MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Physical Activity and Low Back Pain
It’s common for individuals with low back pain to avoid any movement they feel
may worsen their condition. Over time, this behavior can lead to deconditioned back
muscles, setting the stage for either prolonged back pain or later recurrence. That’s one
reason why treatment guidelines recommend patients continue to be active during the
recovery process. But what about physical activity before back pain occurs? Does
exercise reduce one’s risk for back pain in the first place?
In a 2019 study, researchers reviewed data concerning 4,246 Finnish men and women (average age 34 years) and found that those who routinely engaged in five or more sporting activities and/or endurance sports (especially running and cycling) were less likely to have radiating or non-radiating back pain. Meanwhile, those who focused on strength training only had a reduced risk for radiating back pain. The authors concluded that participating in a diversity of sporting activities, especially endurance sports, may be best for reducing the risk of both radiating and non-radiating low back pain.
Another study that analyzed data concerning 4,022 men approaching middle age revealed a clear relationship between lower physical activity levels and a greater risk for chronic low back pain. This finding persisted even after researchers controlled for obesity, which is also a risk factor for back pain.
A 2020 study that utilized data concerning 7,565 older men came to a similar conclusion. In the study, researchers calculated each participant’s total physical activity levels and found that the more one moved during the day, the lower their risk for chronic low back pain. The data show that even intermediate levels of physical activity cut the risk for chronic low back pain by as much as 25%.
The findings of each of these studies suggest that staying physically active can reduce one’s risk for low back pain during each phase of adulthood, especially with the utilization of endurance exercises. If you’re suffering from back pain and have become inactive, your doctor of chiropractic can help identify simple exercises you can perform at home to increase your physical activity levels and help you get out of and stay out of pain.
Neck Pain / Headaches
Exercises to Reduce Neck Pain Risk
As desktop computers, laptops, tablets, e-readers, and smartphones take greater importance in
our lives, more and more people are consulting with healthcare providers for musculoskeletal
conditions like neck pain. Why is this the case, and are there things that can be done to reduce one’s
risk for neck pain in today’s modern world?
When using electronic devices, it’s common for individuals to lean forward and/or look downward. When the head rests in front of the neck and shoulders, the muscles in the back of the neck must work harder to keep the head upright. Over time, forward head posture (FHP) can lead to inflammation and injury in the back of the head/neck, shoulders, and upper back resulting in pain and disability. Past studies have shown that up to 60% of neck/shoulder pain patients have FHP, which suggests that taking steps to reduce FHP may have a dramatic effect on the prevalence of neck pain in the general population.
The following exercises can help improve one’s posture, thus reducing the risk for neck pain (they also benefit patients with neck pain):
1) Stretch the pects, or chest muscles, by grasping a door jam and rotating your body away.
2) Shoulder external rotation strengthening. Lay on your side, elbow bent, and lift/rotate a LIGHT dumbbell toward the ceiling and slowly lower it.
3) “Flies”. Strengthen the interscapular muscles by laying prone and raising the arms up toward the ceiling (like you’re flying), squeezing the shoulder blades together.
4) Chin Tucks. Tuck your chin and nod the head to strengthen the deep neck flexors.
5) Neck Stretches. Pull your neck to the side, look up, and turn toward your pulling hand, followed by looking down and turning away from your pulling hand.
Staying physically active can also reduce your risk for neck pain. In a year-long study involving 367 sedentary workers, those who increased their daily step count by 1,000 steps cut their risk for neck pain by 14%! So, if you work in an office, set a timer to remind yourself to get up and walk around and/or perform the above exercises (at least #4 and #5, which can be done from your seat). Breathing exercises and meditation can also reduce neck muscle tension.
In addition to using manual therapies like mobilization and manipulation to treat patients with neck pain, doctors of chiropractic frequently recommend home exercises like those listed above to improve forward head posture and strengthen the neck muscles to not only reduce neck pain but also to reduce the risk for neck pain recurrence.
Knee Injuries in Youth Soccer Players
There are over 3 million registered youth soccer players in the United States.
While playing organized sports offers many benefits to children and teens, the activity
also comes with the possibility of injury—especially knee injuries among female
There are two types of injuries associated with soccer: acute and overuse. Acute injuries have an immediate onset of symptoms and, typically, a clear cause of injury. For example, a player twists their ankle while making a sudden change in direction. Overuse injuries are caused by repetitive microtrauma that eventually results in an injury with no clear cause. In the world of youth soccer, overuse injuries account for a greater proportion of overall injuries.
One study looked at data concerning 12- to 15-year-old female youth soccer players in order to identify the rate and number of overuse injuries, the anatomic location, type of injury, and any risk factors for injury.
The researchers found that the incidence rate for first-time lower-extremity overuse injuries was 1.7 per 1,000 athlete-exposure hours (AEH) and for repeat injuries, 3.4 per 1,000 AEH. Players with knocked knees were 3.2 times more likely to have a knee injury, while those with stronger leg muscles (hamstrings and quadriceps) had a 30-35% lower risk for a knee injury. Additionally, those who played throughout the year had a 2.5 times higher risk for knee injury than those who only played on one team each year or who played a variety of sports. The findings underscore the importance of strengthening the leg muscles, avoiding sports specialization, and taking steps to correct faulty knee posture as a means for reducing the risk of knee injury in this population of athletes.
Doctors of chiropractic commonly treat athletes who participate in many different sports—both for recovering from injury and reducing the risk of injury in the first place—using a combination of manual therapies, specific exercises, and nutritional recommendations.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome Linked to Migraine Headaches
Carpal tunnel syndrome (CTS) is a condition caused by compression of the median
nerve as it passes through the wrist that’s characterized by pain, numbness, tingling, and
weakness in select parts of the hand. The result of a 2019 study suggests that CTS may be
associated with migraine headaches. How can these two seemingly disparate conditions be
The study itself analyzed data gathered from a survey of nearly 26,000 adults in the United States. In particular, the researchers looked at responses to questions about CTSrelated symptoms within the previous year and whether or not respondents had a migraine in the past three months. The results showed that 3.7% of participants had CTS symptoms in the last twelve months and 16.3% had a migraine in the last 90 days.
When the research team compared those with CTS symptoms and those with migraines, they found that roughly a third (34%) of CTS-positive respondents also reported migraines, which is about 2.6 times more than study participants who did not experience CTS-related symptoms. On the other hand, 8% of individuals in the migraine group had CTS-associated symptoms in the last year compared with just 3% in the non-migraine group.
The relationship between the two conditions indicates they may share one or more underlying cause. One such cause may be cervical dysfunction. While CTS is generally described as a condition caused by compression of the median nerve at the wrist, pinching of the median nerve anywhere along its course from the neck to the wrist can generate hand/wrist symptoms. In many cases, a patient complaining of such symptoms may have median nerve entrapment in several areas that all need to be treated to achieve a successful outcome. While there are many potential triggers for a migraine episode, the root cause/s of the condition are not well understood. However, several studies have found that patients with migraines are more likely to have trigger points in their neck muscles and other cervical issues, and treatment to improve function in this area can reduce the intensity and frequency of migraines.
With both conditions, it’s important to undergo a thorough examination to identify any and all contributing factors—including cervical dysfunction. Doctors of chiropractic are trained to address such issues with manual therapies including spinal manipulation, mobilization, and trigger point therapy, in addition to modalities, nutritional recommendations, and specific exercises.
How the Brain Changes After Whiplash
Whiplash associated disorders (WAD) is a term applied to a constellation of
symptoms that can arise following a motor vehicle collision (MVC), slip and fall, or
sports injury. It’s estimated that up to 25% of WAD patients fail to fully recover from
their injury and new research suggests this may be due to changes in the brain.
Past studies have reported that chronic WAD (cWAD) patients are more sensitive to stimuli like a pin prick than individuals without WAD. This is a called central sensitization (CS). In a 2019 study, researchers used functional MRI to measure blood flow to various parts of the brain in 20 women (12 with cWAD, 8 without cWAD) following various levels of electric stimulation. The research team observed distinct differences in blood flow to areas of the brain involved with pain perception and processing sensory information. This correlation offers a distinct, physiological explanation for cWAD symptoms and should improve the awareness about the disease for both doctors and the public.
During the whiplash process, the brain can collide with the inside of the skull causing bruising or even more severe injuries (also known as traumatic brain injury or concussion). While seatbelts are a lifesaver and should always be worn when you’re inside a moving vehicle, studies have demonstrated that the oblique angle of such restraints can cause the body (including the head) to twist during a collision. This torsion can lead to the brain twisting within the skull, stretching and damaging the small nerve fibers. Though these damaged nerve fibers often heal, they sometimes do not, which is believed to contribute to cWAD symptoms.
The good news is that there is a growing awareness of concussions and other brain injuries, which may aid in the treatment of WAD patients to reduce the risk their condition becomes chronic. Chiropractic care that includes a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation) has been demonstrated to benefit patients with concussion symptoms following a whiplash injury.
Whole Body Health
The Many Benefits of Fasting
The term “intermittent fasting” (IF) describes a variety of eating patterns in which an
individual restricts calories for a given timeframe, which typically ranges from twelve hours to
several days on a recurring basis. The current research suggests that IF optimizes physiological
function, enhances performance, and can slow the aging and disease processes. But how does it do
1. Autophagy: This is the body’s natural process that removes old, broken down dysfunctional cell parts and proteins, including cells that may become cancerous. Researchers believe that reducing the energy needed to process food allows the body to utilize those resources for autophagy, which may improve longevity and overall quality of health.
2. Cancer Prevention: Though additional research is needed to better understand how IF can prevent cancer, researchers have observed that fasting results in a significant reduction of insulin growth factor (IFG-1), which has been linked to prostate and breast cancers.
3. Immune Boost: Fasting stimulates stem cells to produce new white blood cells, which helps fight off infections and toxic stress such as during chemotherapy treatment.
4. Decreases Insulin Resistance: Consuming carbohydrates causes the pancreas to produce insulin, a hormone that helps balance blood sugar levels. Though restricting calories benefits insulin sensitivity, IF does the same thing only better.
5. Reset Your Taste Buds: Prolonged fasts can reset your urge to eat by increasing your sensitivity for sweet and salty tastes, thus reducing the urge to consume unhealthy, processed foods.
6. Liver Health: Liver cells regenerate in the absence of food, which means that fasting may promote liver regeneration.
7. Mental Focus: The current research suggests that fasting is associated with increased focus and clarity. Try delaying your first meal of the day to see if it benefits your early work activities.
8. Metabolic Boost: Research shows that fasting can boost one’s metabolism by 14% within three days, which can aid in weight loss.
9. Reduces Hunger: Fasting is associated with a reduction of ghrelin, a hormone released by the stomach that increases appetite.
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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.