MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
The Lower Back and Fall Prevention
Serious falls can lead to a number of negative outcomes in older adults, from
impaired mobility to loss of independence to early death. Thus, steps that can be taken to
reduce the risk for falls will not only potentially result in a longer life, but also help support a
higher quality of life in those remaining years.
Research has shown that seniors with a history of falls tend to have impaired balance and reduced muscle strength (especially in the back)—both of which are associated with advancing age. Let’s see if addressing these areas can reduce fall risk and what role chiropractic care may play in the process.
In one study, researchers compared three fall prevention approaches (educational classes, home safety assessments, and exercise training) and found that participants in the exercise group had the lowest risk for falls. Another study compared exercise on a stationary bike versus movement-based exercises using a video game system (called exergames). The results showed that the participants in the exergames group experienced greater improvements in mobility and balance. Taken together, these studies suggest that a movement-based exercise approach is effective for reducing fall risk, which coordinates with the research that shows that older adults with a history of regular exercise are less likely to have a serious fall.
A 2020 study involving active-duty military personnel with chronic back pain found that adding chiropractic care to a rehabilitative program featuring isometric and balancefocused exercises resulted in improved back pain, function, muscle strength, and balance compared with a control group that received no care. In another study, researchers observed that a twelve-week chiropractic treatment program was effective in improving sensorimotor function in older adults, which is associated with a reduced fall risk.
Finally, an analysis of data from 39 studies involving 17,626 seniors found that those with pain in the neck, lower back, hip, knee, and foot were more likely to exhibit poor balance, especially those with a history of chronic musculoskeletal pain.
The results from these various studies suggest that older adults can reduce their risk for serious fall by addressing current musculoskeletal complaints—of which chiropractic care is an excellent choice—and regularly engaging in exercise to improve balance and strength.
Neck Pain / Headaches
Causes of Neck Pain Outside of the Cervical Spine
When neck pain strikes, it’s often assumed the cause is also in the neck. It’s only
logical, right? In many cases, focusing on the neck for diagnosis and treatment may lead to a
satisfying result but not all the time. For some patients, neck pain may be related to a
condition elsewhere in the body, which would need to be addressed for the patient to find
One such area of the body is the shoulder. Past research has shown the conditions can co-occur, and there are also cases in which managing a cervical condition led to improved pain and function in the shoulder joint. A review of findings from four published studies found the opposite can also be the case. The review revealed that patients with chronic neck pain experienced improvements in pain and disability following a three-week course of treatment featuring scapular stabilization exercises.
A review of findings from 14 studies showed that manipulative therapy applied to the mid-back resulted in improvements in cervical pain and disability among patients with chronic neck pain.
While it makes sense that areas adjacent to the neck like the shoulder and mid-back can contribute to neck pain, the research suggests that even issues farther down in the body can play a role. A 2019 study revealed that individuals with chronic neck pain exhibited differences in walking symmetry, a known risk factor for problems in the knee and hip joints. Another 2019 study showed that patients with chronic neck pain walked with a stiffer spine. It has also been demonstrated that leg length inequality can lead to dysfunction in the knees, hips, and lower back.
The neck plays an important role in keeping the head upright and keeping the eyes level. If the neck needs to overcompensate for deficiencies in movement in the back or lower extremities, it can lead to a painful cervical condition.
Doctors of chiropractic are trained to evaluate the whole patient and identify factors contributing to the patient’s chief complaint. In many cases, a combination of manual therapies (manipulation/mobilization), specific exercises, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying treatment outcome
Can Spinal Manipulation Help Shoulder Pain or Function?
Non-surgical, conservative care to address shoulder pain, especially when caused by
shoulder impingement syndrome (SIS), is one of the most common reasons patients visit a
chiropractic office. Doctors of chiropractic often manage the condition with a combination of
manual therapies and exercises targeted on the shoulder joint.
The scientific literature is rich with studies showing the benefits of shoulder exercises to address SIS, and a poorer outcome is more likely without exercise. Manual therapies applied to the shoulder have also been demonstrated to benefit the SIS patient, and it’s common for chiropractors to use both specific exercise and manual therapies in combination when managing the condition.
Two recent studies suggest that incorporating spinal manipulative therapy can lead to even better outcomes for the SIS patient.
In one study, researchers assigned participants (half of whom had SIS) to either a treatment (thoracic spine thrust manipulation) or a sham treatment group. Before and after treatment, participants performed an arm raise test to assess scapular kinematics and note their current pain levels. The SIS patients in the treatment group reported improvements in their shoulder pain; however, there was no observed improvement in scapular kinematics among any participants.
The other study took a similar approach, except it assessed shoulder joint range of motion in addition to shoulder pain. In this study, the research team observed that mid-back thrust manipulation led to immediate improvements in both shoulder pain and shoulder range of motion in the SIS patients.
Both studies demonstrated that spinal manipulation applied to the mid-back can lessen shoulder pain (and improve shoulder joint range of motion) without administering any treatment directly on the shoulder.
This suggests mid-back dysfunction may play a role, however small, in many cases of SIS and that patients with shoulder issues should receive a thorough examination to identify all possible contributing factors to the patient’s musculoskeletal pain and disability, even those outside the area of chief complaint, something which doctors of chiropractic are trained to do when assessing a new patient.
Carpal Tunnel Syndrome
Detecting Carpal Tunnel Syndrome Early
The early symptoms associated with carpal tunnel syndrome (CTS) are often easy to
overlook or ignore because they don’t interfere too much with one’s ability to carry out their
daily activities. As such, many people don’t consider it worthwhile to take the time to make and
attend a doctor appointment to deal with the issue. In fact, many individuals with CTS wait
months or even years before seeking care when their symptoms become too activating, limiting,
and bothersome to ignore. But what if there was a way to figure out if those small complaints
were indicative of early CTS from the comfort of home?
In a 2019 study, researchers evaluated the hand movements of 22 CTS patients (seven with CTS in both wrists) and 11 age-matched controls in search of simple diagnostics that could be performed outside of a clinical setting. Investigators ended up focusing on the movement of the thumb as it moved through its full range of motion.
Researchers found that the thumbs of CTS patients moved significantly slower in certain directions when compared to those without CTS. This criterion was consistent in 27 of the 29 CTS-positive wrists, a 93% sensitivity, with a 73% specificity in the non-CTS wrists.
The researchers are using this data to program a mobile app that can be used by individuals outside of a clinical setting determine if their early symptoms warrant contacting their healthcare provider for further examination. The app can also be used in workplace settings to identify workers who may be at increased risk for CTS so that preventative measures can be taken (such as changes in ergonomics, tools, or work processes).
Perhaps the most important benefit from an app that helps identify CTS patients early on is that the condition is much easier to treat when the symptoms are mild. When a patient delays care, secondary issues can manifest, scar tissue can form, and associated soft tissues can weaken. If a patient waits too long, a full recovery may not be possible, even with surgery, and they might have to learn to live with ongoing and life-limiting symptoms.
Doctors of chiropractic are trained to diagnose and manage CTS, often with a combination of manual therapies, specific exercises, anti-inflammatory recommendations (ice and nutritional), nocturnal splinting, and ergonomic modifications. They will also check elsewhere along the course of the median nerve to make sure there are no issues in the neck, shoulder, elbow, or forearm that may contribute to the patient’s CTS symptoms. If nonmusculoskeletal causes are suspected, the patient may be referred to a specialist or their medical physician for additional care.
At-Home Exercise for Whiplash Associated Disorders
There is plenty of research supporting chiropractic care as an excellent approach for
managing whiplash associated disorders (WAD). While the in-office treatment aspect of
care—spinal manipulation, mobilization, soft tissue therapy, massage, modalities, etc.—is
important for restoring motion and reducing pain in the neck and surrounding areas, it’s the
at-home exercises that not only maintain those improvements but reduce the risk for
developing chronic pain or experiencing re-injury in the future.
When the neck is injured in a whiplash event—like a car accident—the superficial muscles in the neck will spasm to protect the nearby tissues from further injury. In the short term, this is a good thing, but if movement remains restricted, the deep neck muscles that are important for maintaining posture can become deconditioned.
As the deep neck muscles weaken, the superficial muscles that normally control voluntary movements will take on the added work, resulting in further weakening of the deep neck muscles—setting up a vicious cycle that can prolong or even prevent WAD recovery. In fact, a 2018 study followed 141 WAD patients for one year and found that those who were unable to return to their pre-injury work activities had an average of 50% reduction in neck muscle strength.
That’s why it’s important to engage in at-home exercises to strengthen the deep neck flexor muscles and put them back to work (so you can get back to your life).
One exercise can be performed by retracting your chin inward followed by nodding your head (as if you’re agreeing with what someone said). You can apply resistance by placing your fist under your chin and slowly working against both the upward and downward movements. Start at 10% maximum resistance. As you improve and as tolerance allows, add additional resistance (up to 50-75% max) and reps to your sets, enough to feel fatigue. If you apply 100% resistance, no motion will occur, which is called an isometric contraction, which works too but not as well as isotonic strengthening (resistance with movement).
There are several ways to strengthen and recondition the deep neck muscles, and your doctor of chiropractic will show you the ideal exercises for your unique case and provide additional self-care recommendations to optimize the healing process, which can include exercise advice, dietary recommendations, and nutrition supplement guidance.
Whole Body Health
Combating the Obesity Epidemic
Obesity is defined as having a body mass index (kg/m²) of 30 or higher. The Centers for Disease
Control and Prevention reports that approximately 42.4% of adults in the United States are obese, up from
30.5% just two decades ago. The current scientific literature notes that obesity is associated with an increased
risk for heart disease, diabetes, hypertension, and some cancers.
Being severely overweight can also elevate one’s risk for musculoskeletal pain conditions. In the past, researchers hypothesized that excess weight places added strain on the joints and soft tissues in the body, increasing the risk for injury. This may be a contributing factor, but a 2020 study suggests that inflammation in the body associated with obesity may be a more important risk factor for developing conditions like back and neck pain. Whatever the mechanisms, obesity can cause both long-term health concerns and can make carrying out everyday activities more difficult due to musculoskeletal pain and disability.
The good news is that even if there is a family history of obesity, it may not be due to genetics but rather shared lifestyle habits among family members. Even if an individual has a genetic predisposition for obesity, it’s not necessarily irreversible, and the research shows that engaging in healthy lifestyle behaviors can change how those genes are expressed. So while it may be more difficult for some to achieve a healthier weight, it’s certainly possible in almost every case.
Fat accumulates in the body when excess calories are stored as fat. Diet and exercise are considered the cornerstones of weight management because you can control how many calories are consumed and can take steps to affect how many are burned.
While there’s no one-size-fits-all diet, the current research supports a meal plan that includes plenty of fruits and vegetables, lean meats, healthy fats, and a lower intake of red/cured meat, added sugar, and highly processed food products. The time of day that calories are consumed may also be important. Some experts suggest eating smaller meals throughout the day while others advise intermittent fasting strategies. It may take trial and error to see what dietary strategies are best for you.
Current federal guidelines recommend 150 minutes per week of moderate intensity exercise (or 75 minutes of high-intensity exercise) as well as two resistance training sessions that target the major muscle groups. There’s no consensus on which form of exercise is the best, so you’ll want to experiment to find an exercise strategy that you enjoy and can incorporate into your lifestyle.
Of course, consult with your doctor before beginning any diet or exercise program, and don’t be afraid to ask questions or seek advice. Your healthcare provider may have insights that can accelerate the weight loss process or even recommend experts such as a dietician or personal trainer to help you. If back pain, neck pain, or any other musculoskeletal conditions are getting in the way of achieving your goals, your chiropractor can treat you in the office and provide home care recommendations to help keep such issues from flaring up in the future
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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.