MONTHLY HEALTH UPDATE
Can Chiropractic Help Dysmenorrhea?
Chad Abramson, D.C.
Whole Body Health
Can Brain Exercises Help Those with ADHD?
For many individuals—especially those with attention-deficit/hyperactivity
disorder (ADHD) and attention-deficit disorder (ADD)—staying “on task” can be a
challenge. Though medications are commonly used as a first line treatment for these
conditions, research has shown the benefits may only last for a few years. University
of California, Irvine scientist Dr. James M. Swanson even reports that
pharmacological interventions for ADHD offer no lasting, long-term benefits.
Because of this, researchers have been on the lookout for non-drug treatments to
improve mindfulness, and it appears meditation may be one useful approach.
Mindful meditation is the process of sitting silently and focusing on your breathing. If you notice your attention starting to wander, return your focus to your breath. Not only will this help you relax but this practice may improve the connections in the brain circuitry that are responsible for maintaining focus. Dr. Swanson notes that individuals with ADHD/ADD appear to have reduced activity in this area of the brain.
In one study that included 50 adults with ADD, researchers observed that those who participated in mindfulness-based cognitive therapy (MBCT) achieved comparable results to standard medications for ADHD/ADD with respect to motivation and inhibitory regulation.
In a 2017 study involving 82 patients with anxiety, researchers found that just ten minutes of mindful meditation helped participants stay better focused on their daily tasks. Researcher Dr. Mengran Xu adds, “Our results indicate that mindfulness training may have protective effects on mind wandering for anxious individuals.”
Mindfulness can also reduce anxiety and depression symptoms, which can also benefit individuals with ADHD/ADD, as the conditions can often co-exist. In one study, researchers found that engaging in one hour of mindful meditation not only reduced anxiety symptoms but also reduced stress and improved arterial function. Doctors of chiropractic often include meditation concepts as part of their treatment recommendations, especially in the promotion of prevention and wellness.
Neck Posture BEFORE a Car Wreck – Is It Important?
Abnormal postures of the neck—straight and reversed (kyphotic) curves, for
example—are commonly encountered after an individual has experienced a motor vehicle
collision (MVC). Many studies discuss the mechanism of injury during a rear-impact MVC
that result in a straight or kyphotic curve, but few have considered the importance of this
abnormal posture being present BEFORE the MVC and the role that plays regarding the
degree of the resulting injury.
A group of researchers looked at this very issue and compared what happens to the cervical spine that is “normal” (lordotic) vs. straight vs. reversed (kyphotic) in a classic rear- end MVC. When the neck flexes or bends forward, the facet joints in the cervical vertebrae open up and the facet capsules and associated ligaments stretch or elongate. To determine what degree of injury would arise among the three postures, researchers measured the amount of stretch/elongation in these ligaments using a validated mathematical model of the human head-neck complex. With a normal lordotic posture, the greatest load during the simulated rear-end collision occurred high in the neck at C2-3, in the back part of the cervical spine, and from C3-4 to C6-7, on the sides of the cervical spine.
Most importantly, as the normal lordotic curve reduced to a straight and then further into a kyphotic or reversed curve, the researchers observed increases in the elongation magnitudes in the facet joints by up to 70%! Excessive elongation of the ligaments and join capsules can result in tearing and subsequent laxity to the facet joints as well as the surrounding ligamentous supporting tissues.
Laxity in these supporting tissues can lead to excessive movement between each vertebra and predispose them to accelerated degenerative changes leading to spinal instability over time. This study provides quantitative kinematic data that is level- and region-specific and supports the clinical findings that abnormal spinal curvatures increase the likelihood of whiplash injury severity.
Chiropractic focuses on the “3-P’s” – Pain management, Posture correction, and Prevention through the use of manual therapies, posture correction techniques, exercise training specific to each individual, and lifestyle management through diet and stress management strategies. The importance of restoring abnormal posture of the cervical spine is well illustrated by this study. Discuss this with your doctor of chiropractic to minimize your risk of injury in the event of a future trauma!
Neck Pain / Headaches
Can the Cervical Spine Cause Shoulder Pain?
Subacromial impingement (SAI) is a common injury in sporting activities that
require overhead motions, especially among pitchers, quarterbacks, and swimmers. Not
everyone responds to treatment to the same degree, and a new study that reviewed two
specific cases may offer a possible reason: the neck.
One of the two cases involved a high school football quarterback and the other a collegiate swimmer. Both participants presented with signs and symptoms of subacromial impingement with minimal neck complaints and few clinical signs that initially supported neck involvement.
Of interest, both patients had poor posture that included forward head carriage and rounded forward shoulders. During the initial examination, both had shoulder pain and weakness while raising their arm up from the side, a “classic” sign of rotator cuff muscle injury and subacromial bursitis. However, neither case did well when treatment addressed only the shoulder, prompting their doctors to test whether or not the patients’ poor posture had a role in their shoulder discomfort.
Once the patients performed chin retraction exercises followed by chin retraction plus extension exercises (three sets of ten repetitions) to improve their posture, they experienced a complete improvement in shoulder impingement and muscle weakness.
The author suspects that both patients experienced intermittent irritation of the C5 nerve root in the neck, which innervates the rotator cuff muscles, leading to their shoulder pain and weakness. In both cases, the two athletes performed home-based exercises and returned to their sports and did not have further problems during the rest of the season.
These two cases are GREAT examples of why doctors of chiropractic evaluate the whole patient to identify any and all factors that may contribute to a patient’s chief complaint. It is very common to find cervical spine joint dysfunction in patients with shoulder pain, and success in treatment favors treating both areas, of which (as noted in these case studies) the neck may be the most important focus.
What is Hip Impingement? Can Chiropractic Help?
Femoroacetabular impingement (FAI) is a pathological hip condition found in 17% of the
population, and it’s caused by abnormal contact between the ball of hip and the socket. To be more
precise, it’s the head-neck junction that impinges against the rim of the acetabulum. There are three
types of FAI: cam, pincer, or a combination of the two. The cam deformity (also called “pistol-grip”)
is from too much bone at the head-neck junction and is found in 65-75% of FAIs (often active young
men 20-30 years old). The pincer deformity is from too much bone off the front of the acetabular rim
(like a spur), and it is often seen in middle aged, active women. Less than 10% have both cam and
pincer deformities together.
In some cases, FAI can arise without either a cam or pincer deformity and occurs as a consequence of extreme hip movements like those associated with ballet, gymnastics, or weight lifting (squatting). There are actually several types of impingement syndromes in the spine-pelvic region, but we will focus on that which occurs at the hip joint specifically, the FAI syndrome.
The pain associated with FAI results from repeated abutment, or contact, between the two bones leading to injury of the adjacent cartilage and/or labrum, which is a crescent-shaped band of cartilage that stabilizes, lubricates, and cushions the hip joint. Over time, repeated trauma can lead to hip joint osteoarthritis (OA). In fact, in a large population study, researchers observed cam and/or pincer deformities in 71% of males and 37% of females with hip OA.
The clinical presentation of FAI is usually found in healthy, active adults between 20-50 years in age. In older patients, it’s frequently accompanied by hip OA. Anterior FAI presents with pain in the front of the hip, groin, pubic bone, and/or anterior thigh and often arises from activities that include running/sprinting, kicking sports, hill climbing, and prolonged/repeated sitting in low chairs – any activity where the hip flexes forward (knee-to-chest positions).
Impingement from pincer deformities can also give rise to posterior FAI, or pain in the back of the hip joint. When this occurs, pain in the buttock and sacroiliac joint (SIJ) have to be differentiated from pain arising from the low back and/or SIJ. Repeated hip hyperextension such as from fast walking and hiking downhill are common causes. So, can chiropractic help? Short answer – YES! The current research shows that non-surgical care for FAI should include avoiding activities that impinge the hip (discontinuing or modifying a sport or daily activity), reducing inflammation, and exercising to stretch the hip flexors and strengthen hip extensors. Once a proper diagnosis is made, your doctor of chiropractic can advise you on the best ways to manage your FAI.
Carpal Tunnel Syndrome
How Does Chiropractic Help Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) occurs when pressure is placed on the median nerve as it
passes through bones and ligaments of the wrist in order to innervate a portion of the hand. This
pressure can be cause by compression of the carpal tunnel due to mechanical injury or when
other tissues near the median nerve become inflamed, either from disease or overuse.
When it comes to treating a patient with carpal tunnel syndrome (CTS), what separates chiropractic care from standard medical care? Both options recommend night wrist splints, anti- inflammatory measures, rest, and the “tincture of time.” Doctors of chiropractic are trained to provide manual therapies like manipulation and mobilization. Two studies show that these therapies can relieve pressure on the median nerve by improving the shape of the carpal tunnel itself.
In a study published in December 2018 in The Journal of Hand Surgery, researchers used dynamic ultrasound to capture images of longitudinal median nerve motion inside the tunnel as compressive forces were applied to the two sides of the wrist and distal forearm in both healthy and CTS patients. The researchers observed that the median nerve moved more within the carpal tunnel in patients with CTS compared to those without the condition.
In an anatomical study published in the journal Clinical Biomechanics (November 2018), lead author Dr. Elena Bueno-Gracia and colleagues measured the cross-sectional area of the carpal tunnel before and after manual manipulation and mobilization of the carpal bones. They observed both an increase in the front-to-back diameter of the tunnel AND a reduction in pressure on the median nerve. Additionally, the researchers noted that the shape of the carpal tunnel itself becomes more round following manipulative therapy. The research team reported that their findings are consistent with prior studies.
These studies demonstrate that the carpal tunnel is indeed dynamic/flexible and that manual techniques can alter its shape, providing more “breathing room” and allowing the contents within (i.e., the tendons and the median nerve) increased mobility with less friction. Doctors of chiropractic are trained to provide manual therapies, which include mobilization and manipulation, of the spine and extremities of individuals with musculoskeletal conditions, including carpal tunnel syndrome. Together with the “standard” therapies previously mentioned, proper exercises, and patient education, chiropractic is the perfect choice for non- surgical CTS care!
Low Back Pain
Can Exercise Prevent Low Back Pain?
While it’s not possible to totally prevent low back pain (LBP), individuals who regularly exercise
appear to have a reduced risk for LBP. Additionally, fit adults who develop back pain may experience it
less often, at a reduced intensity, and for a shorter duration than those who lead a more sedentary lifestyle.
Which type of exercise is the best? A general rule is to keep trying different activities, starting
with those MOST appealing to you. After all, you should enjoy exercise, so start with your favorites:
walking (one of the best), walk/run combinations, running/jogging, bicycling, swimming/water aerobics,
yoga, Pilates, core strengthening, balance exercises, tennis, basketball, golfing, etc.
Specific exercises for the low back can be individualized by determining your "position preference", or the position that feels best to your low back. For example, bend forward as if to touch your toes. How does that feel? Do you feel a good stretch or pain? Does it shoot pain down your leg? If it feels good, then that might be your preferred position and the one to emphasize with exercise. Examples of exercises that fit this scenario include (but are not limited to): posterior pelvic tilts (flatten your low back by rocking your pelvis forward); single and double knee to chest; and bending forward from a chair (as if to touch the floor).
If bending backward feels good (better than flexion and especially if the presence of leg pain lessens or disappears), then “extension-biased” exercises fit that scenario. Examples include standing back extensions (place your hands behind the low back and bend backward); prone "press-ups" (lift the chest off the floor while keeping the pelvis down); and laying back-first over a Bosu- or Gym-ball. Pelvic dysfunction and core weakness can also increase the risk for LBP. Try these exercises: abdominal crunches (bend one knee, place your hands behind your low back, and raise the breast bone toward the ceiling only a few inches and hold); front and side planks (start from the knees if necessary); supine bridges (supine, knees bent, lift the buttocks off the floor); “bird-dog” (kneel on all fours and raise the opposite leg and arm, keep good form, and alternate); and the “dead-bug” (on your back, bend the hips and knees at 90 degrees with your arms reaching toward the ceiling; slowly lower your right arm and left leg and return them to their starting position; repeat with the other arm/leg).
When lifting, bend the knees and hips but NOT your low back; keep weights close to you and lift with your legs. Don’t attempt lifts that you know are too heavy.
If you have a history of low back pain, research shows that receiving maintenance chiropractic care can help reduce the number of days in which low back pain may hinder your activities.
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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.