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Traction for Low Back Pain?

16 Dec

In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.

In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.

With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.

For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.

The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.

For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more—including in-office or at-home traction, if warranted.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Hip-Related Injuries in Athletic Kids

12 Dec

The hip is a very important region of the body, especially since our upright, weightbearing activities rely on a properly functioning hip joint.  With the expansive growth of youth athletic programs, the incidence of hip-related injuries and the associated disability has markedly increased.  But is there a difference between young male and young female hip injuries?

We’ve all observed the rapid rate of growth that occurs from age five to age seventeen, with bone growth reaching maturity around age sixteen for females and eighteen for males.  Prior to skeletal maturity, the growth plates remain open in the long bones of the body, which adds to the complexity and challenge in diagnosing and treating hip injuries in this age group.

Studies show that hip injuries account for approximately 5-9% of all athletic injuries. According to a study that looked at data from 121,047 pediatric visits at a sports medicine clinic between 2000-10, the most common hip injuries for males were labral tear (23.1%), avulsion fracture (11.5%), slipped capital femoral epiphysis (11.5%), dislocation (7.7%), and tendonitis (7.7%). For females, the leading hip injuries included labral tear (59.0%), tendonitis (14.8%), snapping hip syndrome (6.6%), strain (4.9%), and bursitis (4.9%).

The five most common sports that caused hip injuries were dancing/ballet (23.0%), soccer (18.4%), gymnastics (9.2%), ice hockey (8.1%), and track and field (6.9%).  Among adolescents (age 13–17 years), the data show that hip injuries were significantly more common in females than males. Studies have shown that young female athletes, especially in post-puberty ages, exhibit different landing and pivoting movements than males, which may help explain why adolescent females may be more at risk for hip injuries than teenaged boys.

Doctors of chiropractic are trained to diagnose and treat musculoskeletal injuries—including those of the hip joint—in patients of all ages. The key is to manage such conditions as early as possible to help patients get back to sporting activities and reduce the risk for future injuries in the hip and neighboring regions of the body.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Can Carpal Tunnel Syndrome Be Hereditary?

9 Dec

Carpal tunnel syndrome (CTS) is a disorder caused by compression of the median nerve that alters the nerve’s function (neuropathy), leading to pain and numbness/tingling (paresthesia) primarily on the palm-side of the wrist and hand. While factors like hormonal changes and repetitive motions are known to increase the risk for CTS, there might be a genetic component to the condition.

It’s known that conditions that can elevate the risk for CTS—like diabetes, thyroid disease, rheumatoid or osteoarthritis, and obesity—can run in families. Additionally, the data show that having a family member with CTS raises the risk that you too can develop the condition, but it’s not entirely clear to what extent genetic traits are responsible versus shared environmental factors among family members.

In 2007, at the 74th Annual meeting of the American Academy of Orthopaedic Surgeons in San Diego, Harvard professor Dr. David Ring and colleagues presented their evaluation of 117 previously published studies to determine the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors. Their analysis revealed that genetic risk factors were two times stronger than the evidence supporting occupational risk factors, such as overuse.

Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or of unknown cause, further supporting genetics as the primary factor. Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there may be epigenetic factors or environmental changes to genes based on certain foods eaten or certain activities might increase a person’s risk beyond their genetic makeup.  As of 2015, no epigenetic factors have been identified in idiopathic CTS.

The good news is that even if you have a family history of carpal tunnel syndrome, you can reduce your risk for developing CTS by managing any conditions or activities that can contribute to inflammation along the course of the median nerve. This includes maintaining a healthy weight, eating a low-inflammation diet, getting regular exercise, taking frequent breaks from repetitive tasks involving the hand, reducing exposure to awkward hand postures and vibratory forces, etc. If you are experiencing CTS-related symptoms in the hand and wrist, a thorough examination by a doctor of chiropractic can help identify potential causes and help you manage the condition so you can return to your normal activities as soon as possible.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

A Link Between Cold Sores and Alzheimer’s Disease?

25 Nov

Alzheimer’s disease (AD) is the #1 cause of dementia, representing an imminent threat to our senior population. It is one of mankind’s cruelest afflictions that causes patients lose their memory, personality, and eventually self-care skills. According to the Centers for Disease Control and Prevention (CDC), about 6 million people currently have AD with projections of this doubling in the next two decades. The 2015 Framingham Heart study reported that 1 in 5 women and 1 in 10 men will develop AD.

Though researchers have observed an association between beta-amyloid plaque build-up in the brain and AD, well-funded studies have failed to determine that beta-amyloid plaques are the cause of the disorder. Interestingly, two studies published nearly 40 years ago concluded that the virus that causes cold sores (HSV-1) may play a role in the development of AD. This suspicion was bolstered by a 2014 study that detected the virus in the brains of AD patients, particularly in the parts of the brain related to memory. Neuroscientists propose that the plaque build-up commonly seen in AD patients may a consequence of the immune system trying to battle the presence of HSV-1 in the brain.

This finding suggests that AD could potentially be treated, or even prevented, by therapies that target HSV-1. Dr. Robert Rubey notes that as far back as 1968, researchers have known that HSV-1 requires the molecule arginine for replication, which can be blocked by the presence of the amino acid L-lysine. Double-blinded studies have demonstrated L-lysine is effective at both preventing or decreasing/reducing the severity of HSV-1 outbreaks.

Dr. Rubey concludes that AD is a disease process, NOT an aging process. The importance of preventing viral reactivation leading to brain inflammation/damage is key in preventing AD. In 2010, Dr. Rubey speculated that supplementing with 1,500mg of L-lysine twice a day combined with a low-arginine diet (reduced intake of nuts, seeds, grains, and tofu) may protect against AD. However, more research is needed in this area before firm recommendations can be made.

Doctors of chiropractic often recommend anti-inflammatory diets and supplements for both aiding the recovery process from musculoskeletal injuries and living a healthier lifestyle.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Role of Neck-Specific Exercises for Whiplash Recovery

21 Nov

The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain?

A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexion—tucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in  improving muscle performance, disability, and pain intensity over the course of a three-month time frame.

After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a “wait list” group who served as controls.

Here’s where it gets more interesting… At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group!  This study supports the need for specific neck exercises to reduce pain and disability and improve function.

When the deep muscles are injured, it’s common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since there’s research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Cervical Traction for Neck Pain

18 Nov

In addition to spinal manipulation, doctors of chiropractic often use other conservative therapies to reduce pain and improve function in patients with neck pain. When it comes to neck conditions involving herniated disks, radiating arm pain (“radiculopathy”), strains, facet syndromes or sprains, and myofascial pain, cervical traction is one such option.

As part of the initial new patient examination, a chiropractor may use their hands to gently pull on the patient’s neck while in sitting and/or supine (lying on the back) positions. If this feels good, then cervical traction may be warranted either in the office, with an at-home unit, or both. However, cervical traction is not advised if there is instability in the spine/ligaments, vertebral artery insufficiency, rheumatoid arthritis, osteomyelitis, discitis, neoplasm, severe osteoporosis, untreated hypertension, severe anxiety, cauda equina syndrome, or myelopathy.

There are various forms of cervical traction devices, so treatment may be performed while the patient is in a standing, sitting, lying horizontal, or inclined either prone or supine position, and the traction force can be continuous or sustained vs. intermittent or pulsed. Variables include body/head weight and the associated friction against the traction table in lying down types of units, and the angle can often be varied with most types of traction units.

There are pros and cons to different types of traction units. Lying down traction may allow for better relaxation vs. sitting, but more weight may be needed due to the friction of the body on the table. Generally, when hold times are longer (especially with sustained traction), less weight is used. Some doctors advocate starting at 5 lbs. (~2.67 kg) for 15 minutes with a sitting device (sustained traction) and gradually increasing the weight to maximum tolerance while keeping the time constant at 15 minutes.

There are a number of theories on why traction relieves pain: it forces rest through immobilization and by supporting the weight of the head, it pulls apart or opens the facet joints, it improves nutrition to the joint cartilage, stretches ligaments, it decreases the pressure inside the disks, it reduces pressure on nerve roots (by widening the holes through which they travel), it improves head posture, and/or it stretches the neck muscles to improve blood flow and reduce muscle spasm.

The bottom line, if you have neck pain and manual traction applied to the cervical spine provides pain relief, then your doctor of chiropractic may choose to incorporate this therapy into your treatment plan, either in the office, at home, or both.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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