MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Choose Chiropractic FIRST for Low Back Pain
When it comes to a condition like low back pain, does it matter what type of healthcare
provider a patient initially visits for treatment? A study published in 2015 looked at this question and
found that the type of healthcare provider a patient initially consulted had a dramatic effect on both
their short-term and long-term prognosis.
In the study, researchers monitored 719 patients with low back pain, 403 of whom initially consulted with a medical physician and the rest first sought care from a doctor of chiropractic. The results showed that the patients in the chiropractic care group not only experienced a greater reduction in their low back pain, but they were also more satisfied with their experience. Additionally, the average cost of treatment for the chiropractic patients was $368 (US dollars) lower than the average cost of treatment in the group that received care from their medical doctor. The study clearly favored chiropractic care as the initial treatment choice for patients with low back pain.
In a 2019 study, researchers reviewed medical records from over 216,000 patients without a history of opioid use and who had new-onset back pain to see if initial provider choice influenced future prescription narcotic use. The data showed that 22% of patients received a prescription for an opioid in the short-term; however, patients who consulted with a doctor of chiropractic first were even less likely to require either a short-term or long-term prescription than those who visited a medical doctor initially. The authors of the study concluded, “Incentivizing use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.”
Another study followed a set of 2,870 acute and chronic low back pain patients for four years. The research team observed that chiropractic care provided more favorable short-term outcomes for patients with chronic back pain, while both acute and chronic low back pain patients reported better outcomes in the long term, especially in chronic patients with leg pain extending below the knee.
Seeing a chiropractor first can also reduce the chances a patient will require a surgical procedure to address their back pain. A 2013 study published in Spine looked at data from Washington state worker’s compensation cases and found that 43% of injured workers with a back injury who initially consulted with a surgeon ended up having surgery while just 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain—a massive difference.
TAKE-HOME MESSAGE: Seek chiropractic care FIRST to receive the most satisfying, efficient, and cost-effective approach for managing acute or chronic low back pain!
Neck Pain / Headaches
Chiropractic Care of the Elderly with Neck Pain
One-in-five adults over the age of 70 suffer from neck pain, which can dramatically
affect their overall quality of life. So how effective is chiropractic care for a senior’s neck
A 2019 study published in the journal Chiropractic & Manual Therapies surveyed 288 Australian chiropractors and found that individuals over 65 years of age account for nearly a third (28.5%) of total patient volume.
Of these elderly patients, nearly half (46%) sought treatment for neck pain, often with co-existing dizziness and headaches. The researchers found that this group of senior patients also has a fear of falling, which affected their ability to live independently.
The doctors of chiropractic in the survey reported they often approached treatment for seniors with neck pain using a combination of manual therapies (including spinal manipulation, instrument adjusting, mobilization, and active/passive stretches), modalities (ice/heat, ultrasound, electronic stimulation), specific exercises, and self-management recommendations to reduce pain and improve function in the neck and upper back.
Another benefit of a conservative treatment approach like chiropractic care for an older patient is that it does not involve over-the-counter or prescription medications, which can have undesirable side effects or interactions with other drugs the elderly patient may be taking.
In fact, a March 2020 study published in the journal Pain Medicine reported that patients who received chiropractic treatment for a musculoskeletal condition, like neck pain, were significantly less likely to fill a prescription for an opioid to manage their pain in the following year, especially if they consulted with a doctor of chiropractic first. Many of the patients in the study (nearly 99%) reported an improvement in their neck pain and associated symptoms following an average of nine treatments, though patients with both neck pain and migraines required two additional visits, on average.
If you’re an older adult with new-onset or chronic neck pain, consider chiropractic care!
Hip Bursitis and Management Strategies
Hip pain is a common complaint that can arise from many different sources including the spine,
pelvis, and the knee. Greater trochanteric bursitis or gluteal tendonitis (GT) is a condition that occurs five-times more often in women than men, affecting one-in-four women over 50 years of age.
Patients with GT experience pain in the region from the side of their hip toward the buttocks, which can make finding a comfortable sleeping position difficult. This condition can be as painful and disabling as an osteoarthritic or a worn-out hip joint.
The traditional medical approach for GT is a cortisone injection. However, the results are not impressive in the medium-term, and the long-term results are similar to patients who took a wait-and-see approach. More recently, a treatment regimen that includes specific exercise programs with load-management and education to reduce the load on the injured tendon during sustained postures and activities has gained attention due to its significant medium- and long-term benefits. Better still, it’s non-invasive.
A 2018 study found that GT patients treated with a combination of exercise with education and load management experienced a higher success rate after one year (78.6%) than those given a cortisone injection (58.3%) and those who received no treatment at all (51.9%)
The education, load management, and exercise treatment protocol consisted of fourteen sessions over eight weeks plus a daily home exercise program that included four to six exercises, while keeping a weekly diary. Advice on tendon care was included and exercises included functional retraining, targeted strengthening (especially the hip abductors), and dynamic control during function. A pain-guided approach was used that allowed up to a 5/10 pain intensity level when exercising, provided the pain promptly stopped if activity ceased.
Exercises included the following (partial list):
Static hip abduction: a) Supine: place a belt around the lower thighs with feet slightly wider than hip width, put a pillow behind the knees and gently and slowly push outward while tightening the belt. b) “Imaginary splits”: stand, feet slightly wider than hip width, and pretend you’re doing the splits (sideways)— again, slowly and gently.
Supine Bridges: a) Double leg bridge: bend knees, feet flat, draw in the abdominal muscles, press the heels into the floor and lift the buttocks SLIGHTLY—only as high as comfortable. b) Offset Bridge: bring one foot closer to the buttocks and lift buttocks up using mostly that leg slowly (three to four seconds up then, three to four seconds down). Another bridge includes lifting one leg up and straightening the knee. These can be held statically or with movement up/down to the floor. Additional exercises included partial squats, step-ups, and sideways floor slides.
If you have been diagnosed with or suspect you have GT, your doctor of chiropractic can guide you in how to perform these exercises and provide additional care to aid in the recovery process.
Carpal Tunnel Syndrome
Who Gets Carpal Tunnel Syndrome?
Though carpal tunnel syndrome (CTS) affects 4% of the population, some individuals have a
much greater risk for the condition, and several factors may need to be addressed to achieve a successful
Trauma: An acute trauma, such as a bone fracture, can lead to CTS. However, repetitive stress injuries are more commonly associated with the condition.
Anatomy: Not all wrists are equal, and some individuals, especially biological women, may have a narrower carpal tunnel, which increases the chances that the tendons passing through the region will become inflamed and compress the median nerve.
Arthritis: Osteoarthritis can cause spur formations that project into the tunnel and increase pressure on the nerve. Rheumatoid arthritis results in inflammation in the joints of the wrist and the lining around tendons, which can also place pressure on the median nerve as it passes through.
Hormones: Hormonal changes due to pregnancy, menstruation, menopause, birth control pills, hormone replacement therapy, diabetes, hypothyroid, kidney disease, lymphedema, etc. can lead to swelling or inflammation in the carpal tunnel, which can place pressure on the median nerve.
Medications: Certain medications can increase the risk for CTS such as anastrozole, a drug used in breast cancer treatment; diphosphonates, a class of medications used to treat osteoporosis; oral anticoagulants; and more. (When non-musculoskeletal causes are present, care may require co-management with the patient’s medical physician.)
Work Environment: Workplace factors that contribute to CTS include a cold environment, vibrating tools, awkward neck/arm/hand positions, no breaks, prolonged computer mouse work, and more. Individuals who work jobs characterized by fast, repetitive, and forceful, grip/pinch-related activities may be up to 2.5 times more likely to develop CTS.
Other Musculoskeletal Conditions: It’s possible for the median nerve to be compressed as it passes through the neck, shoulder, elbow, and forearm, which can stimulate CTS-like symptoms in the hand and wrist, even if there is no compression in the carpal tunnel itself. It’s also common for patients to have median nerve entrapment in one of these locations in addition to compression at the carpal tunnel.
A patient’s doctor of chiropractic will need to review the patient’s health history and examine the entire course of the median nerve to identify all the contributing factors in order to achieve an optimal outcome.
Understanding Whiplash Associated Disorders
Whiplash associated disorders (WADs) can be a very confusing condition characterized by a
myriad of symptoms stemming from a forceful, rapid back-and-forth motion of the head and neck. While
this process commonly occurs during a rear-end crash, it can also arise from a slip-and-fall injury, sports
injury, physical abuse, or any type of trauma involving a quick, forceful impact. To understand how this
happens, let’s discuss the mechanism of injury and how fast the head and neck movements are that occur
in a classic rear-end collision.
One paper that utilized kinematic studies on cadavers and healthy volunteers reported that a WAD injury can occur in any one of three stages during the impact. STAGE 1: Flexion or forward movement of the head/neck starts with a flattening of the normal C-shaped curve. STAGE 2: The curve then reverses into an S-shaped curve with the lower half of the cervical spine (or neck) extending (C-shaped) and upper half flexing (reverse C-shape) forming the S-shaped spinal curve prior to the head/neck fully flexing. STAGE 3: The entire cervical spine extends into an extreme of the normal C-shaped curve as the head rebounds backward, hopefully stopped by a properly fitting headrest!
These three stages occur FAST—in about 600 milliseconds, which is MUCH quicker than someone can voluntarily contract a muscle. Hence, it’s next to impossible to “brace” for the impact because it’s over before we can react!
Anatomically, the front of the cervical spine is made up of large square-shaped bones called vertebral bodies (VBs) of which there are seven in the neck, each separated by a shock-absorbing disk. There is a strong ligament that runs the entire length of the spine in the front and back of the VBs that help stabilize the spine, or vertebral column. There’s another ligament in the back part of the vertebral canal where the spinal cord travels from the brain to the low back and two “facet joints” at each of the seven vertebrae that holds them together. Hence, each level is like a tripod with a big supporting leg in the front (the VBs) and two spatulated legs in the back (the facets) that allow for motion and protect the cord and exiting nerve roots, which allows us to feel textures and temperatures, as well as move our limbs.
When the head whips forward (Stages 1 & 2), the front of the cervical spine jams together while the facets in the back spread open. This is where the VBs in front can compression fracture and/or the capsules surrounding the facet joints in the back can over-stretch and tear. The latter has been reported to be a common and major source of post-crash pain in WAD injuries.
While many individuals will heal without significant issues after a whiplash injury, up to 50% will continue to experience symptoms such as neck and upper back pain, stiffness, loss of mobility, dizziness, blurred vision, headache, memory loss, and other cognitive dysfunctions associated with concussion. This underscores the importance of seeking prompt treatment (chiropractic care offers a great choice) to reduce the risk of WAD transitioning into a chronic, long-term, and life affecting condition.
Whole Body Health
Energy Boosting Tips
When fatigue hits during the day, many people will reach for a sugary snack or a caffeinated
beverage. While these practices may lead to a quick, short burst of energy, the crash afterwards can
leave one feeling even more tired. Let’s look at healthier methods to improve energy levels.
1) EAT BREAKFAST: Studies have shown that people who eat breakfast have less fatigue and stress than those who skip it. Avoid white flour/sugary options, like donuts. Instead try fruit and fiber-rich foods, like oatmeal, which help maintain satiety longer.
2) EXERCISE: A simple 5- to 10-minute walk or any quick bout of exercise can increase blood flow to the brain and enhance cognitive function.
3) SING/TALK: Singing opens specific brain pathways that can both elevate emotions and reduce stress hormone levels. Try it while driving or anytime you feel those eyelids dropping, but perhaps NOT at an office meeting! Like singing, talking stimulates areas of the brain to make us more alert.
4) DRINK WATER: Feeling lethargic is a common symptom of dehydration. Consider drinking water throughout the day (such as eight 8-oz. glasses per day) as some experts have stated that by the time you feel thirsty, you may already be in a state of mild dehydration, which can also impair cognitive function and increase the risk for headache.
5) SUNSHINE: Spending time in the sun stimulates the production of energy-boosting vitamin D. A recent study showed that exposure to sunlight throughout the workday not only led to better sleep but also improved performance on cognitive tests.
6) SNACK: Try eating almonds and peanuts, which are high in magnesium and folic acid and essential for energy and cell production. Consuming protein and slow-burning carbs like bananas, peanut butter, or granola with fresh berries can also help maintain blood sugar levels. A scented spice, like cinnamon or peppermint, can also fight fatigue and make us more alert.
7) LAUGH: Listen to comedy or think of a recent funny experience and laugh out loud, if possible—it’s amazing how that stimulates certain centers in the brain to give you an energy boost.
8) GET MORE SLEEP: It seems obvious but sleeping less than seven hours a night is unhealthy and reduces the energy you have available during the day. Quality of sleep is important as well, so if you toss and turn or wake up a lot at night, consider a sleep study to assess for sleep apnea.
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.