Car Accidents and neck pain (a.k.a. Whiplash)

Whiplash refers to an injury to the neck resulting from a rapid movement, usually associated with a motor vehicle collision (MVC). However, it can occur with a slip and fall injury, a bar room brawl, during a sports event like being tackled in football, among other things. For the sake of this discussion, we will stick with the classic example of a rear-end MVC.

 Mechanism of injury: So what really happens during the MVC that causes injury? The answer centers around movement of the neck which exceeds the normal tissue’s stretch limits, sometimes referred to as “the elastic barrier.” When the MVC occurs, during the first 100-200 milliseconds the trunk supported by the back of the car seat rapidly moves forwards leaving the head unprotected in its original position resulting in a backward glide or motion of the head and neck. Next, the head (which weighs about 12-15 pounds) drops back (HOPEFULLY) into the headrest stopping the motion, but if the head rest is too far back (>1/2 inch) or too low, then the head keeps going backwards until the tissues in the front of the neck stretch to the point of either stopping the motion or tearing (or both).

Next, the highly stretched front of the neck muscles, ligaments, disks, and tendons (in a “crack the whip” like manner) propel the head forwards to the point of over stretching the tissues in the back of the neck, which similarly stops the movement &/or tears. The degree of injury depends on many things, but is notably worse in the long-necked, skinny female where the “crack the whip” reaction is the greatest. Several factors determine the degree of injury, including the “G-Force,” or the amount of energy produced during the impact. The greater the G-force applied to the head/neck, the greater the potential for injury.

The G-force affecting the occupants inside the vehicle is related to many things: the speed of the crash, the size of the two vehicles (worse if a large automobile hits your smaller car), the angle and springiness of the seat back, the amount of energy absorbed by crushing metal vs. no damage to the vehicles (worse when there is no damage as all the energy is transfer to the occupants), whether the head was rotated or looking straight at impact, and more. The KEY to all of this is that we cannot voluntarily contract our muscles quicker than 800-1000 msec and the whiplash process is over after about 500 msec, so we can’t effectively “guard” or protect ourselves against injury even if we try by bracing ourselves before the MVC!

            Type of injury: The classic injury is called a sprain (ligament tear) and strain (muscle and/or muscle tendon tear) to either or both the front of the neck and/or back of the neck. Sprains and strains come in 1st, 2nd, and 3rd degree tears, getting progressively worse as more tissue is torn. Please refer to previous issues of the Whiplash Health Update where the anatomy is reviewed so you can “picture” this properly.

            Prognosis: The length of time to recovery or maximum improvement varies by the amount of tissue damage. A “prognosis scale,” first introduced in 1995 and validated by 2001, showed that in Type 1 injuries pain without loss of neck motion healed the quickest. Type 2 injuries where neck movement was reduced after the MVC (but no neurological findings occurred) healed next quickest. Type 3 injuries, which included BOTH motion and neurological loss, healed the slowest and had the worst long-term outcomes. Other factors enter into this, of course.

We will continue this “Whiplash 101” discussion next month…

We realize you have a choice in where you receive your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Hippocrates and chiropractic care

Chiropractic may only be 114 years old, but spinal manipulation has been around for thousands of years. Massage and manipulation are two of the oldest remedies known to man. In fact, the first pictures depicting spinal manipulation were discovered in prehistoric caves in Point Le Merd in southwestern France. These drawings depicted crude, non-specific attempts to manipulate the spine that date back to 17,500 bc. The ancient Chinese were using manipulation in 2700 bc. and James Cyriax, in his Textbook of Orthopedic Medicine, included a picture of a Buddhist temple with a statue over 2,000 years old showing manipulation of the lumbar spine.

More recently, Hippocrates (460-377 bc), the father of Greek medicine said, “Get knowledge of the spine, for this is the requisite for many diseases.” He wrote over seventy books on healing and was a proponent of spinal manipulation. This great physician was also the first to deal with the anatomy and the pathology of human spine. In his books, he provides a precise description of the segments and the normal curves of the spine, the structure of the vertebrae, the tendons attached to them, the blood supply to the spine, and even its anatomic relations to adjacent vessels. Hippocrates devised two apparatuses, known as the Hippocratic ladder and the Hippocratic board, to reduce displaced vertebrae.

Hippocrates believed only nature could heal and it was the duty of a physician to remove any interference preventing the body from healing. Hippocrates taught that the essence of life and the ability of the body to heal was the result of a vital spirit.

Denver Chiropractic Center Weekly Health Update

“If you want others to be happy, practice compassion.
If you want to be happy, practice compassion”
~ Unknown

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Mental Attitude: The Elderly and Facebook.
Elderly adults who learned to use Facebook on a daily basis scored 25% better on tests measuring their cognitive abilities than their peers who did not.
University of Arizona, February 2013

Health Alert: Baby Boomers Vs. Preceding Generation!
As each generation grows older, they believe they are healthier than the previous generation. However, the baby boomers are unable to make this claim. Compared to the preceding generation at the same stage of their lives, fewer have “excellent” health (13% vs. 32%), more have high blood pressure (75% vs. 35%), and more are obese (36% vs. 25%).
JAMA Internal Medicine, February 2013

Diet: The Southern Diet and Stroke.
People from the American South are 20% more likely to have a stroke than those from other parts of the country, and the Southern diet may be to blame. People who eat Southern style food high in fat, sugar, and salt at least 6 times a week were at 41% higher risk for a stoke. People whose diets consisted of fruits, vegetables, and whole grains at least 5 times a week were 29% less likely to have a stroke.
American Stroke Association, February 2013

Exercise: Tai Chi?

Tai Chi may reduce falls among adult stroke survivors. Tai Chi is a martial art dating back to ancient China that includes physical movements, mental concentration, and relaxed breathing.
American Stroke Association, February 2013

Chiropractic: Recommended For Back Pain.
The Royal College of General Practitoners’ 2009 recommendation for treating non-specific low back pain advises doctors to advocate exercise and manipulation (such as chiropractic care) before pharmacological (drug) therapies and more invasive treatments (like surgery).
National Institute for Health and Clinical Excellences, 2009

Wellness/Prevention: Sunshine and Rheumatoid Arthritis.
Routine exposure to the sun, especially ultraviolet B (UVB) rays, may decrease the risk of rheumatoid arthritis. Those with the most elevated rates of exposure were 21% less likely to develop rheumatoid arthritis than who had less exposure.
Annals of the Rheumatic Diseases, February 2013

This week’s 1-Page health News from Denver Chiropractic Center

Health Alert: High Fructose Corn Syrup and Type-2 Diabetes. Researchers found a 20% higher proportion of the population has diabetes in countries with high use of High Fructose Corn Syrup (HFCS), like the United States, compared to countries that do not, like the United Kingdom. The United States has the highest consumption of HFCS at 55 lbs (~25 kg) per year per person. The United Kingdom consumes 1.1 lbs (~.5 kg) per year per person.

Global Public Health, November 2012

Diet: Food Advertising. Childhood obesity has tripled in the past 30 years. Food companies spend $10 billion a year marketing in the United States, and 98% of that is on foods high in fat, sugar, or sodium.

Journal of Pediatrics, November 2012

Exercise: Walk Much? The more moderate physical activity (like brisk walking) you do, the better. Compared to doing nothing at all, seventy five minutes of vigorous walking per week was linked to living an extra 1.8 years. Walking briskly for 450 minutes or more per week was found to provide most people with a 4.5-year longer lifespan. The longer people spent each week being moderately active, the greater their longevity. Heart, November 2012

Chiropractic: Keep Your Disks Healthy. In normal healthy disks, the nerves (sinuvertebral) only sense pain on the periphery or outer regions of the disk. In grossly degenerated disks, nerves may penetrate into the center (nucleus) of the disk and be more vulnerable to degeneration and/or inflammation. Lancet, 1997

Wellness/Prevention: Cell Phone Addiction. Cell phone and instant messaging addictions are driven by materialism and impulsiveness and can be compared to consumption pathologies like compulsive buying and credit card misuse. Cell phones may be used as part of the conspicuous consumption ritual and may also act as a pacifier for the impulsive tendencies of the user. Impulsiveness plays an important role in both behavioral and substance addictions.

Journal of Behavioral Addictions, November 2012

Fibromyalgia and Neurotransmission

Neurotransmission is the method by which nerves “speak” to each other so impulses can be sent from one part of your body to the brain and back. For example, when you touch a hot plate by accident, it doesn’t take long before you quickly let go of the plate. The reason you let go quickly is because of neurotransmission. Certain types of neurons or nerves (called afferents) bring information to the central nervous system where the information is processed and then signals are transferred back to the target site (such as your hand touching the hot plate) by different nerves (called efferents) telling you to immediately let go of that hot object.

It’s like the flow of traffic into a city during rush hour. People work all day and then drive in the opposite direction on their way home (afferents in the morning going in the city or “brain” and efferents in the evening bringing new information home). This “give and take” process of information coming in, being processed and going out helps coordinate our bodily functions. This allows us to constantly adapt to surrounding changes in temperature, stress, noise, and so on.

Each neuron has as many as 1500 connections from other neurons, but they don’t actually touch one another. Rather, there are “synapses” where nerve impulses stimulate the release of calcium and neurotransmitters, which either inhibit or excite another neuron and each neuron may be connected to many other neurons. If the total excitatory stimuli are greater than the inhibitory stimuli, that neuron will “fire” and create a new connection resulting in an action (like dropping the hot plate).

Okay, sorry for the enthusiastic description and details of neurotransmission. More importantly, how does all this relate to fibromyalgia? A new study (published May 14, 2012 in NATURE by scientists at Weill Cornell Medical College) discovered that a single protein (alpha 2 delta), “…exerts a spigot-like function controlling the volume of neurotransmitters and other chemicals that flow between the synapses of brain neurons.” This study shows how brain cells “talk to each other” through these synapses relaying feelings, thoughts, and actions and how this powerful protein plays a crucial role in regulating effective communication in the brain. They found that if they added or decreased this single protein (alpha 2 delta), then the speed of neurotransmission increased or decreased by opening or closing the calcium channels that trigger neurotransmission release.

The relationship between calcium and neurotransmission has been known for 50 years, but how to “turn on or off” the volume is a new discovery. They hope this finding will help in the design of new medications that will help regulate the neurotransmission in the brain, thus help reduce the increased pain perception found in people suffering from fibromyalgia.

Our aim in sharing this information with you is to keep you informed with what is on the cutting edge of research as we’ve said many times before, a “team” of health care provision is the BEST way to manage FM including chiropractic and primary care!

Carpal Tunnel Syndrome – Natural Treatment Options

Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness and/or tingling in the hand. This includes the palm and the 2nd, 3rd, and half of the 4th finger, usually sparing the thumb. Another indication of CTS is weakness in grip strength such as difficulty opening a jar to even holding a coffee cup. CTS can occur from many different causes, the most common being repetitive motion injuries such as assembly line or typing/computing work.

Here is a PARTIAL list of potential causes of CTS: heredity (a small sized tunnel), aging (>50 years old), rheumatoid arthritis, pregnancy, hypothyroid, birth control pill use, trauma to the wrist (especially colles fractures), diabetes mellitus, acromegaly, the use of corticosteroids, tumors (benign or malignant), obesity (BMI>29 are 2.5 more likely), double crush (pinching of the nerve in more than 1 place such as the neck and the carpal tunnel), heterozygous mutations in a gene (associated with Charcot-Marie-Tooth), Parvovirus b19, and others. Again, repetitive trauma is still the most common cause. Once the cause(s) of CTS has been nailed down, then treatment options can be considered.

From a treatment perspective, we’ve previously discussed what chiropractors typically do for CTS (spinal and extremity joint manipulation, muscle/soft tissue mobilization, physical therapy modalities such as laser, the use of a wrist splint – especially at night, work task modifications, wrist/hand/arm/neck exercises, vitamin B6, and more). But, what about using other “alternative” or non-medical approaches, especially those that can be done with chiropractic treatment? Here is a list of four alternative or complementary treatment options:

  1. Anti-inflammatory Goals: Reducing systemic inflammation reduces overall pressure on the median nerve that travels through the limited space within the carpal tunnel at the wrist. An “anti-inflammatory diet” such a Mediterranean diet, gluten-free diet, paleo-diet (also referred to as the caveman diet) can also help. Herbs that can helps include arnica, bromelain, white willow bark, curcumen, ginger, turmeric, boswellia, and vitamins such as bioflavinoids, Vitamin B6 (and other B vitamins such as B1 and B12), vitamin C, and also omega 3 fatty acids.
  2. Acupuncture: Inserting very thin needles into specific acupuncture points both near the wrist and further away can unblock energy channels (called meridians), improve energy flow, release natural pain reducing chemicals (endorphins and enkephlins), promote circulation and balance the nervous system. For CTS, the acupuncture points are located on the wrist, arm, thumb, hand, neck, upper back and leg. The number of sessions varies, dependant on how long the CTS has been present, the person’s overall health, and the severity of CTS.
  3. Laser acupuncture: The use of a low level (or “cold” laser) or a class IV pulsed laser over the same acupuncture points as mentioned above can have very similar beneficial effects (without needles)! One particular study of 36 subjects with CTS for an average of 24 months included 14 patients who had 1-2 prior surgeries for CTS with poor post-surgical results. Even in that group, improvement was reported after 3 laser treatments per week for 4-5 weeks! In total, 33 of the 36 subjects reported 50-100% relief. These benefits were reportedly long-term as follow-up at 1-2 years later showed only 2 out of 23 subjects had pain that returned and subsequent laser treatment was again successful within several weeks.
  4. Active Release Techniques (ART): ART releases scar tissue in the muscles that surround the median nerve. This release takes the pressure off of the nerve, and often resolves CTS. We’ve been treating Carpal Tunnel with ART successfully since 2000, and Dr. Hyman is the only ART provider in Denver who is also an ART instructor. Call us today to schedule your CTS evaluation. 303.300.0424

Fibromyalgia and Food

Fibromyalgia (FM) is a disorder that affects everyone a little differently. Therefore, promoting a one diet approach for every FM patient doesn’t make a lot of sense. However, according to Ginevra Liptan, MD, medical director of the Frida Center for FM in Portland, OR, it is clear that what is included in a diet vs. what is eliminated makes a big difference for many FM patients. It has been reported that 42% of FM patients surveyed indicated their symptoms worsened after eating certain foods. Here are some recommendations about diet to consider:

  1. Pay attention to how food makes YOU feel. Many FM patients have sensitivities to particular foods, but this is highly variable from person to person. Sensitivity to MSG, certain preservatives, eggs, gluten, and dairy are quite common. Keep a daily food journal for at least 2 weeks and write down the foods eaten and any associated symptoms like headaches, indigestion (irritable bowel syndrome irritation – IBS), or fatigue.
  2. Try Eliminating Certain Foods. Many FM patients have irritable bowel symptoms, and using an elimination diet can help determine which foods to cut out. Try it out for no less than 6-8 weeks in order to get the best results. Then, add it back into your diet and pay attention to how it makes you feel. The most commonly eliminated foods are dairy and gluten and the most common improvement is in fatigue reduction and reduced IBS symptoms like bloating and constipation.
  3. If you think you might have food sensitivities or allergies, talk with us. Sometimes it is best to obtain an evaluation from an allergist for food allergy testing. Dietitians can also assist in assuring that you don’t eliminate essential nutrients when foods are eliminated from the diet.
  4. Make it easier to Eat Healthy. Everyone, including the FM sufferer, should try to eat fruits, vegetables, whole grains (if not gluten sensitive), and lean meats or protein. A well balanced diet will give you more energy, which in turn, can improve your overall health. When pain and exhaustion are present, choose healthy foods that do not require a lot of preparation such as buying pre-washed vegetables, or purchase pre-prepared foods like beet salad and quinoa.
  5. Use Food to Help Fight Fatigue. Consume foods in a way that increases energy levels and prevent fatigue. Anecdotally, FM patients have reported that eating small meals frequently vs. restricting themselves to 3 meals a day can keep blood sugar levels more even and prevent the “hypoglycemic lows.” A snack high in protein around 3pm can prevent mid-day fatigue.  Make sure your breakfast includes some protein and whole grains (again, assuming there is no gluten sensitivity). Focus on getting enough sleep and staying active during the day as these can also prevent fatigue during the day.
  6. Check on Your Supplements. Some supplements have significant side effects and can interact with medications. Talk to the prescribing doctor or pharmacist about this. For example, antidepressants and certain supplements can interact.
  7. Focus on Your Overall Well-Being. A multiple approach to managing FM symptoms works better than a single approach. Things like yoga, massage, and deep breathing exercises, as well as routine chiropractic treatments can improve the overall quality of life. Increasing the quality of life is the ultimate goal for managing the FM patient. Going to bed at a consistent time, not eating too late, and exercising regularly are key components.

How to keep your brain healthy- some natural secrets from Denver Chiropractic Center and featured guest Mike Roizen MD…

Repeat the mono mantra. Choosing monounsaturated fats instead of saturated fats for protection against brain damage from silent strokes. So, spread peanut butter (or the more sophisticated walnut, avocado, almond or cashew butter—note, yes we know walnuts have 6 times more omega-3’s than any other nut) instead of cream cheese on some celery or apple slices; olive oil and vinegar instead of Ranch or bleu cheese dressing on your salad; and a small handful (6 to 12 halves) of walnuts and a crunchy apple instead of snacking on chips or ice cream.

Catch some omega-3s, even if you don’t love fish. Three 3-ounce servings a week of non-fried fish rich in omega-3 fatty acids – like salmon, trout, haddock or sardines – can make your brain younger. Not into fin food? Take omega-3 capsules. We like the DHA form of omega-3s (and prefer algae-based supplements to fish oil) and recommend 600 to 900 milligrams a day.  I (Glenn) take 900 mg of DHA omega-3s a day (I actually take a purified fish oil available by prescription). Why so much emphasis on DHA? DHA is the healthy fat your brain needs — it is not a storage fat but a structural fat.   Only 2% of ALA (a healthy omega-3 in avocados and walnuts) makes it to EPA, the omega-3s thought to be healthiest for your heart. Only 2% of EPA goes to DHA.  But, DHA readily goes to EPA, so for the healthiest brain and heart, you want 900 mg of DHA a day. We eat avocados and walnuts too.

Focus on produce for brain-pampering vitamins. Drive-through dining with a multivitamin chaser won’t cut it. Aim to eat a rainbow of brightly-colored produce for your vitamin C. Get your B’s here: B6 from baked potatoes, roasted skinless chicken breast and chickpeas; seafood, yogurt or nutritional yeast for vitamin B12; and folate (yep, it’s in the B family) from spinach, lentils, papayas and asparagus. Add almonds, sunflower seeds, spinach or hazelnuts for your dose of mixed tocopherols (known as the active component of vitamin E). Top it off with a vitamin D supplement (1,000 IU of vitamin D before age 60, 1,200 after).

Enjoy lean, free-ranged (not fatty, feedlot or corn-fed) meats, and watch your sweets white carbs. Limiting these also helps protect your thinking ability.  Treat foods with saturated and trans fats and added simple sugars and syrups like criminals (they are). They steal your memories (and increase your risk of other bad things). Choose grass fed beef (way less artery-clogging saturated fat than corn fed); fruit veggies. Try to minimize grains (you don’t have to completely avoid them, I shoot for no more than 50 grams of carbs a day from grains. Sometimes, a guy just wants a sandwich).

Use Curcumin (or tumaric) as a seasoning spice for food.   Cheap mustard?  Yes, the yellow cheap stuff apparently is made with tumaric to give it taste rather than the more expensive mustard seed.   The amount in an average teaspoon is 17 mg. But, enjoy two to be sure, every day.

Do exercise with (as a bare minimum) 2 minutes of very intense exercise at the end of 30 minutes of walking or whatever a day, if your doc says you can. Impressive new research reinforced exercise’s importance as a secret sauce against Alzheimer’s. The study didn’t just do the usual memory tests. Most of my readers do more than this. It tracked the results against scans of brain sizes. In this case, a bigger brain means a better memory. Try kettlebells or CrossFit, or train for a triathlon.

Easy fat loss by going gluten-free

I decided to get strict with the gluten free diet about 4 weeks ago. I simply cut all wheat out of my diet, like I’ve suggested to so many of my Natural Treatment Program patients. I dropped about 6 pounds of fat since then without doing anything else differently. Granted, I’m still training for the Xterra Lory triathlon, and still working with my Russian Kettlebells.

For the record, I give myself one cheat meal per week.

Many people misunderstand gluten. Gluten is a type of protein found in certain grains. For some reason, some people are not able to digest this protein. They lack an enzyme – called transglutaminase – that breaks down gluten. The deficiency of the enzyme usually correlates with the severity of symptoms. The less you make, the worse you feel.

Since lab testing for gluten intolerance is inaccurate, the simplest way to assess yourself is to stop eating gluten containing grains – primarily wheat, and avoid processed foods. After about 2 weeks, take note of how you feel. Many people drop fat without trying, improve thier digestion, sleep better, are less moody, etc.

I’ve tried going gluten-free before, but this is the most effort I’ve ever put into it, and I feel a difference. By the way, the blood test I had at my MD’s office said I had no problem with gluten. So who’s right?