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Core Strengthening to Reduce Low Back Pain Risk

2 Apr

Low back pain is one of the most common and disabling conditions worldwide. It’s estimated that
nearly 200 million acute episodes of low back pain occur each year, of which roughly 20% persist for longer
than three months. With the aging of the global population combined with the obesity epidemic, low back pain
is expected to become an even more substantial physical health issue in the coming decades.
Because weakness in the core muscles that help stabilize the spine has been linked to up to a threetimes increased risk of new-onset low back pain, improving endurance and control in this muscle group may
help reduce one’s risk. The core muscles include the abdominals, back, and gluteal muscles. In addition to
stabilizing the spine to help stay upright, strong core muscles are important for maintaining balance through
proprioception and for supporting the wide range of motion the trunk performs—from rotation, to bending
forward, to side-bending, and backward movement. Key core-strengthening exercises include:

  • Front plank: Lie face down and prop yourself up on your elbows under your shoulders. Lift your body
    onto your elbows and toes (or knees for an easier version). Keep your body in a straight line from
    shoulders to heels, tighten your stomach and glutes, and avoid letting your hips sag or rise. Hold 10–
    30 seconds, repeat three to five times, working up to a 60-second hold.
  • Side plank: Lie on one side with your elbow directly under your shoulder. Lift your hips off the floor
    so your body forms a straight line from shoulders to feet. Keep your core tight and don’t let your hips
    roll forward or backward. For an easier version, bend your knees and lift your hips. Hold 10–25
    seconds per side and repeat three to five times.
  • Bird dog: Start on hands and knees with hands under shoulders and knees under hips. Tighten your
    stomach slightly and keep your back flat. Slowly extend one arm forward and the opposite leg
    backward. Keep hips level and avoid arching your back. Hold for five to ten seconds, return to start,
    then switch sides. Do eight to twelve repetitions per side.
  • Glute bridge: Lie on your back with knees bent and feet flat on the floor about hip-width apart.
    Tighten your stomach and squeeze your glutes. Lift your hips until your shoulders, hips, and knees
    form a straight line. Avoid arching your lower back. Hold three to five seconds at the top, then slowly
    lower. Perform ten to fifteen repetitions for two to three sets.
  • Dead bug: Lie on your back with arms straight up and knees bent at 90 degrees. Tighten your stomach
    gently so your lower back stays flat against the floor. Slowly lower one arm overhead and extend the
    opposite leg toward the floor. Only go as far as you can without your back arching. Return to start and
    switch sides. Perform eight to twelve slow, controlled repetitions per side.
    Further strategies to reduce the risk of low back pain include maintaining a healthy weight; improving
    workstation ergonomics; practicing good posture, especially when sitting and lifting; engaging in regular lowimpact aerobic exercise such as walking or swimming; following a balanced, minimally processed dietary
    pattern (such as a Mediterranean-style diet); avoiding tobacco use; and stretching before and after physical
    activity, especially the hamstrings which are often overly tight in low back pain cases. While these practices
    may not completely prevent low back pain, they can improve the changes for a speedier recovery as well
    reduce the risk of recurrence.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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A Practical Tool for Assessing Health and Longevity

30 Mar

As we age, it is natural to become more concerned about our longevity, especially if we have
experienced health challenges or engaged in unhealthy behaviors earlier in life. One way to assess probabilistic
near-term (under five years) and long-term (10–25 years) mortality risk is to use an assessment known as the
Deficit Index, also called the Frailty Index. Essentially, the index evaluates health across many different
domains. Each item is scored as 0 (not present), 0.5 (a mild or partial problem), or 1 (a severe or fully present
problem). The individual deficit scores are added together and then divided by the total number of items
assessed (61 in this example) to produce a final index value between 0 and 1. Below are commonly included
deficit domains:

  • Chronic Medical Conditions: Hypertension, diabetes mellitus, coronary artery disease, stroke or TIA,
    osteoarthritis, osteoporosis, chronic lung disease, chronic kidney disease, cancer (current or past)
  • Activities of Daily Living (ADLs): Difficulty bathing, dressing, transferring, using the bathroom,
    feeding, shopping, managing medications, managing finances, preparing meals, using transportation
  • Mobility & Physical Performance: Difficulty walking one block, difficulty climbing stairs, slow
    walking speed, poor balance, use of cane/walker/wheelchair, fall/s within previous year
  • Symptoms & Somatic Complaints: Chronic pain, fatigue or low energy, shortness of breath, dizziness,
    poor appetite, sleep problems, urinary incontinence
  • Cognitive Function: Memory complaints, difficulty concentrating, diagnosed mild cognitive
    impairment, dementia, difficulty following instructions
  • Psychological & Emotional Health: Depressive symptoms, anxiety, low mood most days, anhedonia,
    high perceived stress, poor coping skills
  • Sensory Impairments: Poor vision (even with correction), poor hearing, difficulty communicating due
    to sensory loss
  • Nutrition & Body Composition: Unintentional weight loss, low BMI, sarcopenia or muscle weakness,
    difficulty chewing or swallowing
  • Social & Environmental Factors: Living alone, social isolation, limited social support, financial strain,
    low physical activity, limited access to care
  • Laboratory & Physiological Abnormalities: Anemia, elevated inflammatory markers, abnormal
    glucose regulation, low vitamin D, reduced kidney function markers
    In population studies, scores below 0.10 are considered robust and associated with low mortality risk
    over the next 10–20+ years; scores of 0.10–0.15 are considered pre-frail and associated with low five-year
    mortality but increased 10–20 year risk; scores of 0.15–0.25 indicate moderate frailty and a substantially
    elevated 5–10 year mortality risk, with many studies showing a roughly 50–70% chance of death within the
    next decade; scores of 0.25–0.40 indicate severe frailty and high near-term mortality, with up to a 50% chance
    of death within ~3 years and very high five-year mortality; and scores of 0.40 or higher indicate extreme frailty
    and are associated with very high 1–3 year mortality and markedly shortened survival.
    Importantly, this assessment and others like it are not intended to predict exactly how many years any
    one individual has left. Rather, they help visualize how multiple health factors combine to reflect overall
    biological aging and vulnerability. The goal is not fatalism, but insight, so that efforts to improve strength,
    nutrition, mobility, mental health, sleep, and social connection can reduce frailty, improve quality of life, and
    potentially extend both lifespan and health span.

Brent Binder M.S., D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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Whiplash-Related Somatosensory Tinnitus

25 Mar

Most people associate tinnitus with excessive noise exposure, such as the ringing that
can follow a rock concert. However, tinnitus can also develop following a whiplash event,
such as the rapid acceleration and deceleration of the head and neck that occurs during a
motor vehicle collision. While a crash may involve loud noises that can temporarily affect
hearing, the persistent nature of tinnitus associated with whiplash-associated disorders
(WAD) suggests a different underlying mechanism.
Research in this area is ongoing, but the leading explanation involves a process
known as somatosensory modulation. The nervous system has sensory receptors throughout
the body that relay information to the brain, where it is interpreted as somatosensory input—
including touch, body position, temperature, and pain. Importantly, the somatosensory
system shares neural connections with other sensory systems, including the auditory system.
When somatosensory input is altered—due to injury, irritation, or persistent pain
signals from tissues of the head and neck—it can interfere with how the brain processes
information from other systems, such as sound. In this way, whiplash does not necessarily
cause direct injury to the auditory system. Instead, injury to cervical muscles, joints, or
related nerves may disrupt normal sensory signaling, leading the brain to misinterpret
auditory information and produce the perception of ringing in the ears.
In June 2025, researchers studied 80 patients experiencing WAD-associated tinnitus
and assigned them to either an intervention group or a control group. The intervention group
received a combination of manual therapy, stretching exercises, and relaxation techniques
aimed at reducing muscle tension and addressing myofascial trigger points in the head and
neck region, while the control group was placed on a waitlist and received no treatment. As
expected, patients in the intervention group demonstrated improvements in pain and cervical
range of motion. Notably, they also reported a reduction in tinnitus symptoms, suggesting
that addressing dysfunction in the head and neck may help normalize somatosensory
modulation contributing to tinnitus.
Doctors of chiropractic commonly incorporate these types of therapies as part of a
multimodal approach to managing patients with whiplash-associated disorders. Restoring
normal motion and function to the cervical spine may help alleviate not only neck pain but
also associated symptoms, such as tinnitus. In cases where symptoms do not improve,
referral to an appropriate medical specialist may be warranted.

Brent Binder M.S.,D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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Wrist Tendonitis vs. Carpal Tunnel Syndrome

23 Mar

Fast and repetitive hand and finger movements with little rest time can cause the sheaths that cover the
tendons passing through the carpal tunnel to become inflamed, placing increased pressure within the tunnel,
compressing the median nerve, and stimulating the symptoms associated with carpal tunnel syndrome. Injury
or overuse of the tendons themselves can also cause symptoms that may be thought of as carpal tunnel
syndrome. How does a doctor of chiropractic determine which condition a patient has, carpal tunnel syndrome
or wrist tendonitis?
The first step involves the patient’s history and initial consultation. In addition to providing
information on their past and current health issues, the patient may be asked specific questions about their
presenting complaint, such as whether they recall what caused their symptoms, when the symptoms first
became noticeable, what makes the symptoms feel better or worse, what their exact symptoms are, and what
time of day the symptoms are best or worst, for example.
Based on the information provided, the chiropractor will conduct a physical examination. The exam
will include observation; palpation (touching and pressing); range of motion assessments of the arm, wrist,
hand, and fingers; and neurological tests of the upper extremity, including reflexes, muscle strength (such as
grip and/or pinch), and sensation testing (for example, light touch or distinguishing between sharp and dull).
To rule out red-flag issues—such as fracture or advanced joint disease—an X-ray may be ordered. Other
diagnostic studies, such as ultrasound or nerve conduction velocity testing, may be of use to help confirm a
suspected diagnosis.
If carpal tunnel syndrome is suspected, symptoms such as pain, numbness, tingling, and reduced
sensation will follow the course of the median nerve into the thumb, index finger, middle finger, and the
thumb-side of the ring finger, though symptoms may also travel up the forearm. Symptoms may worsen at
night and during the day when the wrist is bent up or down or held in one position for prolonged periods.
Orthopedic tests that involve flexing the wrists for 60–90 seconds, tapping over the carpal tunnel, and
manually compressing the carpal tunnel will also be positive in carpal tunnel syndrome. When performed, a
nerve conduction study will typically show slowed median nerve function across the wrist.
In cases of wrist tendonitis, pain will be localized to a specific tendon with tenderness at one precise
point, and symptoms will mostly be felt in the wrist or forearm rather than the fingers. Symptoms may be
described as achy, sharp, or pulling pain, without numbness or tingling, that worsens with gripping, lifting,
twisting, or resisted motion. With rest, symptoms will usually improve. Diagnostic imaging may show tendon
thickening or inflammatory changes.
Treatment will depend on examination findings, but in general, with carpal tunnel syndrome, the
approach used will be intended to reduce compression on the median nerve, potentially with activity
modifications and ergonomic changes to reduce inflammation while tissues heal. With wrist tendonitis, heavier
activity will be reduced initially to allow the tendon to recover, followed by specific exercises to increase
tendon strength and load tolerance. The good news is that doctors of chiropractic are well-equipped to
distinguish between these conditions and manage them using an effective, non-surgical, conservative approach.

Brent Binder M.S., D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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Chiropractic Management of Shoulder Pain

16 Mar

By some estimates, shoulder complaints affect nearly half of the adult population in a
year, driving many to chiropractic offices looking for a conservative, non-surgical solution.
While back pain and neck pain are the primary reasons patients seek chiropractic care, at least
one study found that 12% of chiropractic visits in a week may involve shoulder issues. How
would a chiropractor manage a shoulder complaint?
The shoulder complex itself is made up of four separate articulations—the glenohumeral
joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic joint—that
work together to support the wide range of motion available to the arm. These joints, along with
the tendons, ligaments, muscles, and other soft tissues involved in upper extremity movement,
are all at risk of injury. When assessing treatment, the first step would be to conduct a thorough
examination to properly diagnose which components of the shoulder are contributing to the
patient’s chief complaints.
Because examination findings will vary, the specific treatment approach for a given
patient will be unique. However, in a general sense, multiple therapies are typically combined
with the goal of restoring normal movement to the affected joint(s). This may include manual
therapies (manipulation, mobilization, and soft tissue techniques), stabilization exercises,
stretches, physiotherapy modalities, and anti-inflammatory measures such as ice. Activities at the
extreme ranges of motion may be limited in the short term, with a gradual return to normal
activities within pain tolerances.
The shoulder does not exist in isolation, and several studies suggest that dysfunction in
the thoracic spine can affect movement of the scapula, which in turn can limit motion in other
aspects of the shoulder. In particular, a February 2024 study found that including mid-back
chiropractic adjustments in a treatment plan for adhesive capsulitis (frozen shoulder) improved
outcomes with respect to shoulder pain, disability, and function, and a January 2025 systematic
review and meta-analysis that included ten clinical trials found that thoracic spinal manipulative
therapy also improved outcomes for patients with subacromial impingement syndrome.
Chiropractic care has been demonstrated to benefit patients with various shoulder
complaints, and the treatments used are well supported in clinical guidelines as first-line
approaches. However, it should be noted that these conditions can have a difficult recovery
process, even if the patient undergoes surgery, and it can take months or even a year to restore
normal function to the affected joints.

Brent Binder, M.S.,D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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In-Office and At-Home Neck Pain Management

9 Mar

Neck pain is estimated to affect approximately 30–50% of the adult population in the
United States each year, making it second only to low back pain as a primary reason patients
seek chiropractic care. The goal of chiropractic care for neck pain is to help restore normal joint
motion and function in the cervical spine, a process that is often a collaborative effort between
care delivered during office visits and self-care performed by the patient between visits.
During office visits, neck pain patients are commonly treated with manual therapies as a
primary intervention. High-velocity, low-amplitude spinal manipulation—sometimes
accompanied by an audible pop or crack—is the technique most commonly associated with
chiropractic care. Chiropractors are also trained in lower-force approaches, including
mobilization techniques and soft tissue therapies. Treatment plans may involve more than one
type of manual therapy depending on the tissues involved, patient presentation, and clinician
judgment.
In-office care may also include cervical traction, particularly when nerve irritation is
suspected to be contributing to symptoms. To assist with short-term symptom relief, patients
may receive adjunctive therapies such as electrical stimulation (e.g., TENS), therapeutic
ultrasound, low-level laser therapy, or heat or cold therapy. In some practices, massage therapy
provided by an on-site massage therapist may also be incorporated.
Between visits, patients are encouraged to take an active role in their recovery.
Continuing to pursue normal activities within pain tolerance helps prevent muscle
deconditioning (which can increase the risk of chronic pain) and supports joint health by
promoting nutrient exchange through movement. When muscle weakness or imbalance is
identified—which is common in neck pain—patients may be instructed in specific exercises to
perform regularly as time allows. Additional guidance may include recommendations for
sleeping positions, pillow selection, and temporary work or activity modifications to support
recovery. Anti-inflammatory strategies, including dietary modifications and selected
supplements, may also be discussed when appropriate.
Once pain and functional limitations reach maximal improvement, patients are typically
released from active care. Some may be advised to schedule wellness or maintenance visits on an
as-needed or periodic basis, along with continuing neck-healthy habits in daily life. Together,
these strategies may help reduce the likelihood of future episodes or allow a subsequent neck
pain episode to be addressed earlier before it interferes with normal activities or quality of life.

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