The Pelvic Floor & Low Back Pain

The pelvic floor is the muscular “hammock” that carries the weight of the viscera located in the pelvis. If these muscles become too loose or too tight, an individual may experience urinary (or fecal) urgency or incontinence, sexual dysfunction, pelvic organ prolapse, as well as pain in the pelvic region and even in the lower back.

This condition, known as pelvic floor dysfunction (PFD), most commonly affects women (95% of PFD patients are female) with advancing age and a history of multiple childbirths. Many women have PFD but often do not complain about it due to embarrassment or “just accepting it as part of having babies” or “just part of aging.” However, the condition can be addressed so that its effect on quality of life is reduced, and a doctor of chiropractic may play a role in managing the condition.

Patients with weak pelvic floor muscles (hypotonic PFD) often benefit from Kegel-type exercises where the patient “pulls-up” (or “draws inwards”) the perineum, as if to stop or prevent urination and/or defecation. Unlike classic Kegel exercises with a short hold time (more rapid frequency), PFD exercises should be done with 10 second holds and gradually increase the number of reps to 30 to obtain muscle fatigue. Although some doctors recommend doing these exercises virtually anywhere and anytime, the KEY is to do them very consciously (using visualization)!

It is important to AVOID abdominal bracing (tightening up the abdominal muscles) because this INCREASES the pressure against the pelvic floor. Keep the stomach, buttocks, and inner leg muscles relaxed, and don’t hold your breath. Try exhaling as you do the exercise. When you sense a sneeze or cough coming, squeeze the pelvic floor to support the bladder.

For patients with tight (hypertonic) pelvic floor muscles, studies recommend manual therapy, scar tissue manipulation, modalities (ultrasound or e-stim), massage, breathing retraining, cognitive behavioral therapy, and meditation.

Both hypotonic and hypertonic PFD may be co-managed with an OB/GYN or the patient’s medical physician with supporting care provided by their doctor of chiropractic. A doctor of chiropractic can address musculoskeletal issues in the pelvic region and lower back with manual therapies (including manipulation and mobilization) to reduce pain and relieve pressure on the pelvic floor. The good news for individuals with PFD is that the condition is manageable, and you don’t have to accept it as a normal consequence of life!

Neck Pain / Headaches

Migraine Headache Triggers

Migraines are characterized by recurrent headache and a hypersensitivity to sensory stimuli that can trigger an episode. Unfortunately, migraine triggers can vary from patient to patient, which can make understanding and managing the patient’s condition a difficult proposition for both the patient and their doctor.

In one study, researchers reviewed data from surveys, patient diaries, and clinical trials and identified stress, menstruation, weather changes, sleep disturbances, alcohol, and food sensitivities as common migraine triggers. In another study, researchers asked 62 migraine patients to use a smartphone app to keep track of their headaches for a three-month time frame. Participants reported headaches on nearly 1 in 4 days. Subsequent analysis identified that the most common triggers among the patients in the study were travelling, hormonal changes, noise, alcohol, over-eating, stress, fatigue, sleep deprivation, and weather changes. Keeping a written record of anything that precedes a migraine such as diet or environmental changes can help a patient develop a sense of what they should avoid.

In the general sense, living a healthier lifestyle appears to reduce the likelihood of encountering migraine triggers. Therefore, patients are encouraged to get adequate sleep, exercise, eat a healthy diet, avoid excessive alcohol consumption, not smoke, and manage stress. In fact, the American Academy of Neurology reported in April 2021 that regular exercise could reduce headache frequency in migraine patients by up to 50%, largely due to exercise’s effect on reducing stress, depression, and poor sleep, all of which are potential migraine triggers.

What about chiropractic care? Can it help patients with migraines? The short answer is yes, to some degree. The current research suggests that patients with migraines often have greater sensitivity to pain in the neck muscles, which suggests abnormal function in the cervical spine. A 2021 study reported that cervical flexor muscle endurance is reduced in migraine patients, and the patients experienced pain in the head when the muscles become fatigued.

Manual therapies provided by doctors of chiropractic to reduce trigger points and restore normal neck range of motion has been demonstrated to reduce migraine intensity and frequency, which was reported in a 2019 systematic review of six randomized control trials. A study published in 2021 found similar results in children with a history of migraines. Thus, regardless of age, patients with migraines (as well as other forms of headache), could benefit from an examination of the cervical spine and treatment to address any dysfunction that’s uncovered.

Joint Pain

The Hip-Foot Connection

When examining a patient for hip pain and other musculoskeletal conditions, doctors of chiropractic will expand their focus beyond the area of chief complaint to identify issues elsewhere in the body that may be underlying or contributing factors. This is especially true with the hip because anything that affects normal locomotion can lead to compensatory changes and abnormal motion in the hip joint, which can easily result in inflammation or wear and tear that causes pain. Such is the case with issues in the foot, like plantar fasciitis.

Plantar fasciitis is one of the most common causes of heel pain and is characterized by inflammation of the thick band of tissue (plantar fascia) located on the bottom of the foot that connects the heel bone (calcaneus) to the toes. Individuals with the condition may experience a stabbing pain that often occurs with initial weightbearing, especially in the morning. The intense initial pain usually improves after a few steps; however, it can also worsen following prolonged standing or intense activity.

The function of the medial longitudinal arch of the foot is to absorb shock and to add “spring” to each step. In the mid-stance phase of gait, the arch flattens out, stretching the plantar fascia (the “string”) and if stress and tension exceeds the tissue’s threshold or becomes too great, micro-tears inflame the fascia and cause pain when initiating weightbearing. This leads to pain and can affect normal gait, which can ultimately lead to issues up the kinetic chain, such as hip pain.

Risk factors for PF include advancing age, stressful exercise (running, ballet dancing, aerobic dance), altered arches in the feet (such as flat feet as well as a high arch), obesity, and occupations that require an individual to be on their feet all day, especially on hard surfaces.

Following diagnosis, which may include a review of the patient history and an examination, a conservative treatment approach in a chiropractic setting may include manual therapies (longitudinal and cross fiber friction massage); Graston technique (using spoon-like tools to stimulate blood flow and break up adhesions); stretching exercises (calf stretches off a step or using TheraBand to bend the foot and ankle upwards and extend the toes); prescription foot orthotics with pronation correction (lateral heel wedge); modalities (laser, ultrasound, extracorporeal shock wave therapy); and dorsiflexion night splinting. Patients may also be encouraged to reduce their intake of processed foods—which can increase inflammation in the body—and eat a more anti-inflammatory diet, like the Mediterranean diet, to aid in the healing process.

Because prolonged standing and stressful exercise can worsen the condition, patients may be advised to reduce the time they spend on their feet and switch to less impactful forms of exercise during recovery. The good news is that conservative treatment approaches, such as chiropractic care, are often successful in helping PF patients manage their condition.

Carpal Tunnel Syndrome

Alpha-Lipoic Acid Supplementation for Carpal Tunnel Syndrome

When it comes to the conservative management of a condition like carpal tunnel syndrome, care will usually focus on reducing inflammation along the course of the carpal tunnel and improving mobility of the median nerve as it travels from the neck and into the hand. This treatment approach may also include the use of nutritional supplements, of which alpha-lipoic acid (ALA) is starting to show promise.

Alpha-lipoic acid (ALA) is an antioxidant that naturally occurs in the body and can also be found in organ meats, spinach, broccoli, and potatoes. However, it’s often consumed as a supplement in order to get enough into the body to have an observable effect. Though research is ongoing, two benefits of ALA that are important for potential carpal tunnel treatment are its ability to reduce inflammation and to protect nerves from damage.

In a 2020 study involving 134 patients on a surgical waiting list with mild-to-moderate CTS, researchers observed that taking a 600mg ALA supplement once a day for 60 days reduced both daytime and nighttime hand and wrist pain, with 14% of participants in the ALA group canceling their surgery. The authors of this study add that previous studies that combined ALA with either curcumin or gamma-linolenic acid provided similar benefits to participants.

A 2018 study that included 31 CTS patients reported that ALA, N-acetyl-L-carnitine, turmeric, vitamins B, E, and C formulated for peripheral neuropathy (taken twice a day for one month) led to similar improvements in pain, symptom severity, and function as extremely-low frequency electromagnetic fields (ELFEF) therapy, but the benefits persisted in the supplement group for another two months while the ELFEF participants reverted to their baseline pain and function levels.

A systematic review conducted in 2020 concluded that ALA is safe, even in groups normally observed to be at risk like smokers, cardiovascular disease patients, diabetics, pregnant women, children/adolescents, and individuals with neurological disorders, rheumatic disorders, and severe renal disease.

While further research is certainly warranted on the benefits of a supplement like ALA for the CTS patient, it is certainly showing promise, and a patient may consider it as part of a multimodal approach that can include manual therapies, specific exercises, nocturnal splinting, heat/ice, and an anti-inflammatory diet.

Whiplash

Initial Treatment Approach for Whiplash-Associated Neck Pain

While neck pain is one of the most common reasons patients seek chiropractic care, the underlying cause of neck pain can vary. In some patients, the cause may be unknown or it may be the accumulation of years of poor posture, bad ergonomics, and an unhealthy lifestyle. In other patients, such as those who experienced a whiplash event in a rear-end automobile collision, the cause is well known and better understood. Is neck pain related to whiplash associated disorders (WAD) different than other types of neck pain, and what’s the best initial approach for those with traumatic vs. non-traumatic neck pain?

In a 2020 study, researchers compared the initial presentation of 22 patients with mechanical neck pain (non-traumatic) and 28 patients with grade I or II WAD-related neck pain with or without loss of range of motion but no neurological sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes.

A review of participant-provided assessment data as well as examination findings revealed the WAD patients exhibited higher neck-related disability, felt pain over a larger area, and had a lower pressure pain threshold over the tibialis anterior (the muscle next to the shin bone).

In the next phase of the study, each patient received two treatments a week for three weeks that included soft tissue techniques targeting trigger points in the cervical region, spinal mobilization, muscle energy techniques, manual traction, and specific cervical spine exercises. This is the type of multimodal approach a patient may receive from their doctor of chiropractic to restore normal motion to the cervical joints as well as to strengthen the deep cervical muscles that often become deconditioned following an injury to the cervical spine and associated tissues.

The researchers hypothesized that due to greater symptom severity and sensitivity to pain, the WAD patients would not respond as well to care. However, patients in both groups reported similar overall improvements in pain and disability following just six treatments.

The findings suggest that a multimodal approach can benefit both types of neck pain patients. However, those with WAD may require more office visits to reach maximum improvement. Treatment guidelines encourage patients to utilize conservative options first, of which chiropractic care is an excellent choice. In the event an individual develops neck pain, either from whiplash or non-traumatic origin, it’s important to seek care sooner rather than later, as delaying care can increase the risk the condition becomes chronic and more difficult to manage.

Whole Body Health

Dietary Management for Chronic Disease Prevention

It’s estimated that cardiometabolic diseases are a significant source of lost years with respect to both a reduced lifespan and fewer years without disability. Despite medical advances, it’s unlikely there will be a pill developed anytime soon that can dramatically reduce the risk for obesity, diabetes, and cardiovascular disease, and it’s incumbent on us as individuals to take measures to give ourselves the best possible chance to live a longer, healthier life.

The obvious way to optimize health, longevity, and quality of life is to PREVENT rather than REACT to the onset of cardiometabolic diseases. The longer we wait, the greater the challenge becomes to reverse the negative effects of dietary and lifestyle abuse. Hence, the “secret formula” for prevention includes modifying risk factors that specifically address body weight (goal: BMI under 25), dyslipidemia (high cholesterol), hypertension, pre-diabetes or diabetes, as well as improving modifiable behaviors such as avoiding tobacco, exercising regularly (30m/day of moderate to vigorous exercise), and EATING A BALANCED DIET.

The obvious way to optimize health, longevity, and quality of life is to PREVENT rather than REACT to the onset of cardiometabolic diseases. The longer we wait, the greater the challenge becomes to reverse the negative effects of dietary and lifestyle abuse. Hence, the “secret formula” for prevention includes modifying risk factors that specifically address body weight (goal: BMI under 25), dyslipidemia (high cholesterol), hypertension, pre-diabetes or diabetes, as well as improving modifiable behaviors such as avoiding tobacco, exercising regularly (30m/day of moderate to vigorous exercise), and EATING A BALANCED DIET.

A 2019 systematic review and meta-analysis regarding the effect of different dietary patterns on diabetes outcomes found that the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), Portfolio, Nordic, and vegetarian dietary patterns were not only effective for reducing the risk for diabetes and for managing diabetes but these diets also improved overall quality of life and lowered the risk and effect of cardiovascular disease, stroke, and obesity. Another benefit of healthy dietary approaches is that they can help reduce inflammation in the body, which is linked to a lower risk for chronic pain.

A healthy diet is also good for the brain, as was shown in another systematic review published in 2019 that looked at the health benefits as they relate to disorders associated with cognitive decline. Since there is no cure for dementia, there is an urgent need for identifying preventive approaches. The authors concluded that the Mediterranean, DASH, and a combination of the two called the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) were all effective for improving cognitive function and reducing AD risk, with the strongest association observed with the MIND diet.

It’s important to understand that while you’re taking steps to improve your own health, we’re all in this together, so if you have any questions or if you develop aches and pains, feel free to consult with your doctor of chiropractic at your next visit.