MONTHLY HEALTH UPDATE
Do Coffee Drinkers Live Longer?
Chad Abramson, D.C.
Whole Body Health
Which is Better: HIGH or LOW Cholesterol?
While many of us have been told we need to take steps to lower our cholesterol levels, it turns out
that having high cholesterol may actually be a good thing.
As far back as 1994, Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University reported that older people with low cholesterol died TWICE AS OFTEN from a heart attack as those with high cholesterol. While this finding sparked debate due to being inconsistent with the belief that high cholesterol levels lead to atherosclerosis, there are now several studies that challenge the lipid hypothesis of heart disease. In fact, a Medline database search revealed 11 studies that concluded high cholesterol did not predict all-cause mortality in older adults (about 90% of all cardiovascular disease occurs in people over the age of 60).
Even better, in 6 of the 11 studies, researchers observed an inverse relationship between all-cause mortality and high total cholesterol or LDL (bad) cholesterol OR BOTH. Other studies have noted that having low triglycerides and low HDL (good) cholesterol levels are also tied to an increased mortality rate.
So how does high cholesterol improve longevity? It appears that high cholesterol helps improve the immune system, protecting us from infections. In 19 large-scale studies including 63,000 deaths, a research group from the University of Minnesota, Division of Epidemiology reported that low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases.
Were the patients’ low cholesterol levels caused by an infection or did having low cholesterol predispose the patients to infection? To find out, researchers followed more than 100,000 healthy subjects for 15 years. At the conclusion of the study, those who had lower cholesterol had more hospital admissions due to an infectious disease vs. those with high cholesterol. In two very large-scale studies of men infected with the HIV virus, the mortality rate in those with low cholesterol (<140) was four times higher than it was in those with high cholesterol (>240).
A range of 200-240 and even higher in older women appears to be a good target for improving longevity. Other studies have found that chronic low-grade inflammation may be the real culprit when it comes to atherosclerosis. In other words, worrying about cholesterol levels may not be more important than engaging in a lifestyle aimed at reducing inflammation: get regular exercise, don’t smoke, get plenty of sleep, and eat an anti-inflammation diet, among other things.
Whiplash – What Will X-Ray Tell Me?
Although whiplash injuries arising from motor vehicle collisions (MVC) are very common, there
doesn’t seem to be consistency in the evaluation one receives at an emergency room (ER) or later in an
outpatient setting when it comes to the utilization of x-ray and other imaging. So, what are the pros and
cons of imaging a whiplash patient?
A review of published guidelines suggests that if a person involved in a MVC presents to the ER awake, alert, with no neurological deficit or other distracting injury, with no neck pain or midline tenderness, and has a full range of neck motion, then x-ray is not considered necessary. If a fracture is suspected, an x-ray and/or CT (Computerized Tomography) scan is appropriate. Magnetic resonance imaging (MRI) has a role when a soft tissue injury such as a ligament tear, spinal cord injury, and/or arterial injury is suspected by clinical impression and/or prior imaging.
The major concern involving trauma to the neck is fracture, but this is actually quite uncommon as a result of an MVC. Some ERs routinely x-ray all trauma cases to rule on the presence or absence of fracture, though CT scan is much more sensitive than x-ray, especially in subtle or the not-so- obvious types of fracture.
Doctors and hospitals utilize treatment guidelines in an effort to provide the best possible care while limiting potentially unnecessary testing. For example, the Canadian C-Spine Rule (CCR) is an assessment to help determine who does vs. does not need x-rays in trauma cases.
According to the CCR, those over 65 years of age or those who have significant trauma and/or numbness in the extremities should receive x-rays. Situations in which x-rays are not needed include a simple rear-end MVC; if the patient can walk around; delayed (not immediate) onset of neck pain; or the absence of midline neck tenderness.
Another study reported that more than 800,000 patients in the United States (US) receive a cervical x-ray each year. Minimizing x-ray use is important, not just because of patient exposure to radiation, but because more than 97% of x-rays are interpreted as negative, and costs associated with x- ray exceeds $175,000,000 per year! Hence, there is a definite need for better guidelines in the US like the CCR!
Doctors of chiropractic see many whiplash patients either soon after an injury or later, though sometimes it may be years before a patient with whiplash presents for care. For patients under age 65 who have a full range of cervical motion, no neurological deficits or complaints, no other distracting injuries, and no midline tenderness, in most cases, x-rays can wait.
Neck Pain / Headaches
Does Slouching Cause Neck and Shoulder Pain?
In a 2015 study, Swedish researchers compared the effect of a slouched vs. normal
body posture with regards to performing lifting tasks.
In particular, investigators wanted a better understanding of how a slouched posture affects neck and shoulder function and muscle activity in three large muscle groups—the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA)—during arm elevation to see if it affects range of motion, muscle activation patterns, maximal muscle activity, and total muscle work.
Study participants—non-injured, young adult males—perform maximum arm elevations in upright and slouched postures that researchers observed using a combined 3D movement and EMG (electromyography) assessment system. This measured the arm range of motion, velocity, and spine curvature simultaneously with EMG activity in the UT, LT, and SA muscles.
The research team found that participants in the slouched position experienced significantly less arm elevation and decreased movement velocity both upwards and downwards, in addition to increased peak muscle activity (that is, the muscles had to work harder) in all three muscles tested.
It appears that increased thoracic kyphosis (slouching) leads to a marked increase in physical requirements when performing simple arm movements. Over time, such changes in function could place added stress on the muscles, tissues, and joints of the neck and shoulder, leading to pain and injury. These findings add to a growing body of research regarding the detrimental long-term effects of poor posture as well as an understanding of how exactly faulty postures increase the risk of musculoskeletal disorders.
In their conclusion, the authors of the study write, "[Patients] suffering from neck- shoulder pain and disability should be investigated and treated for defective thoracic curvature issues."
Common Hip Injuries
Hip pain is a very common cause for lost time in sports, and it can also interfere with one’s daily activities—including work! So, what are some of the more common injuries of the hip?
MUSCLE STRAINS: This is probably the most common injury to the hip and groin because of the weight bearing "job" the hips have when running, cutting, jumping, climbing, twisting, etc. Strains occur more often with "eccentric" muscle contractions (when the muscle lengthens) vs. when the muscle shortens. Examples of eccentric muscle contractions include the lowering of a weight during a biceps curl, running DOWN a hill or steps, or lowering a bar to the chest in a bench press.
BURSITIS: A bursa is a fluid-filled sac located where muscles attach to bone to help lubricate muscles and tendons as they slide back and forth on each other during activity. We have bursae in several joints but especially in the hip, shoulder, elbow, and knee. Injury to the bursa can be the result of overuse, a trauma, or a post-surgical complication.
CONTUSIONS:A direct blow to the hip and/or pelvis can bruise the area, which is called a "contusion." This is a common cause of bursitis and when located on the side of the hip, it is often called a "hip pointer."
STRESS FRACTURE: These are usually seen in long distance runners and in women more often than men. Individuals with a nutritional deficiency (like those with an eating disorder) and older athletes—especially those with poor bone density—also have an elevated risk for stress fracture.
LABRAL TEAR:The labrum is a thick, fibrous ring that borders the hip socket adding depth and support to the hip joint. If the labrum tears, a patient may experience pain, stiffness, and mobility issues.
FEMOROACETABULAR IMPINGEMENT:When bone spurs form on the rim of the hip joint socket (acetabulum), they can cause pinching as the hip is moved to its end-ranges of motion. This can lead to osteoarthritis and is often due to a torn labrum and/or capsule.
OSTEITIS PUBIS:Repetitive pulling of muscles that attach to the pubic bone often seen in runners, soccer, and hockey players. Childbirth can also result in osteitis pubis.
SPORTS HERNIAS:These injuries are frequently seen in athletes from sports that require repetitive twisting/turning at high speeds (like hockey players) and are thought to be caused by an imbalance between strong thigh muscles and weaker abdominal muscles.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome – OVERVIEW (Part 2)
This discussion picks up from last month as we review the "nuts & bolts" of carpal tunnel
syndrome (CTS). We left off at "CLINICAL PRESENTATION"…
CLINICAL PRESENTATION (continued): A weakness in grip and pinch strength usually follows an initial loss of sensation in the second to fourth palm-side fingers. The intensity of weakness is more dependent on the amount of pressure versus duration of time of numbness. In other words, if a high degree of pressure suddenly occurs inside the carpal tunnel (like a fracture with bleeding into the tunnel), the patient may feel weakness right away. But usually, CTS is a slow, smoldering condition and if weakness occurs, it comes on slowly and most patients cannot say for sure when their weakness symptoms started.
PHYSICAL EXAM: It is important to assess other possible areas for neurological compression, such as the neck, shoulder (thoracic outlet), elbow, and/or forearm. Also, it’s necessary to rule out “co-morbidities” or other conditions that contribute to CTS. The list is long but includes diabetes, hypothyroid, pregnancy/birth control pills/recent menopause, kidney disease, arthritis, Lyme disease, multiple sclerosis, and more. The physical exam may also include a sensory exam and a motor exam as well as specific orthopedic provocative tests that can reproduce CTS symptoms. Your doctor may also order an EMG/NCV (electromyography/nerve conduction velocity) but NONE of these tests are 100% sensitive and specific—that is, there are false-positives and negatives. Lab and blood tests can help tease out some of the other possible conditions (listed above). X-ray, MRI, CT scan, and ultrasound may help identify spurs, fracture, cysts, and other space occupying causes of CTS, but no one test is enough.
TREATMENT: Chiropractic offers manual therapies such as manipulation, mobilization, massage, and myofascial release of not just the wrist and hand but also the cervical spine, shoulder, elbow, and forearm regions, if the median nerve is impeded in places beyond the wrist. Doctors of chiropractic often utilize night splints and recommend rest, job modifications, and anti-inflammatory agents such as ginger, turmeric, bioflavonoid, and proteolytic enzymes. Because being overweight can increase one’s risk for CTS, lifestyle improvements aimed at cutting excess mass may be recommended as well. MDs may prescribe anti-inflammatory drugs and help manage co-morbidities such as diabetes, hormone replacement, hypothyroid, and the like. Often, a coordinated "team approach" of care providers works best. Surgery may be necessary in some cases but usually ONLY after all the above fails.
Low Back Pain
Chiropractic & Foot Orthotics: A Great Combination for Back Pain!
When treating patients with low back pain (LBP), doctors of chiropractic have three common goals: 1) pain management; 2) posture alignment or correction; and 3) prevention. When warranted, the use of corrective prescription foot orthotics can help achieve all three goals. In a 2017 study, researchers recruited 225 adult subjects with chronic low back pain (cLBP) and randomly assigned them to one of three treatment groups: 1) shoe orthotics only; 2) chiropractic care (included spinal manipulation, hot or cold packs, and manual soft tissue massage) with shoe orthotics; or 3) a non-treatment group. The primary outcome measures used to track change over time included a numerical pain rating scale and a functional rating questionnaire (Oswestry Disability Index – ODI) at baseline and after six weeks of treatment, with follow-up three, six, and twelve months later. After six weeks, only the first two groups experienced improvements in both average back pain intensity and function, with the orthotic plus chiropractic group reporting even greater functional improvement. While podiatrists have long suggested the use of foot orthotics for some cases of LBP because of the effect foot function has on the “kinetic chain,” it was not until the last decade that researchers in other fields have reported the effects the feet have on knee, hip/pelvic, and back function. Studies have now demonstrated the adverse effects of hyperpronation (rolling in) of the foot on pain, function, and alignment of the pelvis. These studies point out the importance of not overlooking foot dysfunction as a potential (and important) contributing factor when managing patients with LBP.
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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.