MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Beliefs About Back Pain
Since the late 1980s, researchers have embraced the biopsychosocial model (BPS) to
understand both the causative and prognostic factors associated with neuromusculoskeletal disorders, which includes back pain. In order to achieve the best possible outcomes for patients with back pain, it’s important to understand the role that factors outside of the biomechanical injury model play in both the injury and recovery processes. Unfortunately,
there’s a lot of misinformation out there that can be detrimental to the patient.
In one study that included 130 low back pain (LBP) patients with persistent or recurring back pain, participants answered questions about the cause of their LBP, including what they’ve learned since receiving care. Their answers revealed that such patients see their LBP as: 1) due to the body being like a broken machine; 2) permanent; 3) complex; and 4) very negative. Nearly 9 in 10 patients (89%) indicated they learned these beliefs from healthcare professionals.
The study’s findings indicate that healthcare providers may be in the best position to educate patients about their condition. However, responses from 103 primary care physicians (PCPs) suggested that they considered biomechanical risk factors to be the most important short-term and long-term factors for a sudden episode of acute LBP.
When it comes to giving yourself the best possible chance of recovery from LBP, here are some things to keep in mind in addition to utilizing non-surgical treatments that are recommended by current guidelines, of which chiropractic care is an excellent choice: 1) Research has demonstrated that depression, anxiety, and self-limiting beliefs about future ability to work or do physical activity are psychosocial factors that are associated with poor outcomes. 2) Insufficient sleep and smoking are also lifestyle behaviors that can slow one’s recovery from injury, which includes low back pain! 3) Because movement is necessary to diffuse nutrients into cartilaginous tissue, it’s important to stay active during the recovery process to maintain joint health. Physical activity also keeps the muscles from deconditioning, especially the deep muscles that control posture.
Doctors of chiropractic are trained to approach treatment from a biopsychosocial perspective and to consider all factors that affect the patient’s chief complaint and quality of life. Through patient education, spinal manipulation, mobilization, exercise training, the use of modalities, and more, chiropractors can greatly help those struggling with back pain and other musculoskeletal conditions!
Neck Pain / Headaches
Chiropractic Treatment for Wry Neck
Wry neck, also known as torticollis, is a painful condition in which the top of the
head usually tilts to one side while the chin rotates to the opposite side. Torticollis can have several causes from infection (cold, flu, or otitis media, for example) to sleeping in a draft; however, the cause is usually unknown (idiopathic).
In a typical case, torticollis may resolve itself within four to six weeks, but with chiropractic care, cervical function can return to a more normal state much faster, often within a week. Chiropractic treatment for torticollis often includes stretching, in which manual cervical traction, spinal mobilization, and myofascial release techniques help to restore the lost range of motion and faulty posture. Once enough motion has been restored, a doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Chiropractors may also use physical therapy modalities and/or provide instruction on home-based exercises and other self-management strategies.
There’s a type of torticollis called congenital torticollis in which an infant is born with torticollis that either developed in utero or during the birth process. Current guidelines support prompt treatment for congenital torticollis versus taking a wait-and-see approach. One study found that treating infants with gentle manual therapy approaches at one month of age led to higher success rates than waiting until they were six months or older when substantially more care was needed to restore full range of motion with lower odds of success.
There is a less common but more serious type of torticollis called cervical dystonia, sometimes referred to as spasmodic torticollis, which is characterized by involuntary contraction of muscles in the neck that twist the head in a variety of directions. Cervical dystonia can occur at any age, but it’s more common among middle-aged women. While there is no known cure for the condition, there are case studies showing that cervical dystonia may respond to chiropractic treatment. In one such case study, a 59-year-old woman with an eleven-year history of cervical dystonia experienced a dramatic improvement in function (from 3/10 to 9/10 on a scale of 0 to 10, 10 being full function and 0 being no function) following a treatment regimen that included cervical spinal manipulation, reflex therapy, eye exercises, and vibration therapy.
Osteoarthritis of the Shoulder
Osteoarthritis (OA) is the most common form of arthritis and is caused when the
smooth cartilage surface of an articulating/moving joint wears away until there is bone-on-bone contact that results in both loss of movement and pain. Although OA most commonly affects the joints under the greatest load (the hips and the knees), it can occur in any moving joint, including those that make up the shoulder.
Because cartilage lacks a direct blood supply, it relies on a process called diffusion in which nutrients are absorbed into cartilage when it’s compressed by movement. Anything that restricts the movement of the joint (like inflammation or injury) can slow or cut off its supply of nutrients, placing the tissue at risk for injury and degeneration.
When a patient presents for care involving OA of the shoulder, chiropractic treatment will generally focus on improving the motion of the affected joints with manipulation, mobilization, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counseling, and home-based exercises.
Here are some additional ways to self-manage osteoarthritis of the shoulder:
- Stay Active: Movement/exercise is the BEST way to keep joint cartilage nourished and healthy. Many people can manage the pain often without medication by simply pacing themselves and by staying active.
- Eat a Healthy Diet: Keep your diet balanced and emphasize foods that reduce inflammation or swelling like omega-3 fatty acids (fish oil), ginger, turmeric, Boswellia, and more.
- Reduce the Load on the Joints: This includes losing weight, as well as modifying job/lifestyle activities that routinely place force on the affected joints.
- Get Plenty of Sleep: Several studies show that getting too little or too much sleep each night can lead to poor outcomes. Aim for seven to nine hours of restful sleep.
- Use Hot/Cold Packs: This is a great way to reduce inflammation.
- Supplements: Consider glucosamine and chondroitin.
Generally, the more advanced the case, the longer it will take to achieve a successful outcome, if at all. That’s why it’s important to seek care sooner rather than later when you experience pain in the shoulder or any other part of the body.
Carpal Tunnel Syndrome
Chiropractic Management of Carpal Tunnel Syndrome
When someone is diagnosed with carpal tunnel syndrome (CTS), there seems to be an automatic assumption that surgery is imminent or at least inevitable. However, treatment guidelines for CTS that are intended to be followed by ALL healthcare professionals ALWAYS recommend an initial course of non-surgical treatment, NOT jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed, and many patients are not given an option for anything other than surgery.
The following is an excerpt from a 2017 Washington State CTS treatment guideline:
All of the following criteria must be met for surgery to be authorized:
- The clinical presentation is consistent with CTS
- The EDS [electrodiagnostic studies] criteria for CTS have been met
- The patient has failed to respond to conservative treatment that included wrist splinting and/or injection
Medical-based non-surgical care for CTS includes: neutral position wrist splints worn at night and (in certain cases) at times during the day (studies report that 30-70% of patients respond favorably within several months of initial wrist splint use); glucocorticoids injections into the carpal tunnel (these can provide short-term relief with about 50% of
patients requiring surgery within one year); and forearm and wrist exercises.
Doctors of chiropractic often use a combined approach based on the patient’s unique case, which can include wrist splints and exercise training (as described above) along with manual therapies like manipulation and mobilization on the wrist and elsewhere along the course of the median nerve; physical therapy modalities such as laser therapy, ultrasound, and pulsed electromagnetic field; nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia; and ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions.
Studies show that, in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery (though without the potential side effects associated with going under the knife), which underscores the importance of seeking care for CTS as soon as possible.
Whiplash and Tinnitus
While tinnitus is commonly associated with a ringing sound in the ears, it can also involve a buzzing, hissing, or whistling noise. The sound can be intermittent or constant and can change in volume. The noise often intensifies in a quiet room when background noise is absent, such as at night, which can interfere with sleep. Approximately 50 million adults in the United States are affected by tinnitus, and up to 90% of people with tinnitus have some degree of noise-induced hearing loss. Though tinnitus can be due to many different causes, trauma-induced tinnitus from motor vehicle collisions is common.
Studies have demonstrated that an 8 mph (12.87 kmph) rear-end collision can result in 4.5g of neck acceleration, which can cause a sprain/strain injury to the neck that can lead to the cluster of symptoms that characterize whiplash associated disorders (WAD) such as neck pain, back pain, mental fog, headache, balance disturbance, depression, anxiety, tinnitus, and more.
Additionally, this process can also accelerate the head, essentially slamming the brain against the inside of the skull, followed by a rebound into the opposite side of the skull. This can lead to bruising on the brain, which is commonly called a concussion but is more formally known as a mild-traumatic brain injury (mTBI). This type of injury shares many symptoms with WAD, including tinnitus. If symptoms persist, the condition is known as post-concussive syndrome (PCS).
This has led researchers to speculate that WAD and mTBI often co-occur, and treatment to address cervical spine dysfunction commonly observed in WAD patients may also help patients with PCS. In a 2015 study involving five patients with diagnosed PCS, researchers observed that when the patients received manual therapy treatment to address cervical spine dysfunction, they reported improvements in several symptoms associated with PCS.
Doctors of chiropractic are highly trained to manage cervical spine dysfunction, a common sequela following a motor vehicle collision. Frequently, the many symptoms associated with WAD, including tinnitus, improve once the dysfunction is managed through manual therapies applied to the muscles and joints in the neck. If you are suffering from the aftermath of an MVC, please see your chiropractor!
Whole Body Health
Walking Backward Boosts Memory
We previously discussed how walking backward can strengthen the low back extensor muscles, which can aid in both the treatment and prevention of
back pain. According to a study published in the January 2019 issue of the
journal Cognition, walking backward (or even watching a video simulating
backward motion) may also improve one’s memory.
The study involved 114 people who participated in experiments focused on recalling images, word lists, and even details from a crime scene. Before the recall stage of each experiment, participants were instructed to walk forward, backward, sit still, watch a video that simulated forward or backward motion, or imagine walking forward or backward.
The results revealed that participants performed better in nearly every instance when they either physically walked backward, watched a video that simulated walking backward, or simply imagined doing so. Further analysis revealed that this memory boost lasted an average of ten minutes. While it’s unclear how walking backward benefits memory, psychologist Dr. Daniel Schacter of Harvard University hypothesizes that people may associate backward movement with the past, which may trigger a memory response.
When a crime has occurred, detectives will perform a cognitive interview with witnesses that involves walking them through the crime. Including a backward walking component to the process may allow witnesses to recall more details about the event, which may help solve the case.
Another interesting study reported that cooking brown rice under high water pressure increased the water absorbency of brown rice without nutrient loss.
Future studies will aim to uncover why this technique improves memory recall and if motion-based memory aids such as this can be applied to patients with cognitive impairments, either from dementia or brain injury.
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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.