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Shoulder Pain – What Are My Treatment Options?

14 May

The shoulder is not just one joint but rather four: the sternoclavicular (collar bone/breast bone), acromioclavicular (the “roof” of the ball & socket joint), glenohumeral (the ball & socket joint), and scapulothoracic joints (shoulder blade/rib cage joint). There are also many structures in the vicinity that can mimic shoulder pain—namely, the cervical spine (neck), the upper half of the thoracic spine (upper back), and the rib cage.

The most common area that most shoulder pain sufferers point to is the top of the shoulder—between the neck and upper arm/shoulder joint. This may indicate dysfunction in the neck, since it can refer pain to this area. When patients point to their upper arm, the shoulder “could be” the pain generator, but more information is necessary before their doctor can make a firm diagnosis. If raising the arm above the horizontal plane (90°) hurts, it could be an impingement caused by a swollen bursa (“bursitis”), tendon (“tendinitis”), and/or a tear of the rim of the socket (“glenoid labrum tear”).

Specific orthopedic tests exist that help to differentiate between the possible causes or diagnoses but often, an MRI may be necessary to nail down a diagnosis. Unfortunately, an MRI can also show too much information, such as normal age-related changes, “silent” abnormal findings (like tears and frayed tissue that are not pain generators), which can actually make it more difficult to be sure what is causing the patient’s current shoulder pain.

When it comes to treatment, there is evidence to suggest conservative approaches, like exercises, are just as effective as surgical approaches. One review found the following:

  • Subacromial impingement syndrome: Exercise is as effective as surgery at one, two-, four-, and five-year follow-ups (at a fraction of the cost of surgery).
  • Rotator cuff partial thickness tears (<75%): Exercise is as effective as surgery (at a fraction of the cost).
  • Atraumatic full thickness rotator cuff tears: Exercise significantly reduces the need for surgery (75%).
  • Subacromial impingement syndrome: Exercise significantly reduces the need for surgery (up to 80%).

So if you suffer from shoulder pain, don’t jump to surgery as your first treatment option. Conservative treatments offered by doctors of chiropractic—such as manual therapies, exercise training, and the use of modalities—can help improve motion in the shoulder and the surrounding structures at a much lower cost and without the risks that come with more invasive procedures. Also, regardless of the treatment option you choose, keep in mind that it can take three, six, nine, or even twelve months to reach a satisfying end-point in treatment for these types of injuries.

 

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 Most Important Principles for Staying Young: If You Like It, Keep Drinking Black Coffee to Keep Your Brain Young!

10 May

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you and for you to teach others. We want you to know how much control you have over both the quality and length of your life.

This month, I want to talk about how great coffee is, even in light of that judge in California who has mandated that all coffee in California be labeled “as containing a potential carcinogen”…

While it’s true that the acrylamide that coffee contains after roasting (French fries, chips, crackers, chocolate, and grains contain it too) is the same chemical that the International Agency for Research on Cancer has designated as a 2A carcinogen (that boils down to “might or might not be carcinogenic in humans”), it’s not likely to be risky in the minute amounts found even in unhealthy foods. The judge in this case sought “proof” that coffee confers a health benefit and/or is free of all risk.  Unfortunately, this judge needs a remedial course in high-school biology.  He apparently doesn’t understand relative risks and the basics of epidemiologic research for nutritional choices.

How does acrylamide get in coffee in the first place? Well, the chemical is formed by using what the FDA called “traditional high-temperature cooking processes for certain carbohydrate-rich foods.”

Those small amounts per billion (very dilute!) are far, far, far less than the straight dose of acrylamide fed to lab rats to test if it is potentially carcinogenic. Their dose is up to 10,000 times stronger than what you’re getting from the foods you’re eating. Plus, rodents absorb and metabolize the chemical differently than humans.  A cup of coffee has much less acrylamide than a small container of French fries (and a light roast has much less of this chemical than a dark roast).

When asked if the available tests mean humans should stop drinking coffee, the Washington Post quoted Dr. Leonard Lichtenfeld, the American Cancer Society’s deputy chief medical officer, as saying, “No. That’s not what the science shows us.”

A meta-analysis of multiple studies on coffee consumption found that, overall, coffee seems to offer health benefits that include a probable decreased risk of breast, colorectal, colon, endometrial, and prostate cancers and cardiovascular disease. In addition, observational studies showed caffeine was associated with a probable decreased risk of Parkinson’s disease, type 2 diabetes, and dementia—all by 20 percent or more.

So don’t forego your Joe, but do ditch added sugars and high-fat dairy. As for me, I’m still drinking more than six cups a day as I believe the preponderance of data that coffee offers fast metabolizers (those who do not get a headache, arrhythmia, gastric upset or anxiety from a cup in a one-hour period) a protection from cancer, dementia, and type 2 diabetes. And yes, I do believe all who enjoy coffee should continue as it does— IMHO and in more than four studies in humans—decrease brain dysfunction.

Next month, we’ll talk about another choice that keeps your brain young…

Thanks for reading. Feel free to send questions to: AgeProoflife@gmail.com

Dr. Mike Roizen

 

PS: Please continue to order the new book by Jean Chatzky and myself, AgeProof: Living Longer Without Running Out of Money or Breaking a Hip.

  1. https://www.washingtonpost.com/news/food/wp/2018/02/02/coffee-in-california-may-soon-come-with-a-spoonful-of-cancer-warnings/?utm_term=.8da1c9f18940
  2. https://www.annualreviews.org/doi/full/10.1146/annurev-nutr-071816-064941
 NOTE: You should NOT take this as medical advice.
This article is of the opinion of its author.
Before you do anything, please consult with your doctor.
You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have two newly revised books: The patron saint “book” of this column YOU Staying Young—revised and YOU: The Owner’s Manual…revised —yes a revision of the book that started Dr Oz to being Dr Oz.  These makes great gifts—so do YOU: ON a Diet and YOU: The Owner’s Manual for teens.  
Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on http://www.radioMD.com Saturdays from 5-7 p.m. He is the co-author of 4 #1 NY Times Best Sellers including: YOU Staying Young.

Can Carpal Tunnel Syndrome Be Prevented?

7 May

Let’s say you’ve applied for a job that requires frequent gripping and handling of products and you heard that carpal tunnel syndrome (CTS) is a problem at this particular manufacturing plant. You really need the job, but you are leery of the possibilities of developing CTS. Is there anything you can do to PREVENT it?

Though there are no “guarantees” that CTS won’t occur despite our best efforts at prevention, here are some practical approaches that can make a big difference:

  1. LIGHTEN IT UP: CTS risk increases as a result of three things: Force + Speed + No Rest. First, try using less force or lighten up on your grip whenever possible. Though it’s hard to change habits, try gripping tools less tightly (use higher quality tools if they reduce the need to squeeze hard), don’t “pound” the keys of your keyboard, don’t squeeze your computer mouse, kitchen utensils, etc. and don’t strangle your golf club, tennis racquet, garden tools, or steering wheel. Use lighter-weight tools/utensils at home or work.
  2. TAKE BREAKS: Take 30-60 second stretch breaks every 15 minutes to allow the soft tissues in the hands and wrists to recover.
  3. STRETCH 1: Place your palm on the wall/desk pointing your fingers downward and stretch your wrist as far back as possible (elbow straight) until you feel the “pull” in the forearm muscles. HOLD for five to ten seconds and repeat on the other side. STRETCH 2: Make a fist for three seconds, then straighten out the big knuckle joints of the fingers (make a “bear claw”), followed by opening the hands and fanning out the fingers as far as possible. Hold each position for five to ten seconds and repeat as time allows.
  4. KEEP THE WRISTS NEUTRAL: When possible (driving a car, sleeping, etc.), keep your wrists straight/avoid bending. Use a wrist splint at times to help remind you (especially at night).
  5. CHANGE YOUR ROUTINE: Instead of staying at a risky task until you’re done, switch to a task that doesn’t require extreme gripping and force and/or switch between the left and right hand.
  6. CHECK YOUR POSTURE: Keep the chin tucked in (retracted) and head back. Avoid forward head posture and sit up “tall.” At a desk, keep knees, hips, elbows at 90°, and arch the lower back—in other words, don’t slouch!
  7. AVOID COLD HANDS: Try to avoid letting your hands and fingers get cold. Wear gloves (if possible), have a small space heater nearby, or rub your hands together. Even fingerless gloves can help a lot.
  8. ROTATE BETWEEN TASKS: Discuss rotating between job tasks with co-workers and your boss to avoid the same repetitive movements during your shift. This can really help in assembly line work.

SEEK HELP SOONER RATHER THAN LATER: Heed the early warning signs of CTS. Do NOT let CTS advance without seeing a chiropractor, as studies show that waiting too long reduces the success rate of treating CTS! Your doctor of chiropractic can teach you exercises, retrain your posture, suggest ergonomic (work) improvements, and treat your overused muscles and joints.

 

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.

Low Back and Dysmenorrhea – Are They Related?

3 May

Dysmenorrhea, also known as painful periods, is a common gynecological condition that affects up to 70% of menstruating women. About 15% of individuals with the condition report that it significantly interferes with their activities of daily living (ADLs) and in some cases, results in absence from school and/or work. Studies have found that dysmenorrhea is related to early menarche (the onset of menstruation), nulliparity (not having children), and stress. But is it possible there’s an anatomical component to the condition?

The lumbar spine, or low back, consists of five vertebrae that rest on top of the sacrum, or tail bone, which is wedged between the “wings” of the pelvis (the ilia) making up the sacroiliac joints (SIJs). This close anatomical relationship with the pelvic organs suggests that the musculoskeletal dysfunction may play some role in dysmenorrhea. But is this truly an important relationship and if so, can spinal manipulation to the low back and pelvis/SIJs help reduce the pain associated with dysmenorrhea?

One study looked at the relationship between pelvic alignment and dysmenorrhea in 102 females divided into groups of those with and those without the condition. The researchers observed there were differences in pelvic alignment between members of both groups.

Another group studied the lumbo-pelvic alignment and abdominal muscle thickness in 28 women with primary dysmenorrhea and 22 women without the condition and found greater misalignment and smaller diameter abdominal muscles in the dysmenorrhea group.

To determine if there is a change in pain perception after pelvis manipulation in women with primary dysmenorrhea, a randomized controlled trial of 40 women (20 in two different groups) received a “global pelvic manipulation” (GPM) while the other group received a sham or placebo intervention. The participants in the GPM treatment group reported significant improvements in overall pain and sensitivity when compared with the sham treatment group, supporting manipulation as an effective tool in the management of dysmenorrhea.

Though further research is warranted, this study shows there is scientific support for the use of spinal adjustments in women suffering from dysmenorrhea. Therefore, chiropractic may offer an effective, safe, and often fast remedy for those who choose to not risk the side effects of various medications commonly used to treat dysmenorrhea.

 

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 Diet Affect Acne?

30 Apr

Acne most commonly affects us during our adolescent years, but it can strike at any time during our adult lives. Unfortunately, usual treatment seems restricted to taking oral antibiotics along with some form of topical agent such as benzoyl peroxide, topical retinoids, or topical antibiotics. This begs the question: Is there a safer and equally effective method to treat acne? Let’s take a look…

Though it’s not particularly well understood, researchers know that hormones (androgens), bacteria (P. acnes), and an overproduction of sebum (oil) all play important roles in acne causation. Recently, oxidative stress and inflammation have gained more attention, as some researchers report that inflammation may even start the acne process.

Opinions regarding the function that diet plays in acne care range between having no role at all to diet being a vitally important player. However, recent studies show that diet may be very important with regards to both cause and treatment. One such study placed subjects on a diet high in fiber, omega-3 fatty acids from fish and seafood, and total protein, and low in sugar and saturated fats. After twelve weeks, the researchers observed a clinically significant improvement in acne with an average of 22 fewer acne lesions in those consuming the special diet vs. participants who maintained their normal diet.

Similarly, in a one-year study, 87% of over 2,200 acne sufferers reported improvements in their acne after switching to the South Beach diet, which is similar to the findings from the study mentioned above. Of the total, over 80% reported that their acne improved within three months of starting the diet and 91% reported either discontinuing or reducing their acne medication use.

What about milk? Harvard University-based researchers published three important studies involving over 60,000 individuals that concluded avoiding dairy products, with the exception of fermented yogurt, can help manage acne.

RECOMMENDATION SUMMARY (Please consult with your doctor before starting any diet): 1) No dairy; 2) Omega-3 (1-4g/d); 3) Anti-oxidants such as vitamins A and E (20mg/d), selenium (400mcg/d), and curcumin; 4) Zinc (oral 15mg/d and topical); and 5) Chromium (200-400mcg). Many doctors of chiropractic can assist with nutritional counseling to help guide those with acne in deciding which dietary approach may work best for them.

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.

Whiplash – Can We Predict Long-Term Problems?

23 Apr

Whiplash associated disorders (WAD) are most often associated with motor vehicle collisions (MVC) but can occur from any form of trauma arising from slips and falls, sports injuries, and more. A question patients suffering from WAD commonly ask is, “How long will this take to get better?”

There are many factors in play with regards to how quickly one recovers from any injury: the type and degree of injury, the type of care, the “will” to get better, the patient’s education level, gender, emotional factors, and so much more. But what does the research say regarding risk factors for a prolonged recovery from WAD?

A Danish study found that WAD patients with immediate, high-intensity neck pain and stiffness were more likely to be disabled one year following their injury than those with a delayed onset of symptoms or those with low-grade pain. By combining scores for neck pain and stiffness along with other non-painful symptoms (such as blurred vision, nausea, and dizziness), the authors found that they could identify those at risk for long-term disability within a week of their accident.

Their study included 141 adults who contacted the ER within two days of the MVC complaining of neck pain or headaches arising from rear-end collisions without loss of consciousness or amnesia. None had prior neck or back pain or a history of severe headaches. The researchers found that 75% of patients with reduced neck motion still reported disability after one year.

Interestingly, the research team observed that patients involved in ongoing litigation (lawsuits) were at no greater or lesser risk of suffering long-term disability. In a recent large-scale study using an online survey completed by 127,959 respondents, researchers found that collision severity, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain each increased the risk of a poor recovery.

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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