Monthly Pain Update – July 2023

Low Back Pain and Movement Quality

When patients present with low back pain (LBP), they usually move slowly, and they often can’t stand up straight. Even a simple task such as bending over may cause them to grimace and even require the use of their hands pushing on their thighs to return upright.

These are classic signs of lumbar instability to movement coordination impairment. Over time, the patient will adapt and adopt new movement patterns to perform their everyday tasks, which can lead to some muscles weakening while others become overworked and prone to injury. Once acute inflammatory pain is managed—primarily with the application of manual therapies like spinal manipulation and mobilization, ice therapy, nutritional/supplement recommendations, work modifications, etc.— patients may receive instruction on the “BIG 3” core strengthening exercises:

• Abdominal muscle strengthening (AMS) starts with abdominal bracing (tighten up your abs as if bracing for a punch to the midsection). This simple exercise can be done ANYWHERE (while driving, sitting, standing, lying, etc.) A great AMS exercise includes crossing one leg over the other (ankle near the knee) and using the opposite hand, PUSH your knee and hand against each other. Start with ten reps holding each rep for two seconds and increase hold time as your ab muscle become stronger.
• Lateral trunk muscle strengthening is best accomplished with a side plank or side bridge. Start from your knees first. If it’s too hard, alter and adjust the hold time and reps for your abilities.
• Low back and glut muscle strengthening includes front planks (starting from the knees) and the four-point kneeling quadruped or “bird-dog” (raising opposite arm/leg). Squats, lunges, and supine bridges help strengthen the gluts.

Patients may also be advised to add in balance challenges, such as standing on one foot with both eyes closed, as they not only stimulate the core muscles but also improve proprioception—the body's ability to sense where its various parts are in relation to one another for purposes of movement and balance.

In addition to in-office treatment, these at-home exercises will not only help you get out of pain and back to your everyday activities as soon as possible, but also reduce the risk for a future episode of low back pain.

Wrist Treatment for Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is a painful condition that occurs when tendons that attach to the elbow become overloaded. While tennis elbow can be caused by a known traumatic event, it’s more likely the result of microtraumas spread out over time that can be difficult to identify. Because of this, symptoms can come on gradually, and a patient may delay seeking care until the pain and discomfort inhibits their ability to carry out their normal work or leisure activities. It’s important to point out that tennis elbow is NOT limited to tennis players, or even athletes. Rather, lateral epicondylitis can affect plumbers, carpenters, painters, butchers, or any job or hobby that requires a firm grip and fast repetitive use of the hand and arm.

When managing the lateral epicondylitis patient, the in-office visit will likely focus on the use of manual therapies. A systematic review and meta-analysis that included seven studies on the use of manual therapies to manage tennis elbow concluded, “There is compelling evidence that joint mobilizations have a positive effect on both pain and/or functional grip scores across all time frames compared to control groups in the management of LET [lateral elbow tendinopathy].”

 As with many musculoskeletal conditions, the pain associated with tennis elbow can lead sufferers to alter their mechanics when performing some tasks, which can overstress adjacent parts of the body, such as the wrist. As such, treatment may also need to be applied to these areas, such as the wrist, for the patient to experience a satisfactory outcome. A March 2023 systematic review looked at findings from four studies and found that a three-week course of treatment for tennis elbow that included wrist manipulation provided superior results to other treatment options like ultrasound, laser, friction massage, and exercises. The authors concluded, “The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis.”

 Along with manual therapies, a doctor of chiropractic will recommend that patients perform at-home exercises, rest or modified activities, and ice application, when appropriate. A chiropractor may also prescribe a counter-force brace, commonly referred to as a tennis-elbow splint (or brace), that helps when a person can’t take time off work or wants to continue a sport. In addition to getting a proper fit, your doctor of chiropractic will provide advice on how and when to wear it.

 With such a multimodal approach to help restore proper motion to the elbow and other joints in the upper extremity, the tennis elbow patient will likely experience a reduction in pain and disability in the short term and if they follow their doctor’s self-care instructions, they can lower their risk for a recurrent episode.

Wrist Treatment for Tennis Elbow?

     Tennis elbow, or lateral epicondylitis, is a painful condition that occurs when tendons that attach to the elbow become overloaded. While tennis elbow can be caused by a known traumatic event, it’s more likely the result of microtraumas spread out over time that can be difficult to identify. Because of this, symptoms can come on gradually, and a patient may delay seeking care until the pain and discomfort inhibits their ability to carry out their normal work or leisure activities. It’s important to point out that tennis elbow is NOT limited to tennis players, or even athletes. Rather, lateral epicondylitis can affect plumbers, carpenters, painters, butchers, or any job or hobby that requires a firm grip and fast repetitive use of the hand and arm. 

When managing the lateral epicondylitis patient, the in-office visit will likely focus on the use of manual therapies. A systematic review and meta-analysis that included seven studies on the use of manual therapies to manage tennis elbow concluded, “There is compelling evidence that joint mobilizations have a positive effect on both pain and/or functional grip scores across all time frames compared to control groups in the management of LET [lateral elbow tendinopathy].”

 As with many musculoskeletal conditions, the pain associated with tennis elbow can lead sufferers to alter their mechanics when performing some tasks, which can overstress adjacent parts of the body, such as the wrist. As such, treatment may also need to be applied to these areas, such as the wrist, for the patient to experience a satisfactory outcome. A March 2023 systematic review looked at findings from four studies and found that a three-week course of treatment for tennis elbow that included wrist manipulation provided superior results to other treatment options like ultrasound, laser, friction massage, and exercises. The authors concluded, “The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis.”

 Along with manual therapies, a doctor of chiropractic will recommend that patients perform at-home exercises, rest or modified activities, and ice application, when appropriate. A chiropractor may also prescribe a counter-force brace, commonly referred to as a tennis-elbow splint (or brace), that helps when a person can’t take time off work or wants to continue a sport. In addition to getting a proper fit, your doctor of chiropractic will provide advice on how and when to wear it.

 With such a multimodal approach to help restore proper motion to the elbow and other joints in the upper extremity, the tennis elbow patient will likely experience a reduction in pain and disability in the short term and if they follow their doctor’s self-care instructions, they can lower their risk for a recurrent episode.

 

Can Whiplash Cause Persistent Dizziness?

It is estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience persistent symptoms for a year or longer after their motor vehicle collision, sports collision, or slip and fall. One of the most frequent complaints—affecting nearly seven-in-ten chronic WAD patients—is dysregulation of balance or dizziness.

Balance is complex and involves coordination between your brain and sensations in your inner ear, eye movements, and neurological signaling from the nervous system that is ultimately relayed to the brain through the neck. A 2022 study that looked at the case history of 172 WAD patients found that those with higher neck disability scores were more likely to report dizziness, suggesting that persistent dizziness is cervicogenic, or originates in the neck. These individuals are also likely to demonstrate deficits in head and eye movement control as well as impaired postural stability. The hypothesis is that injury to the muscles and other tissues in the neck during a whiplash event leads to abnormal cervical afferent (sensory) input to the sensorimotor control system, or in simpler terms, abnormal nerve function.

The good news is that two common approaches that are often used by doctors of chiropractic have been demonstrated to improve balance and reduce dizziness in WAD patients. In 2015, researchers observed that among a group of 216 WAD patients, those trained to perform neck-specific exercises experienced greater improvements with respect to dizziness and balance than those in a general exercise group. Additionally, a 2015 study found that both passive joint mobilization and sustained natural apophyseal glides applied to the cervical spine two to six times over a six-week time frame led to greater short-term and long-term improvements in dizziness and neck range of motion than a control group that received a placebo treatment.

If you’ve been involved in car accident, sports collision, or slip and fall that caused the sudden acceleration and deceleration of the neck and you’re experiencing issues such as dizziness, contact a doctor of chiropractic to determine if chiropractic care can be an effective treatment to get you back to normal activities pain-free and dizziness-free as soon as possible.

 

Knee Osteoarthritis and Fall Risk

The World Health Organization reports that falls are a significant global public health issue. In fact, each year 37.3 million falls are severe enough to require medical attention, and falls are the second leading cause of unintentional injury and deaths. For an older adult, a non-fatal fall can lead to serious injury that can result in a significant loss of mobility and independence. Research shows that knee pathologies play a part in fall likelihood.

In a study published in December 2022, researchers investigated the role of fear of falls and proprioception (the body's ability to sense where its various parts are in relation to one another for purposes of movement and balance) in 372 patients with knee osteoarthritis (KOA). The participants completed multiple questionaries and underwent several examinations that revealed that those with fewer falls had better balance and knee range of motion. Additionally, the risk for falls was highest among the patients with more severe knee pain and disability, a higher fear of falling, concurrent low back pain or diabetes mellitus, and an overweight/obese body mass index. The authors concluded that knee proprioception and range of motion are protective factors against falls.

In a separate study, researchers separated 72 KOA patients into three treatments groups: mobilization with movements, passive joint mobilization, and electrotherapy. Each patient received twelve treatments and underwent examinations before their first treatment, after treatment concluded, and one year later. The results revealed that patients in the manual therapy groups experienced better outcomes both after the completion of care and one year later, particularly with respect to knee pain, function, range of motion, and strength. The findings suggest that manual therapy treatment for patients with KOA could improve knee function and reduce the risk for falls.

In addition to care to manage KOA, one can lower the risk for falls by getting regular exercise, checking with their medical doctor to identify any medications that can raise fall risk, and create a safer home environment (slip-resistant surfaces, removing throw rugs, installing handrails and grab bars, etc.).

 

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.