An evaluation of data concerning over 8,000 Spanish workers reveals a correlation between chronic neck and back pain, and missing one or more days of work for health-related issues. Individuals who reported having frequent neck and back pain were 44% more likely to be absent from work for more than 30 days out of the year.
Spine, May 2014
Dr. Glenn Hyman’s Denver Chiropractic Center shows you the basics for foam rolling the legs. Combined with regular Active Release Techniques work and chiropractic care, you can run injury-free.
Most people don’t realize how complicated the low back region is when it comes to investigating the cause of low back pain (LBP)? There can be findings on an x-ray, MRI, or CT scan such as degenerative disk disease, arthritis, even bulging and/or herniated disks that have NOTHING to do with why the back hurts. Similarly, there are often other abnormal findings present in many of us who have NO low back pain whatsoever! Because of this seemingly paradoxical situation, we as clinicians must be careful not to over-diagnose based on the presence of these “abnormal findings” AND on the same hand, be careful not to under-diagnose them as well. Many of you know it can be quite tricky.
Looking further into this interesting paradox, one study reported findings that support this point. Investigators examined 67 asymptomatic individuals who had NO prior history of low back pain and evaluated them using magnetic resonant imaging (MRI). They found 21 of the 67 (31%) had an identifiable disk and/or spinal canal abnormality (which is where the spinal cord and nerves run). Seven years later, this same group of non-suffering individuals was once again contacted to see if they had developed any back problems within that time frame. The goal of the study was to determine if one could “predict” who might develop low back pain based on certain abnormal imaging findings in non-suffering subjects. A questionnaire was sent to each of these individuals, of which 50 completed and returned the questionnaire. A repeat MRI scan was performed on 31 of these subjects, and two neurologists and one orthopedic spine surgeon interpreted the MRI studies using a blinded approach (without having knowledge about the subject’s symptoms or lack thereof). Each level was assessed for abnormalities including disk bulging/herniation and degeneration. Those who had initial abnormal findings were defined as “progressed” (worsened) if an increased severity of the original finding was evident or if additional or new spinal levels had become involved over the seven-year time span.
Of the 50 who returned the questionnaire, 29 (58%) had NO low back pain, while 21 had developed LBP. In the original group that had the MRI repeated seven years later, new MRI findings included the following: twelve remained “normal,” five had herniated disks, three had developed spinal stenosis, and one had “moderate” disk degeneration. Regarding radiating leg pain, four of the eight had abnormal findings originally, two of the eight had spinal stenosis, one had a disk protrusion, and one an “extruded” (“ruptured”) disk. In general, repeat MRI scans revealed a greater frequency of disk herniation, bulging, degeneration, and spinal stenosis compared to the original scans. Those with the longest duration of LBP did NOT have the greatest degree of abnormalities on the original scans. They concluded that the original MRI findings were NOT PREDICTIVE of future development of LBP.
They summarized, “…clinical correlation is essential to determine the importance of abnormalities on MR images.” These findings correlate well with other studies, such as 50% or more of all asymptomatic people HAVE bulging disks and approximately 30% of us have herniated disks – WITHOUT PAIN. To be of diagnostic (clinical) value, the person MUST have signs and symptoms that agree with the imaging test, which is used to CONFIRM the diagnosis. Bottom line, If you have LBP, come see us, as we will evaluate and treat YOU, NOT your x-rays (or MRI) findings!
If you, a friend, or family member requires care for back pain, we would be honored to help. Simply call us at 303.300.0424, or use the “Make An Appointment” link on our website at denverback.com
Headaches (HA) play a significant role in a person’s quality of life and are one of the most common complaints that chiropractors see. This comes as no surprise, as one survey reported 16.6% of adults (18 years and older) suffered from migraines or other severe headaches during the last three months of 2011. Another study reported that head pain was the fifth LEADING CAUSE of emergency department (ED) visits in the United States and accounted for 1.2% of all outpatient visits. These statistics are even worse for females (18-44 years old), where the three month occurrence rate was 26.1% and the third leading cause for ED visits! Because of the significant potential side effects of medications, many headache sufferers turn to non-medication treatment approaches, of which chiropractic is one of the most commonly utilized forms of “complementary and alternative approaches” in the management of tension-type headaches. So, why are headaches so common? Let’s talk about posture!
Posture plays a KEY ROLE in the onset and persistence of cervicogenic headaches. If there is such a thing as “perfect posture,” it might “look” something like this: viewing a person from the front (starting at the feet), the feet would flair slightly outwards symmetrically, the medial longitudinal (inside) arch of the feet would allow enough space for an index finger to creep under to the first joint (and NOT flat like so many), the ankles would line up with the shin bones (and NOT roll inwards), the knees would slightly “knock” inwards and hips would line up squarely with the pelvis. The shoulders would be level, the arms would hang freely and not be pronated (rolled) inwards, and head would be level (not tilted). From the side view, the knees would not be hyperextended nor flexed, the shoulders would not be forward (protracted) and MOST IMPORTANT (at least for headaches), the head would NOT be forward and be able to have a perpendicular line drawn from the floor through the shoulder, as this line should pass through the outer opening of the ear. As the head “translates” or shifts forwards, for every inch of “anterior head translation” (AHT), it essentially gains 10 pounds in weight, which the upper back and neck muscles have to counter balance!
A leading University of California medical author, Dr. Rene Calliet, MD, wrote that this altered posture can add up to 30 pounds of abnormal weight to the neck and can “…pull the entire spine out of alignment.” It can also reduce the lung’s vital capacity by 30%, which can contribute to all sorts of breathing-impaired health problems! Think of carrying a 30-pound watermelon around your neck all day – the muscle pain from fatigue would be tremendous! If this is left uncorrected, chronic neck pain and headaches from pinching off the top three nerves in the neck is likely. The combination of AHT and shoulder protraction may also lead to the development of an upper thoracic “hump” and potentially into a “Dowager Hump” if the Midback vertebrae become compressed (wedged). An increased rate of mortality of 1.44 is reportedly associated with this faulty posture!
Between chiropractic adjustments, Active Release Techniques Soft Tissue Treatments, posture retraining exercises, other postural corrective care, and strength exercise training, we WILL help you correct your faulty posture so that neck pain and headaches STOP and don’t progress into a chronic, permanent condition.
If you, a friend, or family member requires care for headaches, we would be honored to help. Simply call us at 303.300.0424, or use the Appointment Request function on our website at denverback.com
A survey of over 500 chronic low back pain patients who have been on work disability for between two and ten months shows that 69.7% report experiencing substantial fatigue as well. Those reporting fatigue are more likely to suffer from depressive symptoms and are also more likely to still be in pain 3, 6, and 12 months after completing their initial survey.
Pain Medicine, April 2014
Chiropractic care and Active Release Techniques from Denver Chiropractor Dr. Glenn Hyman can help.
“Family is not an important thing. It’s everything.” ~ Michael J. Fox
Mental Attitude: Let it Go.
Previous studies have shown that the inability to forgive one’s self for a wrong they’ve inflicted on another can be a factor in depression, anxiety, and a weakened immune system. The results of a new study shows that the more guilty a person feels, the less likely they are to self-forgive. However, attempting to make amends was shown to decrease those guilty feelings and make self-forgiveness easier.
The Journal of Positive Psychology, April 2014
Health Alert: Cholesterol Levels Linked to Fertility.
Couples having trouble getting pregnant may want to get their cholesterol levels checked. A study involving 500 couples found that conceiving a child took longer when both partners had high cholesterol levels than when both partners had cholesterol levels in the normal range.
National Institutes of Health, May 2014
Diet: Three Ideas for Overcoming Childhood Obesity.
To combat childhood obesity, Dr. Kristopher Kaliebe of the Louisiana State University Health Sciences Center has developed three simple ideas that parents and their children can follow: 1) Eat Food — Not too Much, Mostly Plants. Eating mostly raw, natural, unprocessed food eliminates the need to count calories, a large reason most diets fail. 2) Get up and move. Be active whenever possible and avoid sedentary behavior. 3) Honor silence. Avoid sensory overload from TV, the internet, gadgets, and video games and focus on the more important matters like academics, sleep, family, and hobbies.
Journal of the American Academy of Child & Adolescent Psychiatry, April 2014
Exercise: Bursts of Intense Exercise Before Meals Helps Control Blood Sugar.
Brief bursts of intense exercise before meals helps control blood sugar in individuals with insulin resistance better than 30 minutes of moderate exercise performed once per day. Researchers found that distributing the same amount of exercise into three ten-minute, high-intensity, pre-meal exercise periods resulted in a 12% reduction in the average post-meal glucose level, an effect that was also sustained the ensuing day.
Diabetologia, May 2014
Chiropractic: Conservative Care for Lumbar Disk Injuries.
A 31-year-old male with left-sided low back pain and left leg pain received a trial of chiropractic care that included soft tissue therapy, manual mobilization, pelvic blocking, and extension exercises. His pain was almost completely resolved by his third treatment. This finding supports the ability of chiropractic care to reduce pain and improve mobility in patients with a lumbar disk herniation.
Journal of Canadian Chiropractic Association, September 2012
Wellness/Prevention: Calcium Supplementation Does Not Increase Cardiovascular Disease Risk in Women.
While recent studies have indicated that calcium supplementation may increase a woman’s risk for cardiovascular disease, a review of two decades worth of data on over 74,000 female nurses reveals that calcium supplementation is not associated with an increased risk for heart attack or stroke. Lead study author Dr. Julie Paik explains, “Our study has several distinct strengths compared to prior studies including the large number of participants, long-term follow-up, large number of cardiovascular events that were confirmed by medical record review, detailed information about diet and other cardiovascular disease risk factors, and repeated assessment of calcium supplement use over the 24-year follow up period.”
Osteoporosis International, May 2014
Kacee is back with this week’s (approximately) Thirty Seconds on Thursday video. Just click on the video below and it will take to our youtube channel where it will play. We’re talking about Foam Rolling to prevent back pain this week. Hope you enjoy it.
Dr. Glenn Hyman, Kacee Reinisch, Natalie Aceves, and Erin Young, Denver Chiropractic Center
Last month, we started the discussion of self-care options in the management of car accident injuries: whiplash or CAD (cervical acceleration-deceleration) or WAD (whiplash associated disorders). In this series, we are describing various treatment methods that you can be taught to help facilitate in the management process during the four stages of healing (acute, subacute – discussed last month; remodeling and chronic – addressed this month).
Like in the acute and subacute stages, many of the same self-care techniques can be applied here as well. You will NEVER “hurt” yourself with ice or ice/heat combinations (done properly), so they can be continued indefinitely. Many patients find this helpful. Using the analogy of a cut on the skin, in the acute stage, the cut is fresh and new. It is quite pain sensitive and unstable and it will continue to bleed if you don’t take it easy. After 72 hours (entering the subacute stage), the wound has an immature scab on it and it can still easily be re-injured, and if this occurs, especially by NOT self-managing properly, the recovery time can be significantly prolonged. So, “DON’T PICK AT YOUR CUT!!!” As we enter the later subacute phase (fourteenth week), the wound’s scab is quite mature, and self-care can be appropriately more aggressive. Think strengthening and activity restoration!
Stage 3 – REMODELING phase (14 weeks to 12 months or more): In this stage, we are now three months to a year out from the injury date and hence, we SHOULD now be more “aggressive” with care. During the late acute and subacute stages, you would have been performing exercises focused on movement restoration (range of motion / ROM exercises with LIGHT resistance) in addition to self-applied myofascial release techniques using foam rolls, tennis balls, TheraCane, and/or the Intracell (and possibly others). It is NECESSARY to continue the use of these methods, as they help reduce the chances for any scar tissue to become permanent. In this stage, we will guide you into more advanced exercises that include aerobics (walking, walk/run combinations, etc.) as studies show that whole body aerobic exercise helps MANY specific area injuries, including WAD/CAD injuries.
Stretching short/tight muscles, working on balance-challenging exercises (rocker or wobble boards, balance beams, gym balls, eyes closed specific action movements) are VERY IMPORTANT, as they retrain your neuromotor system and reintegrate neural pathways that have been disrupted by the injured tissues and retrain faulty movement patterns you’ve developed from compensating due to pain. Strengthening exercises will include the core since the head sits on the neck, the neck on the trunk, the trunk on the legs, and ALL of this sits on the feet (so we’ll even consider stabilizing the sub-talar joint at the ankle and if pronation is excessive, foot orthotics can help whiplash patients)!
Stage 4: CHRONIC (Permanent): ALL OF THE ABOVE can be employed after the one to two year point to “maintain” your best level of function. If you still have pain, try to “ignore it” and KEEP MOVING, stay active, stay engaged in work, family activities, and DON’T let the condition “win.” AVOID CHRONIC DISABILITY by staying active and fit!
We realize you have a choice in whom you consider for your health care. If you or someone you know needs help recovering from car accident injuries, call us at 303.300.0424, or use the “Make an Appointment” function on our website www.denverback.com.
Whiplash is a condition that can occur from MANY causes – in fact, anything that results in a sudden change in the head/neck position. Usually, there is a rapid acceleration that injuries the soft tissues around the neck area by stretching them beyond their limits. Hence, the more accurate terms for whiplash are, “cervical acceleration-deceleration” or CAD as it describes the mechanism of the injury and “whiplash associated disorders” (WAD) describing the degree of injury.
Most commonly, when we think about whiplash, we immediately envision a motor vehicle collision (MVC), but prior to the invention of the automobile, the term “railroad spine” was coined to describe injuries to the neck from crashes that occurred between trains. Since then, due to pilots landing planes on aircraft carriers, sports injuries, and the rise of the automobile, this once rare condition has affected MOST of us at some point in time!
Today’s topic will focus on self-care. What can you and I do for ourselves WHEN we suffer a CAD injury? Since there are different levels of injury severity, keep in mind that EACH CASE IS UNIQUE and we will ONLY be discussing general options. So ALWAYS let your symptoms guide you in the process of care – that is, if you feel a sharp, piercing/stabbing, activity or movement stopping type of pain, STOP!!! Don’t further injure your tissues!!! We will discuss a common WAD II injury (soft-tissue injury limiting motion but not injuring nerves) and we’ll look the acute and sub-acute stages of the injury.
Stage 1 – ACUTE: The inflammatory phase (up to 72 hours). ICE is necessary to decrease swelling (inflammation). Limit motion but try NOT to use a collar unless you have no choice as even small movements that avoid the sharp/knife-like pain are better than no movement at all. A collar may be needed when driving (especially if the roads are bumpy)! Anti-inflammatory herbs like ginger, turmeric, boswellia, bioflavonoid, and others reduce inflammation WITHOUT irritating the stomach, liver, kidneys, and will NOT inhibit the chemicals needed for healing (like NSAIDs do!). Chiropractic care with Active Release Techniques Soft Tissue Treatment SHOULD begin ASAP after an injury. We may only use gentle manual traction and/or mobilization, also staying within reasonable pain boundaries. It’s been well proven that early movement is best!
Stage 2 – SUB-ACUTE: The repair phase (72 hours to 14 weeks). Ice can continue if it helps control pain. You can also alternate ice and heat at 10/5/10/5/10 minutes, starting and ending with ice (it “pumps” the tissues). Cervical range of motion (ROM) exercises with LIGHT resistance (use 1 or 2 fingers against the head and push in a forward, backward, sideways, and rotating directions first with “isometrics” – not moving the head, and when tolerated, “isotonic” – moving the head against the LIGHT pressure applied in BOTH directions within the range that avoids sharp/knife-like pain. Movement, strength, pain, and coordination are ALL better managed when light resistance + motion is used vs. not moving (isometrics). Self-applied methods of performing “myofascial release” (which we will teach you) include: Self-massage, the use of a tennis ball and/or foam roll and others. During this repair phase, chiropractic adjustments and Active Release Techniques Soft Tissue Treatments REALLY help!!! We will continue this discussion on the next page…