MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Walking Backward for Chronic Low Back Pain
Kinesiophobia, the fear of movement, is a common occurrence for patients with chronic low back pain (cLBP). Unfortunately, self-restricting one’s daily physical activity can result in muscle weakness and atrophy. This can lead to further inactivity and more muscle weakness, and subsequently, poor tolerance of normal activities of daily living, work absenteeism, and depression. When the muscles around the low back or lumbar spine become atrophied and weak, the risk for acute flair-ups of low back pain (LBP) increases, leading to more dysfunction and distress.
Studies have reported that when comparing the muscles in the front of the lumbar spine (the “flexors”) to those behind the spine (the “extensors”) in individuals with cLBP, greater amounts of atrophy and weakness occur to the extensors. The lumbar multifidus (MF) muscles are crucial for maintaining stability of the lumbar spine, while the erector spinae (ES) superficial extensor muscles are known as “global stabilizers”, which are designed to produce gross movements and to counterbalance when lifting external loads.
When treating patients with cLBP, doctors of chiropractic commonly prescribe rehabilitation/exercise programs to improve motor control, muscle strengthening, stretching, and aerobic capacity. One such exercise that may be recommended is walking backward. Compared with walking forward, studies have shown that walking backward can lead to better results with respect to cardiovascular fitness and MF muscle activation (which as noted previously, are often weaker in cLBP patients).
Additionally, walking backward works the lower limb muscles to a greater degree while reducing stress on the patellofemoral joint (the kneecap). This is important, as knee pain can commonly co-occur with low back pain, especially in patients who are overweight/obese. Walking backward also stretches the hamstrings, which are often short/tight in cLBP patients.
So not only can walking backward benefit patients who already have back pain, but adding this activity to your exercise regimen may also reduce the risk for low back pain in the first place!
Neck Pain / Headaches
Migraine Headaches and Nutrition Approaches
People with migraines know all too well about that throbbing, pulsating, and nauseated
feeling that accompanies their headaches and the associated disability that often results. The underlying cause of migraine headaches is still not well understood, but genetics (family history), chemical imbalances in the brain (serotonin, in particular), environmental factors (weather, allergens), and hormonal changes appear to play a part. Because medications to manage headaches can come with potentially serious side effects, especially with prolonged use,many patients opt for non-pharmaceutical treatment approaches to reduce the frequency and intensity of their migraines…
A 2018 survey of 4,356 American adults with a history of migraines found that common symptoms associated with migraines include sensitivity to touch (32%), food cravings (28%), and hallucinations (18%), which include sound and smell. The most common foods to trigger a migraine were chocolate at 75%, cheese (especially aged cheeses) at 48%, citrus fruit at 30%, and alcohol (especially red wine) at 25%. Other foods that may be triggers include cured meats, monosodium glutamate (MSG), aspartame (and other artificial sweeteners), snack foods, fatty foods, dairy products, food dyes, coffee, tea, cola, and nuts.
According to a 2019 study, people who suffer from migraines are often deficient in magnesium (Mg), a mineral naturally found in spinach, nuts, and whole grains. Magnesium is also important in regulating blood pressure, blood sugar (glucose), and muscle and nerve function. A meta-review of previous study findings revealed that migraine patients who received a Mg supplement reported reductions in both headache frequency and intensity. Other benefits included a decrease in hospitalization during pregnancy, and at a higher dose, a lower incidence of type-2 diabetes and stroke!
Another nutritional anti-migraine option includes the use of fever few (Tanacetum parthenium) for both prevention and treatment of migraine headaches. Other benefits of fever few include fever reduction, irregular menstrual cycles, arthritis, psoriasis, allergies, asthma, tinnitus, dizziness, and nausea/vomiting. There is also research support for the use of riboflavin (vitamin B-2), melatonin and coenzyme Q10 by migraine patients.
Doctors of chiropractic often manage their migraine headache patients using a multimodal approach that includes cervical spinal manipulation and mobilization, physical therapy modalities, home exercise training, nutritional counselling (including supplementation advice), and other conservative treatment approaches based on the patient’s specific needs.
Knee Pain and Foot Problems
Patellofemoral pain (PFP) is commonly associated with running, jumping, squatting, and walking up/down stairs. It’s thought that PFP is caused by excessive rubbing between the back of the patella and groove, or track, that it rides in. Besides overuse, additional causes for PFP pain include muscle imbalance or weakness or
direct trauma. The condition is most common in adolescents and young adults, usually due to overuse and/or misalignment, the latter of which is often referred to as poor “patellofemoral tracking.” This can eventually lead to arthritis, which is more commonly seen in older adults with PF pain.
Past research has demonstrated that issues in the foot can increase the risk for musculoskeletal pain in other parts of the body, including the knees. In a 2018 study, researchers examined the effect of knee-targeted exercise vs. a combined approach that included knee- and foot-focused exercise with foot orthotics (shoe inserts to correct pronation or the rolling inwards of the ankle and foot) in patients with patellofemoral pain.
Participants were instructed to perform terminal extension quad exercises that emphasized COMPLETE extension (straightening) of the knee. This exercise can be done sitting or lying on the back with a rolled-up towel behind the knees (with or without an ankle weight) and fully flexing the quad muscles for three to five seconds and repeating the process ten to twenty times, as tolerated.
The results revealed a significantly greater improvement in the group that included foot care, supporting the conclusion that better outcomes are achieved by combining foot exercise and foot orthotics with knee exercises. The authors reported that the benefits were still present four months after the conclusion of care but not a year, suggesting the importance of continuing exercise and foot orthotic use.
Doctors of chiropractic routinely perform posture assessments when examining patients with knee pain in order to identify dysfunction in the hip or feet that may contribute to their chief complaint.
Carpal Tunnel Syndrome
Two GREAT Treatment Options for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) has long been recognized as an occupational disease, and
though the incidence of many other occupational diseases has decreased over time, CTS appears to be becoming more prevalent.
A 2019 study looked at the impact/benefit of wrist-specific exercises and oral enzyme therapy on automotive assembly line workers with CTS (excluding those treated previously or who had a positive history of hormone replacement or current pregnancy, inflammatory joint disease, trauma to the affected hand, polyneuropathy, other relevant conditions).
Participants in the exercise group performed the following exercises at home for nine weeks:
- Deep “push & pull”: Massage the palm-side of the wrist using the thumb from the opposite hand for 30 seconds.
- “Prayer Position”: Place the palms together in front of your chest; press the fingers slowly against each other for five seconds and release for five seconds; press the palms together and then slowly lower the hands toward the floor. Repeat as tolerated, gradually
- Neuromobilization: Stand sideways to a wall; place the palm of the left hand on the wall, fingers pointing back to a “10 o’clock” position. Start with the elbow bent and slowly straighten it while bending the head sideways toward the wall (left). Slowly bend the elbow and bend the neck/head to the right. Repeat six to eight times with each hand.
The enzyme group took oral enzymes (which are known for their anti-inflammatory, antiedematous, and analgesic effects) that included 2,000 mg pancreatin, 900 mg bromelain, 1,200 mg papain, 480 mg trypsin, 20 mg chymotrypsin, 200 mg amylase, 200 mg lipase, and 1,000 mg of rutin for nine weeks divided into two doses a day.
Compared with a third group that continued their usual activities, participants in both the enzyme and exercise groups reported improvements with their CTS symptoms. Nerve conduction velocity tests also revealed improved function in the median nerve.
Doctors of chiropractic commonly utilize a multi-modal approach when treating CTS, which often include manual therapies, nutritional recommendations, exercises, activity/modifications, and overnight wrist splinting.
Reducing the Risk of Car Accident Injury
While doctors of chiropractic enjoy helping their patients get better, the preference is to avoid
injury in the first place, and if that’s not possible, to reduce the risk for serious injury. This is especially important when it comes to car accidents, as whiplash associated disorders (WAD) injuries can persist for months to years and greatly reduce one’s ability to carry out their normal activities.
One of the most important steps you can take is to focus on the road while driving and eliminate distractions, which includes not texting while driving. In one study, researchers observed that even using hands-free functions increased the risk a driver would drift into another lane, drive too closely to the car in front of them, and be less responsive to changing road conditions. Other common distractions include fiddling with the radio, eating, reading (yes, people do this!), talking with other passengers (especially if you turn your head to look at them), and driving while intoxicated, while under the influence of legal/illicit drugs or medications, or while tired.
Strategies to stay safe on the road include taking regular breaks (if driving a long distance), keeping your eyes moving (check mirrors frequently), not speeding or driving faster than road conditions allow, following traffic rules, using your signals, avoiding night and bad weather driving, heeding caution signs, and keeping your car properly serviced (including making sure there is enough air in your tires and that your tires are in good condition). Additionally, it’s important to respond quickly to vehicle recalls. As they say, “An ounce of prevention is worth a pound of cure!”
Sometimes it’s not always possible to avoid an accident. Wearing a seatbelt can reduce the risk you’ll be ejected from the vehicle in the event of an accident (which almost certainly results in fatality) or suffer more serious injuries. Making sure your head rest is properly adjusted can also reduce your risk for a serious head/neck injury.
Automobile manufacturers continue to implement safety improvements in their vehicles. For example, a review of data between 1995 to 2016 supports that vehicle safety design improvements reduced the frequency of rollover crashes from 7% to 3.5% when comparing 1995-1999 vs. 2010- 2016 model year vehicles, respectively. Starting in 1997, General Motors (GM) introduced high retention seats in their new model cars, SUVs, vans, and light trucks. A recent study compared the 1991 to 2000 Fatality Analysis Reporting System (FARS) data to the 2001-2008 FARS data to evaluate the impact of high retention seats. The data show that in rear impacts, high retention seats reduced the fatality risk from 27.1% to 16.6% and the risk of serious injury by 70.2%.
If you’re involved in a car accident, even a low-speed collision, it’s important to be evaluated by a doctor of chiropractic to ensure any soft-tissue injuries that result are properly treated as soon as possible in order to reduce your risk for ongoing pain and disability.
Whole Body Health
White Rice or Brown Rice or No Rice at All
In today’s world, consumers are inundated with contradicting news about foods that are
good for them and foods that can be detrimental to their health. Rice is one such food. Is it good for you? Is it bad? Let’s find out…
In a 2019 study, researchers in India randomly assigned 169 overweight adults (aged 25- 65 years) to consume meals that included white or brown rice twice a day, six days a week for three months. The research team used blood testing to measure glucose, insulin, HbA1c, insulin resistance, lipids, and inflammation. The results showed that those who consumed white rice had test results that suggested a higher risk of type 2 diabetes, while those who ate brown rice had blood test results that indicated less inflammation and a reduced diabetes risk.
In 2012 and 2014, Consumer Reports raised concern about the arsenic levels in US rice. In order to determine if rice consumption is associated with an increased risk for cancer, researchers evaluated data from several long-term databases that include dietary and health information involving 45,231 men and 160,408 women who were cancer-free at the start of the study and tested every four years for 26 years.
Overall, the data show that 10,833 men (23.9% of men) and 20,822 women (12.9% of women) developed cancer. Comparing participants who ate < 1 serving of rice per week vs. those who ate ≥5 rice servings per week, there was NO significant difference or associations between those who did vs. those who did not get cancer, regardless of the type of rice, cancer type, BMI, smoking status, or ethnic background. Additionally, rice consumption was not associated with cardiovascular disease, which is another leading cause of death in the developed world.
Another interesting study reported that cooking brown rice under high water pressure increased the water absorbency of brown rice without nutrient loss.
Other studies have found that fermented brown rice and rice bran appears to reduce the risk of cancers of the colon, liver, stomach, bladder, esophagus, and lung. In animal models, fermented brown rice/rice bran was also observed to reduce tumor size, though this finding has yet to be confirmed in human subjects.
Doctors of chiropractic often encourage patients to live a healthy lifestyle, which includes eating more of the foods that are good for us and less of the foods that are not. So far, the science suggests that eating white rice in moderation may not hurt you and consuming brown rice may offer some additional benefits.
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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.