MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Traction for Low Back Pain?
In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.
In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.
With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.
For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.
The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.
For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more— including in-office or at-home traction, if warranted.
Neck Pain / Headaches
Spinal Manipulation and Headaches
Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.
In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.
After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.
If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.
Hip-Related Injuries in Athletic Kids
The hip is a very important region of the body, especially since our upright, weightbearing activities rely on a properly functioning hip joint. With the expansive growth of youth athletic programs, the incidence of hip-related injuries and the associated disability has markedly increased. But is there a difference between young male and young female hip injuries?
We’ve all observed the rapid rate of growth that occurs from age five to age seventeen, with bone growth reaching maturity around age sixteen for females and eighteen for males. Prior to skeletal maturity, the growth plates remain open in the long bones of the body, which adds to the complexity and challenge in diagnosing and treating hip injuries in this age group.
Studies show that hip injuries account for approximately 5-9% of all athletic injuries. According to a study that looked at data from 121,047 pediatric visits at a sports medicine clinic between 2000-10, the most common hip injuries for males were labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). For females, the leading hip injuries included labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%).
The five most common sports that caused hip injuries were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%). Among adolescents (age 13–17 years), the data show that hip injuries were significantly more common in females than males. Studies have shown that young female athletes, especially in post-puberty ages, exhibit different landing and pivoting movements than males, which may help explain why adolescent females may be more at risk for hip injuries than teenaged boys.
Doctors of chiropractic are trained to diagnose and treat musculoskeletal injuries—including those of the hip joint—in patients of all ages. The key is to manage such conditions as early as possible to help patients get back to sporting activities and reduce the risk for future injuries in the hip and neighboring regions of the body.
Carpal Tunnel Syndrome
Can Carpal Tunnel Syndrome Be Hereditary?
Carpal tunnel syndrome (CTS) is a disorder caused by compression of the median nerve that alters the nerve’s function (neuropathy), leading to pain and numbness/tingling (paresthesia) primarily on the palm-side of the wrist and hand. While factors like hormonal changes and repetitive motions are known to increase the risk for CTS, there might be a genetic component to the condition.
It’s known that conditions that can elevate the risk for CTS—like diabetes, thyroid disease, rheumatoid or osteoarthritis, and obesity—can run in families. Additionally, the data show that having a family member with CTS raises the risk that you too can develop the condition, but it’s not entirely clear to what extent genetic traits are responsible versus shared environmental factors among family members.
In 2007, at the 74th Annual meeting of the American Academy of Orthopaedic Surgeons in San Diego, Harvard professor Dr. David Ring and colleagues presented their evaluation of 117 previously published studies to determine the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors. Their analysis revealed that genetic risk factors were two times stronger than the evidence supporting occupational risk factors, such as overuse.
Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or of unknown cause, further supporting genetics as the primary factor. Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there may be epigenetic factors or environmental changes to genes based on certain foods eaten or certain activities might increase a person’s risk beyond their genetic makeup. As of 2015, no epigenetic factors have been identified in idiopathic CTS.
The good news is that even if you have a family history of carpal tunnel syndrome, you can reduce your risk for developing CTS by managing any conditions or activities that can contribute to inflammation along the course of the median nerve. This includes maintaining a healthy weight, eating a low-inflammation diet, getting regular exercise, taking frequent breaks from repetitive tasks involving the hand, reducing exposure to awkward hand postures and vibratory forces, etc. If you are experiencing CTS-related symptoms in the hand and wrist, a thorough examination by a doctor of chiropractic can help identify potential causes and help you manage the condition so you can return to your normal activities as soon as possible.
Whiplash Injury, Severity, and Recovery
Experts estimate that whiplash associated disorders (WAD) from motor vehicle collisions (MVCs) affect about 300 for every 100,000 people in the Western each year. Suffice it to say, that’s a lot of people!
Crash tests have demonstrated that the risk for whiplash is much greater when the backrest is leaned backward and/or when a headrest is lacking (in older cars) or is too low in relation to the head. The key is to prevent the head from extending backward over the top of the seat, which can lead to more severe soft tissue injuries in the neck. While it’s not always possible to anticipate an MVC, past research has shown that looking forward at the time of the collision may reduce WAD injury/severity risk.
On the topic of necks, individuals with thinner necks have a greater risk for injury, which may explain why woman are more often affected by WAD than men. However, regardless of whether you are male or female, staying fit and keeping the neck muscles strong is important. It’s been suggested that individuals with a history of neck pain are more likely to experience more severe whiplash injuries, as are those in poor general health. There are conflicting studies that report that seat belt use may increase the risk for WAD, but after reviewing multiple studies, the consensus is that seat belts save lives, so buckle up!
In many cases, WAD patients may miss work, especially if they have a job with high physical demands. Patients with more severe injuries may miss up to twenty-five days of work, while those with minor injuries may still be out for up to ten days. One study found that about 31% of the 800 cases the researchers looked at took no time off work, 52% returned to work after only four days off, and 90% returned within thirty days off. About 4.9% of the patients in the study were still not working after twelve weeks.
Several factors suggest a WAD patient may experience a slower or more limited recovery: a history of neck pain; loss of neck motion measured post-MVC; increased sensitivity to cold stimulation; high pain levels post-MVC; less severe crash-type; dizziness, arm pain or numbness; low back pain; and poor expectations of recovery.
The good news is that treatment guidelines have consistently recommended spinal manipulation— he primary form of treatment provided by doctors of chiropractic—for managing whiplash-related injuries.
Whole Body Health
Omega-3 Fatty Acids and the Brain
The omega-3 fatty acids DHA and EPA can reduce the risk for cardiovascular issues and even ease depressive symptoms, but can these healthy fats also help keep our minds sharp as we age?
In one study, researchers from the University of Pittsburgh School of Medicine monitored the diets of 260 healthy, cognitively normal older adults for ten years and found that participants who consumed blackened or broiled (but not fried) fish at least once a week had healthier brains over time. In fact, a comparison of MRIs revealed that these weekly fish consumers had greater gray matter volume in the areas of the brain responsible for memory (4.3%) and cognition (14%).
Previous research has shown that people who eat more seafood have a reduced risk for blood clots and white-matter abnormalities, both of which could impair brain function. Omega-3 fatty acids promote neuron growth in the brain, improve cerebral blood flow, and reduce cellular inflammation. Researchers have also observed that adults with lower blood levels of the omega-3 fatty acids DHA and EPA in late middle age had smaller brain volumes and cognitive dysfunction as older adults compared to their peers with higher blood levels of the omega-3 fatty acids. An analysis of data from the Framingham Study cohort revealed that participants with the highest DHA levels had a 47% reduced risk for all-cause dementia and 39% lower risk for Alzheimer’s disease.
In one systemic review, researchers found that omega-6 fatty acid levels are also important for brain health. Essentially, the investigators found significant evidence that cognitive decline and dementia were more likely in those who had higher omega-6 fatty acid serum levels. This is noteworthy because fast foods are often high in omega-6 fatty acids. According to the Centers for Disease Control and Prevention, 36.6% of adults in the United States consume fast food on any given day!
While some degree of cognitive decline is anticipated with age, these findings suggest that eating a healthy diet that’s high in omega-3 fatty acids and low in omega6 fatty acids can help keep the mind sharp.
FOR YOUR FREE NO-OBLIGATION CONSULTATION CALL
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.