MONTHLY HEALTH UPDATE
Is Your Foot Causing Your Knee Pain?
Chad Abramson, D.C.
Whole Body Health
Can Chiropractic Help Dizziness?
BACKGROUND: To determine how common dizziness is and the personal burden it
imposes on the population, a large-scale study examined 2,751 adults (aged 50+ years) using
multiple measures for dizziness, hearing, tinnitus (ringing in the ears), and quality of life. An
alarming 60% reported some type of vertigo. Interestingly, the researchers observed an
association between tinnitus and vertigo. Also, the participants with vertigo reported lower
quality of life scores than those without dizziness complaints. This study highlights the
significant burden imposed by dizziness/vertigo stating that this is an “important public
healthcare issue” that must be studied further.
CAUSES: The most common causes include benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis or labyrinthitis, Meniere’s disease, migraine headaches, and anxiety disorders. Less commonly, reduced blood flow to the brain/head (“vertebrobasilar ischemia”) and retrocochlear tumors can cause dizziness. The risk also increases with age.
TREATMENT OPTIONS: Most vertigo sufferers do not require extensive testing and can be treated in the clinic. Benign paroxysmal positional vertigo and labyrinthitis are most often successfully managed by doctors of chiropractic with specific exercise to reposition the displaced “canaliths” or small stone-like material in the inner ear. Treatment with a low-salt diet and diuretics (herbal options include: dandelion, ginger, parsley, hawthorn, and juniper) can also be helpful in resistant cases with fewer side effects than prescription vestibular suppressing medications. Consuming potassium-rich foods such as bananas, avocados, raisins, beans, squash, mushrooms, potatoes, yogurt, or fish is often wise when taking a diuretic. Chiropractors often provide nutritional counseling and can help guide you in this area as well.
Whiplash Injury Prevention
Some studies have suggested that 85% of all whiplash injuries occur from rear-end collisions. So, what are some different ways that we might be able to avoid injury if such an event occurs?
HEADREST: It's important that your headrest is high enough so that your head and neck doesn't
roll over it in a collision, which can increase the risk of injury to the neck and head. Additionally, be
careful to keep your head within eight cm (3.14 in) of the headrest while driving. By reducing the spacing
between your head and the headrest, you can lower your risk for sustaining a brain injury in a rear-end
collision. Today's cars may also feature an active head restraint system that adjusts the head rest in an
effort to shorten the distance between the head and the headrest when an accident occurs. ADVICE:
Check the position and condition of your head restraint!
SEAT BACK POSITION: At least one study has concluded that vehicle occupants may have a higher injury risk if the seat back is fully upright. On the other hand, a seat back that leans too far back may serve as a ramp for the body during an accident, which could slide the head over the headrest. This too can increase the risk of injury. ADVICE: Recline the seat back somewhat while driving, but not too far.
BODY SIZE EFFECTS: A literature search study reviewed the potential injury effects as it relates to differences in anatomical size, head-neck orientation, the facet joints (small gliding joints in the back of the cervical spine), and neck muscles mass. The authors of the study reported that smaller sized necks, head positions outside of neutral (vs. looking straight forwards), and smaller muscle mass increased the potential for neck injury in a rear-end collision. ADVICE: Strengthen/exercise your neck muscles.
AIR BAGS & SEAT BELTS: Though these are not an “option” and have become “standard equipment” in cars, it’s clear that airbags and seat belts have saved far more lives compared with the injuries (including some deaths) that can be attributed to them. According to one source, more than 30,000 lives have been saved by front and side airbags. ADVICE: Make sure you act on any recall involving your airbag (and any recalls involving your car in general) and WEAR your seatbelt! FACTORS DIFFICULT TO STUDY: Given all the variables involved in “real-world” car crashes, it is very difficult to predict which criteria are most important for injury prevention. For example, vehicular weight/size difference, multiple collisions—from different directions, readiness for impact, etc. The BEST ADVICE – Stay alert, keep your eyes on the road, and don’t speed.
Neck Pain / Headaches
Neck Pain Management Strategies
Because the human head weighs between 12-15 pounds (5.44-6.80 kg), the neck and upper back muscles must constantly work to maintain an upright posture. Due to our use of computer and electronic devices, many people have forward head posture (FHP), meaning their head rests forwards on the neck more than it should. In fact, studies show that every inch of FHP places an additional 10 pound (4.53 kg) burden on the muscles in the upper back and neck to keep the head upright. It’s no wonder why a common complaint is, “My head feels so heavy and my neck feels compressed—I constantly have to rest my head on the back of the couch when I sit.” So, what can we do about this?
POSTURE: Reducing FHP is essential. To do this, tuck in your chin (creating a “double
chin”) and speak as you do this. You will notice a change in your voice quality—HOLD for ten
seconds and then release JUST ENOUGH for the voice to clear and try to KEEP this position
throughout the day. It takes about three months to retrain old bad posture habits so be patient!
SLEEP: If your neck is narrower than your head (the case for most of us), your pillow
needs to be thicker on the edge to support your cervical spine.
ACTIVITY: You may have to assess which activities (such as sports) are most important to you and either modify how you do it and/or change when and how long you engage in such actions. If your goal is to improve in an activity, gradually increase the frequency, intensity, and duration over time. If you hurt and can’t recover within a “reasonable” time frame (such as 24-48 hours), then you overdid it. Chiropractic offers MANY therapeutic tools to help those with neck pain, which include spinal and extremity manipulation, soft tissue therapy, physical therapy modalities (like ultrasound), nutritional counseling, and exercise training. Your doctor of chiropractic can give you advice on sleeping posture and prescription pillows, home cervical traction options, and more. The goal is not only to manage your neck pain, but more importantly, to teach you self- management strategies so YOU can control of this often disabling condition and reduce the need for prolonged care.
Shoulder Pain – What Exercises Are Best?
The shoulder is a unique joint because it has a great range of motion. Unfortunately, that benefit is negatively balanced with poor stability. This is likely why between 20-25% of the population is afflicted with shoulder pain at some point in life. One of the greatest challenges in managing shoulder pain of musculoskeletal origin (it can also be a referred pain from a visceral organ like the gall bladder or from the heart) is its slow recovery rate. Some studies show that only about 50% of all new episodes of shoulder complaints have a complete recovery within six months. Add in the aging process, conditions that can slow recovery (like diabetes), and hobbies and jobs that increase the risk of re-injury and it's understandable why it may not be possible for some patients to make a full recovery. So, what can doctors of chiropractic do to help those with shoulder pain? The use of manipulation, mobilization, and modalities such as class IIIb and class IV laser (and others) can help a lot. But most importantly, exercise training is the KEY to a successful outcome. Because of the slow recovery time for shoulder injuries, it is IMPORTANT to gradually introduce exercises at the correct time. In the initial acute stage, the following are appropriate:
Pendulum exercises: Like the pendulum of a clock, let the arm hang freely and gently swing while grasping a light weight (2.5-5 pounds, or 1.13-2.27 kg) – DO NOT try to lift the weight! Finger walks up a wall: Face a wall and slowly walk your fingers up the wall but STOP at the point of pain. Remember, the first goal is to restore pain-free motion. Once pain levels have improved and range of motion has been restored, resistance exercises are necessary to regain full function. TheraTube or TheraBand exercises are very practical, as you can travel with these and perform them anywhere. Here is a sample protocol: https://youtu.be/HKdm- 2WYxDQ Start with only three repetitions for each of these movements and SLOWLY release the tubing to help build coordination. If the protocol is too difficult, move toward the anchor point/door to reduce the tension on the tube. Be patient with your progress. It’s a slow but a consistent routine that will get you to your desired goals.
Carpal Tunnel Syndrome
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a condition that arises when the median nerve becomes compressed as it travels through the bony tunnel made up of the eight small carpal bones of the wrist. Its symptoms include pain, numbness, and tingling in the thumb, index, middle, and thumb-side half of the ring finger. If the pressure is great enough, weakness in grip and pinch strength can occur as well. There are many conditions or factors that contribute to and/or cause CTS, which can complicate its diagnosis and treatment. Some of these include: diabetes, obesity, pregnancy, birth control pills, hypothyroid (low thyroid function), arthritis, smoking, alcohol abuse, poor nutrition, being female (due to wrist size and/or hormonal shifts), bony abnormalities (such as spurs, misalignment of the carpal bones, and tunnel shape), aging, and certain occupations (heavy manual labor, vibrating tools, high repetitive tasks, firm gripping requirements, food servers, dental hygienists). Additionally, impingement of the median nerve as it passes through other structures in the body can contribute to a patient's symptoms, so it's important for a doctor of chiropractic to examine the entire course of the nerve—from the neck to the shoulder to the elbow and then to the wrist. In some cases, the median nerve may not be impeded as it passes through the carpal tunnel but rather, there is pressure on the nerve elsewhere that causes symptoms similar to CTS. In these instances, if treatment only focused on the wrist, the patient may not have a successful outcome. Outside of an urgent condition, like a broken wrist that may require surgery to take pressure of the median nerve, treatment guidelines recommend using conservative (non-surgical) approaches first. This can include addressing any activities that place pressure on the nerve (making changes to a workstation, for example) or conditions that may contribute to inflammation or swelling in the wrist. Inflammation within the carpal tunnel can be reduced using both ice therapy, as well as by consuming turmeric, ginger, and other spices with anti-inflammatory properties. To restore normal motion to the joints in which the median nerve may be compressed, doctors of chiropractic may utilize manual therapies such as manipulation and mobilization. Patients may also wear a wrist splint at night in order to avoid increased pressure caused by bending the wrist in an effort to find a comfortable sleeping position.
Low Back Pain
The Mysterious Sacroiliac Joint
Low back pain (LBP) can arise from a number of structures that comprise the lower back like
the intervertebral disk, the facet joints, the muscles and/or tendon attachments, the ligaments that
hold bone to bone, the hip, and the sacroiliac joint (SIJ). Though several of these can generate pain
simultaneously, the focus of this month will center on the SIJ.
The role of the SIJ is quite unique, as it has a big job: it is the transition point between the flexible axial skeleton (our spine) and the pelvis, below which are the lower extremities or legs. The pelvis supports the weight of the torso, which usually accounts for about two-thirds of our body weight. The SIJ is shaped at an oblique angle that diverges or opens at the front and converges inwards at the back of the joint in order to support the weight on top of it. Because the sacrum/tailbone is “V” shaped, it fits like a wedge and is held together with very strong ligaments, making it an inflexible but sturdy joint.
Making a diagnosis of SIJ syndrome or identifying it as a pain generator can be a challenge. Your chiropractor may depend on several types of examinations in order to arrive at an SIJ syndrome diagnosis, such as palpation looking for pain directly over the SIJ; compression tests of the pelvis; front-to- back hip movements to stretch the joint; and imaging, such as x-ray, CT scans, and MRI.
Since the SIJ is NOT a flat and smooth oblique joint, x-ray has many limitations. However, the pubic bone called the “symphysis pubis” (SP), which is located in the front of the pelvis, can be easily seen on x-ray. Because the pelvis is a ring-like structure, an SP that is out of alignment may indicate SIJ dysfunction.
In a recent study, two independent orthopedic surgeons analyzed the x-rays of 20 consecutive patients (17 women and 3 men) with proven SIJ dysfunction and LBP (confirmed by SIJ injection testing), which resulted in the findings of osteoarthritic degeneration and subluxation (misalignment) in 18 of the 20 subjects.
When they assessed the SP in 20 non-SIJ LBP control subjects (16 women and 4 men), 7 had abnormal SP findings (35%) versus 18 of 20 with SIJ-LBP mentioned above (90%). A review of the patients' past radiology reports found that only three reports mentioned this in the SIJ-LBP group and none reported this in the control group. The authors concluded that SP findings are underreported by radiologists, and because SP is much easier to “read” or assess than the SIJ itself, it NEEDS to be looked at!
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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.