MONTHLY HEALTH UPDATE
Chad Abramson, D.C.
Whole Body Health
How You May Prevent a Stroke... Especially if You Experience Headache, Neck Pain, Chest Pain, and/or Visual Disturbance
We all know it’s smart to write down our symptoms before a visit to our healthcare provider, but most
of us simply don’t take the time. In many cases, it may be only subtle symptoms that trigger a proper
diagnosis. This is certainly true when it comes to stroke.
There are basically two types of stroke: hemorrhagic stroke and ischemic stroke. A ruptured aneurism, or a leak in an artery, can result in a hemorrhagic stroke while a blood clot that blocks an artery can give rise to an ischemic stroke. Both types often give immediate and obvious nervous system signs and symptoms that typically prompt a call for emergency services.
There is however, a less common and quite subtle type of stroke that is far less discussed and understood. This is called vertebral-basilar insufficiency (VBI) stroke, which is caused by vertebral artery dissection (VAD). This type of stroke is very rare and only occurs 0.75-1.12 times per every 100,000 person years. In VAD/VBI, there may not be ANY history of trauma or event that the person can identify, and it’s most common in 30-50 year olds (not in older-aged people like the other more common types of stroke), which also makes VAD/VBI far less suspect. Symptoms of VBI can be subtle but may include headache, neck pain, chest pain, and perhaps some transient or short-term visual disturbance (blurred vision or double vision, for example). The KEY is a sudden and/or “different” kind of headache, especially if it’s accompanied by some other unusual symptom.
In one case study, a 30-year- old female experienced an “unusual headache” and a short-term loss of her peripheral vision in her left eye with eyelid numbness. This patient also had a history of migraines that typically occurred at menstruation, which led to an inaccurate diagnosis of “ocular migraine”, and she was sent home from the ER. Soon after, she developed right-sided neck pain with a transient right-sided visual disturbance prompting her to visit a chiropractor. The “unusual type of headache” and the visual complaints that she didn’t previously have with her typical migraines caught her chiropractor's attention. He then ordered a consult and an urgent MRA (magnetic resonant angiography) and MRI of the head confirmed the diagnosis of VAD. With a proper diagnosis and prompt treatment, her symptoms quickly resolved, and the follow-up MRA at the three-month point showed resolution of the VAD.
Neck pain and headaches are COMMON complaints for which people seek chiropractic care. In fact, chiropractic adjustments are strongly recommended in a number of current treatment guidelines. Had “a typical” chiropractic adjustment occurred and the diagnosis of VAD NOT been made, the patient may have progressed to a VBI stroke (which was already in progress BEFORE she even scheduled her chiropractic appointment). Other studies show that neck pain and headaches related to VAD precede visits to both doctors of chiropractic and medical doctors equally and subsequent treatments are typically NOT the cause, as the problem is already present. The good news is that VAD is very uncommon and will hopefully be caught by your doctor and promptly treated so stroke can be avoided.
The Vitamin D and Whiplash Connection
As previously discussed, many patients with a whiplash injury also experience some
degree of traumatic brain injury (TBI), which can prolong the recovery process. A 2012 study
involving patients with severe TBI found the rate of favorable recovery increased 25% in
participants who took a vitamin D supplement as part of their treatment plan. Why is that?
Vitamin D is a fat-soluble micronutrient that regulates inflammation and skeletal muscle size and function. Due to a systemic inflammatory response (specifically pro-inflammatory cytokines), studies have found that vitamin D levels can drop in the body by as much as 74% within three weeks of a major trauma or following a surgical procedure. This was observed in another study published in 2012 that found 77% of a group of 1,830 trauma patients had deficient or insufficient levels of vitamin D, REGARDLESS of age!
Unfortunately, experts estimate that between 30-50% of the United States population is chronically vitamin D deficient. Since vitamin D levels will drop as part of the healing process, you can imagine that people who already have poor vitamin D levels may be in for a longer course of recovery.
Not only that, but because vitamin D plays a role in keeping the musculoskeletal system strong and healthy, people with vitamin D deficiency may be at a greater risk for getting injured in the event of a car accident, collision, or slip and fall. Further, those who do get injured may have a greater risk for sustaining a more severe injury than they may might have had their vitamin D levels been adequate.
Most experts recommend spending time in the sun each day in order for the body to naturally produce vitamin D, but the combination of available sunlight due to latitude or time of year may make this less than practical. Thus, a vitamin D supplement is commonly recommended as part of a healthy lifestyle (minimum 1000 IU/day).
Doctors of Chiropractic commonly provide nutritional counseling which is a large part of the educational/treatment process. Other anti-inflammatory vitamins include magnesium, fish oil, ginger, turmeric, probiotics, and more. An anti-inflammatory diet can be extremely helpful as well!
Neck Pain / Headaches
Chiropractic for Neck Pain?... Really?
There have been MANY studies conducted on the benefits and efficacy of spinal manipulation to
treat back pain—so much so that many medical doctors frequently refer patients with back pain to
chiropractors for this service. But what about neck pain?
Although it’s taken a little longer to compile the evidence, there is now substantial research to support that spinal manipulation for neck pain is equally effective as it is for low back pain in regards to improving pain levels, function, and quality of life.
Multiple reviews and meta-analyses (studies that evaluate the research over a series of years) indicate that mobilization, manipulation, and exercise all work alone but appear to give the best long-term benefits when used in combination with each other.
In the acute and subacute stages of neck pain, studies show cervical manipulation is more effective than various combinations of analgesics, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDs) for improving pain and function in both the short and intermediate term.
Studies show that thoracic or mid-back manipulation is also very helpful for patients with neck pain. Chiropractic approaches often include a combination of spinal manipulation, manual cervical traction, figure-8 mobilization, and deep tissue trigger point/active release forms of therapy.
As noted above, the inclusion of exercise yields the best long-term benefits, especially for chronic neck pain.
One such exercise is Cranio-cervical flexion (deep neck flexor strengthening): Tuck the chin inwards, pushing the mid part of the neck backward with or without resisting into your fingers/hands or a towel wrapped around the neck. A gradual crescendo of pressure followed by a gradual release (or decrescendo) works well!
Another great exercise is Fiber Stretching: Side-bend the head and neck while applying gentle over-pressure while simultaneously reaching downward with the opposite arm/hand, searching for tight muscle fibers. Try combining forward and backward rotations and chin glide head movements while applying the over-pressure/reach combinations, and work each tight fiber until it loosens up.
There are many other exercises your doctor of chiropractic can show you, but these are a great start!
Have You Tried These Movements Before Considering Shoulder Surgery?
If you suffer from shoulder pain, here are some exercises you can do at home that really work
to improve flexibility and strength. Just remember to ALWAYS stay within reasonable pain
boundaries and work BOTH sides of your body, NOT just the injured shoulder!
For flexibility, start with the “Codman” Pendulum exercise. Stand or sit and lean forward so that your arm can swing like the pendulum of a clock while holding a light weight (2-5 lbs, or .9-2.26 kg initially). Move the weight in a clockwise, counter-clockwise, left-to- right, and/or forward- backward ALLOWING the shoulder to RELAX. DO NOT shrug your shoulder upward—let the shoulder go. This is usually comfortable and therefore can be done MANY times a day!
Another great beginning exercise is the Finger Wall-Walk. Stand in front of a wall and slowly walk your fingers up a wall staying within a comfortable range. Go slow and repeat several times. As you improve, rotate your trunk or stand with your body 45º, 60º, and later, 90º to the wall.
To perform the Crossover Arm Stretch, relax your shoulders and gently pull your arm across your chest using the uninvolved arm/hand to assist in the movement. Hold for up to 30 seconds and repeat with the other arm.
The Passive Internal Rotation (stick behind the back) and External Rotation (stick in front) requires a broomstick held parallel to the floor. Grip the stick with both hands held shoulder width apart and allow one arm to move the relaxed arm inward and outward. Do this as two separate exercises. Hold the end-range for up to 30 seconds each, repeat one to three times, as tolerated.
For Strengthening, the use of Thera-Tube or Band works well when anchored into the hinged side of a door. Pretend you are standing on a clock (12, 3, 6, and 9 o’clock positions) and SLOWLY pull and release the tubing three times in each of the four “clock positions,” ALWAYS staying in the pain-free range.
Your “ultimate guide” for advancing in reps, sets, and type of exercise is the comfort factor – AVOID sharp, lancinating painful movements/exercises or those that leave you sore for more than 24-48 hours afterwards. Track your recovery time after exercising to determine safety.
Carpal Tunnel Syndrome
Why Carpal Tunnel Syndrome May Be More Dangerous Than You Think
Carpal tunnel syndrome (CTS) is a very common condition. According to a report by the
Bureau of Labor Statistics (BLS), CTS ranks SECOND among the major disabling diseases and
illnesses in ALL private industries. The BLS states that workers with CTS may eventually have to
give up their livelihood. They cite one study in which almost half of all CTS patients changed their
jobs within 30 months following their diagnosis. Due to the controversy surrounding the issue of
CTS and worker’s compensation, workers do not always receive compensation benefits.
The KEY to long-term cost containment associated with CTS is EARLY DIAGNOSIS and PREVENTION! The challenge is getting the worker to identify early symptoms and NOT feel intimidated to report them, which could then lead to prompt care and possibly job modifications, resulting in the best chance of preventing a more complicated and far more costly problem.
Because of the many factors that contribute to and/or cause CTS, there is similarly no one way to prevent it from happening. Treating any/all underlying medical condition(s) is important. Using simple common sense can go a long way to help minimize some of the risk factors that predispose a person to work-related CTS and other cumulative trauma disorders (CTDs).
For example, watching and mimicking veteran workers can be a great guide as to how to maximize efficient work methods while minimizing unnecessary stresses and strains. Other preventative “tricks” include learning how to adjust the work area, handle tools, or perform tasks that minimize hand/wrist strain. Maintaining proper posture and exercise programs to strengthen the fingers, hands, wrists, forearms, shoulders, and neck may also help prevent CTS.
Many companies have taken action to help prevent repetitive stress injuries. In one study, 84% of the companies surveyed reported that they were modifying equipment, tasks, and processes as part of a prevention effort; nearly 85% analyzed their workstations and jobs; and 79% purchased more ergonomic equipment. Unfortunately, there is NO EVIDENCE that any of these methods can completely protect a worker against CTS. Often, the best approach is to relocate the worker to a less repetitive job, but this is not always an option.
Doctors of chiropractic can observe the worker through a video or during a factory tour/visit and often identify ergonomic problems that can result in a low-cost, easy modification. Simple modifications coupled with quality care, patient education, and cooperation from BOTH the worker and the employer can typically help yield the best outcome for the CTS patient.
Low Back Pain
Have You Tried This for Your Back Pain?
It’s not uncommon for low back pain patients to reduce their activities in an effort to avoid their pain.
Unfortunately, it's likely their core muscles—the muscles that help support their midsection—will become
deconditioned over time due to inactivity, which may only increase the risk of further injury. Therefore, to
effectively improve one's low back pain status, he or she must first strengthen and keep their core muscles
strong! Think in terms of one to three sets of ten reps for ease of application and ALWAYS release the
exercise SLOWLY—don’t just drop back from the end-range of the exercise.
The ABDOMINAL muscles include four groups: the rectus abdominis (they attach our rib cage to our pelvic area, and the fibers run straight up and down), overlapping on the sides are the internal obliques (fibers run down and inward), the external obliques (fibers run down and out), and lastly, the transverse abdominis (the fibers run horizontal and attach to the fascia in the low back).
If we think of three levels of exercise difficulty, an easy (or Level 1) sit-up can include a “crunch” or simply lifting the head and shoulders off the floor. A more difficult (Level 2) ab exercise would be to bend the knees and hips at 90 degree angles while performing a sit-up, while a more difficult (level 3) ab exercise could be a double straight leg raise during the sit-up. The rectus is stimulated by coming straight up and down while the overlapping obliques require a trunk twist. You can employ an “abdominal brace”, or holding the stomach muscles firmly as if someone is going to punch you in the stomach, in any position or activity during the day.
You can strengthen the LOW BACK extensor muscles using a number of effective exercises including (but not limited to) the “bird-dog” (kneeling on “all-fours”) straightening the opposite arm and leg separately (Level 1) and then simultaneously and switching back and forth (Level 2). Level 3 could be longer hold times, drawing a square with the hand and foot, or increasing the repetitions.
Another low back strengthener is called the “Superman”, which requires laying on the stomach (prone) initially lifting one arm and then the opposite leg separately (Level I); then opposite limbs at the same time (Level 2); and finally raising both arms and legs simultaneously (Level 3). Placing a roll under the pelvis/abdomen can make it more comfortable.
You can strengthen the SIDES OF THE CORE, or lateral trunk stabilizers, using a side-bridge or plank (laying on the side propped up between the elbow and feet, with the hips up and off the floor). Level 1 could be a six-second hold from the knees, Level 2 a six-second hold from the feet, and Level 3 could be a twelve-second hold between the elbow/forearm and feet. A modification could include slow repetitions of lowering the pelvis to the floor and back up. Mix it up!
There are MANY more exercises, but these should keep you going for a while! Remember, stay within “reasonable pain boundaries” that you define, release each exercise SLOWLY, and most importantly, have fun!
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.