MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Spinal Stenosis and Non-Surgical Care
It’s common to see older adults with a slumped posture, and though there are many
possible reasons for this, perhaps the most common cause is a condition called spinal
The Mayo Clinic notes that spinal stenosis can result from wear-and-tear that narrows the spinal disks. This narrowing can place pressure on the nerve roots as they exit the spine prior to traveling down into the legs. The symptoms—which can include pain, numbness/tingling, and weakness—typically come on gradually and may worsen over time. The spinal stenosis patient may feel more comfortable by leaning or bending forward as this posture opens the holes in the spine (the foramen), taking pressure off the nerves.
Because spinal stenosis is a condition caused by wear-and-tear, some individuals may be at more risk than others, especially those with a history of spinal/disk injury, heavy labor, poor nutrition, or obesity.
The good news is that patients with spinal stenosis can benefit from non-surgical approaches!
In a 2019 randomized trial involving 259 seniors with spinal stenosis, researchers compared the effectiveness of three approaches: medical care (including epidural steroid injections), group-based exercise, or manual therapy (spinal mobilization performed by a doctor of chiropractic) with individualized exercise (stretches and strength training).
While participants in the medical care and exercise-only groups reported some benefits, the research team noted that the patients in the manual therapy plus individualized exercise group experienced greater improvements with respect to pain, function, and walking ability.
The “take-home” message here is that in all three measured outcomes—pain, function and walking ability—the chiropractic approach did the BEST! If you suffer from spinal stenosis and its associated symptoms and walking limitations, PLEASE consider chiropractic not only as an option but perhaps as this study points out, the BEST option!
Neck Pain / Headaches
Headaches May Suggest a More Severe Concussion
Cervical dysfunction is often a cause or contributing factor of headaches, especially those
that occur following a sports injury, slip and fall, or motor vehicle collision. The results of a
2019 study suggest that headaches may also indicate when a patient has a severe traumatic brain
In the study, researchers asked 121 children with a history of TBI to fill out a questionnaire called the Sports Concussion Assessment Tool (SCAT). A higher score on the SCAT is indicative of a more severe TBI. Among the participants, the SCAT revealed that a third (40) reported headaches following their injury. When the researchers compared the SCAT scores of the kids with post-TBI headaches and those without headaches, they found that the participants who experienced headaches scored five times higher (median score 45.5 vs. 9). These children also performed worse on cognitive assessments involving color naming, matrix reasoning, letter sequencing, and letter switching.
The authors concluded that when headaches are associated with TBI, higher symptom scores (i.e. more severe symptoms) for ALL other symptom categories (sleep, mood, sensory, and cognitive domains) can be expected. In addition, those with headaches also tested worse on neurocognitive examinations.
Interestingly, a study that included a wider age range reported that headache “is consistently the most common symptom following concussion and occurs in over 90% of athletes with sport-related concussion,” which is much higher than the 33% found in the above mentioned study.
Another study that analyzed information from two large databases found that patients who are hospitalized for headache symptoms associated with TBI are two times more likely to experience more frequent or worse headache symptoms over the following decade. Thus, the worse the initial TBI, the more likely headaches will persist or worsen.
These studies suggest that when an individual suffers a TBI from a sports injury, slip and fall, or car accident AND they have headaches, their condition may be more severe and may require more specialized care or intensive treatment to achieve a successful outcome. These injuries can also affect the cervical region, which may explain why patients with TBI benefit from many of the same treatment approaches doctors of chiropractic use to treat whiplash associated disorder patients.
Running and the Knees
Running is one of the most popular forms of exercise, largely because it can be done almost anywhere
at any time and it doesn’t require much in the way of equipment (other than a pair of running shoes). While
there is a common belief that running always leads to osteoarthritis (OA) of the knee, the current research
suggests that running may reduce the risk for knee OA and it can also improve pain and disability in patients
who have developed the condition. Here are four tips for reducing the risk of experiencing a running-related
injury so that you can reap all the benefits this activity has to offer…
Tip #1: Practice good form. Avoid running like you’re on a tight rope or balance beam (crossover gait). Practice walking, and then slowly run while keeping your feet apart (about the width of your pelvis). A crossover gait is bad because it increases foot/ankle pronation (rolling in), knee valgus stress (knock-knee affect), hip internal rotation (turns in), hip adduction stress (pulls on the outer thigh and impinges the hip), and low back extension (too much arching)—ALL of which can lead to injury in multiple body regions, including the knees!
Tip #2: Wear the “right” shoes for your foot. Dip your foot in water and look at your footprint on the floor. If your foot looks wide, you have a flat, pronated foot and a “motion control” shoe (designed for the low or no arched foot) is recommended. Avoid stiff soled shoes as they reduce the ability to feel the ground, leading to new or further injuries. If your footprint looks skinny, a “cushioned” shoe designed for the high arched foot is ideal as it absorbs the shock caused by the lack of pronation. If your footprint is between skinny and wide, a “stability” or “neutral” shoe designed for the normal arched foot is ideal. If you’re not sure, consult with a representative at your local running store. Many businesses that cater to runners have equipment on site to help identify the best shoe for you. Also, remember to replace your shoes every 250 miles REGARDLESS of your foot and shoe type!
Tip #3: Avoid progressing too fast. The tendency is to want to get into shape NOW! This can lead to overtraining and places too much stress on the body, which can result in injury. Practice the 10% rule. If you ran ten miles in total last week and you want to increase your total distance, try adding 10% to each run so you achieve a total of eleven miles this week.
Tip #4: Strengthen your legs and hips with these exercises: 1) Posterior lunge - Stand and reach back with your left leg while squatting down as if to touch your left knee to the floor while bending your right knee (arms out front for balance). Go as far down as you COMFORTABLY can, keeping the right knee behind your toes. Repeat on the other side. Go slow, start with a half or quarter lunge to avoid injury! 2) Advanced Clam - Lie on your side, raise the upper leg and rotate the hip in and out slowly. 3) Side Plank Leg Raise - Lie on your side, legs straight (advanced) or bent (easier), and raise the pelvis off the floor (elbow under the shoulder), then raise the upper leg toward the ceiling.
If you feel as though running is causing pain or worsening existing pain, then consult with your doctor of chiropractic. He or she can examine your body and mechanics and provide conservative treatment to help make sure your next run is as pain free as possible.
Carpal Tunnel Syndrome
The Chiropractic Approach to Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition that occurs when pressure is applied to the
median nerve as it passes through the wrist resulting in symptoms such as tingling, numbness, and
weakness. Outside of an emergency leading to a sudden onset of such symptoms—like a broken
wrist—surgery is rarely advised as a first-line treatment. In general, treatment guidelines recommend
exhausting all non-surgical options before consulting a surgeon. So, what happens when a patient
consults a doctor of chiropractic for CTS?
First, the patient completes paperwork regarding their current symptoms and their health history. The information provided will inform the doctor about the chronicity, frequency, and intensity of the patient’s symptoms. The history may also reveal conditions that are known to contribute to an elevated risk for CTS such as diabetes, birth control pill usage, pregnancy, hypothyroid, etc.
Next, the doctor of chiropractic will conduct a thorough examination, with added focus on the course of the median nerve. The median nerve arises from the spinal cord in the neck as nerve roots travel down through the shoulder, past the elbow, and through the wrist. If the nerve is compressed anywhere along this route, a patient may experience CTS-like symptoms, so it’s important to locate where the nerve is “pinched” in order to ensure the best chance for a positive outcome. To complicate matters, the median nerve may be compressed at several points, a condition referred to a double crush or multiple crush syndrome. Not only that, but the median nerve isn’t the only nerve that supplies sensation to the hand. When entrapped, the ulnar and radial nerves can also produce symptoms in the hand and these symptoms can be mistaken for CTS by the layperson because it’s the most commonly known peripheral neuropathy.
Once all the potential contributing factors to the patient’s hand and wrist symptoms are identified, the doctor of chiropractic will recommend a course of treatment that may involve manipulation, mobilization, therapeutic exercises, modalities, wrist splinting, and even dietary recommendations, depending on the patient’s unique situation. The goal is to reduce pressure on the median nerve by restoring normal motion in the affected joints, as well as in reducing inflammation that may be present from a variety of causes.
While patients with more severe cases of CTS can benefit from non-surgical approaches, like chiropractic care, it’s important to note that it may take longer for such patients to experience improvements in pain and disability, and it may not be possible to totally reverse the course of the disease if it has progressed too far. As with many conditions, the sooner a patient seeks care, the greater their chance for achieving a successful outcome.
Management Strategies for Whiplash and Dizziness
Of all the symptoms associated with whiplash associated disorders (WAD), dizziness
may be one of the most concerning to patients because of how it can limit their ability to get
up and move around. What can be done to treat dizziness following a WAD injury?
Two studies published in 2019 suggest that manual therapies and therapeutic exercises may be an effective option for such patients.
The first study included 40 WAD patients randomly assigned to either a treatment group or control group. The treatment group engaged in twelve 50-minute exercises sessions spread out over a six-week time frame. The exercises included standing on a foam surface and turning the head side-to-side; walking on an inclined plane and turning the head side-toside; standing on a trampoline and moving the eyes side-to-side; heel-to-toe walking on a line for up to 5 meters (16.4 feet), and standing on one leg. If able, the treatment group repeated the same exercises with their eyes closed. Assessments completed at the end of the experiment revealed substantial improvements in both dizziness and quality of life among participants in the exercise group that were not experienced by those in the control group.
In the other study, researchers assigned 86 patients with chronic cervicogenic dizziness to one of three groups: SNAG (Sustained Natural Apophyseal Glide) exercise for six weeks; passive joint mobilization with range of motion (ROM) exercises for six weeks; or a control group that received no treatment. The SNAG exercises involved two movements (repeated ten times each): 1) Sit/Stand. Place a towel across the upper neck; as you pull forward with the towel, chin-tuck while pushing back into the towel. 2) Hold one end of the towel against the chest; rotate the head/neck toward the same side as far as possible; with the towel wrapped across the top of the neck, gently push the head further into rotation.
The research team reported that participants in both treatment groups experienced improvements with respect to dizziness, balance, cervical range of motion, and head repositioning accuracy. The authors of the study concluded that both treatment approaches are effective for cervicogenic dizziness (dizziness caused by cervical dysfunction).
The good news is that both spinal mobilization and active exercise are utilized by doctors of chiropractic!
Whole Body Health
Reasons to Eat More Blueberries
Not only are blueberries delicious and easily attainable at the supermarket but they are
also incredibly good for you. But don’t take our word for it, let’s look at what researchers say…
A 2019 review looked at findings from eleven studies that involved blueberry interventions. The researchers found that blueberries benefit memory and executive function in both children and adults, and blueberries can improve psychomotor function in seniors, including those with mild-cognitive impairment. The authors also reported that blueberry intake reduces risks for developing metabolic syndrome (heart disease, stroke, and type-2 diabetes), cancer, cardiovascular disease, and cognitive decline.
In a 2018 study involving 215 older adults, researchers observed that those with the greatest cognitive impairments who consumed a daily 600mg polyphenol-rich grape and blueberry extract for six months experienced significant improvements with respect to episodic memory.
Not only are blueberries low in calories (only 84 calories per cup) but just one cup of blueberries contains four grams of fiber, 24% of the recommended daily allowance (RDI) of vitamin C, 36% of the RDI of vitamin K, and 25% of the RDI of manganese.
Blueberries are antioxidant rich, which can protect the body from the free radicals that are known to damage cells and contribute to aging and diseases, like cancer. These antioxidants can also reduce oxidization of LDL (“bad”) cholesterol, which is a risk factor for heart disease.
There is research that suggests regular blueberry intake is associated with lower blood pressure and a reduced risk for heart attack.
Blueberries can improve insulin sensitivity and glucose metabolism—both of which can reduce the risk for diabetes and may even benefit diabetics.
Much like cranberries, blueberries contain anti-adhesive substances that can help keep bacteria from sticking around in the bladder and causing a urinary tract infection.
If you regularly exercise (you do, don’t you?), then the good news is that blueberries may reduce soreness and aid in muscle recovery following a strenuous workout.
BOTTOM LINE: Eat blueberries!
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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.