MONTHLY HEALTH UPDATE
Whole Body Update
Chad Abramson, D.C.
Low Back Pain
Do YOU Want to Avoid Back-Related Disability?
In 2008, a study published in the journal Spine sought to identify EARLY
PREDICTORS in an effort to reduce the number of low back pain (LBP) patients who go on
to experience long-term disability. Researchers followed 1,885 low back injury claimants for
a year and then later reviewed data collected during the first three weeks following their
injury to identify anything that might predict a greater risk of work-related disability one year
According to their findings, the factors that increase the risk of work-related disability include: injury severity, the type of healthcare provider from which they initially sought treatment; worker-reported physical disability, the number of pain locations, work-related stress; no available option for job accommodation (such as light duty); and a prior injury involving a month or more off work.
Of note, one VERY important factor mentioned in the study was the type of healthcare practitioner (HCP) the injured worker first consulted with for treatment. Those who sought chiropractic care initially were far less likely to become disabled (only 5%) than those who first visited doctors who specialize in primary care (12%), occupational medicine (26%), or “other” disciplines (23%).
Studies have also noted additional benefits by seeking chiropractic care for work- related musculoskeletal injuries versus other forms of healthcare delivery, as chiropractic care reduces the likelihood for extended time off work, results in less total healthcare costs, higher quality of life, fewer medications, fewer emergency department visits, and higher levels of patient satisfaction.
In addition, LBP Guidelines published in the United States and around the world consistently recommend spinal manipulation as a FIRST form of care for most types of low back pain based on these findings. We all have the option of seeking the type of care that we believe will best solve our problem. But with the findings reported in this and many other studies, evidence STRONGLY supports that seeking chiropractic IS the logical FIRST choice!
Is a Labral Tear Causing Your Hip Pain?
One of the structures that is frequently blamed for hip pain is called the labrum—the
rubbery tissue that surrounds the socket helping to stabilize the hip joint. This tissue often wears
and tears with age, but it can also be torn as a result of a trauma or sports-related injury.
The clinical significance of a labral tear of the hip is controversial, as these can be found in people who don't have any pain at all. We know from studies of the intervertebral disks located in the lower back that disk herniation is often found in pain-free subjects—between 20- 50% of the normal population. In other words, the presence of abnormalities on an MRI is often poorly associated with patient symptoms, and the presence of a labral tear of the hip appears to be quite similar.
For instance, in a study of 45 volunteers (average age 38, range: 15–66 years old; 60% males) with no history of hip pain, symptoms, injury, or prior surgery, MRIs reviewed by three board-certified radiologists revealed a total of 73% of the hips had abnormalities, of which more than two-thirds were labral tears.
Another interesting study found an equal number of labral tears in a group of professional ballet dancers (both with and without hip pain) and in non-dancer control subjects of similar age and gender.
Another study showed that diagnostic blocks—a pain killer injected into the hip for diagnostic purposes to determine if it’s a pain generator—failed to offer relief for those with labral tears.
Doctors of chiropractic are trained to identify the origins of pain arising from the low back, pelvis, hip, and knee, all of which can mimic or produce hip symptoms. Utilizing information derived from a careful history, examination, imaging (when appropriate), and functional tests, chiropractors can offer a nonsurgical, noninvasive, safe method of managing hip pain.
Posture and Whiplash
Posture assessment is a key component of the chiropractic examination, and the posture of
the head and neck is especially important for a patient recovering from a whiplash injury. Forward
head carriage describes a state in which the head sits more forward on the shoulders than it should. In
order for the muscles in the neck and shoulders to keep the head upright, they must work harder. This
added strain can increase one's risk for neck pain and headaches, which is why retraining posture is a
key component to the management of neck pain and headaches in patients with or without a history
Forward head carriage also increases the distance between the back of the head and the headrest in the seated position, especially when the seat is reclined. In a rear-end collision, a gap greater than a half an inch between the head rest and the back of the head increases the probability of injury due to the greater distance the head can hyperextend as it rebounds backwards into the headrest. This makes posture correction of forward head carriage an important aspect of treatment from both a preventative and curative perspective.
So this begs the question, can forward head carriage be corrected? The simple answer is “yes!” One study evaluated the effects of a 16-week resistance and stretching program designed to address forward head posture and protracted shoulder positioning.
Researchers conducted the study in two separate secondary schools with 130 adolescents aged 15–17 years with forward head and protracted shoulder posture. The control group participated in a regular physical education (PE) program while the experimental group attended the same PE classes with the addition of specific exercises for posture correction. The research ream measured the teens' shoulder head posture from the side using two different validated methods and tracked symptoms using a questionnaire. The results revealed a significant improvement in the shoulder and cervical angle in the experimental group that did not occur in the control group.
The conclusion of the study strongly supports that a 16-week resistance and stretching program is effective in decreasing forward head and protracted shoulder posture in adolescents. This would suggest that a program such as this should be strongly considered in the regular curriculum of PE courses since this is such a common problem.
Doctors of chiropractic are trained to evaluate and manage forward head posture with shoulder protraction. This can prove beneficial in both the prevention as well as management of signs and symptoms associated with a whiplash injury.
Carpal Tunnel Syndrome
Should Playing Music Create Tingling Wrists?
Carpal tunnel syndrome (CTS) is a condition caused when pressure is applied to the median
nerve as it passes through the wrist. When playing a musical instrument, especially for hours at a
time for several days in a row, the fast repetitive movements of the fingers can cause the
tendons—all nine of them—that travel through the carpal tunnel to rub together, creating friction.
This leads to heat and eventually swelling or inflammation, which manifests as pain, numbness, and
tingling. Without treatment or modifications to your practice schedule, it is likely the
numbness/tingling in your hands and fingers will gradually worsen and may even completely prohibit
you from playing your instrument.
We must accept that every tissue in our body has a certain capacity or threshold, and if it is exceeded, problems will surface, and there are factors that can make some of us MORE SUSEPTIBLE to CTS. Some of these differences include: female gender, age over 50, hormone imbalances (low thyroid function, diabetes, and others), birth control pill (BCP) usage, pregnancy, obesity, and manually intensive jobs. Personality can even play a role—if you’re someone who will push yourself to play through the pain, then your risk for CTS is greater.
Because both hands are typically required to play an instrument, it is more common than not that BOTH hands may eventually become symptomatic if you don’t practice some VERY SIMPLE preventative “tricks of the trade.” So what are those tricks?
Take 30-60 second mini-breaks every hour during your practice sessions to stretch. Simply BEND your wrist and fingers back as far as you can with your other hand or against a wall (fingers pointing downward) and try to touch your palm to the wall. Hold the maximum stretch for five to ten seconds and repeat until the forearm feels looser (usually three to four times).
Another “trick” is to wear a cock-up wrist splint at night, since we cannot control our wrist/hand position when sleeping. When the wrist is bent to its maximum, the normal pressure inside the carpal tunnel increases six times or more, which can REALLY irritate the median nerve. Doctors of chiropractic can teach you proper exercises, fit you with a wrist splint, AND check to make sure pressure on the median nerve isn't the result of dysfunction in other anatomical areas along the course of the nerve, such as the neck.
Neck Pain / Headaches
Where Does Your Neck Pain Come From?
Let’s first look at the anatomy of the neck in order to better understand the structures of
the cervical spine that can generate pain.
Starting at the back of the spine, the facet joints allow us to move our neck and head in all directions, and each facet joint is surrounded by a joint capsule that is rich with nerve endings and when swollen, can generate pain both locally and radiating.
One study of volunteers with existing neck pain looked at the various pathways that pain travels when investigators injected each individual facet joint capsule with normal saline solution. Interestingly, the subjects felt pain in parts of the body other than just the neck. For example, injecting the C6 facet joint capsule consistently reproduced radiating pain down the arm into the thumb side of the forearm and hand, similar to when a disk herniates and a nerve root is pinched. The primary difference was that a deep aching pain occurred in this area, as opposed to a more geographically well-defined pathway when a disk ruptures and pinches a specific nerve root.
The intervertebral disks are small shock absorbers that lie between each vertebral body. These disks are sort of like a jelly doughnut, which can sometimes leak out and pinch a nerve root producing pain (as well as numbness, tingling, and even weakness) that radiates along the course of the nerve.
Poor posture is perhaps one of the most common causes of neck pain. The muscles in the chest tend to be stronger than those in the upper back and pull the shoulders forward resulting in forward head carriage with protracted shoulders. For each inch of forward head shift, an additional ten pounds is added to the weight of the head, which already weights around ten to twelve pounds. Hence, a five-inch forward head carriage places an additional 50 pound load on the upper back and neck just to hold the head upright!
Doctors of chiropractic are trained to identify these faulty postures and track down the pain generator(s) when a patients presents with neck pain. Through patient education, spinal manipulation, mobilization, exercise training, modalities, and more, chiropractors can greatly help those struggling with neck pain!
Whole Body Health
High-Intensity Interval Training – What Is That?
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-
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.
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.