MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
When Spinal Fusion Is Needed…
You’ve probably heard of a friend or loved one whose back pain resulted in a spinal fusion surgery, but you may not understand what prompted surgery over nonsurgical approaches, including chiropractic care.
Simply put, spinal fusion is a surgical technique that aims to eliminate excessive motion (instability) in the spine by fusing two or more vertebrae together. Fractures related to trauma are a common reason for spinal instability, but excessive motion can also be caused by conditions such as spondylolisthesis (when one vertebra slides forward on another) and age-related disk degeneration.
When is a fusion necessary? The short answer is after every non-surgical option fails to result in a satisfactory outcome. The long answer is when there is progressive neurological loss or deficit, cauda equina syndrome, failed non-surgical care, failed prior surgical care, x-ray evidence of instability with neurological signs, and unremitting pain that affects one’s quality of life. Treatment guidelines are not always followed, as many patients consult with a doctor of chiropractic only after they’ve already been advised that their lower back condition requires surgery.
The good news is that most conditions of the lower back can be managed with non-surgical chiropractic care, especially early on. With any musculoskeletal injury, it’s almost always best to seek care right away when the symptoms may be milder. Ignoring an injury may cause it to worsen and/or lead to the formation of scar tissue in the affected area and secondary problems elsewhere as the body attempts to compensate for mobility impairments. Conditions like chronic back pain can still respond well to chiropractic care, but keep in mind, it may take longer to achieve a successful outcome.
However, there are times when surgery is necessary. Surgery may include decompression of the nerve without fusion, but in cases of spinal instability, fusion may be needed, which is determined on a case-by-case basis. There are always risks associated with surgery, which is why it’s so important to exhaust non-surgical options first. When appropriate, your doctor of chiropractic can help facilitate in the referral process for a surgical consultation.
Neck Pain / Headaches
Exercise and Posture Training for Neck Pain
A quick look around any airport, mall, or auditorium/theater will reveal that poor posture is common. There’s forward head posture, rolled forward shoulders, and uneven/misaligned heads/shoulders/pelvis-hips. Some people even limp or shuffle while walking. Research shows that when a person adopts an abnormal posture, it can place added strain on various areas of the body, which can elevate the risk for musculoskeletal pain, including neck pain. The good news is that when combined with chiropractic care, at-home exercises are great for improving a patient’s posture, which can also reduce their risk for future episodes of neck pain. Let’s look at some of the studies that support the use of at-home exercise and posture training for neck pain…
- For older adults with a bent forward posture due to rounding of the mid back (“hyper kyphosis”), a six-month study that included 99 seniors revealed that a one-hour, three times a week exercise program resulted in both improved spinal curvature and selfesteem
- Among two groups of young adults with rounded shoulder posture, researchers found that shoulder stabilization and shoulder stretching exercises (40 mins, three times a week for four weeks) benefited patients in different ways. This suggests that combining these exercises may be the best approach to improve balance, strength, flexibility, and posture.
- In another study that included young adults with rounded shoulder posture, researchers reported that patients experienced better results when scapular stabilization exercises were combined with abdominal bracing exercises.
- Teenagers with forward head and protracted shoulder posture exhibited improved posture when specific neck and shoulder exercises were incorporated into their physical education program for sixteen weeks.
Doctors of chiropractic are highly skilled in manual therapies, exercise training, and functional assessments – all of which have been found to successfully improve outcomes for patients with persistent neck pain. As with most conditions, prompt treatment yields the best results, so don’t delay in starting your chiropractic management program!
Hip Problem, Back Problem, or Both?
Musculoskeletal conditions drive millions of patients to doctor’s offices each year, with back and hip pain being among the most common. Because the hip and low back neighbor one another in the body, these conditions often overlap, with only one of the two being diagnosed. This can lead to inadequate treatment, unnecessary costs, and unsatisfying outcomes for the patient with prolonged pain, disability, and mental health distress.
In some cases, a problem elsewhere in the body can refer pain to another region. For example, dysfunction in the upper neck could result in symptoms in the wrist and hand that could appear to be carpal tunnel syndrome. Or an issue in one area, like the foot, can change a patient’s gait and lead to a problem with the knee. It’s possible that the patient may only seek care for their knee pain, as their foot may not have obvious symptoms for concern. With the hip and low back, both scenarios can occur, which is why it’s important to focus on the whole patient and not just the area of chief complaint.
That’s why doctors of chiropractic consider the whole patient when they present for conditions like hip pain or back pain, starting with a thorough patient history. This includes asking the right questions, in which we frequently use the acronym LMNOPQRST, which stands for: Location, Medical History (or Mechanism of injury), New, Other Symptoms (or, Onset), Provoking/Palliative, Quality, Radiation, Severity, and Timing. These questions MUST be asked for each complaint.
The remaining history of Past, Family, and Social histories and, a Review of Systems allows the doctor of chiropractic to consider other potentially important aspects of the patient’s past such as prior injuries, accidents, surgeries, current medications, genetics, social aspects (smoking, drinking, exercise habits, sleep quality) and more, which can give clues to the current presenting complaints. The use of pain diagrams and questionnaires helps quantify the amount of suffering and serve as good outcome tools to determine treatment success.
The examination includes observing the patient walk and move (with or without distress), their posture, and their affect (is their condition all-consuming); palpating or feeling for painful structures and performing movements that both increase and relieve their pain; measuring patient’s range of motion; determining what position is favored or “best” vs. “worst”; and nerve function tests to look for impairments with regards to sensation, strength, and reflexes.
Each part of the examination is considered in order to arrive at the correct diagnoses so that treatment can accurately focus on healing and improving the function of the ailing parts.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome and Pregnancy
Carpal tunnel syndrome (CTS) is a condition that we typical associate with overuse activities, especially occupations that require fast, repetitive hand work such as typing, sewing, and packaging. However, the hormonal changes that occur in pregnancy can also lead to swelling or inflammation in the wrist, and subsequently, the symptoms associated with CTS.
A 2019 study involving 382 women in the third trimester of pregnancy revealed that 111 (23.03%) experienced the signs and symptom consistent with mild-to-severe CTS. Further analysis showed that the women who were older, left-handed, and had gestational diabetes mellitus were more likely to have severe CTS symptoms.
It makes sense to assume that pregnancy-related CTS would resolve once a woman has given birth, but another study suggests this isn’t always the case. In one longterm study, researchers monitored the status of 45 women who presented with CTS during their pregnancy. One year following the birth of their child, only 40% of the participants reported that their symptoms (pain, tingling, numbness) and function had improved. Half of the women reported no change in their symptoms or function and a small portion said their condition worsened (13.3% symptoms, 4.4% function). Nerve conduction testing showed no problems in 17.8% of participants, with the rest experiencing some degree of nerve interference. At the three-year mark, 51% were symptom-free, while 49% were still symptomatic but less so compared to their situation at the start of the study and at the one-year follow-up.
In conclusion, although many women who develop CTS during pregnancy will experience improvement over time, almost half will continue to report symptoms and functional impairments up to three years after the birth of their child. Doctors of chiropractic offer a non-surgical, effective combination of management strategies that can be easily and safely applied during pregnancy and after delivery. Because CTS can be highly disruptive to sleep and cause other quality-of-life issues, women with the condition should strongly consider chiropractic care during pregnancy and after if symptoms or problems persist.
The Link Between Whiplash and Jaw Pain
While neck pain is most commonly associated with whiplash associated disorder (WAD), patients often report jaw or temporomandibular joint (TMJ) pain following a car accident, sport injury, or slip and fall.
Common symptoms associated with temporomandibular disorders (TMD) include pain in the jaw joint area (in front of the ear), neck and shoulder pain, ear area pain with chewing or yawning, a “stuck” or locked feeling, and clicking, popping, or grating sounds with jaw movements. Patients with TMD may also feel like their teeth don’t fit well together, or report toothaches, headaches, dizziness, and tinnitus (ringing in the ear).
An MRI (magnetic resonant imaging) study of TMD following a WAD injury revealed joint effusion or swelling and/or disk displacement in more than half of the participants, along with alterations in the thickness of the lateral pterygoid muscle (LPM) that helps open the mouth. Studies have shown that rear-end collisions can result in trauma to the muscles in the area of the TMJ, along with its joint capsule and fibroelastic disk. Post-traumatic muscle imbalance can then perpetuate the problem, leading to chronic TMD.
A 2018 study found that patients with TMD following a whiplash injury (wTMD) had higher pain intensity scores, worse exam findings, worse function, and greater muscle atrophy in the LPM than patients whose TMD resulted from another cause. The patients with wTMD were also more likely to be affected by stress and headaches than the other TMD patients.
The authors concluded that TMD is a common WAD-related injury, and MRI findings of disk displacement and LPM alterations are often found together. They also point out that TMD from whiplash appears to involve a different mechanism than TMD from other types of trauma or no trauma.
Doctors of chiropractic are trained in the assessment and treatment of WAD, including TMD, which often involves a multi-faceted approach that includes manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more).
Whole Body Health
Detoxing from Social Media and Electronic Devices
The ability to take out a small device and check email, take photos, interact with friends, play games, and answer almost any question seemed like a great idea when smartphones and social media debuted over a decade ago; but in recent years, several studies have looked at the downsides associated with heavy social media and device use.
For example, a 2018 study found that people who use social media platforms for extended periods of time are more prone to make risky decisions. Another study revealed an association between heavy social media use and an elevated risk for physical ailments. Most people are aware of the term “text neck”, which results from spending so much time looking down at the phone that it changes a person’s posture for the worse. Other studies have linked social media use with poor mental health, especially among teens and young adults. One study even suggests that the more someone uses social media, the more likely they are to consult with a plastic surgeon to “improve” their appearance
The Cleveland Clinic’s Dr. Joseph Rock notes that these issues associated with social media/device use may be due to both how social media changes the brain and the effects of sedentary activity on the mind and body. After all, if you’re staring down at your phone all day, you’re probably not moving your body enough.
One of the big problems with social media is that it produces feelings that keep luring people back for more—to the point where they have difficulty coping if they’re not glued to their device. The best way to determine if you’re using your device too much is to ask family and friends what they think, and if the answer is consistently “too much”, that’s a good indication of a problem. Dr. Rock recommends a “cold turkey” approach to test the addiction intensity. He warns, though it will be initially uncomfortable, it does gradually improve.
Not only will you find yourself spending more time having face to face conversations and smelling the roses, but you’ll probably increase your physical activity levels and take on a healthier posture. If you’re still experiencing some neck/shoulder discomfort, your doctor of chiropractic can show you some exercises that can help retrain your body to sit up straight, which can take a lot of pressure off your neck and upper back.
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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.