Monthly Pain Update – May 2023
Greater Access to Chiropractic Reduces Low Back Pain Costs
Not only is low back pain a musculoskeletal condition that will affect nearly everyone at least once in their lifetime, but it also accounts for a significant portion of all healthcare expenditures. When an individual experiences low back pain, they have a variety of treatment options, including chiropractic care. While there is an abundance of literature available on the safety and effectiveness of chiropractic treatment for the low back pain patient, perhaps just as interesting is the cost and societal benefits associated with chiropractic management of low back pain.
Past research has shown that greater access to chiropractic care is linked to a lower reliance on primary care services for treatment for a condition like low back pain, which is handy as experts predict a severe shortage of primary care physicians in the near future. But is the inverse true, does reduced access to chiropractic lead to greater utilization of primary care?
In a 2019 study, researchers examined Medicare claim data concerning nearly 40,000 older adult chiropractic patients who moved to an area with less access to chiropractic care. The research team observed that following their move, the seniors were more likely to visit their primary care physician for spine conditions, which can lead to potentially harmful opioid prescriptions, unwarranted testing, and invasive procedures, including surgery. This equated to an additional cost of nearly $115,000 per 1,000 beneficiaries on medical services or $391 million nationally.
In another study, researchers looked at the healthcare costs and utilization of 2.5 million adults with low back pain and leg pain. They found that 1.2% received surgery and these patients accounted for 29.3% of all healthcare costs among the study population. The data also show that many of the patients who received non-surgical care underwent advanced imaged within 30 days of diagnosis and/or without an initial trial of hands-on care (like chiropractic care), which is contrary to treatment guidelines. A 2022 study that looked at low back pain patient experiences found that 41.7% who underwent back surgery had minimal non-pharmaceutical, non-operative treatment in the six months before their operation.
BOTTOM LINE: The current research suggests that greater access to chiropractic care not only provides large cost savings to the public and private insurance agencies, but patients who utilize chiropractic care for low back pain are less likely to receive treatment that may be less effective and may carry greater risks for adverse side effects.
Conservative Chiropractic Care for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition the occurs when mobility of the median nerve is restricted as it passes through the wrist, resulting in symptoms that extend into parts of the hand including pain, numbness, tingling, and weakness. Generally, symptoms come on gradually but worsen and become more frequent over time. While most often associated with computer work, CTS can affect anyone whose work involves repetitive hand movements—especially when combined with non-neutral wrist postures or vibration exposure—or who is affected by conditions that create swelling or inflammation in the wrist tissues, such as pregnancy, obesity, diabetes, rheumatoid arthritis, and more. There are many treatment options available to the CTS patient, of which chiropractic care is highly favored both by patients and the clinical treatment guidelines.
When the CTS patient first presents for chiropractic treatment, they will complete a patient history that describes both their current symptoms as well as any other health conditions they’ve had in the past or are currently experiencing. In addition to letting the doctor of chiropractic know if there are health conditions that may contribute to CTS and may require co-treatment to achieve a successful resolution, the history will also indicate the potential for conditions that can co-occur with CTS or be mistaken for it, such as median nerve compression elsewhere along the course of the median nerve or compression of another nerve that innervates other parts of the hand, such as the ulnar nerve. With this information, the chiropractor will conduct an examination to better understand the patient’s unique situation, which may include diagnostic imaging, such as X-ray. At this point, they can confirm a diagnosis and decide upon a treatment approach.
Treatment will typically include a combination of in-office therapies and at-home instruction. In-office treatment will primarily involve manual therapies, such as manipulation, mobilization, and soft tissue work, to increase mobility of the median nerve as it passes through the wrist as well as elsewhere along the course of the nerve’s course if multiple entrapments are present. In-office treatment may also include modalities such as cold laser, e-stim, pulsed electromagnetic field, and more.
Between visits, patients may be advised to wear a wrist splint at night or during some activities, though not all the time, to help keep the wrist in a neutral position that takes pressure off the median nerve. They may also be instructed on exercises or stretches they can perform several times a day and/or receive instruction to take supplements or modify their diet to reduce inflammation.
While several studies support these conservative treatment approaches for managing CTS, it’s important to note they work best early in the course of the disease. The longer a patient waits to seek care, the more time it may take to achieve a satisfactory outcome. In severe cases, the only option may be surgical intervention. If you’re currently dealing with bothersome symptoms in the hand and wrist, don’t just shake your hand and carry on. Contact your doctor of chiropractic and schedule an evaluation.
Preventing Shoulder Injuries in Athletes
Shoulder injuries are common in athletes, especially those requiring overhead repetitive movements at high velocity and extreme range of motion. For example, shoulder injuries account for 19% of injuries to baseball players and nearly 40% of injuries to swimmers. Because a shoulder injury can sideline an athlete and even prematurely end their season, a current trend in sports medicine is to find ways to prevent shoulder injuries in the first place.
A systematic review conducted in 2022 looked at 25 studies conducted between 1970 and 2018 to uncover common risk factors for shoulder injuries among athletes from a variety of sports including volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis. In the final analysis of the review, the authors concluded that prevention programs should focus on strengthening the rotator cuff muscles and maximizing shoulder range of motion.
In fact, another literature review found that a pre-season range of motion evaluation may help identify athletes at risk for a shoulder injury during the coming season. The review included 15 studies involving a total of 3,313 collegiate or Olympic athletes from sports with overhead shoulder movements such as baseball and swimming. The results indicated that the risk for shoulder injury was greatest for swimmers whose external shoulder rotation range of motion fell outside of the 94-degree to 99-degree range. For baseball players, especially pitchers, an external shoulder range of motion difference between the throwing and non-throwing arm below five degrees was associated with a two-fold greater risk for shoulder and/or elbow injury.
As the saying goes, prevention is the best medicine. So if you participate in sports that include overhead movements, schedule an appointment with your doctor of chiropractic before the season starts so they can evaluate you to uncover any current conditions that may lead to issues during competition as well as instruct you on ways to augment your pre-season training regimen to maximize the function of your shoulder, including its external range of motion.
Cervical Spondylosis, Neck Stiffness, and Neck Pain
As we age, the shock-absorbing disks that sit between the spinal vertebrae in the neck can become dehydrated, leading to a condition known as cervical spondylosis (CS). Due to the thinning and reduced flexibility of the disks in the neck, the patient will experience a limited range of motion which they may describe as stiffness. In fact, the Mayo Clinic reports this is very common and affects about 85% of older adults. While a stiff neck can interfere with some daily activities, it’s when CS leads to neck pain that such a patient is most likely to visit their doctor of chiropractic. Why does neck pain affect CS patients when it does?
The first explanation is that CS compromises the disk’s ability to absorb energy and to flex and extend in response to external forces. Just picture how an old rubber ball that’s been left in the sun not only has less bounce but can break if it hits the ground hard enough. Likewise, a simple fall that may not have any effect on a young neck may be much more traumatic to that of an older person. Even something as mundane as sleeping in an awkward position can leave the CS patient with a sore neck.
Another pain generator is the result of bone spurs that form in response to the vertebrae being pulled closer to one another. This bone growth can narrow the spaces in the vertebrae the spinal nerves pass through leading to both local pain and pain referred down into the upper extremities—a conditional known as cervical myelopathy.
Currently, about 13% of adults in their third decade of life show signs of CS on X-ray. Unfortunately, with forward head posture from excessive device use that places added strain on the neck becoming more common, as well as increased obesity rates and sedentary lifestyles, there’s a great potential CS will start to become common at earlier ages. This highlights the importance of maintaining a healthy lifestyle.
When a CS patient seeks chiropractic care, their doctor of chiropractic will use information from the patient’s history, physical examination, and sometimes x-rays or other imaging tests to establish an accurate diagnosis and decide on a treatment approach. Care will typically include the application of manual therapies with at-home exercises to try and restore as much movement to the neck as possible. In more challenging cases, they may work in coordination with the patient’s medical doctor or a specialist or other healthcare provider.
Picturing Chronic Whiplash
Whiplash-associated disorder (WAD) is a condition characterized by a collection of symptoms that can arise after the sudden back-and-forth movement of the head and neck—most commonly from motor vehicle collisions. It’s estimated that 2-3 million Americans experience whiplash each year and the current data suggests as many as half may continue to experience ongoing, chronic WAD symptoms lasting longer than a year. Unfortunately, there’s no clear way to identify which patient may be at elevated risk for chronicity but a 2022 study suggests it part of the answer may have to do with drawing a picture.
In the study, researchers provided 205 chronic WAD patients with electronic diagrams of the human body and asked them to draw or fill in where they feel pain on their body. The patients also completed a Neck Disability Index questionnaire. They repeated the process a year later. The research team identified an association between perceived pain and disability (from the questionnaire responses) and the degree to which the patient’s pain was widespread (from their drawings).
This widespread pain is indicative of central sensitization, which is described as greater sensitivity to pain, even stimuli that isn’t normally painful. The system in the body that relays pain signals to the brain is the nervous system, and these signals must pass through the neck. This suggests that a nerve injury or an injury that interferes with the nervous system’s function may be a driving risk factor for chronic WAD. Interestingly, a systematic review that looked at health data from more than 390,000 WAD patients found evidence that a third of grade II WAD patients show signs of nerve injury, which would classify them as grade III WAD and necessitate a more comprehensive treatment approach. Other risk factors for chronic WAD include high initial pain and disability, current low back pain at time of whiplash event, history of neck pain, new onset headaches, post-injury anxiety, and cold hyperalgesia (high sensitivity to cold).
Doctors of chiropractic are trained to assess patients with whiplash injuries and to provide a conservative treatment approach that not only addresses the patient’s pain and disability, but also to educate them on the importance of maintaining their usual activity as best they can and to reassure them that they can get better—both of which are important for reducing the risk for persistent, ongoing symptoms. If necessary, they will team up with allied healthcare providers to provide the patient with the best possible chance for a satisfactory outcome.
Is Peanut Butter a Health Food?
Peanut butter is the creamy and ground form of dry roasted peanuts that’s enjoyed by millions of people around the world. Because peanut butter is typically 90% peanuts—the rest is a combination of additives to improve flavor, shelf life, and consistency—and peanuts are considered a healthy food, do those benefits extend to peanut butter, and should we be eating it?
One serving (one tablespoon) of peanut butter contains 95 total calories and includes 8 grams of fat (mostly unsaturated fat), 4 grams of carbohydrates, and 3.5 grams of protein. Because of its high-protein content (20% of total calories come from protein), eating peanut butter can also increase satiety, which may help reduce total calories consumed in a meal and reduce snacking between meals—both of which may aid in weight loss.
Each serving of peanut butter also includes about 7% of one’s daily fiber requirement, which benefits bowel health. Peanut butter also contains zinc, which provides anti-aging and immune system-boosting benefits. The phosphorus contained in peanut butter also promotes healthy nerve conduction, manages energy and storage, facilitates muscle contraction, and keeps bones healthy.
Natural or organic peanut butters contain fewer—if any—additives, but their natural oils separate over time and float to the surface, requiring a good stir before use. Conventional peanut butter usually contains additives to enhance taste, as well as oils that are heated and exposed to hydrogen to solidify them at room temperature. This gives a smooth, creamy texture and prolongs shelf life. No-stir peanut butter or peanut butter spread contains palm oil, which has become increasingly less describable to many health-conscious consumers due to its trans-fat content.
A 2021 study found that increasing daily nut intake (which includes peanuts and peanut butter even though peanuts are actually a legume and not a tree nut) by five grams may lower the overall risk for cancer by 3% and for pancreatic and colon cancers specifically by 6% and 25%, respectively. Additionally, the same 5 gram per day increase in nut intake can lower the risk for cancer mortality by 4%.
It’s clear that peanut butter offers a great way to include healthy nutrients and minerals in an individual’s diet. However, there are other nuts, such as walnuts, that may confer even greater health benefits. So eat a variety of nuts when you can and unless you have a nut allergy, consider eating peanut butter (preferably the organic or natural variety) in moderation as part of a healthy lifestyle.
This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
