MONTHLY HEALTH UPDATE
Women with Back Pain... The Silent Majority?
Chad Abramson, D.C.
Whole Body Health
Women with Back Pain... The Silent Majority? Part 2
Last month, we discussed four factors that increase a woman's risk for back pain: a wider
pelvis (resulting in greater pelvic instability due to knock-knee effect); breast size, mass, and
weight; hormone levels and variability during menstruation and menopause; and adolescent
growth spurts that can trigger idiopathic scoliosis three-times more commonly in women than
men. We'll continue the discussion this month…
During the first trimester (three months) of pregnancy, the fetus' rapid growth combined with the hormonal, physical, and emotional changes that occur can be quite an adjustment! However, it's during the second and third trimesters when an expectant mother's risk for back pain can increase the most. During this time, the growth of the baby shifts the center of gravity forward, increasing the low back curve or “lordosis” to maintain balance. This new posture can create inflammation in the facet joints, the sacroiliac joints, and/or the coccyx (tailbone), which can result in pain and general discomfort. Common self-help approaches include ice or heat (ice is typically preferred over heat), rest, special cushions or supports, and specific exercises. Manual therapies provided in a chiropractic setting, like mobilization and/or manipulation, can also provide relief.
Though the mechanism may not be fully understood, women who have undergone menopause have an elevated risk for reduced bone density, which is called osteopenia. You may be more familiar with the term osteoporosis, which describes a fracture that occurs in the presence of reduced bone mass. Management can be successful with non-surgical approaches. However, if non-surgical approaches fail, a doctor may recommend a procedure, called kyphoplasty, in which he or she injects a cement-like substance into the fractured vertebral body.
Another factor that can increase a woman's risk for back pain is wearing high heels. A 2015 study found that wearing heels over two inches tall (or ~50mm) can increase the curve of the lumbar spine by about ten degrees, placing added pressure on the two lower lumbar disks (L5/S1 and L4/L5). This may be one explanation as to why low back pain complaints are more common among women who regularly wear high heels compared with those who do not. Additionally, other studies have shown that wearing heels also alters the curvature of the thoracic and cervical spine, which can increase the wearer's risk for neck and upper back problems.
Whiplash Injuries and Neck Strain
The terms “whiplash” and “neck strain” are often used interchangeably, though there's debate
about whether this is appropriate. Let’s take a closer look at the differences between these two common
descriptions of neck pain...
The term “strain” technically means a stretch injury to a muscle and/or the tendon that attaches muscle to bone. The terms mild, moderate, and severe offer a classification approach commonly used by healthcare providers to describe the degree of injury. As implied, a mild strain is just that—little to no muscle fiber or tendon tearing has occurred and thus, the injury will have a faster recovery time than a moderate strain. Moderate strains include partial tissue tearing and take longer to mend. Severe strains described complete tearing and in certain muscles in our body, surgery may be needed to repair the tear.
There are many muscles and tendons in the neck that overlap each other to allow for various functions or movements to occur. The deep “intrinsic” muscles are described as “fine movers” and allow for the individual cervical vertebra to move in a very specific manner and direction. The superficial muscles are larger, stronger, and utilized in global/large movements and help to protect the neck and the deeper, more delicate structures.
It can take a total of about 600 msec for the head to “whip” forwards and backwards in a classic rear-end collision, which is faster than we can voluntarily contract a muscle. This explains why an injury is difficult (if not impossible) to avoid in a motor vehicle collision, even if you “see” that an accident is about to happen.
To further differentiate the whiplash injury from a simple muscle strain, the brain is suspended by ligaments and cushioned further by fluid inside the calvarium (or skull) and can easily get bruised by literally slamming into the walls on the inside of the skull in a whiplash injury. This results in “traumatic brain injury” (TBI) or concussion. Interestingly, it’s been reported that one does NOT have to directly hit the head on a hard object to suffer TBI.
The symptoms associated with TBI include mental fog; fatigue/tiredness; slow mental functioning, such as having difficulty formulating thoughts, staying on task, and/or expressing one’s self; visual complaints; memory loss; and/or headache. The term “Whiplash Associated Disorder” or WAD is preferred, as it encompasses the many different symptoms associated with whiplash.
Doctors of chiropractic are trained to evaluate, diagnose, and treat patients who have sustained a whiplash injury. Generally, the sooner treatment commences after the injury, the more favorable the outcome or prognosis. Therefore, don’t delay in obtaining care following a collision!
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome Splints
Wrist splints are often a beneficial form of CTS self-care, as they can assist in
relieving the pressure within the carpal tunnel by restricting wrist flexion and extension.
Because we cannot control the position of our wrist during sleep and the pressure on the
nerve worsens the more it bends forwards or backwards, splints are most commonly used
There are literally hundreds of options of splints available online that range from simple glove-like splints (some with and without the fingers covered) to full arm splints. The majority block wrist motion and use Velcro closures with metal bars on the bottom and/or top of the splint. Your doctor of chiropractic can help you choose the best splint for your particular case.
There are studies that have attempted to isolate one form of treatment from others for conditions like CTS, but as noted in a 2012 Cochrane report, many of these studies involve small sample sizes, making it difficult to draw firm or hard conclusions. Moreover, healthcare providers typically utilize MANY approaches simultaneously to achieve the best, most prompt results, keeping surgery as the last resort.
Typically, the non-surgical management of carpal tunnel syndrome (CTS) includes several approaches such as splints; rest; job modifications; anti-inflammatory measures like ice, drugs, vitamins, and herbs; physical modalities, such as ultrasound and laser; and manual therapies, such as manipulation and mobilization.
Care may also focus on relieving pressure on the median nerve in other anatomical locations (the neck or shoulder, for example) as dysfunction elsewhere on the course of the nerve can contribute to a patient's CTS symptoms. Furthermore, a treatment plan may also address other conditions that can contribute to the build-up of pressure in the carpal tunnel such as diabetes or hypothyroidism. Generally, it’s more challenging to manage the condition when a patient has waiting years or even decades to seek care. Thus, for the best possible outcome, please have a doctor of chiropractic evaluate your wrist and hand symptoms sooner rather than later.
Hip Pain and Iliotibial Band Syndrome
WHAT IS IT? Iliotibial band syndrome (ITBS) is one of the most common causes of hip and/or
knee pain among athletes. The pain is caused from swelling or inflammation of a muscle group (including
the tensor fascia lata or TFL, gluteus medius, and minimus muscles), the tendons that attach muscles to
the knee or hip, and/or the bursa that surrounds the attachments at the hip and/or knee.
How common is it? Experts estimate that the prevalence of ITBS may be as high as 12% among participants in sports that involve running. This is also common during basic training—with ITBS reported by between 5.3% to 22.2% of United States Marine Corps recruits.
What is the clinical presentation? Typically, ITBS presents with a history of pain with activity (walking, running, cycling, etc.), with soreness at the outside of the knee just above the joint. Pain can radiate up or down and include the hip and/or ankle. Climbing steps and running downhill are common irritating activities. Rest can help alleviate symptoms in the short term but isn’t a long-term remedy.
What are some physical exam findings? ITBS patients may exhibit an abnormal gait or walking pattern in which knee flexion (bending) is avoided. They may also have tenderness to touch above the knee joint on the outside and/or along the iliac crest (where the TFL inserts). Squatting can reproduce pain, and lying on the side with the leg extended backward and dropped toward the floor from a bench often reproduces pain (called “Ober’s Test”).
Treatment Options: Because these are “overuse” injuries, changing the frequency, intensity, and/or duration of the sport or injury-causing activity is often necessary. Consider changing up your routine by cross training. If your athletic shoes are worn down, replace them and stay within the rated mileage of the shoe.
For those with ankle pronation (where the ankle shifts inwards), a foot orthotic with a measured rearfoot post can “make or break” a successful, long-term outcome. Similarly, if one leg is measurably shorter compared to the other, a heel or heel-sole combination lift is also very helpful.
If the muscles that move the hip are weak or if there is altered/abnormal muscle activity, then proper exercises to improve the neuro-motor pattern and/or strengthen the weak muscle group are a must! The inclusion of a gait/walking and running assessment can also reap great benefits for long-term success. Your doctor of chiropractic can help you with this assessment.
Chiropractors are trained to evaluate and treat ITBS and other hip/knee conditions, whether they are sports-related or not.
Neck Pain / Headaches
Chiropractic Care vs. Medication for Neck Pain
Neck pain can arise from a multitude of causes, from trauma like sports injuries
and car accidents to just sleeping in an awkward position. It can also arise from non-
traumatic causes like stress, anxiety, or depression. In the past, we’ve noted how forward
head posture can increase the risk of neck pain and headaches. Suffice it to say, neck pain
can arise from almost anything, and many times it’s very challenging to figure out the
A recent study involved 272 nonspecific neck pain patients between the ages of 18-65 years who received twelve weeks of one of three treatments: spinal manipulative therapy (SMT); medication; or home exercise with advice (HEA). The primary method of assessing change involved tracking self-reported pain levels at 2, 4, 8, 12, 26, and 52 weeks and secondary measures included self-reported disability, global improvement, medication use, satisfaction, general health status, and adverse effects.
The results showed that SMT had a statistically significant advantage over medication regarding pain relief after 8, 12, 26, and 52 weeks, and HEA was superior to medication at 26 weeks. The study concluded that SMT was more effective than medication in both the short and long term for those with acute and subacute neck pain.
The research team added that 60% of participants in the medication group reported side effects—of which gut irritation and drowsiness were the most common. The SMT group experienced no significant adverse effects, but 46% of the SMT and HEA groups equally reported short-term soreness or achiness.
Another study showed for that for chronic neck pain patients, the COMBINATION of SMT and HEA yielded the best long-term outcomes compared to either one alone, with SMT favored in the acute stage (initial stage) of care. The challenge for doctors is to get people to continue with their exercises after their pain subsides, as studies show the dropout rate can be as high as 90%!
Low Back Pain
Pregnancy and Low Back Pain – Part 3
In Part 1 of this series, we discussed the many aspects of pregnancy that contribute to low back
pain (LBP) including hormonal, chemical, biomechanical, and psychological changes that occur
throughout pregnancy. In Part 2, we looked at the results of several studies showing that chiropractic care
can help reduce low back pain (LBP) both during pregnancy as well as during labor and delivery. This
month, let’s focus on what to expect when you visit a doctor of chiropractic.
The initial visit typically consists of an intake process: a history, examination, vital signs, and so on. Your doctor of chiropractic will discuss the treatment goals and procedures typically utilized during the three trimesters of pregnancy and will provide a treatment recommendation.
After the initial treatment, it is not uncommon for people, pregnant or not, to feel a “post-exercise soreness” type of discomfort. This makes sense as chiropractic adjustments and mobilization are indeed “exercising” your spinal joints with the goal of reducing joint stiffness and fixations, which some chiropractors may refer to as “spinal joint subluxations.”
There are many types of manual therapies available, and finding the method that matches your choice and needs is important. One type of manipulation often associated with chiropractic includes the use of a “high-velocity, low-amplitude” (HVLA) thrust, which is frequently referred to as “an adjustment.” Joint cavitation or the “cracking” sound that commonly occurs with adjustments is created by the formation of a gas cavity within the spinal joint space during the maneuver. The spinal joints often become looser during pregnancy due to the increase in circulating progesterone, estrogen, and relaxin, especially in the third trimester. Typically, very little force is needed to successfully cavitate a spinal joint when utilizing HVLA adjustments. For some patients, the cracking sound can provoke anxiety and in those cases, low-velocity, low-amplitude techniques may be preferred, as this does not typically result in joint cavitation.
Exercise throughout pregnancy is important, as studies show it improves energy, reduces mood swings, facilitates in stress management, and results in more restful sleep. Other benefits include less weight gain during pregnancy (by approximately 21%); shorter and easier labor (decreased by an average of two hours); fewer medical interventions experienced (24% fewer cesarean deliveries and 14% reduction of forceps use); less fetal distress; and faster recovery times. Nutritional counseling is also appreciated and very important during pregnancy, and chiropractors are well trained in this form of management. Doctors of Chiropractic can work with OB/GYN doctors, primary care physicians, and/or midwives to coordinate care throughout the pregnancy with the common goal of making this the best experience of your life!
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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.