MONTHLY HEALTH UPDATE

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Courtesy of:

Chad Abramson, D.C.
(425) 315-6262

Whole Body Health

The Role of Diet in ADHD...

Due to concern about the side effects and the long-term use of medications typically prescribed to treat attention-deficit/hyperactivity disorder (ADHD), there is an increasing demand for alternative forms of treatment for patients with the condition, with dietary medications and supplementation showing promise.

Research has shown that deficiencies in zinc, iron, calcium, magnesium, selenium, glutathione, and/or omega-3 fatty acids can contribute to oxidative stress and altered neural plasticity needed for brain development and healing. For children with ADHD, this can manifest as poor concentration and memory and learning challenges.

Hypersensitivity to foods and/or additives can increase inflammation in the blood, which presents in children as atopy (hereditary allergy like asthma, hay fever, or hives), irritability, sleep issues, and prominent hyperactive-impulsive symptoms. Studies have demonstrated that taking a probiotic can help manage inflammation, which may benefit children with ADHD as well.

The link between ADHD and food additives including (but not limited to) preservatives, artificial flavorings, and colorings has been debated for decades. A 2007 Lancet publication reported that sodium benzoate and commonly used food colorings may exacerbate hyperactive behavior in children under the age of nine. A 2010 follow-up study concluded that children affected by these types of additives may share common genetic factors.

Essential fatty acids (EFAs) and phospholipids are both essential for normal neuronal structure and function, of which diet is the only source of these important nutrients, especially during critical periods of development (childhood). Dietary deficiency early in life has been reported to increase the risk of developing ADHD signs and symptoms.

Past studies have established the importance of maintaining a healthy balance between the omega-3 vs. omega-6 fatty acids in one’s diet to reduce systemic inflammation. When the ratio of omega-6 to omega-3 becomes too high (3:1 is favorable), it’s considered a risk factor for ADHD. Diets low in protein and high in carbohydrates (refined carbs/sugar) are also a well-known risk factor for developing ADHD because the amino acids that make up proteins are essential for our body to manufacture neurotransmitters.

Whiplash

Whiplash Management Options - Where Does Chiropractic Fit In?

Recent studies suggest that in a rear-end collision, the injuries collectively described as whiplash associated disorders (WAD) result from the simultaneous hyperextension of the lower cervical spine and hyperflexion of the upper cervical spine. This can lead to a variety of injuries to the bony and/or soft tissues of the neck, some of which may not manifest for hours, days, or even weeks following a car accident.

Traditionally, doctors have advised patients with an acute whiplash injury to limit movement, which may have included the use of a cervical collar. However, more recent studies have found that restricting motion in the neck can actually hinder recovery from WAD. Rather, new data suggests that early mobilization actually improves outcomes for WAD patients, reducing their risk for long-term disability.

The primary form of treatment utilized by doctors of chiropractic is spinal manipulation (SM), which is described as a high velocity, low amplitude (HVLA) thrust applied to specific joints in the neck, mid-back, low-back, pelvic regions as well as to extremity joints. Manipulation improves the mobility of the spinal facet joints, which allows for an increase in the global range of motion of the neck.

SM also breaks the vicious pain cycle where the inflow of sensory information to the brain is attenuated, thus reducing the reflex muscle spasm and accompanying pain. Additionally, there is substantial evidence that SM increases pain tolerance or thresholds by modulating central (brain) sensory processing (called central sensitization). There are also measurable neuro- endocrine benefits following SM as well as many other measurable “somato-visceral" reflex responses.

Chiropractic management of WAD injuries includes not only SM (both HVLA and non- thrust types), but also soft-tissue therapies, exercise training, the use of physiotherapy modalities (electric stim, ultrasound, laser or light therapy, and more), nutritional counseling, ergonomic/work modifications, and more. Doctors of chiropractic frequently co-manage WAD patients with other healthcare providers when it is appropriate.

Neck Pain / Headaches

Neck Pain - Is It Arthritis?

There are many different types of arthritis, with the most common being osteoarthritis (OA), also known as degenerative joint disease (DJD). Osteoarthritis is often referred to as the “wear-and-tear” type of arthritis, as the smooth, cushion-like, shiny cartilage covering the joints that allows for a nice gliding surface wears down. This can cause pain, swelling, loss of motion, and spurs that further limit motion. According to the Arthritis Foundation, OA/DJD affects about 27 million Americans and is most commonly found in the knees, hips, low back, neck, small joints of the fingers, and base of the thumb and big toe.

In one study, researchers reviewed cervical x-rays and detected spondylosis—degeneration of the intervertebral disks, which rest between the vertebrae of our spine—in approximately 60% of non-symptomatic persons more than 40 years old and in 95% of men and 70% of women over age 60. Similarly, cervical spine MRIs of individuals without neck pain frequently show a disk bulge or herniation. According to the AMA Guides to the Evaluation of Permanent Impairment (5th edition), 30% of us who have never had neck or back pain will test positive for a herniated disk and 50% or more will have bulging disks on a CT or MRI!

So, if you have neck pain and your doctor takes images that show arthritis or a disk problem is present, how do you know whether or not DJD is to blame? The answer is: it varies and must be clinically determined on a case-by-case basis.

Though frustrating, the ability to determine what is truly generating a patient's pain can be a challenge. This is why a careful, detailed history and examination of the patient, as well as tracking their response to treatment, is so important. Doctors of chiropractic approach these conditions with various forms of manual therapies including (but not limited to): joint manipulation; mobilization; massage; trigger point therapy; exercise training; activity modifications; self-management strategies, such as traction; the use of specially designed pillows; modalities such as electrical stimulation, ultrasound, and laser therapy; and nutritional counseling to reduce inflammatory markers. Guidelines published around the world recommend joint manipulation for neck pain and headaches as one of the first courses of care because it is both safe and effective.

Joint Pain

Knee Pain - Do I Need a Replacement?

About a quarter of adults experience frequent knee pain, which results in limited function, reduced mobility, and impaired quality of life. Osteoarthritis (OA) is the most common cause of knee pain in those over 50 years of age, and it is the #1 reason for total knee replacement (TKR). The rate of TKR in the United States and the United Kingdom has increased substantially in recent decades, which many have written off as a consequence of our aging populations. But is that really the case?

One study reviewed long-term data from the National Health and Nutrition Examination Surveys (NHANES) and the Framingham Osteoarthritis (FOA) study. The research team concluded that advancing age is indeed a factor behind the increase in TKR since the 1970s, but it doesn’t tell the whole story. The researchers also found that obesity is a risk factor for symptomatic osteoarthritis of the knee, and as you know, obesity rates have skyrocketed in the last four decades.

So, what can be done to reduce your risk for a total knee replacement? There isn’t anything you can do about getting older, but there’s a lot you can do to maintain a healthy weight. Begin by switching to a more anti-inflammatory diet such as the Mediterranean diet or the Paleo diet. You don’t have to change everything you eat all at once. Start by eating an extra serving of vegetables and one less serving of processed food a day. As you notice yourself starting to feel better, it will give you the confidence to make further dietary modifications. Because the primary way for the cartilage in your joints to get nutrients is through movement, you’ll need to become more active. Increase the number of steps you take per day and raise the intensity over time. You should also engage in balance and strength training exercises.

Of course, you’ll also need to ensure your knee isn’t subjected to abnormal movements both above and below that can compromise the tissues that make up the joint. For example, ankle pronation can overload the medial compartment of the knee. Similarly, a problem in the hip, pelvis, or lower back can also place stress on the knee, which can impair its function. That’s why doctors of chiropractic evaluate the whole patient to identify any and all contributing factors to a patient’s chief complaint. Otherwise, the patient may not experience a satisfactory outcome.

Carpal Tunnel Syndrome: A Brief Overview

Carpal tunnel syndrome (CTS) is a condition that arises when the median nerve is compressed as it passes through the narrow, rigid carpal tunnel, resulting in numbness, tingling, pain, and/or weakness in the hand and wrist.

The underlying cause of CTS can be obvious and easy to trace, such as an injury to the wrist, or the cause of the condition can be the result of cumulative trauma from months or years or repetitive strain caused by working with vibrating tools or poor ergonomics. Another cause can be the result of swelling/inflammation from conditions like arthritis, thyroid disease, pregnancy, or diabetes. In many patients, there are several factors at play, which all must be treated in order to obtain a successful outcome.

Women are three times more likely to develop CTS than men, mostly due to differences in the shape of the wrist. This disorder usually occurs in adults (especially over the age of 50), but it can occur at younger ages, such as college music majors who practice their instrument for several hours each day with little time allotted to rest the tissues in the wrist.

After a thorough examination to identify all contributing factors for a patient’s CTS- related symptoms, a doctor of chiropractic may employ the following conservative treatments: a wrist splint to maintain proper posture at night when sleeping; anti- inflammatory measures such as ice; anti-inflammatory nutritional products such as ginger, turmeric, bioflavonoids, and others; work and/or leisure activity modifications that reduce strain on the wrist; manipulation of the small joints of the wrist as well as to joints proximal to the wrist including the elbow, shoulder, and cervical spine; muscle release techniques to the upper extremity, especially the forearm and hand; stretching exercises; and the use of some physio-therapeutic modalities can also facilitate in reducing inflammation.

According to the National Institute of Neurological Disorders and Stroke, CTS usually responds well to conservative treatment, especially early in the course of the condition. However, in some cases, surgical intervention may be necessary.

The "Red Flags" of Low Back Pain

Low Back Pain

Treatment guidelines published around the world note that ruling out “red flags” is a healthcare provider’s number one responsibility, which is in line with the decree exhorted by all healthcare professionals when first entering practice to do no harm. When detected, red flags prompt a doctor to stop and immediately send the patient to the appropriate healthcare provider or emergency department to avoid a catastrophic outcome, which may include death.

The four main red flags cited for low back pain include: cancer, fracture, cauda equine syndrome, and infection. In 1992, Dr. Richard Deyo reported that the patient’s history is more important for identifying red flags than a routine physical exam, especially in the early stages of these conditions. This is partially why new patients need to fill out so much paperwork on their initial visit. These are the factors that suggest red flags when it comes to low back pain:

Cancer: a past history of cancer, unexplained weight loss, failure to improve with a month of therapy, no relief with bed rest, and duration of pain over one month. However, when the combination of age over 50 years, past history of cancer, unexplained weight loss, and failure to improve with one month of therapy exists, the sensitivity or "true-positive" reaches 100%—in other words, IT IS CANCER until proven otherwise!

Cauda equine syndrome: acute onset of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, “saddle” anesthesia, and global or progressive motor weakness in the lower limbs.

Infection: prolonged use of corticosteroids (such as organ transplant recipients); intravenous drug use; urinary tract, respiratory tract, or other infection; and immunosuppressant medication and/or condition.

Spinal fracture: history of significant trauma at any age; minor trauma in persons over 50 years of age; patient over 70 years of age with a history of osteoporosis (with or without trauma); and prolonged use of corticosteroids. A checklist that includes these important historical questions can be easily applied in any practice, which is highly recommended.

All healthcare providers—including chiropractors—managing patients in a primary care setting are obligated to rule out red flags in order to ensure patient safely when rendering treatment for LBP. The good news is that most cases of low back pain aren’t caused by these red flags and respond well to conservative chiropractic care!

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425.315.6262


Abramson Family Chiropractic

10222 19 th Ave SE, Suite 103, Everett, WA 98208

(425) 315-6262


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.