that SHOULD get our attention! Since carpal tunnel syndrome (CTS) is
one of the most common causes of hand numbness, that must be it, right? Not necessarily!
CTS is caused by pinching of the median nerve as it travels through a sometimes too tight boney tunnel made up of the eight small carpal bones at the wrist. But there are two other nerves that arise in the neck and travel down the arm to the hand that may be the culprit, one of which is the ulnar nerve (the other is the radial nerve).
When the ulnar nerve is entrapped near the humorous, it creates a condition called cubital tunnel syndrome (CuTS). It’s during the examination that a doctor of chiropractic can determine if the culprit behind a patient’s hand symptoms is the median nerve, the ulnar nerve, or even both nerves.
Diagnosis can become tricky, as there are other causes of whole hand numbness such as diabetic neuropathy or an injury to a network of nerves closer to the neck called the brachial plexus. More commonly, cutting off the blood supply in the upper, inner arm will make the whole arm (not just the hand) numb and feel "dead" until it "wakes up," which may take a few minutes for the blood to percolate back into the arm and hand.
CuTS can occur from repeatedly applying pressure to the pinky-side of the elbow, such as leaning on the elbow against a hard surface, keeping the elbow bent too long (such as talking on a cell phone), resting the arm or elbow on the sill of a car door with driving, and/or maintaining prolonged awkward positions, like playing a musical instrument such as a flute or violin. Baseball pitchers throwing too many sliders and curve balls are also at increased risk of developing CuTS.
Like with CTS, the longer you wait before seeking treatment for CuTS, the longer it may take to recover (or in some cases, full recovery may not be possible) so if you're feeling numbness, tingling, or pain in one or both hands, please consult with a doctor of chiropractic right away!
Low Back Pain
Low Back Pain: Who Will Respond Best to Care?
Is it possible to identify which low back pain patients might experience the most
benefit from spinal manipulation combined with exercise? In a 2011 study, researchers
identified which patients might respond best to this combination of care and which patients
might need a more aggressive approach.
Directional preference (DP) describes a situation in which it feels better for the patient to move in one direction versus another. For example, if a patient feels worse bending forwards (which is quite common) and feels better bending backwards, then “extension- biased exercises” are preferred.
If leg pain is present, the DP that reduces or eliminates the leg pain (called centralization, or CEN) is the exercise-biased direction, and it’s important to avoid any exercise that increases leg pain (peripheralization).
In the study, which involved 584 patients with low back pain, the researchers found that 60% of the participants had a DP and of those patients, 60% had CEN. The researchers found that the patients with a DP that reduced CEN responded the best to care (in this case, spinal manipulation combined with exercise) in regards to improved pain and function. On the other hand, the patients who had no DP experienced the least overall improvement. The value of using a classification system like this allows a doctor of chiropractic to determine which exercises will help each individual LBP patient the most. It also provides them with the ability to identify those most likely to respond favorably and those patients who may need a more comprehensive treatment.
So, if you feel best bending backwards and/or leg pain lessens, the preferred exercises include bending backwards (extension) from standing, prone press-ups (“saggy” push-ups) or hugging a gym ball, and/or extending your back over a gym ball or a stack of large pillows. Of course, there are many additional exercises but ANY position that reduces LBP and/or leg pain will help.
FOR YOUR FREE NO-OBLIGATION CONSULTATION CALL
Abramson Family Chiropractic
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.