MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Stabilization Exercises for Low Back Pain
Low back pain (LBP) is extremely common and will affect at least 80% of us at
least once during our lifetime, with many experiencing recurring or prolonged chronic
episodes. While chiropractors often utilize manual therapies—like spinal manipulation—
to manage low back pain, he or she may also recommend spinal stabilization exercises as
part of the treatment process.
Studies have shown that patients with low back pain often have weakness in their core muscles. In particular, certain important deep involuntary muscles like the fine rotators of the spine called the lumbar multifidus can become deactivated and out of sync or coordination with other core muscles like the transverse abdominus and gluteus maximus during normal movement patterns. This loss of lumbar spine support increases stress and load on the spine, which can lead to injury and/or poor treatment responses.
Core stabilization exercises are intended to help reactivate normal muscle function, which increases spinal stability, promotes neuromotor control in the lumbopelvic region, and induces inter-segmental stiffness to prevent shear forces that lead to injury and/or poor recovery and chronic low back pain.
Examples of core stabilization exercises include the plank, the side plank, the bird dog, and the bridge, as well as movements that incorporate a stability ball. Based on your particular case, your doctor of chiropractic can provide recommendations on which exercises to focus on.
So, just how good are core stabilization exercises in the management of chronic low back pain? A 2021 systematic review found that core stabilization exercises benefit patients with both short-term and long-term low back pain more than other exercise approaches like general strength and stretch training, treadmill walking, and use of various training devices. Additionally, core stabilization exercises work even better to reduce pain and disability and improve the strength and function of the core muscles when combined with other treatment approaches like spinal manipulation, mobilization, and myofascial release technique—forms of treatment that are performed by doctors of chiropractic.
Neck Pain / Headaches
What Is Occipital Neuralgia?
Occipital neuralgia (OccN) is a somewhat rare form of headache that affects about 3 in 100,000 people a year. How is OccN different than other forms of headache and what treatment approach might a doctor of chiropractic take to manage the condition?
This type of headache is characterized by a sharp, shooting pain that radiates into the back of the head, and it’s often felt at the top of the head or above an ear, depending on which of the three occipital nerves are irritated (C1-3). Additional symptoms may include aching, burning, or throbbing that may be only on one side of the head or both. If the trigeminal nerve is also affected, the patient may feel pain in the orbit or behind the eye. Patients may also report light sensitivity, scalp tenderness, and pain when moving the neck.
Occipital neuralgia is a secondary form of headache, which means it has a known cause. In the case of OccN, the underlying cause can be neck or head trauma, neck muscle tension, neck osteoarthritis, neck tumors, cervical disk disease, infection, gout, diabetes, and/or blood vessel inflammation the irritates the occipital nerves that exit out of the upper neck or cervical spine and run into the scalp.
During the chiropractic examination, your doctor of chiropractic will be on the lookout for red flags or non-musculoskeletal causes, like suspected infection or a tumor, that would be reason to refer you to the emergency room or your medical physician. If necessary, diagnostics like x-ray or more advanced imaging may be utilized to provide a clear picture of the cause of injury to formulate a treatment plan.
A literature review published in 2020 recommended that initial care for OccN should be a conservative approach that’s focused on alleviated muscle tension and postural improvement—common goals embraced by most, if not all, chiropractors.
A chiropractic treatment plan for OccN would likely include manual therapies, like spinal manipulation and mobilization, complemented by modalities, at-home exercises targeting the cervical muscles, nutrition advice, and other forms of self-care, like heat/ice.
Hip Pain and Runners
Running is a form of exercise that many people utilize to stay in shape, lose weight, and
reduce stress, among other reasons. While many avid runners do their best to ignore hip pain
while on the road, trail, track, or treadmill, there is a point when their pain forces them to seek
care. Let’s discuss the most common causes of hip pain seen in recreational runners…
There are two main categories of hip pain: intra-articular (within the joint itself) and extra-articular (outside of the joint). The most common causes of intra-articular hip pain are osteoarthritis and labral tears. Perhaps the most common cause of extra-articular hip pain is bursitis.
Osteoarthritis (OA) is caused by wear and tear often tied to sports and/or weight bearing occupations, and it is more common in the elderly. Your doctor of chiropractic is well-versed in identifying those with OA-related hip pain and can manage the disease up to the end-stage when “bone-on-bone” contact occurs. At that point, hip replacement becomes the standard of care.
Labral tears can be trickier to identify because advanced imaging such as MRI is often needed since the labrum does not appear on standard x-rays. If a tear is present, then care will focus on improving range of motion and flexibility, as well as addressing muscular imbalances in the hip and associated areas.
Bursitis occurs when the bursa—a fluid-filled sac that lubricates areas where friction is common such as at muscle-tendon attachments to bone—becomes inflamed, which can cause pain and affect joint motion. In the hip, there are two major bursae—one at the greater trochanter (the bone that sticks out of the side of the hip by our pants front pocket) and the other at the ischial tuberosity (the “sitting bones” in the buttocks). Another hip bursa is the iliopectineal located in the front of the hip in the groin area in front of the hip and under the hip flexor muscle. Chiropractors frequently manage bursitis using a combination of manual therapies, physical therapy modalities, activity modifications, and home instructions on ice massage and exercise training.
Doctors of chiropractic are well versed in managing many common conditions that affect the hip, as well as conditions in the low back, sacrum, buttocks, pelvis, and lower extremities that can contribute to or co-occur with hip pain. For runners, as with most patients, one of the primary goals of treatment is to reduce pain and restore function so that they can resume their normal activities as quickly as possible.
Carpal Tunnel Syndrome
Cervical Disorders and Carpal Tunnel Symptoms
Neck pain is the second most common reason that patients seek out chiropractic care. While the
initial paperwork patients complete will ask about pain and disability in other areas of the body, many
might overlook issues like mild or infrequent numbness in the hand because they think that it's unrelated
and not something to be concerned about—at least at the moment. But once care begins, a patient might
notice those “carpal tunnel syndrome” symptoms seem to resolve. Why’s that?
First, it’s important to understand that carpal tunnel syndrome is caused by pressure placed on the median nerve and restricting its mobility as it passes through the wrist. This can be the result of inflamed tissues due to rapid, repetitive hand movements or from swelling cause by hormonal issues, like pregnancy.
However, the median nerve doesn’t just appear out of nowhere and travel into the wrist to innervate the hand and fingers. It runs from the cervical spine, through the shoulder, and down the arm, passing through a variety of tissues that are all capable of placing pressure on the nerve. When this occurs, symptoms like pain, numbness, tingling, and weakness in the hand and wrist—the textbook symptoms of carpal tunnel syndrome—can manifest, even if there is no issue in the wrist.
Additionally, problems affecting the median nerve as it exits the neck can also make it more susceptible to problems elsewhere. An example of this can be seen in a 2021 study that found that patients with a cervical spinal cord injury have a two-times increased risk for carpal tunnel syndrome. Another study, also published in 2021, found that patients with double crush syndrome—compression of the median nerve at two locations along its course, which may include the wrist—are more likely to have reduced spinal mobility and abnormal alignment in the cervical and thoracic spine.
Because musculoskeletal disorders that affect the neck can produce or contribute to symptoms in other regions of the body, a doctor of chiropractic will examine the whole patient when they come in for complaints like hand and wrist pain. This will also include an examination of the shoulder and arm to look for other causes of median nerve interference. A study published in 2016 found that about 6% of carpal tunnel syndrome patients also have a condition called pronator teres syndrome, which is restriction of the median nerve as it passes through the forearm.
Treatment will aim to address all potential causes of median nerve entrapment observed during the initial examination using a multimodal approach that can include spinal manipulation, joint mobilization, soft tissue work, nutritional recommendations, nocturnal splinting, activity modifications, and specific exercises. If non-musculoskeletal issues are suspected, the doctor of chiropractic may co-manage the condition with an allied healthcare professional such as the patient’s medical physician or a specialist.
Four Whiplash Myths
Whiplash associated disorders (WAD) describes a constellation of symptoms that can
arise from the sudden jerk or snap of the head/neck that results in the overstretching of joint
capsules, ligaments, muscle tendons, disks, and nerves of the neck and upper back. While it’s
estimated that about two million Americans experience a whiplash injury each year, there’s a lot
of inaccurate information on WAD. Let’s discuss four common whiplash myths…
Myth #1: Whiplash Is Only Caused By Rear-End Automobile Collisions. Although most WAD injuries are associated with this mechanism, impacts from other directions can also lead to whiplash injuries, as can a slip and fall, sports collision, or even a physical altercation.
Myth #2: Low-Speed “Fender Benders” Don’t Cause Whiplash. It does NOT take a lot of force to become injured. Studies have demonstrated that a collision as slow as 5-10 mph can cause bodily harm. This is partly because modern vehicles are designed to crumple and absorb energy during more forceful impacts. In a low-speed crash, these forces can be transferred to the occupants of the car.
Myth #3: There’s No Rush to See a Doctor. It’s very common for people to delay seeking treatment if it’s not an emergency and if they feel like taking time off work to make a doctor appointment might be more inconvenient than their aches and pains. Or they might think they can self-manage the condition with over-the-counter medications or home remedies. However, in most instances, WAD will not go away on its own, and delaying care can actually increase the risk that one develops chronic WAD.
Myth #4: Recovery from Whiplash Requires a Lot of Rest. Years ago, treatment recommendations emphasized bed rest and a cervical collar. However, the current research supports the opposite approach: continue your normal daily activities as much as possible. Excessive rest and immobilization can weaken tissues, especially cartilage that requires movement to receive nutrients. Here’s the bottom line: If you’re involved in a car crash or another form of serious collision, get checked out by a healthcare provider as soon as possible. Doctors of chiropractic are a great option, and studies support that early intervention with manual therapies and other forms of conservative care can effectively manage most acute WAD symptoms and reduce the risk for chronicity.
Whole Body Health
How to Improve Cholesterol Levels
Cholesterol is a type of lipid—or fat—that’s used by the body to build healthy cells. When
transported through the blood, cholesterol is generally attached to a protein, creating a lipoprotein. There
are two main types of lipoprotein, low-density and high-density, which are also referred to as the bad and
good forms of cholesterol, respectively.
Low-density lipoproteins (LDL) transport cholesterol through the blood so it can be delivered to their intended cells throughout the body. If there are more than needed, LDLs can accumulate in the arteries as they await removal from the body, just like how you place the garbage can on the curb or in the alley the night before trash pickup.
That’s where high-density lipoproteins (HDL), the “good” cholesterol, comes in. These lipoproteins act like sanitation workers and pick up excess cholesterol and take it to the liver so it can be broken down and either reused or excreted from the body. If HDL levels are too low, then the “trash” will accumulate on the walls of the arteries, causing them to become more narrow and rigid, setting the stage for stroke and other serious health events.
While there is a genetic component to LDL and HDL levels, the current consensus is that lifestyle is the driving force behind one’s blood lipid readings. Unfortunately, the lifestyle typical to the United States and other Western countries is very good at creating LDL levels that are too high and HDL levels that are too low.
To keep cholesterol levels in balance, consider the following lifestyle modifications as they can either directly or indirectly affect HDL and LDL readings:
1) Meet exercise guidelines of at least 150 minutes of moderate-intensity exercise a week.
2) Limit/avoid trans fats, foods high in saturated fat like meat and whole-dairy products, and foods prepared with shortening (cakes, cookies, fried foods, and some margarines).
3) Don’t smoke.
4) Avoid excessive alcohol consumption.
5) Eat more nuts.
6) Get sufficient, restful sleep each night.
7) Maintain a healthy weight, blood pressure, and blood sugar level.
8) Eat more servings of fruits, vegetables, nuts, and omega-3 fatty acid-rich foods.
9) Spend some time in the sun each day.
10) Get a lipid panel as part of your annual check-up.
Of course, if aches and pains are hindering your ability to live a healthier lifestyle, make an appointment with your doctor of chiropractic.
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.