MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
The Effect of Back Pain on Walking
For the patient with low back pain, guidelines recommend seeking treatment in the
acute state of the condition instead of waiting for it to become chronic. While it’s
generally easier and faster to achieve a satisfactory outcome in the earliest stages of a
back pain condition, there’s another reason: to reduce the risk for additional injury. To
see how this is the case, let’s look at the effect low back pain has on walking.
In a February 2020 study, researchers examined the lower limb kinematics (function) in 40 subjects, half of whom had chronic back pain, using a special sevencamera system that tracked the movements of the pelvis, hip, knees, and ankle joints during walking. The data show that individuals with chronic low back pain had significantly altered movement in all three joints of the lower extremities.
Another recent study used a marker-based motion capture system to examine the spinal kinematics of 22 adults (half with chronic low back pain) while walking by breaking down the spine into four sections: upper and lower lumbar (UL and LL) and thoracic (UT and LT). This experiment also revealed significant movement differences between the two groups.
Using a sophisticated assessment method called statistical parametric mapping (SPM) to capture a 3D analysis of subjects (20 with vs. 20 without low back pain), yet another study identified altered movement patterns among those with low back pain.
These studies demonstrate that individuals with back pain exhibit altered walking kinematics, which may be a response by the body to avoid pain. But doing so may place added stress on other parts of the body, like the hips, knees, and ankles, which could lead to secondary conditions. On the other hand, there’s the possibility that pre-existing dysfunction in the lower extremities resulted in abnormal motion which led to a lower back condition.
Either way, these findings underscore the importance of examining the whole patient to identify any and all issues that may contribute to their low back pain, something which doctors of chiropractic are trained to do in order to achieve the best possible outcome for each patient.
Neck Pain / Headaches
The Neck and its Relationship to Headaches
Experts estimate that headaches affect half the population, with up to 25% of headaches originating
from the cervical spine or neck, which is referred to as a cervicogenic headache (CGH). There are many
studies that demonstrate the effectiveness of chiropractic management for CGH, often involving a multi-modal
treatment approach to address biomechanical dysfunction in the cervical spine that may contribute to or cause
a patient’s headache. These treatment options include…
• SPINAL MANIPULATION THERAPY (SMT): There are multiple methods or techniques of spinal manipulation to improve joint movement that can be sub-divided into two types: high velocity, low amplitude (thrust) where joint noise (called cavitation) occurs; and low velocity, low amplitude (nonthrust) where joint cavitation is not common. Some refer to the later as “mobilization.” Doctors of chiropractic often use both, but ultimately, the decision is decided by provider and patient preference.
• EXERCISE: On its own, exercise does not appear to be as effective as spinal manipulation, but when exercises—especially those targeting the deep flexors—are combined with SMT, the benefits last longer and are more satisfying in the long term.
• OCCIPITAL NERVE FLOSSING: Tension on the occipital nerve as it exits the skull can exacerbate CGH symptoms. Nerve flossing can reduce this tension. While lying on the back with the chin tucked in, the chiropractor lifts the patient’s head and moves the chin toward the chest to stretch the muscular attachments at the base of the skull (which often pinch the nerves that cause headaches) while the patient bends the elbows to touch their collar bones. As the chiropractor lowers the patient’s head, the patient extends their elbows and wrists/hands and lowers the arms toward the floor. This is frequently repeated five to ten times (depending on tolerance).
• ACTIVITY (ERGONOMIC) ADVICE: Here, your chiropractor assesses your work and hobbies, looking for ways to reduce the load on your neck and upper back. Forward head posture is VERY common and once identified, he or she can teach you ways to correct the faulty posture—often by making simple adjustments to the activity.
• HOME CERVICAL TRACTION: Traction works by stretching the vertebra and muscles. Though this can be done in the office, you can do it at home much more frequently. An over-the-door unit works well. Typical treatment time is 15 minutes. Gradually increase the weight to a maximum comfortable point (10-15 lbs. / 4.5-6.8 kg) is a common threshold of tolerance). The “KEY” is to RELAX to get the best effect.
Bottomline: If you suffer from headaches, then it may benefit you to consult with a doctor of chiropractic to determine if your headaches may be caused or exacerbated by dysfunction in the neck. If so, then your chiropractor will have a variety of treatment options available to reduce the frequency and intensity of your headaches.
Subacromial Impingement Syndrome
Shoulder pain is a VERY common problem, especially among individuals over 40 years old.
Experts estimate that between 16-30% of the population has experienced shoulder pain in the last
month, with subacromial impingement syndrome (SIS) being one of most likely diagnoses made by
Why is SIS so common? The short answer is because the ball and socket part of the shoulder joint is shallow to allows for a wide range of motion but at a cost of reduced stability. Factors that can increase one’s risk for SIS include increasing age, overhead work, repetitive microtrauma, hypoxia (lack of oxygen), type III acromion shape (a hooked-shaped “roof” over the ball and socket joint), spurs off the acromioclavicular joint and/or front part of the acromion (the roof of the joint), and ligaments becoming calcified.
These risk factors can cause wear-and-tear of the rotator cuff muscle tendon, which can lead to a muscle tendon rupture (partial or complete) over time. In turn, this results in a high position of the humeral head (the ball part of the joint), which when it shifts upwards, causes pinching of the subacromial bursa, especially when the arm is raised, resulting in bursitis. Lying on the affected shoulder is often uncomfortable and a common complaint of SIS. In fact, finding ANY comfortable position in bed can be a challenge! Overhead work is often prohibited due to pain.
The diagnosis of SIS is made using a combination of a thorough history, physical examination, and imaging studies (x-ray, MRI, CT, diagnostic ultrasound). Imaging facilitates the differential diagnosis, which includes spurs, tears, assessing the acromion shape, and more.
Interestingly, a 2019 review of previously published studies concluded that surgery has little benefit for impingement (SIS) in the middle-aged patient. Instead, it’s advised that patients seek a multi-modal, non-surgical treatment approach often utilized by doctors of chiropractic that may include:
• Patient education with respect to the cause of their pain, the realization that progress may be gradual and take three to six months or longer, and the importance of performing a home exercise program.
• Exercises to reduce the high position humeral head (ball), regain range of motion without impingement, strengthen the rotator cuff and surrounding muscles, restore scapular and clavicular function and stability, and reduce pain to regain function.
• Manual therapies (manipulation and mobilization) to the shoulder’s multiple joints.
• Physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field) to facilitate healing and reduce pain and inflammation.
Carpal Tunnel Syndrome
Masquerading as Carpal Tunnel Syndrome
Most people have heard about carpal tunnel syndrome (CTS) as it’s the most common of
the peripheral neuropathies or pinched nerves in the extremities, but few have heard of pronator
Carpal tunnel syndrome occurs when the median nerve is pinched or compressed while passing through the wrist. However, the median nerve originates in the neck and must pass through several anatomical regions before reaching the wrist and ultimately the hand. One of these areas is the elbow where the median nerve passes between the two heads of the pronator teres muscle. The good news is that pronator teres syndrome is much less common than CTS. The bad news is that it can produce similar symptoms in the hand and can even co-occur with CTS.
That’s why when a patient seeks chiropractic care for carpal tunnel syndrome symptoms like pain, numbness, tingling, and weakness in the hand, a doctor of chiropractic will examine the entire course of the nerve to identify where the median nerve is pinched. This can include the wrist, the forearm, the elbow, the shoulder, and even the neck. Chiropractors will also review a patient’s history for non-musculoskeletal conditions that may be associated with an elevated risk for CTS, such as type 2 diabetes, which may necessitate co-managing care with other healthcare professionals.
Once the potential musculoskeletal causes are identified, which may include pronator teres syndrome, treatment can proceed. In most cases, doctors of chiropractic will utilize manual therapy techniques such as joint manipulation and mobilization to improve joint motion, along with soft tissue manual release methods to relax tight, tender muscles. A chiropractor may also use physical therapy modalities such as pulsed ultrasound, electromagnetic field, electrical stim, and/or the use of therapeutic lasers. Additionally, patients may be advised to temporarily modify their job function, make ergonomic changes to their workstation, use a nighttime splint to keep their wrist in a neutral posture during sleep, or make dietary changes to reduce inflammation (which may include using herbal supplements like ginger, turmeric, and Boswellia).
Most studies show that the best outcomes or results are obtained when conditions like pronator teres syndrome and CTS are caught early in the mild to moderate stage of the condition. Waiting too long can result in scar tissue formation around the nerve making satisfying results more difficult to obtain regardless if management is non-surgical or surgical.
Seat Belt Truths & Myths
Some of us have been around long enough to remember when wearing a seat belt was
optional, and some of us are even old enough to remember when car manufacturers weren’t
even required to install them in the first place! Nowadays, not only is it the law in most
jurisdictions for all passengers to fasten their seat belt but our cars will obnoxiously beep if
we forget. This is for good reason because according to the Centers for Disease Control and
Prevention (CDC), seat belts can reduce the risk for injury and save lives in the event of a car
accident. However, despite this obvious statement, MILLIONS do not buckle up when
traveling in a motor vehicle.
In 2016 alone, 23,714 vehicle occupants (drivers and passengers) died in automobile collisions, of which more than half were not wearing a seat belt at the time of the accident. Let’s dispel some of the myths associated with seat belt use and misuse… MYTH: Seat belts are uncomfortable and can restrict one’s movement and ability to operate a vehicle.
REALITY: You can adjust the seat belt properly for body size and height.
MYTH: If you are a good driver, you don’t need a seat belt.
REALITY: You can’t control the OTHER DRIVERS.
MYTH: Airbags are enough. I don’t need my seat belt.
REALITY: Airbags are designed to work in coordination with seat belt use, and they may not help you in a roll-over crash.
MYTH: If I brace myself for the impact, I’ll be fine.
REALITY: Studies have demonstrated that the whiplash process can occur faster than the brain can react to it.
MYTH: I’d rather be thrown away from the vehicle.
REALITY: There isn’t a bed of pillows outside the car waiting for you. The chances for survival when ejected from the vehicle are extremely low.
So always make sure to wear a seat belt. If you do experience a collision, the injuries you sustain will certainly be less serious than you’d suffer without a restraint.
Whole Body Health
8 Tips to Help Maintain a Healthy Weight
Losing excess weight and keeping it off can be a challenge. Hopefully, these eight tips can help make
it easier to win the battle of the bulge…
1. FOOD JOURNAL: A study published in the journal Obesity reported that in a 142-obese person group, those who consistently logged their meals and held online group sessions about weight-loss strategies lost an average of 10% of their body weight within six months. This process reportedly took participants just 15 minutes per day.
2. WHEN TO EAT: It’s not just WHAT we eat but also WHEN we eat that can make a BIG difference. One study showed that a “time-restricted feeding” (TRF) group (eating breakfast 90 minutes later and dinner 90 minutes earlier than usual) felt more energetic, shed more weight, and experienced greater improvements in their blood sugar and blood lipid readings than individuals who continued to eat on their normal schedule.
3. SELF-CONTROL: Before reaching for another serving, rate your satiety on a 0-10 scale (10=feeling stuffed) and aim for a score of 4-6/10 maximum to avoid feeling like you ate too much. Studies suggest that exercising this rating method can reduce the risk you’ll consume excess calories at mealtime.
4. WHAT TO EAT: When the urge to eat junk food strikes, think about eating a healthy food choice instead of an unhealthy choice. A KEY to success with this recommendation is to have healthy choices pre-prepared so it is easy to grab when the urge for a snack strikes.
5. READ & FOLLOW THE LABELS: Restrict the volume of food to the serving size that is printing on the packaging. For example, when it comes to a bowl of cereal, many people fill the bowl to the brim, which may actuallybe three servings, not one. One study reported that when participants followed this simple instruction, they consumed an average of 300 fewer calories per day.
6. FRONT-LOAD YOUR CALORIES: Studies show that individuals who consume more of their daily caloric intake earlier in the day tend to be less likely to feel hungry during the day and crave sweets than those who eat a light breakfast and a large supper.
7. BE BEVERAGE AWARE: Be mindful of what you drink as well as what you eat. Many beverages such as sodas, juices, iced tea, and milkshakes are full of sugar and/or high in calories. Drink water instead. Staying hydrated is very important to ensure proper metabolic functions as well. Drinking a full glass of water before eating will also reduce the volume of food consumed.
8. EAT MORE PROTEIN: Avoid processed/fast food as these stimulate dopamine in the brain which may increase cravings for such foods. Eat nutrient-dense foods rich in protein and fiber (chicken, fish, lean meats, and non-starch veggies) instead.
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.