MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Keeping Low Back Pain from Becoming Chronic
It’s estimated that about one-in-seven adults in the United States have chronic low
back pain (lasting longer than three months), which can have a major effect on one’s ability
to carry out their daily activities. As such, it’s important to identify which factors may be
associated with an increased risk for progressing from acute low back pain to chronic low
A systematic review published in 2020 reported that 26% of patients who seek treatment for new-onset low back pain will still have back pain three months later, and a third of these patients will continue to have low back pain at the six-month mark.
A February 2021 study reviewed data concerning 5,233 acute low back pain and found that 32% transitioned into chronic low back pain. Further analysis identified the following risk factors for chronic low back pain: smoking; obesity; severe initial disability; depression/anxiety; and a high score on the STarT Back screening tool, which looks at nine specific items (pain referred to the leg; shoulder/neck pain; difficulty walking long distances; difficulty getting dressed; fear of physical activity; worrisome thoughts; despair about condition improving; reduced ability to enjoy hobbies and other pleasurable activities; and bothersome pain). Additionally, the researchers concluded that exposure to care outside of current guidelines in the first 21 days can raise the risk for low back pain chronicity by up to 2.16 times!
So, what are the current recommendations for acute low back pain? Clinical guidelines recommend that all provider types (including chiropractors) offer reassurance to reduce fear of movement and encourage patients to maintain normal activity as tolerated. The guidelines also recommend non-pharmacological treatments including ice/heat, spinal manipulation (a chiropractic specialty), massage, or acupuncture as FIRST-LINE treatment options. Patients should avoid diagnostic imaging, specialty consults, and prescription opioids in the absence of “red flags” (cancer, fracture, or infection).
In addition to manual therapies, like spinal manipulation, to reduce pain and improve function in the low back, doctors of chiropractic will also look for dysfunction in associated areas of the body that commonly co-occur (or even contribute) to low back pain. For example, individuals with tight hamstrings may be more likely to develop back pain, and issues in the hip are often present in low back pain patients. Patients will also be encouraged to stay or become active and to engage in home-based exercises to strengthen the muscles in the low back.
Neck Pain / Headaches
Migraines and Lifestyle Choices
For adults under 50 years of age, migraine headaches are one of the leading causes of
disability. There are several potential underlying causes for the condition, of which one appears
to be a proinflammatory and oxidative state in the body. Fortunately, this can be addressed
through healthier lifestyle choices.
Low-grade or systemic inflammation happens when the immune system is chronically under stress due to the effect of obesity, smoking, excessive drinking, a poor diet, lingering injury, stress, or a combination of these things. In addition to being a potential cause of migraines, systemic inflammation is also linked to an elevated risk for cardiovascular disease, type 2 diabetes, and poor cancer outcomes.
Eating patterns such as the Paleo, DASH, and Mediterranean diets are characterized by a high intake of foods with anti-inflammatory properties (such as fruit and vegetables) and avoidance of pro-inflammatory fare, such as highly processed foods and those with added sugars. Other studies have found that the Ketogenic, low-glycemic, and even a modified Atkins diet can reduce inflammation. On the other hand, the typical Western diet is associated with a high intake of unhealthy fat and sugars, which can stimulate an inflammatory response.
It’s suspected that the gut microbiota may play a role in the inflammatory process, so consuming food that nurtures a healthy population of bacteria in the gut may benefit migraine headache patients. Other research has shown that eating more omega-3 fatty acid-rich foods can help reduce inflammation.
The diets associated with lower inflammation can also aid in weight loss, which is important because carrying excess weight can also stimulate inflammation in the body. A systemic review presented in 2019 at the annual meeting for the Endocrine Society concluded that weight loss can reduce migraine headache frequency, intensity, duration, and disability. In addition to its role in weight loss, exercise can also reduce stress, which is another driver of inflammation.
Living a healthier lifestyle isn’t easy, especially after years or decades of unhealthy habits. Your doctor of chiropractic can answer nutrition and fitness-related questions and even show you exercises that may be a better fit for your current situation. If aches and pains are getting in the way, your chiropractor can provide treatment in the office to help restore normal motion so that you can stay active—especially when it comes to the cervical spine as dysfunction in the neck has been shown to play some role in the migraine process.
Exercise vs. Manual Therapy for Shoulder Pain
Subacromial impingement syndrome (SAIS) is one of the most common causes of
shoulder pain and functional restrictions. This condition is caused when the tendons of the
rotator cuff, the head of the biceps brachii, and/or subacromial bursa are pinched or impinged
during normal movement. This results in pain and reduced function and range of motion (ROM).
Most people typically envision the shoulder as one joint, but it’s actually four joints that work together to complete complex movements. These joints include the “ball and socket” glenohumeral joint (GHJ), the acromio-clavicular joint (ACJ), the sterno-clavicular joint (SCJ), and the scapulothoracic joint (STJ).
A 2020 study compared the collective and independent movement of these joints in SAIS patients and individuals without a history of shoulder pain. The researchers observed differences between the two groups where symptomatic volunteers consistently demonstrated less SCJ posterior rotation, regardless of angle, phase, or plane of shoulder motion. There was also less STJ motion at 30° and 60° of humerothoracic elevation. The take home message is that treatment to restore movement in SAIS patients must focus on methods addressing the lost motion at the SCJ, ACJ, and STJ as well as GHJ!
What’s the best approach for managing SAIS? Two excellent conservative options include manual therapies and specific shoulder exercises. One study compared these approaches in 40 SAIS patients who had shoulder pain/disability for longer than six weeks. Patients in both groups reported similar outcomes as well as high satisfaction with their care. Another study found that patients who received both treatments concurrently achieved greater improvements in pain and function than those in an exercise-only group. Doctors of chiropractic often utilize a combination of manual therapy and specific exercises when treating patients with SAIS.
In addition to treatment focused on the shoulder joints, chiropractors will also assess nearby structures because their interaction with the shoulder can affect these joints as well. In one study, researchers reviewed MRIs of SAIS patients and found that 35% had nerve root compression on the same side as their affected shoulder, which can result in similar symptoms. Another study found that joint mobilization therapy and exercises to address dysfunction in the thoracic spine resulted in improved shoulder range of motion.
If shoulder pain and/ or reduced shoulder range of motion affects your ability to work or carry out other activities of daily living, consult with a doctor of chiropractic to see if this conservative treatment approach will benefit your condition.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome Treatment Choice
When individuals experience pain, numbness, weakness, and other abnormal
symptoms in the hand and wrist, their first thought is that it’s carpal tunnel syndrome (CTS)
followed by a worry that they’ll inevitably need surgery to resolve the condition. Some
sufferers may even contact a surgeon as their first option for care. However, treatment
guidelines do not recommend surgical consultation as an initial treatment approach for CTS.
In fact, outside of emergency situations, like a major fracture, surgery is generally only
recommended after exhausting all non-surgical options.
Part of this reason has to do with outcomes and the other part is the inherent risks associated with surgery such as reaction to anesthesia, bleeding, infection, injury to the median nerve and/or its nerve branches; nearby blood vessel injury; a sensitive scar, and a prolonged time off work post-surgically. Regarding time off work, one study reported that more than a third of patients do not return to work within eight weeks after an operation. Another study found that patients may experience reduced strength and dexterity in the hand following their procedure.
With respect to outcomes, one study that included 56 middle-aged adults who received surgical care for CTS found that only two-thirds reported an improvement in their symptoms and just one in four experienced complete resolution.
On the other hand, there are several studies showing that conservative treatment approaches—such as chiropractic care—are as or more effective than surgery for the CTS patient. In one study that included 120 women. half of participants received three manual therapy treatments and the other half underwent a carpal tunnel decompression/release procedure. The results showed that non-surgical care achieved superior results in the short term and similar results at the one-year point.
Doctors of chiropractic are trained to evaluate the whole patient and not to focus on just the area of chief complaint. In the case of CTS, pressure applied to the median nerve at any point on its way to the hand can create CTS-like symptoms. Hence the importance of reviewing the patient’s history (which may be more helpful in diagnosing CTS than diagnostic testing) and a thorough examination of the entire course of the median nerve as it travels from the neck and through the shoulder, elbow, forearm, and wrist. In many cases, a patient may have CTS in addition to another condition that’s affecting the median nerve, and both will need to be addressed to achieve a satisfactory outcome.
Five Things Many People Don’t Know About Whiplash
It’s estimated that more than two million Americans sustain a whiplash injury each year.
Despite the prevalence of the condition, the general population doesn’t know much about it. Here
are five important things everyone should know about whiplash.
1) Whiplash isn’t only caused by car accidents. Although motor vehicle collisions are the most common and well-studied mechanism for whiplash, this type of injury can occur any time there is a sudden acceleration and deceleration of the neck. Other whiplash causes include falls, sport collisions, and physical altercations.
2) The force of the impact is less important than the forces applied to the cervical spine and tissues. Studies have shown that the forces that can cause whiplash can occur at speeds as low as 5-10 mph (8.04-16.09 km/h). This is due to plastic vs. elastic deformity. That is, the LESS vehicular damage (think “plastic” breaking absorbs energy), the GREATER the forces are transferred to the contents within the vehicle (think “elastic” or bounce).
3) Whiplash injury risk increases with age. Older individuals tend to have less movement in the neck largely because of wear and tear on the disks in the cervical spine (osteoarthritis). A less flexible neck appears to be more prone to injury during the back-and-forth whiplash process.
4) You may not feel pain immediately after a crash as symptoms often will not manifest for hours, days, and sometimes even weeks. Don’t ignore injury warning signs. Experts in the field recommend an early evaluation to detect potential trauma BEFORE symptoms are apparent. Simple tests can often reveal abnormal findings. Studies show that the treatments that promote movement and enhance mobility—such as chiropractic spinal manipulation and mobilization— performed EARLY ON help to speed recovery.
5) Rest is NOT best! The MOST important “take-home” message that can be gleaned from this article is RESUME NORMAL ACTIVITIES ASAP! Although it may seem intuitively wise to rest after a whiplash injury, this approach can quickly cause the muscles to atrophy or shrink and weaken as fast as only 24 hours of bed rest. This can lead to fear of movement and reinjury, which can prolong recovery.
Doctors of chiropractic utilize physical techniques that help to restore motion, which minimizes pain and promotes recovery, an approach that falls in line with treatment guidelines for whiplash care.
Whole Body Health
Does Coffee Slow the Brain?
For centuries, people have reached for a cup of coffee to help focus the mind, but according to a
study published in 2021, a morning cup of java could have the opposite effect.
Researchers recruited 32 habitual coffee drinkers and 24 non-coffee drinkers and asked them to complete questionnaires used to measure stress, anxiety, and depression. Each participant then underwent a resting-state functional MRI scan that measured connectivity in various parts of the brain.
The coffee drinker group exhibited decreased functional connectivity in two important networks: the somatosensory, which processes sensations like pressure, pain, or warmth; and the limbic, which is involved in emotional responses and memory formation, among other things. The coffee drinkers also had decreased connectivity in the subcortical and posterior brain regions, which include motor and emotional processing as well as the visual network and the cerebellum.
Among the coffee drinkers, the researchers identified a clear association between coffee consumption frequency and reduced connectivity— the more coffee one drank, the less connectivity they had in these areas of the brain. The coffee drinkers also had elevated stress and anxiety levels, which were even higher in the heaviest coffee drinkers.
In the second phase of the experiment, researchers asked the non-coffee drinkers to drink a cup of coffee and then imaged their brains for a second time. The post-coffee scan showed altered activity in the same areas of the brain, which suggests that coffee itself is more likely to be responsible for the reduced brain connectivity, rather than individuals with reduced connectivity being more likely to desire coffee.
So, is coffee bad for you? This is just one study, and the findings may not be reproducible in another group or the data could be interpreted in another manner. That’s why researchers do follow-up studies with larger groups and more variables. Over time, as research grows on a particular topic, more scientists will conduct meta-analyses to try and come to firmer conclusions that may make their way into lifestyle recommendations or treatment guidelines.
On the other hand, there is a lot of research that drinking up to 3.5 cups of coffee a day may be associated with reduced risk for cardiovascular disease, death from cardiovascular disease, early death, and a lower risk for some cancers and conditions that affect metabolic health and liver function.
Time will tell if coffee is more bad than good for you, but the present data suggests it’s most likely beneficial, and if you enjoy the beverage, do so in moderation. And if you have aches and pains that are interfering with your ability to get into the kitchen to make a cup or to walk to a nearby coffee shop, then make an appointment with your doctor of chiropractic to see if a short-term course of treatment might help resume your normal activities.
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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.