MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Chiropractic Management of Scoliosis
Scoliosis is a condition that affects about 3% of teenagers, though the cause is
typically unknown. In most instances, the degree of spinal curvature is mild (10-15º
curve), but in some cases, the curve may continue to increase as the child grows.
Visible signs of adolescent idiopathic scoliosis include the following: uneven shoulders, one shoulder blade “sticking out” (more prominent) than the other; an uneven waist or a hip higher than the other; and/or a prominent rib cage, usually on the convex side of the curve.
When the curve is small, there are often few if any symptoms. However, if the curve worsens, the child may experience complications, which may require treatment. Complications associated with scoliosis primarily occur in those with larger curves and involve heart and/or lung problems due to the spine shortening and rib cage distortion as the curve progresses, making it more difficult for the heart to pump or for the lungs to expand. Due to changes in spinal biomechanics, individuals with scoliosis may also report chronic back pain and other musculoskeletal conditions.
Scoliosis is diagnosed following a routine patient history and physical examination, as well as standing x-ray of the lower and middle back in order to more accurate determine the degree of spinal curvature. In mild cases, treatment may not be required; however, if the condition worsens or in more severe cases, standard medical treatment may include wearing a back brace or possibly even surgery.
Does chiropractic offer a treatment approach for scoliosis? In a study published in January 2017, researchers reviewed the case history of 60 scoliosis patients treated in a chiropractic setting. The patients received a combination of chiropractic spinal manipulation and exercise approaches including cantilever, postural weighting, fulcrum block, and rotatory torso therapy ball exercises. The results showed successful outcomes in 90% of the cases with 52% of patients experiencing a curve correction and curve stabilization in 38% of the patients. This adds to previous studies and case reports on the effectiveness of both therapeutic exercises and manual therapies for the management of scoliosis.
Neck Pain / Headaches
Electronic Tablet-Related Neck Pain
When individuals use their smartphone, they often adopt an awkward posture in which
their head rests forward of their shoulders. This forward head posture, or “text neck,” places
added strain on the muscles in the back of the neck, shoulders, and upper back, which can lead to
musculoskeletal pain. Researchers are now looking into how electronic tablet use affects posture
and can elevate the risk for pain in the neck, shoulders, and upper back.
In a 2018 study, University of Nevada, Las Vegas researchers reviewed survey data from 412 university students, staff, faculty, and alumni regarding their electronic tablet use and associated musculoskeletal symptoms. The research team found that 55% of frequent tablet users reported at least moderate levels of neck and shoulder pain, which is a rate higher than the general population. Furthermore, 10% of the daily tablet users in the survey cited severe neck and/or shoulder pain associated with tablet use. However, only about half (46%) said they stopped using their device when experiencing discomfort.
The researchers added that regular tablet users, especially younger individuals without a dedicated workspace, often used their device in awkward positions, such as sitting with their legs folded on the flood or laying on their stomach or side while looking down at their device. Such postures can place excessive stress on the neck, shoulders, and upper back, leading to musculoskeletal discomfort.
The research team also found that women were over two times more likely to experience pain related to tablet use (70% vs. 30%). While this may partially be explained by women being more likely to sit on the floor with their legs crossed while using their tablet (77% vs. 23%), the researchers hypothesize that a primary driver of the disparity may be in the anatomical differences between men and women. Women often have more slender necks and less muscle mass/strength. Their shorter arms and narrower shoulders may also result in more extreme postural strain while typing on their device.
These findings concern researchers because tablets are becoming more popular for personal, school, and business use, which may place a larger burden on the healthcare system in the years to come. To reduce the risk for musculoskeletal pain associated with tablet use, experts recommend sitting in a chair with back support; placing the screen slightly below eye level; using an external keyboard; typing with the elbows bent at 90 degrees; taking mini breaks to stretch; and performing forward posture correction exercises. If you continue to experience pain associated with tablet use, consult with your doctor of chiropractic.
Groin Pain Syndrome
Groin pain syndrome is a term used to describe groin pain without clinical evidence of hernia
or hip pathology. Though the condition is thought to affect between 2% and 20% of athletes, there is
not a lot of conclusive research on its cause or the best way to treat it. Most of the published research
on those with groin pain without hernia or hip joint pathology are case studies (primarily of
professional male athletes), making it difficult to establish agreed upon treatment guidelines, as these
types of studies are considered to be of low quality and do not apply to the general population.
Understanding the anatomy of the trunk and pelvis helps us appreciate why physical activity applies tremendous strain to this region. First, the pubic joint is in the front/midline of the pelvis, the sacrum or “tail bone” is in the back, and ilium (or “wings” of the pelvis) make up the sacroiliac joints. These joints only partially move as we walk, run, twist, jump, etc. while the hip joints move freely. The muscles arising from the legs connect to multiple places on the pelvis and spine.
With groin pain syndrome, there is a significant amount of tension directed at the pubic joint by the muscles, tendons, and ligaments (collectively called “soft tissues”) during intense athletic activities (and sometimes regular daily life). These soft tissues also provide shock absorption and add structural support to the pubic joint.
Researchers speculate that groin pain syndrome is caused by the significant difference in strength of the opposing muscle forces from above (abdominal muscles) and below (adductors) leading to strain/sprain and eventually pubic joint pathology (osteoarthritis). Because of this high level of force, injury to the labrum that lines the rim of the hip joint may occur simultaneously resulting in two separate injuries or pain generators, making it easy to overlook the often more subtle, less known groin pain syndrome. Degeneration or joint arthritis can result in both the pubic joint and hip joint, again, adding to the confusion and differential diagnosis.
One case study that involved three soccer players with groin pain syndrome reported that all three athletes experienced satisfactory outcomes after an eight-week course of conservative treatment that included manual joint and soft tissue manipulation. Another study that looked at outcomes from NFL players who underwent either conservative or surgical treatment for groin pain syndrome found no difference in performance between the two groups, though the data suggests that players who underwent surgery for groin pain syndrome may have had shorter careers than those in the nonsurgical group.
Doctors of chiropractic are trained to identify all potential causes for a patient’s musculoskeletal condition and to offer conservative treatment options to reduce pain and restore function so the patient can resume their normal activities.
Carpal Tunnel Syndrome
Traction for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy that affects
roughly 4-5% of the general population and about 10% of working adults. The chiropractic
treatment approach for the CTS patient typically involves many of the same therapies as those
used for conditions like neck and back pain, such as joint manipulation, mobilization, specific
exercises, and nutritional recommendations to reduce inflammation. In some cases, patients with
neck and back pain can benefit from traction. Could the CTS patient also benefit from traction
applied to the wrist?
Back in 2004, the Journal of the Canadian Chiropractic Association reported on a case series concerning four patients with confirmed CTS who underwent a mechanical traction treatment protocol that involved between five and twelve five-minute treatment sessions over a three-month time frame. The results showed an improvement on nerve conductive tests that persisted up to one year following the conclusion of treatment.
In a study published in October 2017, researchers assigned 181 CTS patients to receive either mechanical traction (two treatments a week for six weeks) or usual medical care. The criterion used by the investigators for a successful outcome was whether or not the participants had elected to undergo carpal tunnel release surgery within the following six months.
According to the research team, 43% of the participants in the usual care group had undergone surgical carpal tunnel release in the allotted timeframe compared to just 25% of the patients in the mechanical traction group. The authors concluded that mechanical traction appeared to be an effective conservative treatment option for the CTS patient. Treatment guidelines recommend that patients exhaust all non-surgical treatment options before considering surgery, unless warranted otherwise.
However, as with any musculoskeletal condition, it’s important to identify all contributing factors of a patient’s chief complaint. In the case of a patient with suspected CTS, there may or may not be median nerve compression at the wrist. Similarly, median nerve compression can occur elsewhere along the course of the nerve from the neck into the hand. There may also be non-musculoskeletal causes for inflammation in the carpal tunnel that would need to be addressed in conjunction with other healthcare providers in order for the patient to achieve a satisfactory outcome.
Car Accident Risk-Reducing Technologies
Whiplash associated disorders (WAD) is a collection of symptoms commonly associated with
motor vehicle collisions. Because WAD can have such a negative effect on one’s quality of life, it makes
sense to take steps to reduce the risk for a car accident. Let’s look at some of the modern technologies that
our automobiles may include to lower the chances that a crash occurs:
• Hands-Free / Voice Controls: Cell-phone distractions are the underlying cause of many vehicle collisions, especially texting while driving. In fact, studies suggest that texting while driving may be as dangerous as driving while intoxicated. If you must make a call while driving, use a handsfree option. Fiddling with the radio can also be distracting, so use voice commands or steering wheel functions to change the station, if your car has them.
• Adaptive Cruise Control: This feature accelerate/deaccelerates your vehicle depending on what the car ahead of you is doing. This feature can reduce the stress of long highway drives and eliminates the need to constantly turn on/off or change your cruise control. Some systems will allow your car to stop and start in busy stop-and-go traffic.
• Lane Departure Warning/Lane Keeping Assist: This warns you when you drift out of your lane by vibrating the steering wheel, beeping, and/or giving a visual warning. Many vehicles also have an auto-correction steering feature that keeps you in your lane, provided there are line markings on the road for the sensors to detect. This feature is not meant to steer for you, but it can be particularly helpful, such as when driving at night on a winding road.
• Backing Up/Forwards Safety Features: These include a rear camera and a warning beep if unseen cross traffic is near. Your vehicle may also have an emergency brake assist feature where the vehicle automatically brakes to avoid a crash. Some vehicles also have a collision avoidance system that works when driving the car forward by detecting another car, a pedestrian, or some other obstacle and stops the car or steers the car out of harm’s way. The Insurance Institute for Highway Safety REQUIRES this feature in order to earn its highest safety score.
• Blind-Spot Warning: This feature is usually located on your side mirrors, which illuminate when a vehicle is approaching from the rear of your vehicle and remains lit until the vehicle passes. Many systems will also sound an alarm if you attempt to change lanes or activate your turn signal. More advanced systems can also brake or steer the vehicle back to the center of your lane.
There are many other features such as antilock brakes, traction control, electronic stability control, advanced safety belt features, brake assist, and more. While chiropractic care is an effective way to manage many of the soft tissue injuries associated with motor vehicle collisions, the best outcome is to completely avoid a crash in the first place!
Whole Body Health
Walk for Longevity
In recent decades, several studies have identified risk factors for early death such
as reduced cardio-respiratory fitness (CRF), obesity, smoking, diabetes, heart disease,
pulmonary disease, etc. Of all the causes listed, poor CRF appears to be the leading risk
factor for early death. If CRF is so important, can walking help? If so, how many steps do
we really need to live longer and better?
For years, experts have suggested walking 10,000 steps per day to live a long and healthy life, but there isn’t much research to support this claim. A 2019 study looked at how many steps a group of 18,289 elderly females took over a seven-day period and compared that data with their health outcomes four years later. The researchers associated a reduced mortality risk with more steps taken per day, up until about 7,500 steps per day. Compared with participants taking 2,700 steps per day, those averaging 8,400 steps per day were 58% less likely to die during the course of the study.
In a similar study involving 4,840 middle-aged adults, researchers compared daily step count data collected during 2003-2006 with health outcomes a decade later and identified an association between steps taken per day and a reduced risk for early death.
Neither study concluded that a fast or slow walking speed played a role in overall mortality risk. However, several studies have linked a faster walking speed with better cognitive health and a reduced risk for disability. A thirteen-year study that compared members of a running club with those who didn’t run found that those who regularly jogged were less likely to experience physical impairments or a premature death.
These studies suggest that getting up and moving your body can improve your cardio-respiratory fitness and reduce the risk of early death. Additionally, staying active may be associated with a better quality of life. Other ways to prolong life include avoiding excessive alcohol consumption, not smoking, maintaining a healthy weight, preserving/building muscle mass, and eating a healthy diet. If you develop musculoskeletal pain that interferes with daily function, seek treatment from your doctor of chiropractic as soon as possible so that you can resume your normal activities painfree.
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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.