MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Spinal Stability and Low Back Pain
When it comes to managing a low back condition, the goal of chiropractic treatment is for the
patient return to their normal daily activities as soon as possible. This not only means addressing low
back pain but also low back disability, including impaired postural control and reduced spinal
stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.
Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.
To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.
In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.
For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).
To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.
To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.
For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system. Be safe, and do these in a corner to prevent falling!
Make these exercises a habit. Consistency will help improve low back function and you’ll reduce your risk for a future episode of low back pain!
Neck Pain / Headaches
Forward Head Posture and Neck Pain
Neck pain is one of the most common complaints that drive patients to seek
chiropractic care. Sometimes the cause of injury is a known traumatic event, but in many
cases, neck pain is the result of wear and tear from poor posture—forward head posture
The head, which weighs 10-11 lbs. (4.5-5 kg), typically rests above the shoulders. When an individual’s head leans forward to look at a computer screen or to look downwards at their smartphone/tablet, the muscles in the rear of the neck and upper back/shoulders need to work harder to keep the head upright.
Experts estimate that for each inch (2.54 cm) of forward head posture, the head feels about 10 lbs. heavier to the muscles that attach to the back of the head and neck. To illustrate this, pick up a 10-pound object like a bowling ball and hold it close to your body. Then, hold it away from your body with your arm outstretched and feel how much heavier it seems and the strain it places on your body to maintain that position for even a short time.
In the short term, forward head posture is something the body can manage, but over time, the muscles can fatigue and the strain can injure the soft tissues in the back of the neck, shoulders, and upper back. To adapt, some muscles may become stronger (and some may atrophy), the shoulders can roll forward, the cervical curve can straighten, etc. Researchers have observed that forward head posture can also reduce neck mobility, especially with rotation and forward flexion movements. While these changes can lead to several negative health issues, neck pain is perhaps the most obvious and common.
When a patient presents for chiropractic care for neck pain, postural deficits will likely need to be addressed to achieve a satisfactory outcome. This can be achieved with manual therapies to restore proper motion in the affected joints and with exercises to retrain the muscles that may have become deconditioned. Additionally, a patient will need to develop better postural habits, especially when interacting with their electronic devices. While the process can take time, the good news is that it’s possible to reduce forward head posture, which can also lower the risk for neck pain recurrence.
Common Shoulder Sports Injuries
With many sports requiring overhead movements that can place the shoulder at the
extreme end of its range of motion, it’s not surprising that shoulder injuries are so common
among athletes. For instance, up to 50% of NCAA college football players have some history of
shoulder injury, which comprises about 10-20% of total injuries in the sport. When looking at
collegiate quarterbacks, one study found that shoulder injuries accounted for more than half of
injuries among players in the position. When it comes to sport-related shoulder injuries, these are
the three most common (and to complicate matters, they often co-occur):
1) SLAP (or labrum) tears: Superior (top) Labral tear from Anterior (front) to Posterior (back) tear is a term used to describe a torn piece of cartilage located along the rim of the socket. The labrum adds depth to the cup, which helps to stabilize the ball in the socket. Individuals with a SLAP tear will often report a loss of motion and power, a feeling like their shoulder could pop out of socket, and a deep ache that is hard to pinpoint when attempting overhead movements.
2) Shoulder instability or dislocation: With contact sports, there’s the opportunity for a collision that can dislocate the ball of the shoulder joint (the end of the humerus bone) from the shoulder socket. Because the muscles in the front of the shoulder tend to be larger and stronger, the dislocation will more often occur in that direction. Symptoms can include a severe, sudden initial pain followed by short bursts of pain as well as swelling and a noticeable deformity in the appearance of the shoulder.
3) Rotator cuff tears (RCTs): This is common in sports that require repetitive overhead motion like baseball (especially among pitchers), swimming, and tennis. Symptoms include a deep, hard to locate ache, weakness, and reduced range of motion (especially overhead or to the back).
In general, early/prompt care yields the best results. While there are instances when a prompt surgical procedure is warranted, treatment guidelines typically emphasize non-surgical therapies first with surgery only after all other options have been exhausted.
Chiropractic management of these conditions will often involve a multi-modal management approach that includes manual manipulation and mobilization to the shoulder’s multiple joints, the neck, and the mid back; specific shoulder exercise instruction; physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field, and more); and nutritional recommendations.
Carpal Tunnel Syndrome
When to Seek Surgical Care for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is
compressed as it passes through the wrist. One treatment option available to patients is carpal
tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected
nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS.
When is surgical treatment for CTS necessary and when should a non-surgical option be
The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.
In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.
The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.
A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that nonsurgical care provided more satisfying results in the short term with both approaches achieving similar results over time.
While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.
Whiplash Associated Headaches
One of the symptoms commonly associated with whiplash associated disorder (WAD)
is headaches. The current research suggests that up to 50% of patients who experience
whiplash-associated headaches may continue to suffer from them for up to a year or more,
and many of those will continue to have headaches as late as five years following their
whiplash injury event. There are many potential causes for WAD-related headaches, which
can include cervical injury, jaw dysfunction (TMJ), psychological distress (depression and
anxiety), brain structure abnormalities (concussion), and/or overuse of headache medications.
To address these potential causes of whiplash associated headaches, treatment may include the following:
MANUAL THERAPIES: Mobilization and manipulation, which are commonly used by doctors of chiropractic, have been demonstrated to be effective for reducing pain and improving function for many conditions, including WAD and headaches of cervical origin. Treatment may also involve massage and physical therapy modalities, depending on the patient’s needs.
EXERCISE: A review of research published between 1990 and 2015 found that craniocervical, cervicoscapular, and posture correction exercises can be helpful in the treatment of whiplash-related headaches.
STAY ACTIVE: Try to carry on with normal activities within pain tolerances, as movement is needed to keep soft tissues healthy and to ensure a continuous supply of nutrients to the cervical disks. Don’t use a cervical collar to immobilize the neck unless directed to do so by your doctor.
NUTRITIONAL SUPPORT: There are several vitamins and supplements that have been shown to reduce inflammation and/or reduce pain. These include flavonoids, curcuminoids, omega-3 fatty acids, taurine, and vitamin D. Adopting an anti-inflammatory diet can also aid in the healing process.
Doctors of chiropractic frequently use a combination of these approaches when managing WAD patients to help reduce pain and disability and assist the patient in returning to their normal activities as soon as possible.
Whole Body Health
The Reason Blood Pressure May Rise in the Winter
A 2009 study that monitored over 8,800 elderly French adults found that an individual’s
blood pressure can fluctuate with the seasons. In particular, the researchers observed that as
temperatures fell, both systolic and diastolic blood pressure could rise to unhealthy levels, but
they were unable to determine why.
However, a study published just five years later may have solved the mystery. The solution has to do with the molecule nitric oxide. Nitric oxide is a vasodilator, meaning that it causes the walls of blood vessels to relax and expand, with a resulting reduction in blood pressure.
Researchers have discovered that nitric oxide is stored in the dermal vasculature at levels much greater than are found circulating in the bloodstream. When exposed to long-wave ultraviolet (UVA) rays, the skin releases some of that stored nitric oxide into the bloodstream. Because individuals tend to spend less time in the sun during the winter months, there are fewer opportunities for the skin to release nitric oxide into the blood, dilate blood vessels, and moderate blood pressure. This may also help to explain why stroke and blood vessel rupture (aneurism) are more common in the winter months among the elderly.
How can one maintain healthier levels of nitric oxide in their bloodstream when it’s not convenient to spend time in the sunshine? The answers may be found in diet and exercise.
A 2018 study found that eating leafy greens and root vegetables and drinking beetroot juice effectively increased nitrate plasma (blood) levels for the purpose of enhancing exercise performance.
In 2020, researchers observed that schoolteachers in South Africa with greater physical fitness levels had higher levels of nitric oxide in their blood, as well as lower systolic and diastolic blood pressure readings. The research team concluded, “These results may suggest that even moderate physical activity could increase nitric oxide synthesis capacity, which in turn may mitigate the development of cardiovascular disease in this population.”
The take home message is that to maintain a healthier blood pressure, consider getting plenty of sunshine, eating leafy green and root vegetables (or drink beetroot juice), and exercising!
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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.