MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
A Link Between Back Pain and Urinary Incontinence
While under chiropractic treatment, it’s not uncommon for a patient to report
improvement for an issue that seems unrelated to their chief complaint. For example, a
patient with a temporomandibular disorder may experience an improvement in their jaw
symptoms following treatment to the neck or upper back. Or treatment to improve hip
function may also benefit the ankle or knee. In this article, we’re going to look at how
treatment for low back pain may help a patient who also has urinary incontinence (UI) issues.
There are many potential causes for UI, but one contributing factor is weak pelvic floor muscles. Thus, it makes sense that treatment to address impaired pelvic function may benefit some UI patients. A 2018 Cochrane systemic review concluded that pelvic floor muscle training (PFMT) is more effective than either a sham treatment (placebo) or no treatment for some individuals with UI.
This is where back pain comes into play. It’s estimated that back pain will affect more than 80% of us during our lifetime. We often adjust how we perform everyday activities to avoid pain, both consciously and unconsciously. These abnormal movements can place added stress on other parts of the body. In the case of the lower back, altered function in the hips and pelvis is common.
A November 2019 study published in the Journal of Craniovertebral Junction & Spine concluded that individuals with lumbar degenerative disk disease, spondylolisthesis, and failed back surgery syndrome are more likely to exhibit abnormal spino-pelvic alignment. Overtime, these individuals can develop secondary conditions in the hip or pelvis, which can impair the function of soft tissues, including muscles, in the region. Or likewise, injury to the hips/pelvis can lead to dysfunction in the lower back, which may be why the patient sought care in the first place.
Doctors of chiropractic are trained to review a patient’s case history and conduct a thorough examination on the whole patient in order to identify contributing factors for the patient’s chief complaint. Hence the importance of noting all symptoms, even those that seem unrelated or may be embarrassing. If a low back pain patient’s history notes UI and the examination identifies abnormal pelvic posture, then treatment will likely address improving function in both the pelvis and low back to achieve a successful outcome.
Neck Pain / Headaches
Neck Pain Among Office Workers
Neck pain is the second most common reason patients seek chiropractic care, and it’s
particularly a problem with office workers. One study estimated that neck pain affects 42-
69% of those who work in office environments. Many such individuals will experience
recurring episodes of neck pain, and at least one in six may develop chronic, ongoing neck
pain. While chiropractic offers a safe and effective way to manage neck pain, are there any
steps an office worker can take to reduce the risk for neck pain in the first place?
According to one study, taking a daily walk may be an effective neck pain prevention strategy. In the study, which included 387 office workers without spinal symptoms in the previous three months, researchers asked participants to wear a pedometer and note any spinal pain symptoms over the next year.
Of the 367 participants who completed the study, 16% reported the onset of neck pain. The results showed that for every 1,000 steps a participant averaged each day, their risk for neck pain fell by 14%. The authors concluded that increasing daily walking steps is protective for the onset of neck pain in those who work sedentary jobs, and managers should formulate and test strategies to encourage walking to reduce the incidence of neck pain among employees.
What about other forms of exercise? A meta-analysis of data from two randomized control trials that included over 500 participants showed moderate-quality evidence that participating in a workplace exercise program can reduce the risk for developing a new episode of neck pain by up to 68%. In the first trial, participants performed stretching and endurance training twice a day at work and twice a day at home. The second trial involved a combination of strength, stabilization, aerobic, and body awareness exercises that included health information, ergonomic training, and stress management training three times a week for one hour over a nine-month time frame.
While it’s not possible to completely avoid a condition like neck pain, the evidence suggests that regularly engaging in physical activity may substantially lower the risk. For those who do develop neck pain, it’s important to seek chiropractic care as soon as possible, which may lead to a faster resolution of symptoms and reduce the risk for both neck pain recurrence and chronic neck pain.
Footwear Changes for the Knee Osteoarthritis Patient
Osteoarthritis (OA) is the leading cause of knee pain and disability in the elderly
population. While treatment to address knee OA will often focus on the knee itself, a
patient may also need to change their footwear. Why is that?
During normal walking, joint loading is NOT evenly distributed, and the distribution most often greatest on the medial (inner) side of the knee. This greater load can cause wear and tear over time and lead to thinning of the smooth, slippery cartilage surfaces on the medial side of the joint, which eventually leads to bone-on-bone contact, the end-stage of OA. By changing where joint loading occurs on the knee, it’s possible to slow this process and potentially delay or even prevent the need for a knee joint replacement.
This can be accomplished through either a change in footwear or adding an insole or orthotic to an existing shoe. On the footwear front, an OA patient may need to avoid clogs, barefoot shoes, high heels, and extra-rigid/stiff shoes. Rather, walking or running shoes or, for more formal occasions, a shoe with a shock-absorbing sole and padded collars that’s not too rigid may be a better choice. A well-trained employee at a specialty shoe store can help identify which shoes will work best for your situation.
One study investigated the use of lateral wedges both with and without custom arch supports for people with medial knee osteoarthritis (OA) and pronation (rolled in feet). Each of the 26 participants wore one or the other for two months and switched to the other option after a two-month “washout” or rest period. The researchers concluded that the lateral heel wedge WITH foot orthotic/arch supports provided the best benefit to the participants with respect to performance on a timed stair climb test. Another study found that adding a mobility shoe reduced medial joint loading to an even greater degree.
For the knee OA patient, chiropractic treatment may also include specific exercise training, weight management/nutrition, manual therapies, modality use (electrical stim, magnetic field, laser, ultrasound, and more), and the use of a knee brace—all in the effort to reduce pain and improve mobility.
Carpal Tunnel Syndrome
Repetitive Movement and Carpal Tunnel Syndrome
Of all the potential contributing factors for carpal tunnel syndrome—diabetes, thyroid
dysfunction, inflammatory arthritis, pregnancy, birth control usage, and obesity—perhaps the most
well-known is participating in jobs and activities that require fast, repetitive hand movements that
can place increased pressure on the median nerve as it passes through the wrist. What can someone
do if they begin experiencing tingling and numbness or pain and weakness associated with carpal
tunnel syndrome without giving up their livelihood or their hobby?
First, understand that when the wrist is bent, the pressure on the contents of the carpal tunnel can increase substantially, especially when inflammation is present, which can affect the median nerve. So, if an activity frequently leads to numbness, tingling, or painful sensations in the hand and wrist, look for ways to maintain more neutral wrist posture. This may also involve using tools with a more ergonomic, wrist-friendly design. For the carpal tunnel syndrome patient, a doctor of chiropractic may also recommend wearing a splint overnight to keep the wrist from bending during sleep.
It's also important to take frequent breaks (every 30 minutes, for example) to allow the affected wrist and hand to rest. Or if possible, switch to a different activity for a short time before returning to the task that places the greatest strain on the wrist.
Here are three great exercise options to improve finger, thumb, wrist, and forearm flexibility, which may stretch the soft tissues in the wrist and increase activity tolerance:
1) Thumb-finger “push-ups”: Place the pads of your fingers and thumbs together in front of you and keep the fingers straight, spread apart, and pointing down. Push the hands together (try to touch your palms) and then push them apart by flexing your fingers and repeat. This stretches all five digits and the palm/forearm muscles ALL at the same time.
2) Shake ‘em out: …as if you’re shaking your wet hands to dry them. Continue this for as long as one to two minutes every hour.
3) Wall-stretches: Place your palm on a wall, elbow straight, fingers pointed down and push your palm flat into the wall as far as you can. Reach over and pull your thumb back off the wall with your other hand and hold for 20-30 seconds. Switch hands and repeat the stretch. This can be repeated two to three times per hand every hour.
Of course, consult with your doctor of chiropractic so that he or she can take a look at your patient history and examine the entire course of the median nerve to identify any other factors that may contribute to your carpal tunnel syndrome-associated symptoms.
Reducing the Risk for Chronic Whiplash-Related Pain
A study published in 2019 found that nearly half of whiplash associated disorders (WAD)
sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce
their risk for chronic WAD symptoms?
The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn’t become more severe. This is one reason why cervical range of motion is reduced when the neck is injured.
You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck.
The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature.
The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines.
Whole Body Health
Lowering the Risk for Chronic Disease
It’s common for the elderly to have multiple chronic conditions, all of which can
impact their ability to live a vibrant, independent lifestyle. While it may not be possible
to avoid adverse health conditions in our later years, it appears there are steps we can take
now to give ourselves the best possible chance to maintain good health for as long as
In an April 2020 study published in the Journal of the American Medical Association, 32 researchers from around the world collaborated to investigate the association of a healthy lifestyle with years lived free of major chronic diseases like type 2 diabetes, coronary heart disease (CHD), stroke, cancer, asthma, and chronic obstructive pulmonary disease (COPD). The data set for the study included 116,043 adults (average age 43.7 year) whom researchers followed for an average of 12.5 years.
At baseline, the investigators looked at four lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) and assigned a scoring system for each factor (0=poor; 1=intermediate; 2=optimal) for a total score of 8.
During the course of the study, 15% of participants developed at least one chronic disease. The research team’s analysis showed that every one-point increase in an individual’s healthy lifestyle score translated to an increase of .96 chronic disease-free years in men and .89 chronic disease-free years in women.
Compared to individuals with a score of 0, those with a score of 16 benefited from an average of 9.4-9.9 additional chronic disease-free years!
The findings showed that maintaining a healthy weight (BMI or body mass index of ~25), not smoking, avoiding excessive alcohol consumption, and getting regular exercise dramatically increased the odds of reaching age 70 without chronic disease.
Doctors of chiropractic frequently encourage patients to live a healthy lifestyle because not only can it add years to your life, as this study suggests, it can add life to your years.
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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.