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
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
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…
Mental Attitude: Is Stress Contagious?
A new report finds that not only do babies pick up on their mother’s stress but their bodies will also mimic physiological changes. Researchers found that when mothers were stressed and then reunited with their infant, the child quickly adopted his/her mother’s stress response, including a corresponding change in heart rate. Lead author Dr. Sara Waters writes, “Before infants are verbal and able to express themselves fully, we can overlook how exquisitely attuned they are to the emotional tenor of their caregivers… Your infant may not be able to tell you that you seem stressed or ask you what is wrong, but our work shows that, as soon as she is in your arms, she is picking up on the bodily responses accompanying your emotional state and immediately begins to feel in her own body your own negative emotion.”
Psychological Science, February 2014
Health Alert: Buckle Your Children Up!
Tragically, car accidents still claim the lives of over 9,000 American children each year. Researchers working for the Centers for Disease Control and Prevention (CDC) believe that nearly a third of these deaths can be prevented if parents simply secured their children in age/size appropriate car seats. They point out that in states where car seats are required until ages 7-8, more children are put into car and booster seats and serious injury rates are 17% lower than in states without such laws.
Centers for Disease Control and Prevention, February 2014
Diet: No More Than 2-3 Cups Per Day…
Using current research on the over-consumption of caffeine as a guide, Dr. Laura Juliano, co-author of “Caffeine Use Disorder: A Comprehensive Review and Research Agenda,” recommends healthy adults limit caffeine consumption to no more than two to three cups of coffee per day (about 400 mg/day) and pregnant women to no more than half that amount. She also recommends people with health problems such as anxiety, insomnia, heart problems, or urinary incontinence limit or even eliminate caffeine consumption.
Journal of Caffeine Research, February 2014
Exercise: Sitting and Disability.
For the first time, a study has labeled sedentary activity as a risk factor for disability for people over age 60. Using data on over 2,000 adults over 60 years of age, researchers were shocked to discover that being sedentary is just as large a risk factor for disability as not exercising, and the risk of disability dramatically increases for each additional hour spent sitting at a computer or on the couch watching TV.
Journal of Physical Activity & Health, February 2014
Chiropractic: Acute Low Back Pain Treatment Comparison.
In this study, researchers compared the efficacy of spinal manipulation to diclofenac, a non-steroidal anti-inflammatory drug (NSAID), for the treatment of acute low back pain. Based on outcomes including self-rated physical disability, function, time missed from work, and rescue medication use during the following 12 weeks, spinal manipulation proved to be a significantly better treatment.
Spine, April 2013
Wellness/Prevention: Mammography Recommended for Women in Their 40s.
While the United States Preventive Services Task Force’s 2009 guidelines recommend against routine mammograms for women in their 40s, new research shows that regular screenings would benefit this age group by helping doctors catch the disease when it can still be treated without extensive surgery or chemotherapy. Current statistics show that one in eight women will develop breast cancer, and if the disease is caught early enough, the five-year survival rate is 97%.
American Journal of Roentgenology, February 2014
Evidence from many trials and many research projects clearly demonstrates the superiority of chiropractic services over standard medical care and even traditional physical therapy in the treatment of musculoskeletal conditions:
Last month, we discussed three types of headaches: Tension Headache (the most common), Cluster Headaches (a vascular headache – less common, short duration but REALLY painful), and Sinus Headaches. Migraine headaches were discussed the month before last. In keeping with the theme, ONE more headache type will be discussed: Rebound Headaches, followed by anti-inflammatory herbal remedies, and finally, “Headache Triggers.”
Rebound headaches are the result of pain killer overuse. Of course, one would think of pain killers like aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin, Nuprin, etc.) as well as many prescription drugs as being “friendly” and commonly reached for when a headache or any other ache or pain occurs. But, as the old saying goes, “…too much of a good thing can be bad!” These culprits, instead of helping, can actually hurt you! One theory for the cause of rebound headaches is that too much of these meds can cause the brain to shift into an excited state that triggers the headache. Another theory is that these headaches result from too sudden of a drop of the medicine in the bloodstream, which would only occur if the medication was being taken at a high dose for a relatively long period of time. According to the Migraine Research Foundation, EVERY 10 SECONDS, someone in the United States goes to the emergency room with a migraine or headache due to the intense pain, severe nausea or dehydration, drug interactions, or side effects from headache medications! DON’T BE ONE OF THEM!!!
As mentioned last month, PLEASE FIRST try an anti-inflammatory herb like ginger (Zingiber officinale), turmeric (Curcuma longa), Feverfew, passionflower (Passiflora alata), Peppermint (menthe piperita), ginko (ginko biloba), caffeine (Coffea Arabica), black or green tea, Valerian (Valeriana officinalis), Coriander Seed (Coriandrum sativum), Dong Quai (Angelica sinensis), Lavender Oil (Lavandula angustifolia), Rosemary (Rosmarinus officinalis), Lime or Linden (Tilia spp.), horseradish (Armoracia rusticana), honeysuckle (Lonicera japonica), and more!
So what triggers headaches? Here are a few of the more commonly researched triggers: weight [in females, a BMI of 30 (mild obesity) = 35% greater risk, and BMI of 40 (“severe obesity”) = 80%]; personality (traits such as rigidity, reserve, and obsessivity); “let-down” or weekend headaches (breaking your routine, like staying in bed until noon); odors and fumes (e.g., fresh paint); dehydration (drink water AND eat fruits / veggies to get more water); skipping meals (hunger is a common trigger); physical exertion (certain sports like running, weight lifting); too much caffeine (small amounts help, but too much can trigger headaches); inactivity (sedentary lifestyles trigger – 30 min./day cardio, 5x/week is ideal); sleep deprivation (those averaging six hours have more frequent & severe headaches); and certain foods like red wine, beer, MSG, chocolate, aged cheese, sauerkraut, and processed meats like pepperoni, ham, and salami. Foods that can reduce headaches include those high in magnesium– spinach, tofu, oat bran, barely, fish oil, olive oil, white beans, sunflower, and pumpkin seeds.
In addition to GOOD CHIROPRACTIC CARE, and Active Release Techniques headache management requires a multidimensional approach for best results!
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 service for those needs. If you, a friend, or family member requires care for headaches, we would be honored to render our services.
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.
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
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