MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Cauda Equina Syndrome
The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel
down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer
information (motor and sensory) to and from our legs and brain.
If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.
Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.
Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.
If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.
If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.
Neck Pain / Headaches
The Neck and Tinnitus Relationship
Experts estimate that approximately 10% of the adult population in the United
States experienced an episode of tinnitus—the perception of sound or noise without
any external auditory stimulus being present—within the last year. Tinnitus can be
caused by wax buildup in the ear, medication side effect, noise-induced hearing lost,
ear and sinus infections, cardiovascular disease, Meniere’s disease, brain tumors,
hormonal changes in women, and thyroid disorders. One cause that gets less attention
is dysfunction in the cervical spine.
While the prevalence of cervicogenic tinnitus—tinnitus that originates from the neck—is unknown, a 2015 study that evaluated 87 chronic tinnitus patients found that nearly half (47%) tested positive for cervicogenic tinnitus. Thus, individuals with ongoing tinnitus symptoms may benefit from receiving a thorough examination of their cervical spine by a doctor of chiropractic.
A 2020 case report detailed the experience of a 67-year-old female patient with a five-year history of left-sided chronic tinnitus, neck pain, and headache. Her treatment plan included exercises that emphasized the direction(s) that produced symptom relief and postural correction. Not only did the patient report significant improvements in her symptoms following her course of care, but she continued to experience relief at a follow-up appointment six months later.
This case study exemplifies the significant short- and long-term benefits that focused, tailored self-exercise (that the patient can perform at home) can have in improving chronic cervicogenic tinnitus.
Chiropractic management centers on three common goals: pain management, posture improvement, and prevention. Many studies support significant short-term benefits that can be achieved with manual therapies, particularly spinal manipulation. Patients can achieve and sustain long-term benefits with exercise training when it’s specifically tailored to them.
Baker’s Cyst and Knee Pain
A Baker’s cyst is a swelling located in the back of the knee that can be either asymptomatic or
bothersome, especially when bending the knee. Researchers estimate that up to 94% of popliteal (back of
the knee) cysts are associated with an intra-articular disorder, most commonly meniscus (“cartilage”)
tears, as well as osteoarthritis, inflammatory arthritis (like rheumatoid), and ACL tears.
In about 50% of healthy adult knees, there is a valvular opening located high on the inside of the knee joint that connects the joint capsule to a bursa (a fluid filled sac that functions to lubricate muscle attachments). It is thought that when there is an effusion or swelling inside the knee joint, the excess fluid flows one way to the inner knee joint bursa (called “pes anserine bursitis), which reduces pressure from inside the joint. Although there are other causes of popliteal cysts, this is the most common.
So, what can chiropractors do for the patient with a Baker’s cyst? Chiropractic management includes both passive and active care approaches that focus on the knee joint and surrounding soft tissues to help reduce pain and swelling and improving function, as well as home exercise instruction to maintain the health of the knee joint. Such exercise recommendations can include the following:
1) Standing calf stretch: stand upright grasping a chair or wall for balance; step back with the involved leg and flatten the heel to the floor with toes pointing as straight as comfortably possible; slowly straighten the bent knee until you feel a firm stretch behind your knee; hold for five to ten seconds and repeat five to ten times or until the muscle feels less tight; repeat on the opposite leg.
2) Heel lift: sit with your feet flat on the floor with your knees bent 90°, lift one heel keeping the ball of the foot on the floor; push down on the knee and slowly lower the heel to its starting position; repeat ten times as tolerated and switch sides, gradually increasing reps and sets, as tolerated.
3) Sitting hamstring stretch: sit on the ground with one leg straight out, keeping the heel on the floor; bend the ankle and bring your toes toward you; arch your low back until you feel a strong stretch in the back of the thigh and knee; lean forward as tolerated for a greater stretch; repeat five to ten times with a three to five second hold, as tolerated.
4) Heel Slides: lie on your back, legs straight; slowly bend one knee while sliding the heel toward your buttocks; repeat five to ten times, as tolerated, and repeat on the opposite side.
5) Wall squats: stand with your back against a wall and slide down slowly, keeping the toes well in front of the knees; only squat down as far as you can; repeat five to ten times, as tolerated.
6) Side-steps: place a loop or resistance band around your ankles; partially bend the knees; step sideways, alternating between the left and right foot, stepping wide enough to always keep tension on the band.
Your doctor of chiropractic can train you in these exercises and provide care to address any musculoskeletal issues that may contribute to your knee pain.
Carpal Tunnel Syndrome
Chiropractic Care for Chronic Carpal Tunnel Syndrome
Because the early symptoms of carpal tunnel syndrome (CTS) can be mild and
tolerable, many patients put off seeing a doctor until the pain, numbness, tingling, and
weakness in their wrist and hand is no longer bearable. The current research supports
chiropractic care as an excellent non-surgical option for new-onset CTS, but what about
patients with chronic CTS?
In a case series study of 18 women with chronic CTS (defined as CTS lasting more than six months), researchers looked at the potential benefits of soft tissue mobilization combined with nerve slider neurodynamic technique on pain and pressure sensitivity at various points along the course of the median nerve from the cervical spine into the hand before, immediately after, and one week following just a single treatment.
The treatment session consisted of a 30-minutes of soft tissue techniques (including soft tissue mobilization, nerve slider neuromobilization, myofascial release, stretching, and cross-fiber friction over the muscular interfaces through which the median nerve travels) at four locations: the front/side of the neck (anterior scalene muscles), the distal to middle anterior upper arm (biceps brachii), the proximal palm-side forearm (pronator teres), and stretching the transverse carpal ligament and soft tissues on the palm-side of the hand. The patients reported a reduction in pain following treatment that persisted for up to one week following just one treatment.
Another study looked at the long-term effects from manual therapies on patients with chronic CTS. In this study, patients received two treatments a week for three weeks. Not only did the patients report improvement in their CTS symptoms following the conclusion of care, but these benefits persisted when researchers followed-up with participants six months later.
Manual therapies are a primary treatment approach utilized by chiropractors for both acute and chronic CTS, along with many standard management strategies such as night splints, physical modalities, and specific home-based exercise recommendations. This multi-modal approach places chiropractic at the top of the list as the ideal choice for the CTS patient!
Useful Tests for Diagnosing Whiplash
When it comes to whiplash associated disorders (WAD), the process of making an
accurate diagnosis and treatment recommendation can vary from healthcare provider to
healthcare provider depending on their educational background, ongoing training, and clinical
experience. There is also a growing pile of research with respect to WAD that helps refine
existing processes and introduce new perspectives to take on the condition and its treatment.
Here are developments that can help doctors better evaluate the presence and severity of WAD.
In a 2017 study, researchers evaluated a diagnostic test that utilizes six isometric muscle fatigue tests of the neck and arm muscles in search of an inexpensive and relatively low-tech method for identifying the presence and degree of WAD injury—WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury—muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). The study included 75 patients who had experienced a whiplash injury in the previous six hours and 75 non-injured subjects with a similar make-up (age, gender, body type, etc.).
The investigators observed that the participants with WAD injuries fatigued at a much faster rate in each of the six tests, and those with a higher grade of WAD injury experienced fatigue even quicker. Based on the fatigue data alone, evaluators were able to identify the WAD patients with a more than 90% accuracy. While additional studies are underway to confirm these findings with more participants, this may offer healthcare providers an easy, accurate, and safe method to determine the severity of WAD injury and offer more tailored treatment recommendations in the time period immediately following an automobile collision.
A study published in 2020 used video fluoroscopy (VF) to observe both WAD patients with chronic neck pain and non-injured subjects while they performed five movements to a firm end range involving the motion of the cervical spine. Using the VF data, radiologists were able to differentiate members of the two groups with significant accuracy. The use of x-ray taken at a firm end range of each motion can also be used to make these measurements. This is important as most patients and healthcare providers don’t have ready access to VF but many times, X-rays can be done in the office or a short drive away.
The most current treatment guidelines for WAD recommend seeking care as soon as possible versus taking a wait-and-see approach. Chiropractic care is an excellent option that can reduce one’s risk for developing chronic WAD symptoms that may be more difficult to resolve.
Whole Body Health
Coffee May Benefit Colorectal Cancer Patients
Coffee is one of the most consumed beverages around the globe, and many individuals can’t
seem to start their day without a cup or two. Past research has identified several compounds present
in coffee that can offer health benefits, and new research suggests that coffee intake can also help
patients under treatment for colorectal cancer.
The study, published in September 2020 in JAMA Oncology, looked at the association of coffee intake and survival in patients with advanced or metastatic colorectal cancer. In the study, which included 1,171 patients (median age 59), participants kept track of their caffeinated and decaffeinated coffee consumption for five years. The researchers observed that participants who consumed two to three cups of coffee per day were not only more likely to survive but their cancer was less likely to progress. Additionally, those who consumed at least four cups a day had even better results. The study concluded that “Coffee consumption may be associated with reduced risk of disease progression and death in patients with advanced or metastatic colorectal cancer. Further research is warranted to elucidate underlying biological mechanisms.”
The longevity benefits aren’t limited to patients with advanced colorectal cancer. A 2015 study looked at the association of coffee consumption (both caffeinated and decaffeinated) with total and cause-specific mortality in three large prospective cohorts: 1) 74,890 women; 2) 93,054 women; and 3) 40,557 men. The research team’s analysis revealed that regular coffee drinkers (one to five cups a day) had a lower risk for early death, though those who frequently consumed more than five cups a day did not experience increased longevity.
Regular coffee drinkers often report that it improves their ability to think and focus, but are there any long-term cognitive benefits to coffee? Perhaps. In 2019, researchers used advanced imaging to look for amyloid plaque build-up, a characteristic of Alzheimer’s disease, in the brains of 411 seniors without cognitive impairment. When researchers separated the data based on the participants’ coffee habits, they observed that those who consumed two or more cups of coffee a day had lower amyloid levels in the brain, suggesting a reduced risk for Alzheimer’s disease.
A review of past studies has shown coffee consumption to be associated with a reduced risk of developing many diseases including type 2 diabetes, liver cancer, endometrial cancer, lethal prostate cancer, basal cell carcinoma of the skin, neurological diseases, and cardiovascular disease when consumed in moderation. Doctors of chiropractic often encourage patients to adopt a healthier lifestyle, which includes consuming vital nutrients, vitamins, and minerals, and getting regular exercise. If you enjoy coffee and do so in moderation, the current data suggests it may provide benefits beyond helping you become more alert.
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.