Low Back Pain “ON-THE-GO” Exercises (Part 1), from Denver Chiropractic Center’s Chiropractors

Low back pain (LBP) is a reality in most of our lives at one point or another. It can range from being a “nag” to being totally disabling. While we use Active Release Techniques and traditional chiropractic adjustments at Denver Chiropractic Center, home exercise is an important part of our protocol.

Let’s look at some exercises for the low back that can be done from a SITTING position so that they can be: 1) Performed in public (without drawing too much attention) and 2) Repeated every one to two hours with the objective to AVOID LBP from gradually getting out of control (STOP the “vicious cycle” so LBP stays “self-managed”).

RULES: 1) DON’T do any exercise that creates SHARP pain; 2) Stay within “reasonable” pain boundaries; 3) DO these multiple times a day WHEN you feel tight, stiff, sore (take 10-30 sec. every hour rather than 15 min. twice a day).

SITTING LOW BACK EXERCISE OPTIONS:

1)    SITTING BEND OVERS: 1) Slowly bend forward from a seated position and attempt to reach the floor; 2) Spread the knees as needed to allow for a full range of motion; 3) Hold for 3-10 seconds or until it feels “loose.” 4) Do the opposite – sit and arch your low back as far back as is comfortable. Repeat frequently for short hold-times – make it “fit” your time limitations/schedule!

2)    SITTING HIP / BACK STRETCH: 1) Cross your leg; 2) Raise the knee to the opposite shoulder; 3) Arch the lower back until you feel an increase stretch in your buttocks; 4) Twist your trunk to the side the knee is raised; 5) Move your knee up/down and around to “feel” for the tightest “knots” and “work” them loose; 6) Modify by bending forward 7) REPEAT on the opposite side.

3)    SITTING TRUNK ROTATIONS: 1) Slowly twist your shoulders and trunk to one side while keeping your knees straight; 2) Reach back and pull for additional stretch if comfortable; 3) Hold for 3-10 seconds or, until it feels “loose;” 4) REPEAT on the opposite side.

 

Remember, DO these MANY times a day (at least once every hour). We have many others as well (ask us)! We realize you have a choice in whom you consider for your health care and we sincerely appreciate your trust in choosing Denver Chiropractic Center for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Chiropractic: Suggested For Low Back Pain by the American Medical Association

An information article published by The Journal of the American Medical Association suggests patients consider chiropractic care as an option to treat low back pain. They also noted that back surgery is usually not indicated and should only be performed if other therapies fail.
JAMA, April 2013

Copyright Denver Chiropractic Center

Denver Chiropractic Center’s 1-Page Health News Jan 22, 2014

We’re back with another edition of the 1-Page Health News. We also want to thank all of who who’ve been distributing the “Gift of Health” referral certificates that we mailed out. It’s our privilege to help your friends and family members.

“Always do right. This will gratify some people and astonish the rest.”
~ Mark Twain
Mental Attitude: The Importance of Self-Worth.
Reflecting on better times can help the downtrodden take steps to escape their poverty. In an experiment conducted in a New Jersey soup kitchen, 150 participants were asked to recount a proud moment or memorable achievement prior to taking a series of problem-solving tests. A control group took the tests without a positive affirmation beforehand. The affirmation group performed dramatically better than the control group with a difference in scores representing roughly a 10-point increase in IQ. Participants in the affirmation group were also more likely to seek out help from local government or charity programs that are used by only a fraction of those eligible.
Psychological Science, December 2013

Health Alert: Inflammatory Proteins?
A recent study shows there is an abnormal amount of an inflammatory protein called PAR2 in the abdominal fat tissue of overweight and obese people. Previous research has shown that PAR2 is also increased on the surface of human immune cells by the excessive consumption of fats and sugars. This finding links obesity and fattening diets with changes in immune cells and inflammation levels within the body.
The FASEB Journal, December 2013

Diet: Facebook and Diet?
“Appearance exposure” on the Internet has been linked to body image disturbances among adolescent girls. A recent study found an association between time spent on Facebook and poor body image among adolescent girls who internalize a thin ideal physique, which may lead to eating disorders.
Cyberpsychology, Behavior, and Social Networking, December 2013

Exercise: Reduces Fatigue in Cancer Patients.
An analysis of 56 studies involving over 4,000 cancer patients discovered that aerobic exercise, such as walking or cycling, reduces fatigue in those undergoing treatment. Fatigue is a common and problematic side-effect of cancer and cancer treatment. This exhaustion may last for months or years and make a patient less inclined to continue any further treatment. Previously, doctors recommended rest to treat cancer-related fatigue; as it turns out, the proper course may be physical activity.
The Cochrane Library, November, 2012

Chiropractic: Pain Affects Quality of Life.
Over half of older adults in the United States have experienced bothersome pain in the previous month, impairing their physical function and underscoring the need for proper health care. Three-quarters of older adults with pain reported having pain in multiple locations, such as in the back, hips, and knees. Additionally, pain was strongly associated with decreased physical capacity.
PAIN, December 2013

Wellness/Prevention: Fight Fat with Heat?
People who live in well-heated homes above 73.4 degrees Fahrenheit (23 degrees Celsius) are less likely to be obese, or have a high body mass index, compared with individuals who keep their dwellings cooler. People may eat less and burn more energy when residing in a warmer indoor environment. At temperatures above 73.4 degrees Fahrenheit, heat must be lost to maintain a constant body temperature and this process (such as sweating) requires energy. Coupled with decreased appetite and food intake, the additional energy expenditure could lead to weight loss.
Obesity, November 2013

Chiropractic for Headache Relief.

Spinal adjustments resulted in almost immediate improvement for headaches that originate in the neck. As a treatment for tension-type headaches, spinal adjustments resulted in significantly fewer side effects and longer-lasting relief than prescribed medication.
Duke University, January 2001

Carpal Tunnel Syndrome, Exercise, and Chiropractic

CTS, Exercise, and Chiropractic

            Carpal Tunnel Syndrome (CTS) is a condition characterized by numbness, tingling, and/or pain located on the palm side of the wrist, hand and into the index, third, and half of the ring finger. It’s caused by pressure exerted on the median nerve as it passes through the “tunnel” located in the wrist. The “floor” of the tunnel is a ligament while the “walls” are made up of eight small carpal bones that lock together in the shape of a tunnel. There are nine tendons (tendons attach muscles to bones allowing us to move our fingers), sheaths covering the tendons, blood vessels, and the median nerve that ALL travel through the tunnel, so it’s packed pretty tight. ANYTHING that increases the size of any of these structures or anything “extra” that shouldn’t be there can increase the pressure inside the tunnel, pinch the median nerve, and result in the classic numb/tingling symptoms that wake people up at night, or interfere with work or driving.

In the Unites States (US), about 1 out of 20 people will suffer from CTS. Caucasians have the highest incidence rate and women are affected more than men by a 3:1 ratio between ages of 45-60 years old. Only 10% of the reported cases of CTS are under 30 years old. Occupational CTS (as of 2010) affects 8% of US workers with 24% attributed to manufacturing industry jobs. This equates to approximately 3.1 million cases of work-related CTS in 2010. The risk of developing CTS increases with age, diabetes, hypothyroid, pregnancy, taking birth control pills, having an inflammatory arthritis, being obese, pinched nerves in the neck, thoracic outlet, elbow, and others. Therefore, managing CTS requires a thorough evaluation in order to assure accuracy in the diagnosis. With this background information, let’s look at the question, WHAT CAN YOU DO TO HELP CTS? One answer is, don’t age – good luck with that! In addition to keeping your weight under control, exercise can be VERY effective and YOU can be in charge of that process, but we have to teach you the exercises.

1)     The Carpal Stretch (“nerve gliding”): Place your palm on the wall near shoulder height with the fingers pointing down at the floor and press the palm of the hand flat on the wall. Lastly, reach across with the opposite hand and pull your thumb back off of the wall and hold for 5-15 seconds.

2)     The Wrist Extensor Stretch: Do the same as #1 but place the back of the hand on the wall in front of you, again fingers pointing downward. Here, there is no need to stretch the thumb.

3)     The “Bear Claw”: Make a fist and then open up the hand. Keep the small finger joints flexed while extending the knuckles at the base of each finger straight (not bent). Repeat 5-10x.

4)     Putty Squeeze: Simply squeeze putty in your hand for two to five minutes until fatigued.

5)     Yoga has been shown to reduce pain and improve grip strength in CTS patients!

Now the question, “…can these exercises prevent surgery?” The answer is “maybe.” They certainly help in some cases, but a multi-dimensional treatment plan is the BEST approach. This includes:  1) Chiropractic manipulation of the hand, wrist, elbow, shoulder, and neck; 2) Active Release Techniques of the muscles in the forearm, upper arm, shoulder, and neck; 3) Cock-up wrist splint to be used at night, and in some cases, at times during the day; 4) Ergonomic management of your work station or situation (to minimize repetitive insult to the area); 5) Nutritional support that may include an anti-inflammatory diet and nutrients (vitamins, minerals, herbs, etc.), and 6) Managing any contributing conditions like diabetes, hypothyroid, and/or the others. Here’s the

GOOD NEWS: CHIROPRACTIC can manage these six steps, though some cases will require co-management with primary care and/or specialist.

We realize you have a choice in whom you consider for your health care and we sincerely appreciate your trust in choosing Dr. Glenn Hyman’s Denver Chiropractic Center for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Fibromyalgia: Dietary Considerations

In last month’s Health Update, we discussed fibromyalgia (FM) management from a multi-modal approach, which included dietary recommendations to reduce inflammation. We’ll cover this topic in more detail this month…

Anti-inflammatory foods can be broken down into four categories: 1) Fruits and vegetables; 2) Protein Sources; 3) Fats and Oils; and 4) Beverages.

In the fruits and vegetables category, whole fruits, berries, and vegetables in general are rich in good things like vitamins, minerals, fiber, anti-oxidants, and phytochemicals. In particular, green and brightly colored vegetables and whole foods (such as broccoli, chard, strawberries, blueberries, spinach, carrots, and squash) are great choices.

Besides being low in calories, high in fiber, rich in vitamin/minerals and more, berries EVEN taste good! For example, one cup of strawberries contains >100mg of vitamin C (similar to a cup of orange juice), which helps our immune system function. One cup of blueberries includes a little less vitamin C but it has minerals, phytochemicals, and anti-oxidants at only 83 calories per cup. A cup of cranberries has only 44 calories (it can also help with bladder infections), and a cup of raspberries has 64 calories and has vitamin C and potassium. Less common, but equally nutritious, are loganberries, currants, gooseberries, lingonberries, and bilberries. Put these, or a mixture of these, on salads, yogurt, or a whole grain cereal and enjoy a VERY satisfying snack or meal! The health benefits of phytochemicals and flavonoids include cancer prevention, bladder infection treatment, and may even help your eyesight (such as from lutein in blueberries and raspberries).

Protein sources include fish/seafood, especially oily ocean fish like salmon and tuna, as these are rich in omega-3 fatty acids. Soy and soy foods like tofu and tempeh as well as legumes are great plant sources of protein, though some doctors may recommend staying away from soy. Nuts such as walnuts, almonds, pecans, and Brazil nuts are also great protein sources.

Fats and Oils: Omega-3 fatty acids can be found in flax seeds, canola oil, and pumpkin seeds, as well as cold-water oily fish. Other fats that are anti-inflammatory include monounsaturated fatty acids, which are found in olive oil, avocados, and nuts and have been found to be cardiovascular disease “friendly” as well. Other healthy oils include rice bran oil, grape seed oil, and walnut oil.

Beverages: Our bodies need water! Of course, tap, sparkling, or bottled water are great sources of water. So are 100% juices, herbal tea, low-sodium vegetable juice, and if tolerated, low or non-fat milk.

Meal suggestions include: Breakfast – oatmeal with fresh berries and walnuts; Snacks – whole fruits, nuts, seeds, and fresh vegetables; Lunch and Dinner– choose fish and less fatty red meats; cook with olive and canola oil; load up a salad with fresh vegetables and fruit, avoid deep fried foods – rather, bake, broil, poach, or stir-fry instead. Fill up HALF of your dinner plate with dark green or brightly colored vegetables. Avoid the following: junk food, high-fat meats, sugar (sodas, pastries, candy, rich desserts, and sweetened cereals), highly processed foods, trans-fats and saturated fats (i.e., bacon and sausage), and white flour products (get 100% whole grain instead). Some research suggests not eating “nightshade plants” like tomatoes and eggplant.

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing Denver Chiropractic Center. 303.300.0424.

Chiropractic Yields Significant Improvement in MRI-confirmed neck pain

Fifty patients with neck and arm pain caused by an MRI-confirmed cervical disk herniation received chiropractic adjustments over a 90-day period. After two weeks, 55.3% of patients reported their pain had significantly improved. This number rose to 68.9% after one month and 85.7% after three months of care. No adverse events were reported.
Journal of Manipulative and Physiological Therapeutics, October 2013

Carpal Tunnel

Last month, we covered what Carpal Tunnel Syndrome (CTS) is, its symptoms, causes, who is at risk, and how it’s diagnosed. This month, we’ll center our focus on CTS treatment.

How is CTS treated? For the best success, treatment should begin as early as possible. Unfortunately, most people wait a long time before they get to the point where the symptoms interfere with daily activity enough to prompt them to act quickly and make an appointment. Once the cause or causes of CTS are determined, treatment can address ALL the presenting contributing conditions. The FIRST course of care should be NON-SURGICAL, though this is not always practiced – so be aware! Non-surgical care includes the following:

Chiropractic:
Manipulation: This usually includes adjusting the small bones of the hand, the wrist, the forearm, elbow, shoulder, and/or the neck.
Active Release Techniques: This includes loosening up the overly tight forearm muscles where the median nerve runs through (on the palm side of the forearm).

Nutritional: Nutrients such as vitamin B6 have been shown in studies to be effective in some cases. Also, anti-inflammatory herbs (ginger, turmeric, bioflavinoids) and / or digestive enzymes (bromelain, papain, and others) taken between meals are quite effective.
Anti-inflammatory: The first important distinction is that ice can be very effective depending on how long the CTS has been present. In particular, ice cupping or rubbing ice directly on the skin over the carpal tunnel is the most effective way to use ice as an anti-inflammatory agent. When doing so, you will experience four stages of cooling: Cold, Burning, Achy, Numb or, “C-BAN.” It’s important to remember this as you are REALLY going to want to quit in the burning/achy stages when it feels uncomfortable. Once the skin over the wrist / carpal tunnel gets numb (which takes about four to five minutes) QUIT as the next “stage” of cooling is FROST BITE! Most medical practitioners promote the use of NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, aspirin, or Aleve. However, these carry negative side effects including gastritis (burning in the stomach that can lead to ulcers), or liver and/or kidney damage. Try the nutritional anti-inflammatory approach FIRST as they are extremely helpful without the bad side effect potential!
Diet: An ant-inflammatory diet, like the Paleo-diet or gluten free diet, serves as a great tool in reducing the inflammatory markers in the body. Though only 7-10% of the population has celiac disease (gluten intolerance), it’s been estimated that over 80% of us are gluten “sensitive.” Reducing systemic inflammation can make a BIG DIFFERENCE in the management of many conditions including CTS!
Mechanical: Wrist “cock-up” splints can also be REALLY HELPFUL, especially for nighttime use. The reason for this is because when our wrist is bent forwards or backwards, which frequently occurs when sleeping, the pressure inside the carpal tunnel increases, and over time (minutes to hours), the increased pressure in the tunnel exerts compression on the median nerve which then creates numbness into the thumb, index, third and half of the fourth finger, which can wake you up out of a sound sleep. Keeping the wrist straight at night prevents you from curling your wrist under your jaw while sleeping.
Ergonomic Modifications: Changing your work station (computer station, line position, machine controls, pace or rate of repetitive movements, and more) is VERY effective.

WE have a great track record with Carpal Tunnel Syndrome at Denver Chiropractic Center. Call us 303.300.0424.

Whiplash – Can We Predict Long-Term Problems?

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors who also use Active Release Techniques, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

Can Chiropractic Help the Post-Surgical Patient?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!

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