MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Staying Active Helps the Lower Back
In the past, patients may have been prescribed bed rest by their family doctor for low back pain. These days, treatment guidelines recommend staying active during the recovery process. Why the change?
There are two types of muscles in the back: the superficial muscles and the deep muscles. The superficial muscles are used to perform motions like bending and twisting. These muscles are strengthened by exercise that places stress on the muscles, like lifting weights. The deep muscles help stabilize the spine and maintain posture, and physical activity helps keep them in shape.
When a person goes on bed rest, the muscles in the back will weaken and begin to atrophy. As activity is resumed, the body will recruit the superficial muscles to help stabilize the back. Because the muscles are not adapted for this function, the superficial back muscles will tire more easily, and in the presence of deep muscle weakness, normal movement will be impaired. This can place abnormal stress on the structures in the spine and other parts of the body, increasing the risk for additional musculoskeletal injuries. Bed rest can also affect the disks that act as “shock absorbers” in the spine.
In one study, researchers recruited 72 middle-aged adults and assessed their physical activity levels in the preceding years based on how many days they engaged in strenuous activity every two weeks: active (9 to 14 days), moderately active (1-8 days), or inactive (0 days). About one in five (21%) were classified as active, half (53%) were described as moderately active, and the remainder (26%) were inactive. The researchers also performed an MRI on each participant and gathered information on low back pain-related pain and disability.
The results clearly showed that physically inactive individuals were more likely to have back pain, reduced function, loss of disk height, and fat build-up in their back muscles. The research team concluded that getting regular, regimented exercise throughout life is important for reducing the risk of back pain.
There are very specific exercises that help strengthen the deep, low back stabilizing muscles. Doctors of chiropractic regularly prescribe exercise to address an acute flair-up of LBP and to help prevent future occurrences.
Neck Pain / Headaches
Do Cell Phones Cause Horns?
It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?
If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.
A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.
The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.
The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.
The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.
Exercise Can Help Knee Osteoarthritis
In the face of musculoskeletal pain, it’s common to restrict activity. Unfortunately, doing so can weaken the muscles and joints in the affected area, which can prolong pain and elevate the risk for future injury. Patients with osteoarthritis of the knee often fall into this trap. So, what type of exercises are best for improving knee strength in the presence of knee osteoarthritis?
First, let’s define two types of muscle activity that can occur during exercise: eccentric and concentric. During a bench press, when you’re pushing the barbell upward, the muscles in the chest shorten in a concentric motion. As you lower the bar downward, your pectoralis muscles lengthen, which is an eccentric motion.
A 2019 study that involved 54 seniors with knee osteoarthritis investigated which of the two phases builds better strength for the knee – the concentric/muscle shortening phase or the eccentric/muscle lengthening phase of muscle activity. The participants were split into three groups: CNC RT (concentric resistance), ECC RT (eccentric resistance), or CON (control group – no exercise/wait-list group). The two exercise groups received four months of supervised exercise training using traditional weight machines with proper set-ups and instructions that emphasized the concentric or eccentric phase of the exercise.
Each week, participants completed questionnaires to measure knee pain and disability. The researchers also recorded the maximum weight each subject could lift with respect to knee flexion, knee extension, and the leg press.
The results showed that BOTH exercise groups experienced strength increases in comparison to the control group, with the eccentric resistance group achieving greater gains on the leg press and knee flexion exercises, but not for knee extension. Both exercise groups also reported less pain and disability than the control group. The authors concluded that both types of resistance training effectively improved leg strength, pain, and function, and they recommend that the mode an individual emphasizes should be based on personal preference, goals, tolerance, and equipment availability.
This study is a great example of the many benefits that exercise can offer for an elderly population suffering from knee osteoarthritis. Doctors of chiropractic often prescribe exercises for patients with knee pain in addition to providing manual therapies, modalities, orthotics (knee braces and foot orthotics), as well as dietary and nutritional counselling for inflammation reduction and pain management purposes. Before throwing in the towel and jumping to a total knee arthroplasty (replacement), you owe it to yourself to seek less invasive management strategies FIRST.
Carpal Tunnel Syndrome
Great Exercises for Wrist Pain
There are many conditions that affect the hand and wrist: tendonitis (strains), ligament
injuries (sprains), as well as carpal tunnel syndrome (CTS). A contributing factor for these
conditions is inflammation caused by overuse and repetitive motions. That’s why your doctor of
chiropractic recommend taking mini-breaks (30 seconds to one minute) throughout a busy
workday to give the wrist a chance to rest. The following exercises are also helpful for selfmanaging
wrist pain (in addition to chiropractic care):
1) SHAKE: As if to dry off your wet hands, shake your arms and hands vigorously.
2) FIST/BEAR-CLAW/FAN: This three-step exercise includes making a firm fist, then a bear-claw (bending only the ends or tips of the fingers/thumbs), and lastly, opening the hand wide and fanning or spreading the fingers out.
3) THUMB-FINGER “O’s”: Make an “O” by touching the tip of the thumb to each of the four fingertips. Vary the speed and pressure. Mix it up.
4) WRIST BENDS (OPTION #1): Sit or stand, elbow straight, palms up, and bend the hand toward you (fingers pointing up). Bend the wrist back so the fingers point down. Hold each position for about five seconds and repeat five to ten times. Repeat on your opposite hand to add pressure to the end-range stretch (to “super-stretch”).
5) WRIST BENDS (OPTION #2): Repeat Exercise 4 but with the palms down.
6) TENDON TETHER: Hold the arm out in front and bend the elbow 90°, palm facing you. Bend the wrist back so the palm faces upward. With the other hand, pull down on each finger while slowly straightening the elbow until the elbow is fully extended (arm straight) and hold for five seconds. REPEAT on each finger and thumb (both hands).
7) WRIST RESISTANCE: Rest the forearm on the arm of a chair (elbow bent 90°) palm down, with the wrist and hand extended off the end of the arm (an edge of a table works too). Place the other hand across the knuckles (to form a “+” sign). First, raise the bottom hand against the resisting/top hand slowly through the full range of motion (ROM) and then reverse it by slowly lowering the hand while STILL RESISTING as you move back down toward the floor (full ROM). Repeat five to ten times slowly and repeat on opposite side. Perform the same exercise with the palm up and repeat on both sides.
8) HAND SQUEEZE: Hold a soft rubber ball or a pair of balled up socks and slowly squeeze to a maximum tolerance and SLOWLY release it. One repetition should take at least five seconds. Repeat five to ten times with each hand.
When exercising, THINK ABOUT what you are doing (visualize the movement in your head) to enhance the neuromotor response for the best results. Your doctor of chiropractic can train you on these and many other exercises to facilitate CTS/wrist injury recovery.
The Link Between Whiplash and Fibromyalgia
It’s estimated that up to 50% of whiplash associated disorder (WAD) patients will develop
chronic symptoms such as neck and upper back pain, headache, dizziness, emotional and cognitive
disturbance, referred pain, and physical dysfunctions. Fibromyalgia (FM) is a condition that is also
characterized by long-term, persistent symptoms such as chronic widespread musculoskeletal pain, sleep
disturbance, cognitive disturbance, fatigue, and physical dysfunctions. Both WAD and FM patients share
similar chronic, debilitating signs and symptoms. Why is this so?
In one study, researchers evaluated cognitive loss, central sensitization, and health-related quality of life (QoL) in chronic WAD patients, FM patients, and individuals without any known chronic conditions to serve as a control group. Participants in both the WAD and FM group exhibited significant cognitive impairment, central sensitization, and decreased health-related QoL, suggesting that brain injury plays a significant role in each condition.
In WAD injuries, the mechanism of injury causing cognitive loss (the brain’s inability to process information) appears to arise from the brain slamming into the inside of the skull. In a classic rear-end collision, the brain first hits the back of the brain casing followed by the rebounding into the front of the skull, causing a concussion.
A 2011 study found that among 58 women who had been admitted to the emergency room for a whiplash injury, three met the clinical criteria for FM three years later. Another 2011 study found that among 326 WAD patients with persistent neck pain lasting longer than three months, up to 14% met the criteria for FM. Based on these findings, it’s clear that the whiplash process could be a strong contributing factor for developing FM. Indeed, a 2015 study that looked at the health histories of 939 FM patients identified trauma as a precipitating factor in 27% of cases.
While we typically associated whiplash with motor vehicle collisions, such injuries can also occur in sport collisions, physical assaults, and falling. It’s possible that a greater percentage of FM cases may be due to trauma the participant simply wasn’t able to recall. Emotional trauma and post-traumatic stress disorder have also been associated with an elevated risk for FM. The disease process for FM isn’t entirely understood, and in cases when the cause is not known, it’s possible the condition could be the result of a cumulation of factors, including WAD.
Nonetheless, it’s clear that chronic WAD and FM are potentially debilitating conditions and seeking treatment after a trauma, such as a motor vehicle collision, is important for mitigating the risk for chronic symptoms. The good news is that both FM and WAD patients respond very favorably to chiropractic care! Doctors of chiropractic are trained to examine, diagnose, and treat those presenting with FM and WAD. Studies have reported that the inclusion of spinal manipulation enhances recovery in acute and chronic WAD, as well as FM.
Whole Body Health
The Power of Music on the Mind
Using functional MRI, researchers have observed that music activates the visual, motor,
and coordination centers on both sides of the brain. Research also shows that music affects
deeper brain areas involving memory and emotion—more than almost any other stimulus.
Additionally, music engages less used neural connections in the brain, strengthening them to
potentially restore or improve impaired/lost functions.
The American Music Therapy Association (AMTA) notes that music therapists work with older adults to help with dementia, children and adults to reduce asthma episodes, hospitalized patients to reduce pain, children with autism to improve communication skills, premature infants to improve sleep patterns and increase weight, people with Parkinson’s disease to improve motor function, and more.
One of the most publicized music therapy cases involved Congresswoman Gabby Giffords. After a near-fatal head injury, Giffords suffered from aphasia, the inability to speak due to damage of the language pathways located on the left side of the brain. By layering words on top of melody and rhythm and with a lot of practice, new neuropathways were formed, allowing her to regain the ability to speak. Her music therapist, Meaghan Morrow, compared the process to a freeway detour, describing the brain’s ability to form new roads or paths around damaged areas (a process called “neuroplasticity”) so the information can reach the same part of the brain that the damaged freeway once provided.
Dr. Oliver Sacks’ book Musicophilia describes the role of music therapy in managing Parkinson’s disease, which spurred the book and film “Awakenings.” In his book, Dr. Sacks cites an 1871 article by neurologist Dr. John Hughlings Jackson entitled, “Singing by Speechless Children.”
In previous months, we’ve discussed how walking backward can improve memory recall. Other research has found that trying new things or performing activities in a different way can create new pathways in the brain, which may improve brain health. So next time your drive to the store, take a different route. Tomorrow, try holding your toothbrush or your hairbrush with your other hand.
Of course, continue to get regular exercise, eat a healthy diet, get plenty of sleep, avoid smoking, abstain from excessive drinking, and get regular chiropractic care to keep your mind and body in the best shape possible to give yourself the best chance of a long and happy life!
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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.