Archive for September, 2009

10 Facts About Whiplash

Posted: September 11, 2009 in Whiplash

1. In a series of recent human volunteer crash tests
of low speed rear impact collisions, it was reported that the threshold for
cervical spine soft tissue injury was 5 mph (delta V) (1 ref).

 

2. Other reports have shown that crashed cars can
often withstand collision speeds of 10 mph or more without sustaining damage (5
refs). Thus: the concept of "no crush, no cash" is simply not valid.

 

3. Recent epidemiological studies have shown that
most injury rear impact accidents occur at crash speeds of 6 mph to 12 mph (2
refs.) –the majority at speeds below the threshold for property damage to the
vehicle.

 

4. A number of risk factors in rear impact accident
injury have now been verified including: rear (vs. other direction) impact (18
refs), loss of cervical lordotic curve (2 refs), pre-existing arthritic changes
(5 refs), the use of seat belts and shoulder harness (at slow speeds) (4 refs),
poor head restraint geometry (3 refs), non-awareness of the impending collision
(4 refs), female gender (4 refs), and head rotation at impact (2 refs).

 

5. Once thought to suggest minimal injury, a delay
in onset of symptoms has been shown to be the norm, rather than the exception
(13 refs).

 

6. Mild traumatic brain injury can result from
whiplash trauma. Often, the symptoms are referred to as the post-concussion
syndrome. This condition, often denied in the past, has now been well-validated
in recent medical literature (4 refs).

 

7.  A recent
outcome study of whiplash patients reported in the European Spine Journal found
that between one and two years post injury, 22% of patients’ conditions
deteriorated (1 ref). This second wave of symptoms has been observed by others
as well (1 ref).

 

8.  Radanov
et al. (1 ref) followed whiplash patients through time and reported that 45%
remained symptomatic at 12 weeks, and 25% were symptomatic at 6 months. Other
researchers have reported time to recovery in the most minor of cases at 8
weeks; time to stabilization in the more severe cases at 17 weeks; and time to
plateau in the most severe categories as 20.5 weeks (1 ref). Thus, the notion
that whiplash injuries heal in 6-12 weeks is challenged. (Incidentally, there
never has been any real support for this common myth.)

 

9.  Of the 31
important whiplash outcome studies published since 1956 (19 published since
1990) pooling patients from all vectors of collision (i. e., rear, frontal, and
side impacts), a mean of 40% still symptomatic is found. For rear impact only,
a mean of 59% remain symptomatic long-term.

 

10 . Although estimates vary, about 10% of all
whiplash victims become disabled (79).

If
you, a loved one, or a friend is struggling with whiplash residuals from a
motor vehicle collision, you can depend on receiving a multi-dimensional
assessment and therapeutic approach at this office.

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            Fibromyalgia
(FM) is a complex condition that includes widespread symptoms of muscle and
joint pain, where everything seems to ache and is associated with severe
exhaustion and fatigue.  It affects up
to 4% of the population (woman > men), with no known cause or known
cure.  With these facts, it’s not
surprising that many sufferers have turned to diet as a means of trying to
improve their quality of life. 
Unfortunately, there are many conflicting dietary recommendations for
FM, some completely contradicting the other, leaving the patient and doctor
confused as to who or what to believe.

            FM
can be primary (of unknown cause) or secondary (caused by a different specific
condition). Because many conditions can give rise to FM, it’s not surprising
that there is no one diet that works universally for all FM patients. However,
many FM sufferers respond from eliminating one or more of several types of
foods according to experts interviewed by WebMD, and utilizing these
recommendations can prove highly effective. 
They specifically identified 7 foods to avoid in the management of FM,
which include the following:

1. Aspartame
(NutraSweet): All of the experts interviewed by WebMD agreed a large majority
of FM patients could worsen by eating or drinking foods sweetened by aspartame.

2.  MSG (monosodium glutamine) and
nitrates: MSG is a common additive to enhance flavor in many processed and
frozen foods as well as in some Asian (eg., Chinese) foods.  Hence, lunchmeats like ham, bologna and
bacon should be avoided.

3.  Sugar, fructose, and simple carbohydrates:  Though no study has clearly identified that
these foods directly worsen the symptoms in FM patients, eliminating foods like
cake, white bread and sugar in general, will decrease the risk of developing
secondary conditions such as yeast infections that can give rise to FM.  Eliminating foods with high levels of
fructose corn syrup has been reported to help some FM patients.

4.  Caffeine (coffee, tea, colas/soda,
& chocolate):  After a brief
stimulating effect (energy boost), there is a longer lasting sedative affect,
which is amplified in FM patients.  The
good news is that most of the caffeine is out of the body within a week of
discontinuing use.

5.  Yeast and glutens:  These two are not related but are frequently
used together in foods like cake, donuts and bread and both contribute to FM
symptoms.  Yeast gives rise to yeast
fungus where an overgrowth may cause or exacerbate FM symptoms resulting in
joint and muscle pain.  Glutens can
cause stomach and other GI problems, which in turn can give rise to fatigue.

6:  Dairy: Regardless if its low or high
fat, some reports indicate that dairy products, particularly milk can increase
the symptoms of FM and avoiding these can help.

7.  Nightshade plants: Tomatoes, chili and
bell peppers, potatoes and eggplant can trigger flare-ups of FM and various
forms of arthritis.

            Some
GOOD diet approaches include a
heart-healthy diet – that is, one that is low in saturated fat and includes
lean meats & poultry, fresh fruits and vegetables. This diet improves one’s
overall health, thus reducing the risk of secondary FM and allowing the body to
better fight off other disease processes. 
This diet is also anti-inflammatory, the common link found in many
health conditions.  A vegetarian diet
comprised of mostly whole foods was also reported as helpful.  High potency vitamin supplement and
specifically Omega 3 fatty acids (main ingredients – EPA & DHA) included in
fish oil, flax seed, walnuts, some fortified cereals, and eggs also help reduce
inflammation. These recommendations are research supported and we can further
discuss the nutritional approaches that benefit patients suffering with
fibromyalgia.

     There are many exercise options for Carpal
tunnel syndrome (CTS).  This is because
CTS is a “cumulative trauma” condition where repetitive motion results in
overuse and subsequent injury to multiple areas in the upper extremities.  Most exercises address the forearm, wrist
and hand as well as the neck, shoulder, and elbow, depending on the extent of
the cumulative injury.  Since each case
of CTS is unique and individually different from other cases, it is smart to
start with basic exercises and add more exercises over time rather than to
begin too many exercises at once.

     Because CTS is caused most frequently from
overusing the hands over time such as a repetitive job or hobby, stretching the
inflamed tendons (the string-like attachments of muscles to the bone) in an
important objective.  There are 4 basic
movements of the wrist and the muscles that move the wrist and fingers are
located in the forearm and hand.  Hence,
stretching will take place in these four different directions as overuse
injuries or tendonitis is usually not limited only to the carpal tunnel tendons
(located on the palm side of the wrist), but usually includes many of the other
muscle/tendons on the thumb and/or back side of the wrist.  The following are 3 exercises that stretch
the wrist/hand on the thumb side, back side, and palm side.

     Exercise 1 (for the thumb side of the
wrist):  START POSITION:  Sit or stand with both arms held out
straight (elbows, wrists & fingers), thumbs pointing upwards & palms
facing each other.  MOVEMENT 1: Tuck the
thumb into the each palm and grab it with the other 4 fingers making a fist
with the thumb inside the fist. 
MOVEMENT 2:  Bend the wrist downwards
towards the ground and feel the stretch on the top/thumb side in the wrist and
thumb.  Hold for 8-10 seconds and repeat
many times a day (example once an hour).

     Exercise 2 (for the back side of the
wrist):  START POSITION: Same as above.
MOVEMENT 1: Bend (flex) the fingers at the big knuckles (base of the fingers)
followed by flexing the wrist.  MOVEMENT
2:  Using your other hand, pull the back
of the hand and apply a gradually increasing stretch until a “good hurt” is
achieved on the back side of the forearm, wrist and hand. Hold for 8-10 seconds
and repeat many times a day (example once an hour).

     Exercise 3 (for the palm side of the
wrist):  START POSITION: Same as
above.  MOVEMENT 1:  With the fingers pointing downwards, place
the palm of the hand on the wall or hook the fingers on the edge of a desk or
table’s edge and apply a gradual increasing stretch by bending the hooked
fingers backwards until the “good hurt” is felt in the forearm palm-side
muscles.  MOVEMENT 2:  Reach over the top with your other hand and
grasp your thumb and pull back adding an additional stretch to the tendons that
travel through the carpal tunnel.  Hold
for 8-10 seconds and repeat many times a day (example once an hour).

     Done together, these 3 exercises, performed
multiple times a day, (especially during work or at times of fast, repetitive
arm/hand movements) can act as a “mini-break” from the fast, repetitive
work.  Chiropractic approaches include
training of these and other exercises as well as manipulation/mobilization of
the joints including the neck, shoulder, elbow, forearm, wrist and hand,
depending on what is needed for each case. 
Wrist splinting, especially at night, nutritional advice, workstation
assessments, also play important roles in the non-surgical care of CTS.  We appreciate the opportunity to help you,
your family, friends or co-workers who are suffering from CTS.  Remember – try this approach first, BEFORE
surgery, as this approach carries less risk and, it is frequently all that is
needed!

Low Back Pain and the Hamstrings

Posted: September 11, 2009 in Back Pain

     Have you ever considered how important your
hamstrings muscles are in relationship to the low back?  Most people do not think about those tight
muscles on the back of the upper leg / thigh as having much to do with low back
pain (LBP).  However, it is one of the
most important muscles groups to keep loose both as a means of improving
current low back trouble as well as preventing future LBP.  Think of the hamstrings as a stabilizing
guide wire that keeps us upright.  When
we bend over with our knees straight, we can feel the hamstrings gradually
tighten, often limiting us from reaching our toes.   When the hamstrings are too tight, some of us can hardly reach
past our kneecaps as we bend over.  We
then (unconsciously) bend our knees to put slack in the hamstrings so we can
easily reach the floor.

     The low back is only so flexible and in
reality, most of our ability to touch our toes comes from our hip joints.  In fact, after scoliosis surgery where metal
rods are placed on both sides of the spine, these patients will often make up
for the loss of low back movement by increasing hip motion and still be able to
touch their toes!  This, however, can
only be accomplished if the hamstrings are stretched to a point of allowing the
hips and pelvis to rotate forwards when bending with the knees straight.

     So, what happens if the hamstrings are too
tight?  Think of a young sapling tree
branch versus an old oak branch. When bending the two branches, the young
sapling can easily bend, while the old oak branch breaks early into the
process.  Similarly, as we bend over to
lift a box, when the back and leg muscles, ligaments, and tendons are tight,
something has to give or “break,” similar to the old oak branch. The “weak
link” in the injured person bending over may be a disc that ruptures, ligaments
and/or muscle tendons that overstretch and tear.  By keeping the hamstrings loose (like the young sapling branch),
much less force is placed on the spine because the pelvis can rock forwards
during the bending process, thus unloading the spine.  Another way to look at it is that when the hamstrings are too
tight, something else has
to be correspondingly loose to make up for the tight
hamstrings or else the task of bending forwards and performing daily tasks will
be limited.

     Tissues in our back are injured when forces
exceed their capacity to withstand the load. 
By keeping our hamstrings stretched, we reduce the need for our spine to
have to make up for the tightness; thus both preventing a new injury, as well
as perpetuating a current problem.  The
best way stretch the hamstrings is to lay on our back in an open doorway with
one leg placed on the door jamb (edge of the doorway) and the other leg is kept
flat on the floor (knee straight) through the door opening. Scoot as close as
you can so that the hamstring muscles are stretched tightly to the point of a
“good hurt.”  Maintain that position for
at least 2 minutes and then switch legs. 
Because the hamstrings tighten up during sleep, it’s usually best to
perform the stretch in the morning. 
Repeating this multiple times a day may be required to obtain proper
hamstring muscle length.  Exercise
training is a routine part of chiropractic care!

     If you, your family, or a friend is
struggling with low back pain, sharing this information may be one of the
greatest acts of kindness you can give to that person. At this clinic, we
strive to provide the highest quality care and follow evidence and “best
practice” approaches.  We greatly
appreciate the trust that our patients place in us and our services as we help
them recover as well as teach ways to prevent future LBP episodes.