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Low Back Pain and Travel Tips

Low back pain (LBP) and the discussion of traveling tips will be concluded this month. Please refer to the last 2 months for other great traveling tips. Keep a copy of these in your travel bag!

 

BE PROACTIVE WITH THE AIRLINES: 1. Get an aisle seat. Request an aisle seat out of “medical necessity.” By stating it this way, the airlines will go out of their way to find you an aisle seat. It is easier to exit the seat in case you have to use the restroom or an emergency occurs. It also allows you to get up and walk around for exercise, which can reduce the irritation of LBP and reduce the chances of blood clots. We can provide a letter to travel with stating that you have LBP, which can help you get special considerations. 2. Request a wheelchair. Make sure the airline knows you would like a wheelchair. They will handle your carry-on, get you through security quicker, and get you to and from the gate in a safe, timely manner. Typically this request is done at the time you make your reservation, but you can also tell a flight attendant prior to landing and they will have it arranged by the time you de-plane at your arrival site. Since there is no way to know how long the security line will be or how long the distance will be between gates or to baggage claim, having a wheel chair pre-arranged is wise. 3. Request a row of seats. Typically, if the plane isn’t full, you can ask for a row of seats that are empty so you can put the arm rests up and spread out, lay down and be much more comfortable. 4. Recline your seat. Depending on your type of low back condition, you may feel most comfortable either in a vertical upright position or reclined position. Some seats, such as in the exit row or last row, do not recline so ask when booking your flight or when you check-in to make sure your seat is adjustable. 5. Stay stretched. Prolonged sitting has many negative effects on muscles, joints, and circulation. Performing stretches from sitting or standing can help a lot, especially on long flights. Ask us to show you some easy-to-perform exercises that can be done in confined spaces! 6. Pre-board. This option allows you to board the plane first and gives you extra time. 7. Handicapped parking sticker. Consider this if walking is challenging for you. We can assist you in this effort and it will allow you to park close to the entrance at the airport. 8. Get a seat assignment. Getting “bumped” is common practice these days due to airlines purposely over-booking. If you do not initially obtain a seat assignment, call the airlines immediately to obtain a seat. Getting bumped can mean a delay for a couple hours up to a couple days!

 

SIT WITH SUPPORT: 1. Back Support. Using a special back support (if possible) or even a rolled up towel, pillow, or airline blanket between your back and seat can really help decrease low back pain. A small water bottle (tighten the cap!) is also a good option. The “bottom line” is comfort. If it feels good and relieving, it will be of benefit and help you. 2. Sit “supported.” Sitting with your knees bent at a right angle (90°) pushing your feet into the floor can be relieving and offer good support, especially during take-offs and landings. Also, stretch your legs out straight periodically under the seat ahead of you. You may have to place your briefcase or carry-on behind your legs, in front of your seat to open up the space so you can stretch out. Lastly, drink plenty of water, slip your shoes off at times, get up and walk periodically, carry a note from us for special needs, and most importantly, ENJOY YOUR FLIGHT!!!

Common Questions about Cervical Disk Herniations

Last month, we discussed the topic of neck pain arising from cervical disk herniations. The focus of this month’s Health Update is common questions that arise from patients suffering from cervical disk derangement.

1. “What can I do to help myself for my herniated disk in my neck?” The mnemonic device “PRICE” stands for Protect, Rest, Ice Compress, and Elevate is a good tool to use in the acute stage of many musculoskeletal conditions.

  • Protect your health by NOT placing yourself in an environment that is likely to harm you, such as playing sports or doing heavy yard work. That is, think about what you do BEFORE you do it and if sharp, radiating pain occurs, STOP and assess the importance of what you are doing. Use the concept, “…don’t pick at your cut.” This means if you want the injury to heal, don’t keep irritating it!
  • Rest is similar. Limit your activities to those that can be done without increasing symptoms, especially radiating pain.
  • Ice – The use of ice reduces swelling/inflammation, which reduces pain and promotes healing. Alternate it every 15-20 minutes (on/off/on/off/on) several times a day. You can also use contrast therapy (Ice/heat/ice/heat/ice) at 10/5/10/5/10 minute intervals to “pump” out the swelling.
  • Compress – The use of a collar worn backwards, if it’s more comfortable that way, can literally “take the load off.” the neck and disks. There are even inflatable collars which are pumped up with air to traction the neck. Other forms of traction will be discussed further.
  • Elevate – The concept of raising the ankle to the height of the heart so swelling can drain out of the ankle is the classic example of “elevation.” In the neck, the traction concept may apply once again.

2. “I don’t want to have surgery if I can help it. What can you do as a chiropractor to help me?” This is one of our primary goals, and in fact, the goal of ALL health care providers, even surgeons! Chiropractic offers anti-inflammatory measures: ice, herbal anti-inflammatory agents (ginger, turmeric, bioflavonoid, curcumin, bromelain, Rosemary extract, Boswellia Extract, and more), digestive enzymes taken between meals, muscle relaxant nutrients (valerian root, vitamin D, a B complex, chamomile, magnesium, and others) as well as other non-pharmaceutical options. Treatments consist of manual manipulation, mobilization, traction (for home and office), modalities such as laser and low-level laser, electrical stimulation, magnetic field, ultrasound, and others.

Most important is having a “coach” guide you through the stages of healing by first addressing the acute inflammatory stage (first 72 hrs), the proliferative or reparative phase (up to 6-8 weeks), followed by the remodeling phase (8 weeks to 1 or 2 years) and finally, the contraction phase (lifetime – includes the natural shortening of scar tissue). If manual traction reduces neck and arm pain, the use of home traction is very effective. Options include sitting over-the-door traction, laying down versions, and mobile traction collars (discussed previously).

Exercises to stretch and strengthen the neck are also very important in reducing neck pain as well as preventing recurrences. If in spite of all the best efforts of this non-surgical care approach should ongoing neurological loss and relentless symptoms continue, we will coordinate care with physiatrists for possible injection therapy and pharmaceuticals, with neurology for further testing (such as EMG/NCV – a nerve test), and/or neuro- or orthopedic surgery – THE LAST RESORT!

We realize that you have a choice in where you receive your healthcare services.  If you, a friend or family member requires care for neck pain, 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. 303.300.0424 [email protected]

 

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.

How and why to avoid knee replacement surgery and this week’s !-Page Health News

“Let food be thy medicine and medicine be thy food.”
~ Hippocrates

Health Alert: Hip/Knee Replacement?
Joint damage from osteoarthritis is responsible for 80% of hip replacements and 90% of knee surgeries. Only 50% of individuals with arthritis who had a hip or knee replacement reported a significant improvement in pain and mobility after surgery. 25% of patients who get a single joint replacement will have another within two years.
Arthritis & Rheumatism, April 2013

“Did you know that if your spine is not moving well or is not aligned (known as subluxation of the spine), you could easily get an injury in your hips, knees, calves or ankles? This is because spinal subluxations inhibit the nervous system, leading to poor motor control. Reference- Seaman et al, JMPT; 18;21(4): 267-280.

Getting your spine adjusted regularly is the best way to keep your body moving well and keep those muscles firing. Our athletes who get adjusted regularly hold up better than the ones who wait for the pain to set it. Call us – 303.300.0424 – or just reply to this email.

Diet: Unleaded Please!
Levels of lead in rice imported into the United States (US) ranged from 6-12 mg/kg. For adults, the daily exposure levels from eating imported rice are 20-40 times higher than the Food and Drug Administration’s accepted levels. For infants and children, the daily exposure levels are 30-60 times higher. Lead is a neurotoxin that can damage the brain, and in young children whose brains are still growing, it can seriously diminish their capacity to learn and develop. It can disrupt children’s behavior, such as make them more aggressive, impulsive, and hyperactive. Lead increases blood pressure and causes cardiovascular diseases in adults.
American Chemical Society, April 2013

Exercise: Walking vs. Running.
Brisk walking can reduce a person’s risk of diabetes, high blood pressure, and high cholesterol just as much as running can. The risk for first-time hypertension was notably reduced 4.2% by running and 7.2% by walking. The risk for first-time high cholesterol was reduced 4.3% by running and 7% by walking. The risk for first-time diabetes was lowered 12.1% by running and 12.3% by walking. The risk for coronary heart disease was lowered 4.5% by running and 9.3% by walking.
Arteriosclerosis, Thrombosis and Vascular Biology, April 2013

Chiropractic: Lowering Blood Pressure.
Chiropractic adjustments to the upper neck were shown to lower high blood pressure. Researchers found a 14 mm Hg greater drop in systolic blood pressure, and 8 mm Hg greater drop in diastolic blood pressure following a cervical adjustment. This effect was greater than would result from two blood pressure medications given in combination, and it was adverse-event free.
Journal of Human Hypertension, March 2007

Wellness/Prevention: Vitamin D.
A hormone produced in the skin with exposure to sunlight, Vitamin D is also found in fish, fish liver oils, and egg yolks. Muscle function and recovery from fatigue has been shown to improve with Vitamin D supplementation, which is thought to enhance the activity of the mitochondria – the power plants of the cell.
Newcastle University, April 2013

Confessions of a barefoot failure


Me & Bobby McGee. Trying to solve the problem.

In early 2010, I drank the barefoot running Kool Aid. I’ve written about that part of the story before, but I’ll briefly review it for those of you who may not remember.

After reading the book Born to Run, I decided to start running barefoot on my treadmill. I felt good, so I bought some “Barefoot Shoes”. My knee pain went away, I started telling all of you to try it, blah, blah, blah. I tried to go from running as a heel striker to running as a mid-foot striker. It worked for about a year. And then some new injuries set in.

Last week (as I sit writing this) I spent Friday at my 1st grader’s field day. For those of you who don’t know, it’s like a kiddie Olympics held outside at school on a nice spring day. The kids do all sorts of things, like tug-of-war, throw the ball as far as you can, and a round-the–bases relay race.

The round-bases-race was interesting, because I got to watch kid after kid after kid run. As a student of running mechanics, it was quite enlightening.

After observing about 30 kids, I can tell you that only about 1 in thirty kids is a heel-striker. They’re almost all mid-foot strikers, and their feet are quick – touch down, pull up. They all looked smooth and efficient.

So why do the people who gather data on such matters say that about 75% of adult runners are heel strikers*? What happens? Should we all be mid-foot striking or do what comes naturally?(*reference- Foot Strike Patterns of Runners At the 15-Km Point During An Elite-Level Half Marathon HASEGAWA, HIROSHI; YAMAUCHI, TAKESHI; KRAEMER, WILLIAM J. Journal of Strength and Conditioning Research, August 2007 – Vol. 21 – Issue 3.)

The answer? I have no idea.

So I decided to go see expert running coach Bobby McGee for a 90 minute mechanics evaluation / lesson. Here’s what Bobby had to say (paraphrasing):

“For most runners, unless they want to be elite runners, it doesn’t make any sense at all to try to force a style of running. If you’re a heel striker, don’t try to force yourself to be a mid foot striker. If you are strong enough to run barefoot, great. But if you’re not, it’s a disaster waiting to happen.”

The conclusion – be who you are, and work to optimize the mechanics that you’re used to. So instead of forcing yourself out heel striking, work with it. Remember, we’re all individuals, and your unique running style is just that- yours. Don’t go changing for the sake of change. Like I did.

For the record, Bobby spent more time working on what my upper body was doing than he spent on my lower body. This made a huge difference. He also told me that my feet were not strong enough for running in so-called barefoot shoes. So there you go, I’m a barefoot failure. If you are serious about running, you might want to go spend 90 minutes with Bobby. He’s brilliant.

Denver Chiropractic Center is proud to be an authorized dealer for the A-Line foot suspension system. Do you have foot, ankle or shin pain?

A-Line foot suspension system is unlike any other insole. It is designed as a foot suspensions system, to balance the foot and let your leg align itself while you move. We are one of the few authorized A-Line dealers in Denver. We offer free fitting and reasonable prices ($100-$110) per pair, and a 30-day money back guarantee.

Foot pain can be both annoying and debilitating. Anything that affects your ability to move around and participate in sports is a problem. Several factors can contribute to foot pain, and in this article, we’ll look at one of the most common…Poor foot, ankle and knee alignment.

Many of you know that the so-called barefoot running movement became incredibly popular in the last few years. And while many of us were willing to go minimal on the shoes and experiment, most of us couldn’t hack it.

The theory seemed sensible – get rid of supportive shoes and your feet will naturally strengthen. But there was a problem- many of us had spent 30 or 40 years in supportive shoes. Or feet were like lifelong welfare recipients – the simply didn’t know how to support themselves.

So the barefoot running experiment failed a lot of people. Here’s why: The human foot does well if you’re out shoes from an early age (like from the time you start crawling). If you stay away from flat surfaces, like sidewalks, streets, floors, etc, varying terrain challenges your feet. This builds strong feet.

Strong feet have arches that function well, and exhibit good alignment between the foot, ankle, and knee. Appropriately strong ligaments and equally strong muscles support this alignment.

The correct this alignment is start with an assessment. Some people have better alignment than others. The use of a dynamic insole like the A-lines that we carry at Denver Chiropractic Center allows the foot to get some supports, while also allowing the arches of the foot to strengthen. Rigid orthotics weaken the feet and further degrade natural alignment.

Specific low-impact strengthening exercises can help as well. An example is standing on one foot while making circles with the other foot. 10 circles in each direction with the “flying” foot circling in from of and behind the working foot works well. Another great exercise is simply trying to stand on one foot for 3 minutes.

At Denver Chiropractic Center, we use Active Release Technique to address the scar tissue that develops in muscles that are overworked in poorly aligned feet. This can include muscles of the foot, shin and calf. Scar tissue further weakens muscles, making alignment worse.

If foot or ankle pain has been bothering you, we can probably help. But it all starts with the initial exam, including a foot-ankle-knee alignment check. Call us today to schedule yours. 303.300.0424. We’re here to help.

A Question about knee pain

The Question (from a real patient):

Hi, Glenn

You sucessfully treated me over a year ago for tarsel tunnel syndrome. I had my left knee scoped about four months ago to remove torn cartilage. I went through several months of PT and regained reasonable strength (it took me longer than some people because I had lots of edema and the VMO had been shut down for months.) However, I still have tightness, localized tenderness and restricted range of motion when I attempt to get back into certain yoga poses or do deep squats. My ortho and PT suspect that I have some scar tissue. I’ve been receiving deep tissue massage, which is helping but feel I need to do more to recover normal function. Have you treated similar issues before and do you think that ART would be helpful in my situation?

Dr. Glenn’s answer:

Residual scar tissue often follows arthroscopic surgeries. In my experience, the targeted techniques of Active Release are the best way to access and break up this scar tissue. On average, 4-8 sessions are required, but the results are usually good.