Monthly Pain Updates – February 2022

Low Back Pain

Myofascial Release for Low Back Pain

Through their initial chiropractic college instruction, as well as continuing education and post-graduate training/certification, doctors of chiropractic are equipped with a variety of techniques and therapies to manage musculoskeletal conditions, including low back pain (LBP). Studies have found that a common contributory cause of LBP is dysfunction of the thoracolumbar fascia (TLF). The purpose of the TLF is to allow the various muscle groups between the lower rib cage and the pelvic brim on both sides of the low back to smoothly slide independently between each other during normal movement. When adhesions form in the fascia, they can restrict the ability of the muscles to move independently, which can increase the risk for pain and injury in the low back and associated areas of the body.

One treatment option to address issues in the TLF that can cause pain and disability in the lower back is myofascial release (MFR). Myofascial release is a hands-on treatment in which a doctor of chiropractic applies pressure with their hands, elbow, or a tool to stretch the muscles to knead out trigger points or adhesions that may inhibit the ability of the muscles to slide against one another during normal movements.

In a 2021 study, 36 patients with non-specific chronic LBP received either a single 40-minute session of MFR or a sham treatment. The patients in the MFR group experienced improved muscle activity in the lower back (based on diagnostic testing), as well as a reduction in both self-reported pain and disability.

In another study that included 109 patients with chronic LBP, researchers observed that those who received a single 40-minute session of MFR not only experienced improved muscle activity in the lower back immediately following treatment, but these improvements persisted up to one month later at a follow-up visit. No such improvements were recorded among participants who did not receive any treatment.

Because a low back condition may have several underlying causes that need to be addressed together, a doctor of chiropractic will often adopt a multimodal approach to achieve the best outcome for the patient. In addition to MFR, a chiropractor may also employ spinal manipulative therapy, mobilization therapy, soft-tissue therapy, exercise training, activity modification, physiotherapy modalities, nutritional counseling and more. It all depends on the patient’s unique case, as well as their doctor’s training and treatment preferences.

Neck Pain / Headaches

Managing Dizziness By Addressing Cervical Dysfunction

For the elderly adult, falls can result in severe injury and a loss of independence. One major cause for serious falls in the older population is dizziness. While there are many causes of dizziness, one that is often overlooked is dysfunction in the cervical spine that affects proprioception, or the ability to know where parts of the body are in relation to one another. In fact, according to one retrospective study that included 1,000 patients with dizziness as their chief complaint who visited one Japanese hospital found that cervical dysfunction was the underlying or a contributing cause in nearly 90% of cases! So if issues that affect the neck may be a potential cause of dizziness, let’s see how treatments to improve function in the neck, upper back, and shoulders affect patients with dizziness.

• In a 2021 study, researchers observed that elderly adults who performed scapular training exercises for 40 minutes a session five times a week for four weeks experienced improvements in static balance, dynamic balance, and physical function that were not observed in participants in a general exercise group.

• Another interesting study found that older adults with both neck pain and dizziness who received manipulative therapy targeting both the cervical spine and thoracic spine once a week for four weeks experienced significant improvements in both disability and dizziness following the conclusion of treatment.

• A similar study found that seniors with neck pain and dizziness who were unable to stand on one leg for at least 5 seconds reported favorable results in neck pain and dizziness, as well as improved balance on a one-legged standing test, following 16 chiropractic treatments spread over eight weeks.

• A six-month study that included 305 middle-aged and older dizziness patients found that a multi-faceted approach that included hands-on treatment achieved greater results than usual medical care.

In each of these studies, researchers found that improving the function of the cervical spine and associated areas of the body reduced dizziness, likely due to improved proprioception and balance—which was confirmed by the study that included the 5-second one legged balance test.

When examining a patient with dizziness as their chief complaint, a doctor of chiropractic will assess the whole patient in order to determine any potential contributing causes to the patient’s condition. This may include addressing dysfunction in the cervical and thoracic spine, as well as the low back, pelvis, legs, and feet which can affect normal joint movement, proprioception, and balance.

Joint Pain

HIIT for Improving Shoulder Function

To restore function following a shoulder injury or surgery, it’s important for the patient to perform rehabilitative exercises. While there are many classic exercises that are considered “standard” in rehab post-injury/surgery shoulder conditions, new research suggests that high-intensity interval training (HIIT) may be more effective.

High-intensity interval training is an exercise concept that is characterized by performing exercise at maximal intensity for short bursts of time followed by periods of low- or moderate-intensity activity. Studies have investigated various HIIT approaches with respect to length of time of maximum effort, rest periods, how many sets to perform during each session, and how often to engage in the exercise. In fact, there is some evidence to suggest individuals may achieve better outcomes in the long-term by mixing up their HIIT approach from time to time.

With respect to addressing the shoulder, in a 2021 study that included 21 patients with subacromial pain syndrome (SAPS), 13 were assigned to an HIIT exercise group and the rest to a usual care rehabilitative exercise group for eight weeks. Examinations conducted at the conclusion of the study period revealed that individuals in the HIIT group exhibited significant improvements in shoulder abduction endurance (by 233 seconds compared with the usual care group), shoulder pain, and shoulder disability. The HIIT group also experienced improved tendinous blood flow, as well as less pain while exercising. The authors concluded that the HIIT exercise approach results in better outcomes than usual care and that HIIT exercise is a feasible treatment approach for SAPS.

Chiropractors usually combine manual therapy with exercise training when treating patients with shoulder pain. This multi-modal treatment approach may also include various forms of physical therapy modalities such as electric stimulation, ultrasound, laser, pulsed electromagnetic field, shockwave therapy, and more.

Carpal Tunnel Syndrome

Vitamin D and Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is most often associated with repetitive movements and inflammation that impedes the function of the median nerve as it passes through the wrist, but recent studies have identified vitamin D deficiency as a risk factor for CTS, as well as more severe CTS-associated symptoms.

Vitamin D plays many roles in the body, some of which include facilitating nerve function, speeding the healing process following nerve injury, reducing nerve fiber hypersensitivity, and reducing inflammation and scar tissue formation. As such, when vitamin D levels are low, nerves may be more susceptible to injury and take longer to heal.

In a study published in December 2021, researchers reviewed data from four studies involving vitamin D supplementation in CTS patients with low vitamin D status (less than 20 ng/ml). The data show that administering between 7,100-8,600 IU of vitamin D3 per day for three months was effective for improving vitamin D levels to a more normal range of at least 20 ng/ml. The authors noted that sensory symptoms like numbness and tingling improved sooner than motor functions (like strength), which is logical as sensory symptoms are often the first to manifest in patients with CTS. They also reported that median nerve function—as per neuroconductive velocity testing—only improved in mild-to-moderate CTS cases but not in severe cases.

In their conclusion, the research team noted that for patients with poor vitamin D status, the duration of supplementation may vary from patient to patient but should not be the sole form of treatment. Rather, addressing insufficient vitamin D levels should be just one aspect of a multimodal approach for alleviating pressure on the median nerve and restoring more normal median nerve function.

octors of chiropractic have extensive undergraduate, graduate, and even post-graduate training in clinical nutrition, and many jurisdictions require continuing post-graduate education hours to maintain licensure. Vitamin D3 is commonly recommended for MANY reasons, and CTS can be added to that long list.

Whiplash

Whiplash and Soft Cervical Collar Usage

When paramedics suspect a neck injury following a motor vehicle collision, they will utilize a cervical collar to immobilize the neck for transport to the emergency room so a more comprehensive examination can take place. While a cervical collar is essential in these situations for achieving the best possible outcome, there is another type of collar that may be prescribed to a patient with a whiplash injury following a car accident that may impede recovery: the soft cervical collar.

The soft cervical collar allows for some movement while still supporting the head and neck with the idea of relieving the cervical tissues from some stress while they heal. A study published in 2021 that included 2,162 patients who visited the emergency room within 48 hours of a motor vehicle collision found that 85.4% received a soft cervical collar. The authors of the study found that patients who received the soft cervical collar were nearly four times (8.4% vs. 2.5%) more likely to return to the emergency room within three months. The results suggest that soft cervical collar use is a risk factor for a return visit to the emergency room, implying that recovery is dramatically affected, even though it’s common practice in this setting.

In another 2021 study, researchers investigated a different approach for treating whiplash associated disorders (WAD) patients during their initial visit to the emergency room. Among a group of over 5,200 WAD patients, the research team observed that incorporating spinal manipulative therapy—the primary form of treatment provided by doctors of chiropractic—not only led to a reduction in soft cervical collar use, but also fewer x-rays and orthopedic referrals. Additionally, this approach was more effective for detecting grade IV WAD cases (fractures).

The findings from these studies suggest that immobilization with soft cervical collars following an emergency room visit for WAD may hinder recovery, while early active treatment may hasten recovery. This aligns with many WAD treatment guidelines that dissuade from practices that restrict movement (such as cervical collar use and prolonged bed rest) and encourage treatment that promotes activity. This includes carrying out normal activities (provided they don’t lead to sharp painful sensations) and manual therapies (like spinal manipulation and mobilization) that help to restore normal joint movement. Patients may also be encouraged to perform exercise to strengthen the deep neck muscles, which are commonly weakened in WAD patients, and to adopt an anti-inflammatory diet to speed recovery.

Whole Body Health

The Many Benefits of Nuts

While nuts make for a tasty snack, they are also a great source of nutrients that are linked to better health. In January 2022, the American College of Cardiology reported that nuts contain healthy fats, protein, vitamins, and minerals, and regular nut consumption can reduce the risk of heart disease by up to 14%. Not only that but a meta review of data from 22 published studies found that a high intake of nuts may offer neuroprotective benefits to individuals at elevated risk for cognitive decline. Another study reported that children born to mothers who ate over 2.5 ounces of nuts per week during pregnancy scored considerably higher on tests of sustained attention, working memory, and IQ than kids whose mothers ate fewer nuts. Let’s take a look at some of the nutrients found in nuts that offer these various benefits…

Nuts are rich in healthy unsaturated fats (both monounsaturated and polyunsaturated fats), which lower bad cholesterol levels, as well as omega 3-fatty acids which have been found to reduce and/or prevent irregular heart rhythms that can result in heart attacks. Nuts also contain fiber that makes us feel full so we in turn, eat less. Fiber also plays a role in preventing type 2 diabetes. Nuts contain vitamin E that helps reduce plaque build-up in the arteries, which can cause them to narrow and lead to chest pain, coronary artery disease, and heart attack. Certain nuts contain plant sterols, a substance that can lower cholesterol. Nuts are also a source of Larginine, which improves the health of the artery wall by making them more flexible and less likely to form blood clots that can block blood flow.

Because up to 80% of a nut is fat, which contains more calories than proteins and carbs, moderation is recommended to avoid excessive calorie intake. The American Heart Association recommends eating about four servings of nuts per week—preferably dry roasted or raw nuts rather than those cooked in oil. One serving is a small handful (1.5 ounces) of whole nuts or 2 tablespoons of nut butter.

Nut oils are a good source of healthy nutrients but lack the fiber found in whole nuts. These oils work well as homemade dressing for salads or cooking; however, it’s important to note that nut oils react differently to heat than the vegetable oils we may be more familiar with, and they can become bitter when overheated.

In addition to reducing the risk for chronic disease, the anti-inflammatory properties of nuts can help to reduce one’s risk for chronic pain and assist in the healing process when a musculoskeletal injury occurs.