MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
A Vascular Cause of Low Back Pain
For the older adult, pain that radiates into the leg is a common complaint. This process,
called neurogenic claudication, occurs when the spinal cord and/or nerve roots are pinched as
they exit the arthritic spine (a condition called spinal stenosis). However, there is another
degenerative condition that can cause pain in the legs called peripheral vascular disease, and it
can be quite challenging to differentiate between vascular and neurogenic claudication.
Peripheral vascular disease (PVD) is a slow, progressive narrowing, blockage, or spasm in a blood vessel that can affect any blood vessel outside of the heart including arteries, veins, or lymphatic vessels. This hardening of the arteries most often affects the legs and feet, although it can affect any organ, including the brain. The most common cause is atherosclerosis, which is the buildup of plaque inside the vessel wall that narrows the blood vessels in one or both legs. This depletes blood flow, and as a result, oxygen and nutrients can’t easily reach their intended destination. Other causes can include injury to the affected part, irregular anatomy of the muscles and ligaments, and infection.
The first symptom of PVD is typically painful leg cramping during exercise that is relieved with rest. This usually occurs after a certain length of walking time, which gets shorter as the disease progresses. This experience is similar to symptoms reported by patients with spinal stenosis, and as such, individuals with PVD may find themselves consulting with a doctor of chiropractic about what they suspect is a musculoskeletal condition. So how does a doctor of chiropractic differentiate leg pain from PVD from leg pain from spinal stenosis associated with dysfunction in the lumbar spine?
One study that administered questions to patients with either neurogenic claudication (NC) or vascular claudication (VC) found that specific symptoms could help in the diagnostic process. For example, if standing still does not trigger pain, NC could be ruled out. On the other hand, NC is likely if standing triggers or increases pain, bending or leaning forward relieves pain when symptoms are above the knees, and sitting provides relief. Patients with VC are more likely to experience leg pain down to the calf that is relieved by standing still. For a definitive diagnosis, a referral for more advanced diagnostics may be required
Doctors of chiropractic frequently treat patients with spinal stenosis with neurogenic claudication and will refer a patient to a vascular specialist or their medical physician if PVD is suspected so the patient can be provided with appropriate care.
Neck Pain / Headaches
Smartphones and Neck Pain, a Different Approach
In the last decade, the increased use of smartphones, tablets, and other electronic devices has
resulted in more and more individuals taking on a slumped posture as they spend excessive amounts of
time looking down to check email, browse the web, play games, or use social media. This forward head
posture can place added strain on the neck and mid-back, increasing the risk for pain in these areas.
That’s hardly news to anyone. However, is it possible these same devices can be used to manage one’s
In 2017, researchers conducted a study using a smartphone app designed for office workers with neck pain. Based on the users’ responses to questions about the nature of their neck pain, the app provided an individualized neck exercise program to be used for ten to twelve minutes a day, three days a week, for eight weeks. At the conclusion of the program, the participants reported significant improvement in neck pain intensity and disability and improved quality of life. However, the app did not appear to improve fear avoidance behavior or cervical range of motion.
An experiment conducted in 2020 with an app that promotes neck pain self-management through stretching and deep breathing exercises found that this approach resulted in improvements with respect to pain intensity, muscle tension, pressure pain threshold, and cervical range of motion.
Because there’s an abundance of research showing that neck-specific exercises can benefit patients with neck pain, these results aren’t very surprising. However, apps have the ability to remind users to perform their exercises and track their progress, which is important since exercise protocol adherence is often an issue.
For individuals with neck pain who are unable to manage their condition with exercise alone, chiropractic care can be an excellent choice. Doctors of chiropractic are trained to diagnose the root causes of a patient’s mechanical neck pain and to deliver manual therapies to restore motion to the affected joints, which can reduce pain and disability. Treatment may also involve nutritional recommendations to aid the healing process and the prescription of specific exercises to strengthen weakened deep neck muscles and reduce the risk for neck pain recurrence.
While devices have become a part of life and advice to limit screen time will go unheeded, there are steps that can be taken to reduce one’s risk for device-related neck pain. For example, avoid looking downward when using an electronic device. Instead, hold it at eye level so you can maintain good posture. Additionally, get regular exercise as the stress of movement is how the joints in the body (including those in the neck) are nurtured and hydrated. Since low grade inflammation in the body may increase the risk for neck pain, get plenty of sleep, manage stress, and eat more fruits and vegetables (and less processed food). If you have any questions on which neck-specific exercises may be most beneficial for your individual case, ask your doctor of chiropractic at your next visit.
The shoulder joint is really four joints—glenohumeral, scapulothoracic, acromioclavicular, and
sternoclavicular—that all work in a coordinated manner to maneuver the upper arm. The shoulder blade,
or the scapula, is an important player in normal shoulder movement because important muscles and
related tissues are anchored in this bone. However, an issue with the scapula is easy to miss when
diagnosing a patient seeking care for shoulder pain.
The main reason the scapula is overlooked is that when its position or motion is affected—a condition referred to as scapular dyskinesis—the patient may not initially experience pain or discomfort. However, though the condition may start in an asymptomatic manner, abnormal scapular movement can affect the motion of the rest of the shoulder, which can lead to the type of painful condition that drives a patient to their medical doctor or chiropractor’s office.
Indeed, the available research shows that patients with rotator cuff tears, glenohumeral instability, impingement syndrome, and labral tears often have scapular dyskinesis as well. One review found that between 67% and 100% of athletes with shoulder injuries have scapular dyskinesis. The same review noted that 54% of athletes in sports that require overhead motions had scapular dyskinesis.
Researchers have also observed abnormal scapular kinematics in sedentary, non-athletic individuals due to poor posture that places excessive strain on the upper back and neck to keep the head upright.
What can be done if a patient with shoulder pain exhibits scapular dyskinesis? First, treatment in a chiropractic setting might focus on manual therapies to restore normal motion to the affected joints. A doctor of chiropractic may also provide recommendations with heat and ice or nutrients to reduce inflammation. The patient will also be encouraged to perform at-home exercises as part of the recovery process.
A good starter exercise is to sit up tall by holding the head in line with the thorax (retract the chin), and “kiss” the scapula together followed by rolling the shoulders forward to separate the scapula WITHOUT shrugging the shoulders upward. Repeat this slowly, initially in front of a mirror, and concentrate on moving both sides rhythmically and equally. Eventually, do the same while on all fours or from a push-up position for something more difficult. Exercises that address forward head posture may also be recommended to reduce the load on the scapula caused by slouching.
As with many musculoskeletal conditions, the sooner a patient seeks care, the more likely they will achieve a successful treatment outcome—often in fewer visits—using conservative treatment approaches like chiropractic care.
Carpal Tunnel Syndrome
Reducing Carpal Tunnel Syndrome in the Office
Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is
compressed or restricted as it passes through the wrist. Because repetitive wrist and hand
motions can inflame the tissues in the wrist and place pressure on the median nerve, workers in
jobs that require such movements—such as those seated at a computer workstation all day—tend
to have an elevated risk for the condition. That said, what can be done to minimize the risk?
A January 2021 study looked specifically at 1,000 office workers under age 50 from 30 workplaces in China. Participants completed a questionnaire that included information on demographics, work type, related physical and psychosocial factors, and wrist and hand symptoms using a body chart and a rating of the intensity of symptoms, nocturnal symptoms, and aggravating activities. Then, participants were clinically evaluated, and CTS was confirmed using standard testing protocols.
The authors reported that 22% of participants had wrist symptoms and 15% had hand symptoms, with 9.6% meeting the clinical criteria for CTS. Further analysis identified the following risk factors for CTS among office computer users: smoking, working with hand/wrist pain, prolonged computer use time, and working without breaks.
Mandatory breaks spread throughout the workday may be an effective strategy for reducing the risk for CTS among office workers. There is also strong research supporting the health benefits of integrating exercise with meditation during such breaks.
Meditation has been found to reduce stress and anxiety, as well as reduce chronic neck pain—another common complaint in the office environment. Incorporating physical activity during a short break will not only help lower the risk for CTS, but it may also reduce the risk for chronic ailments like cardiovascular disease and diabetes that are associated with high levels of sedentary behavior.
While it may not be possible to eliminate one’s risk for CTS, if hand and wrist symptoms are present, it’s important to seek care sooner rather than later because earlier intervention improves the odds for a satisfactory result. Doctors of chiropractic are trained to examine the whole person and look for all contributing factors in a patient’s chief complaint. With suspected CTS, it’s not uncommon to find additional areas along the course of the median nerve (the neck, shoulder, elbow, forearm) that need to be addressed to resolve the patient’s pain, numbness, tingling, and weakness symptoms.
Whiplash and Mid-Back Pain
When it comes to whiplash associated disorders (WAD), injury to the cervical spine is
generally the focus, but what about the mid back? Can this area be injured in a whiplash event?
According to the available research, not only can the mid back become injured in an automobile accident, slip and fall, or sports collision, but it’s surprisingly common. A review of data concerning 6,481 patients who had been involved in a motor vehicle collision found that 66% reported mid-back pain (MBP) and 23% still experienced pain in this region a year later.
The mechanism of injury helps us understand how MBP may happen and why it is so common. The head weighs an average of 12 lbs (or ~5.4 kg)—similar to a bowling ball. The sudden acceleration and deceleration of the neck that occurs during whiplash can place significant strain on the soft tissues that connect the base of the skull with the mid and upper back.
A review of 38 studies that included over 50,000 WAD patients found that not only is MBP common following an automobile collision (over 60% based on the authors’ criteria), but mid-back pain intensity is higher in more severe WAD cases. Additionally, WAD patients experience heightened muscle activity in the neck and mid-back/scapular muscles, have an elevated risk for pinching the nerves that innervate the arm at both the neck and shoulder, are more likely to have myofascial pain and trigger points in the neck and mid-back muscles, and exhibit altered mid-back posture and reduced thoracic spine mobility.
Even if injury is isolated to the cervical spine, the mid back is not out of the woods. The thoracic spine can contribute to up to 33% and 21% of head-neck movement during cervical flexion and rotation, respectively. If mobility is reduced in the neck, then the thoracic spine must take on more of the load, which can increase the risk for overuse and injury.
Proper management of WAD requires treating the whole person and not restricting focus to just one area of the body, such as the neck. Doctors of chiropractic are trained to take this approach when evaluating a patient. Once a thorough examination has been completed, care often involves a multimodal approach that combines spinal manipulation, mobilization, and other manual therapies, along with specific exercises and nutritional recommendations to support the healing process.
Whole Body Health
A Look at Resveratrol
Polyphenols are a group of over 500 phytochemicals, which are naturally occurring organic
compounds produced in plants, that can reduce oxidative stress and inflammation in the body.
Consumption of polyphenols has been reported to improve and help manage digestive disorders, obesity,
diabetes, neurodegenerative conditions, and cardiovascular diseases.
In recent decades, a great deal of research has focused on a polyphenol called resveratrol that is found in over 70 plant species (most notably in the skins of red grapes) and of varying amounts in tea, pomegranates, nuts, dark chocolate, and many berries. However, because the body quickly metabolizes resveratrol, it’s generally taken in supplement form in order to achieve a dose high enough to provide a therapeutic effect.
A 2017 study reported that resveratrol can increase insulin sensitivity and improve blood glucose control, which may reduce the risk for diabetes and help type 2 diabetics manage their disease. It also improves blood vessel flexibility, which can help control hypertension or high blood pressure. A 2020 study reported that elderly women who took resveratrol experienced improved blood flow in the brain, which improved cognitive function.
Is resveratrol something that every adult should take as part of a healthier lifestyle? Unfortunately, no. As more studies are conducted on resveratrol, some adverse effects and interactions have come to light. A 2020 study reported that like many antioxidants, resveratrol can have a pro-oxidant effect in some situations, which could in theory have negative consequences, although human volunteers in resveratrol studies have not reported serious issues or side effects. Taking resveratrol prior to exercise may counteract some of the health benefits associated with physical activity. Other reported side effects can include diarrhea, nausea, itchy bottom, and allergic reactions. There have been some anecdotal reports of tendonitis such as ankle pain, swelling, and tennis elbow, although this side-effect is difficult to find in scientific literature.
Importantly, resveratrol has been observed to interact with the anti-blood clotting medication warfarin, which can result in unexpected anticoagulation and potential bleeding. Hence, it’s important that anyone taking resveratrol supplements should consult with a pharmacist to check for potential drug interactions.
As with any vitamin or supplement, inform yourself on the potential risks and benefits before deciding on adding them to your health regimen. With resveratrol, there are clearly a lot of health benefits to be obtained, but there are some individuals who should avoid its use. Your doctor of chiropractic can assist you when making decisions about a healthy diet and natural anti-inflammatory approaches for maintaining health and reducing the risk for chronic diseases that can interfere with your quality of life.
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.