Archive for April, 2013

Low Back Pain and Travel Tips

Posted: April 1, 2013 in Back Pain

Low back pain (LBP) is a common complaint when it comes to traveling, whether it’s in a car, bus, train or airplane. Traveling is hard on our joints, muscles and nerves for many reasons. Traveling requires us to do something our bodies are not used to, such as prolonged sitting in a cramped area. Remember the last time you had the middle seat on a plane? Also, unless you have a very unique exercise routine, injuries commonly occur from hoisting carry-ons into overhead bins or yanking them off the baggage claim belt. This month’s article will offer tips about traveling and things you can do to minimize risk of irritating or creating LBP. Bon voyage!

Luggage Wisdom

Lifting (in preferential order of lowering the risk of LBP injury):

a) Ask for help if you know your carry-on is too heavy for you to place into the overhead bin safely. There are many kind co-travelers who will jump at the chance to facilitate (especially if you ask them nicely). If that fails, most flight attendants will be happy to help if they know you are struggling with LBP (be honest with yourself; now is NOT the time to be in denial of your back issue!)
b) When it is possible, try to ship your heavy items ahead of time. It’s not only good for your back, but it’s often cheaper than the cost many airlines charge per bag! If you do this, all you need is a small carry-on that can easily fit under the seat in front of you.
c) Why NOT simply check a bag, especially heavy items? You still have to be careful removing it from the luggage carousel, but again, ASK FOR HELP!
d) Try a backpack. It sure beats slinging a heavy briefcase over only one shoulder, which should be reserved for a light hand bag only.
e) If no one comes to help, and you end up having to complete this often unpleasant task yourself, think before you lift. Break the lift into small movements or actions. For example, when placing your carry-on into an overhead bin, keep the luggage close to your body since the farther away from your body you hold the bag, the heavier it becomes to your lower back (up to 10x the load!). Try this method: 1st lift the bag to the arm of the seat that lies below the overhead bin; next lift it to the top of the seat back top; and then (the hard part), squat down, arch your low back, grip the bag, and in a smooth continuous movement, raise the bag up and onto the edge of the overhead bin. At that point, wiggle it in the rest of the way. Another important point about lifting is to try to avoid twisting, ESPECIALLY if combined with bending. A bend / twist combination is often the cause of a low back injury. Try to pivot your feet to move your body to avoid your back from twisting.

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Carpal Tunnel Syndrome (CTS) sufferers frequently report a cluster of symptoms, but almost all have one symptom in common – numbness, usually in digits 2-4 on palm-side of the hand. CTS is usually attributed to an over-use type of injury such as repetitive work including (but not limited to): typing, assembly work, packaging jobs, machine operators, and many more. Last month, we discussed CTS “Facts” and learned many important points about CTS. This month’s focus centers around the common question, “….where is this numbness coming from?”

To answer this, let’s review the anatomy: The carpal tunnel is made up of 8 small “carpal bones” that form an arch or tunnel, and the base of the tunnel is formed from the transverse carpal ligament. There are nine tendons that attach muscles in the forearm to each finger and work when we grip or form a fist with our hand. Wiggle your fingers and look at your wrist and forearm – do you see all the activity or movement going on?

The tendons travel through sheaths which help lubricate the sliding tendons. When we move our fingers fast (such as typing, playing piano, performing assembly work, etc.), friction and heat builds up, resulting in swelling. If adequate rest does not occur, the increased pressure from the swollen tendons end up squeezing all the contents within the tunnel, which includes the median nerve. It’s the median nerve pinch that results in the numbness, tingling, and/or pain into the index, third and forth fingers.

There are other conditions that can either complicate or cause CTS. These include: hypothyroid disease (due to myxedema), diabetes (due to neuropathy), inflammatory arthritis (of which there are several kinds – rheumatoid is the most common), and pinching of the nerve either in the neck, shoulder, elbow or forearm (called double or multiple crush syndrome).

The reason chiropractic helps so much is that we can alleviate the pressure on the nerve from the neck down to the wrist and restore nerve function. This alleviates the multiple sleep interruptions, weakness in the grip that is so common, as well as helping to restore the nerve’s function. Many studies support the success of chiropractic and CTS – try it first as surgery should be the last resort.

Fibromyalgia (FM) management involves many treatment approaches. As was pointed out last month, the importance of sleep quality, hormonal balance, infection management, nutritional supplementation, exercise and more was discussed as the “SHINE” approach. This month, we are going to explore how important diet is in the management of FM.

It’s been said that one of the most powerful tools the FM patient has in their possession is their FORK because, “…food becomes cells.” That is to say, the food we eat is used to build cells, tissues, and support our organ systems. The National Fibromyalgia Association (NFA) has reported that all FM patients have some common physiological abnormalities that include:

A. Too much Substance P (a pain producing neurotransmitter).
B. Too little tryptophan (an essential amino acid that helps make serotonin which helps mood and many other things).
C. Not enough serotonin (a brain neurotransmitter that fights depression)..
D. Abnormalities in muscle cells, especially the mitochondria that provides energy (ATP) to the cell.

With the exception of substance P, we can control ALL of the above, at least in part, with diet and eating the right food. The following 7 nutritional recommendations can make a significant improvement for the FM sufferer:

1. ELIMINATE FOOD TRIGGERS: Eliminate foods that irritate the digestive system. The NFA reports that 40% of FM patients have irritable bowel problems and food sensitivities that trigger abdominal pain, diarrhea, and headaches. Common food triggers include: monosodium glutamate (MSG), caffeine, food coloring, chocolate, shrimp, dairy products, eggs, gluten, yeast, milk, soy, corn, citrus, sugar and aspartame. Regarding aspartame and MSG – a 2010 study out of France reported FM symptoms subsided significantly after eliminating both from the diet, as they found that they stimulated certain neurotransmitters.

2. EAT MORE TURKEY! That’s because turkey contains tryptophan, an essential amino acid that can help combat chronic fatigue and depression, which are common FM symptoms. In a large NFA 2007 survey of 2,596 FM patients, about 40% of the group complained of energy loss. Tryptophan is only acquired through food as our bodies cannot make it or convert it from other substances. Tryptophan is needed by our body to make serotonin (the “happiness hormone”) which improves our mood and makes melatonin, the chemical that helps us sleep deeply. Hence, to fight fatigue, avoid the food triggers mentioned in #1 and increase tryptophan, which can be found in certain protein rich foods such as cold-water fish (salmon, tuna, anchovies, and mackerel), nuts and seeds, soy (soymilk, tofu, and soybeans), turkey, and yogurt. Many of these foods also contain tyrosine, which increases levels of brain neurotransmitters dopamine and norepinephrine. These brain neurotransmitters help with cell messaging, alertness, and reduce cognitive “fog,” often described by FM sufferers. Also consider taking melatonin if sleep is an issue.

3. EAT MORE SARDINES! Okay, turkey is more “palatable,” but sardines have the ability to reduce muscle pain, of which, according to the NFA survey, 63% of FM sufferers experience. This is thought to be due to coenzyme Q10 (CoQ10) deficiency, essential for muscle function and found in sardines and organ meats. Of course, if these natural food approaches don’t appeal to you, a CoQ10 supplement may be easier. In two studies, FM patients were found to be 40% deficient in CoQ10, and 30% experienced less muscle pain and fatigue after taking 300mg/day for 9 months.

Stay tuned next month for the last 4 nutritional “tips.”

How many times have you heard, “I have a pinched nerve in my neck and have to have surgery.” Though there certainly are cases where surgical intervention is required, surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and failed). It is alarming how many cases of cervical radiculopathy (i.e., “pinched nerve”) end up being surgically treated with NO trial of non-surgical care. Hence, the focus of this month’s article will look at research (“MEDICAL EVIDENCE”) that clearly states neck surgery DOES NOT improve the long term outcomes of patients with chronic neck pain.

Chronic neck pain (CNP) is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, as many neck pain sufferers have had neck pain, “…for years” or, at least longer than three months. Depending on the intensity of pain and it’s effect on daily function, many patients with CNP often ask their primary care provider, “…is there anything surgically that can be done?” The desire for a “quick fix” is often the focus of those suffering with neck pain. Unfortunately, according to recent studies, there may not be a “quick fix” or, at least surgery is NOT the answer. The December 2012 issue of The European Spine Journal reports that spine surgery did NOT improve outcomes for patients with CNP. Moreover, they pointed to other studies that showed some VERY STRONG REASONS NOT to have spine surgery unless everything else has failed. One of the reasons was a higher hospital readmission rate after spine surgery. Another reported that most studies on surgical vs. conservative [non-surgical] care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, “The benefit of surgery over conservative care is not clearly demonstrated.” It is important to point out that the research analyzed studies that included patients with and without radiculopathy (radiating arm pain from a pinched nerve), and myelopathy (those with pinching of the spinal cord creating pain, numbness, weakness in the legs, and/or bowel / bladder dysfunction).

In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spinal manipulation in the treatment of both acute and chronic neck pain with or without radiculopathy. Bronfort published similar findings in 2010 in a large UK based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine manipulation was effective for neck pain of ANY duration (acute or chronic). Chiropractic utilizes manipulation, manual traction, mobilization, muscle release techniques, home cervical traction, exercise, as well as a multitude of physiotherapy modalities when managing patients with CNP. Given the overwhelming research evidence that surgical intervention for CNP is NOT any better than non-surgical care, the greater amount of negative side-effects, and the obviously long recovery time post-surgically, chiropractic treatment of anyone suffering from CNP should be tried FIRST.

Whiplash “Anatomy”

Posted: April 1, 2013 in Whiplash

To better understand Whiplash, let’s take a look at the anatomy and what is actually injured in a whiplash injury. Our spine is basically a long chain made up of blocks that are larger at the bottom and smaller at the top. This means the low back vertebra are huge compared to the neck vertebrae. The vertebrae fit together in a way that “locks” them together by the small joints in the back called “facets” and in the front by the disks. These joints function as shock absorbers between the blocks or “vertebral bodies.” Also in the front, there is a tough piece of tissue called the “anterior longitudinal ligament” that provides a barrier so that when the neck is bent backwards (into “extension”), it becomes tight and stops that movement so it doesn’t over-extend, which could fracture the small facet joints in the back.

There are ligaments, or tissues that hold bone to bone, in the back of the spine that connect between the “spinous processes,” or bony “bumps” in the middle of the back. These ligaments check or stop excessive forward motion of the neck during whiplash. Joint capsules surround joints, which we all have seen when we separate a chicken leg from the thigh. Remember how smooth and shiny the end of the chicken leg is? That smooth surface at the end of long bones is call “hyaline cartilage”, and it allows for slippery gliding between the ends of our bones when we move any joint, including our fingers, wrists, shoulders, hip as well as the facet joints of the spine. Joint movement is facilitated by the presence of an oily substance called “synovial fluid” which acts like a lubricant for the joint allowing for pain-free movement.

A “sprain” occurs when we damage a joint capsule or a ligament, or when the muscle or its attachment (tendon) is injured. These are graded as mild, moderate or severe, or grades 1, 2,or 3, with grade 3 being the worst at 75% or greater tearing, and healing takes progressively longer with each grade.

During a whiplash injury, the classic rear-end collision results in over stretching of the ligaments in the neck, and tearing can occur (sprain, grades 1, 2 or 3). If one of the nerves gets pinched, then numbness, pain, and/or weakness can occur, radiating down the arm to a specific location. When this occurs, the long-term prognosis is worse. Concussion can also occur if the brain is slammed against the inside of the skull. Chiropractic adjustments, when administered early, yield the best results for treating whiplash, according to many studies.

We realize you have a choice in where you choose 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.