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Pregnancy and Low Back Pain – Part 3

4 Sep

In Part 1 of this series, we discussed the many aspects of pregnancy that contribute to low back pain (LBP) including hormonal, chemical, biomechanical, and psychological changes that occur throughout pregnancy. In Part 2, we looked at the results of several studies showing that chiropractic care can help reduce low back pain (LBP) both during pregnancy as well as during labor and delivery. This month, let’s focus on what to expect when you visit a doctor of chiropractic.

The initial visit typically consists of an intake process: a history, examination, vital signs, and so on. Your doctor of chiropractic will discuss the treatment goals and procedures typically utilized during the three trimesters of pregnancy and will provide a treatment recommendation.

After the initial treatment, it is not uncommon for people, pregnant or not, to feel a “post-exercise soreness” type of discomfort. This makes sense as chiropractic adjustments and mobilization are indeed “exercising” your spinal joints with the goal of reducing joint stiffness and fixations, which some chiropractors may refer to as “spinal joint subluxations.”

There are many types of manual therapies available, and finding the method that matches your choice and needs is important. One type of manipulation often associated with chiropractic includes the use of a “high-velocity, low-amplitude” (HVLA) thrust, which is frequently referred to as “an adjustment.” Joint cavitation or the “cracking” sound that commonly occurs with adjustments is created by the formation of a gas cavity within the spinal joint space during the maneuver. The spinal joints often become looser during pregnancy due to the increase in circulating progesterone, estrogen, and relaxin, especially in the third trimester. Typically, very little force is needed to successfully cavitate a spinal joint when utilizing HVLA adjustments. For some patients, the cracking sound can provoke anxiety and in those cases, low-velocity, low-amplitude techniques may be preferred, as this does not typically result in joint cavitation.

Exercise throughout pregnancy is important, as studies show it improves energy, reduces mood swings, facilitates in stress management, and results in more restful sleep. Other benefits include less weight gain during pregnancy (by approximately 21%); shorter and easier labor (decreased by an average of two hours); fewer medical interventions experienced (24% fewer cesarean deliveries and 14% reduction of forceps use); less fetal distress; and faster recovery times.

Nutritional counseling is also appreciated and very important during pregnancy, and chiropractors are well-trained in this form of management.

Doctors of Chiropractic can work with OB/GYN doctors, primary care physicians, and/or midwives to coordinate care throughout the pregnancy with the common goal of making this the best experience of your life!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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.

Women with Back Pain… The Silent Majority? Part 1

28 Aug

Because humans are bipeds—that is, two-legged animals—our spines tend to experience greater loads than those our four-legged friends. This leads to men and women experiencing degenerative conditions such as osteoarthritis much earlier in life compared with lions, tigers, and bears (and your dog or cat). Also, the majority of us (about 90%) have one leg that’s shorter than the other (average 5.2mm or ¼ inch), which can tilt the pelvis downward on the side with the shorter leg, which increases the risk for both back pain and neck pain. Fortunately, this can be rectified with a heel lift in the shoe.  However, women also face unique anatomical, physiological, and social challenges when it comes to back pain…

Females have a wider pelvis, which aids in childbearing. This results in a greater Q-angle or “knock-knee” measurement in females than males (the “normal” angles are <22 degrees and <18 degrees, respectively). The greater the Q-angle, the less stable the pelvis, as it’s similar to folding the legs of a card table inward, which makes the table unsteady.

Another obvious anatomical difference includes breast size (weight and mass). Large breasts can place a great deal of stress on the mid-back as well as the neck and low back. Wearing a high-quality support bra or having a breast reduction may be appropriate management options for this population.

Hormone levels and variability represents a physiological difference between genders, as levels vary significantly more throughout a woman’s life than a man’s. This is particularly true of estrogen, especially from the time menstruation starts (called menarche), sometime between ages 9-14 years, and menopause. Menopause typically occurs between 49-52 years of age, which is triggered by a decrease in hormone production by the ovaries. (Note: a total hysterectomy— which includes removal of the ovaries—creates premature menopause.)

During adolescence, growth spurts are common and idiopathic scoliosis or an abnormal curvature of the spine can develop. The term “idiopathic” means the cause is unknown, and why women are three-times more likely to develop scoliosis than men is also a mystery. Treatment may range from a “wait and watch” approach to specific manual therapies and posture correction options that may include heel lifts for a short leg, foot orthotics for hyper-pronation of the ankles, as well as specific exercises for forward head carriage. Bracing may be needed if curves exceed 40 degrees although this varies on a case-by-case basis.

We will continue this important discussion next month—stay tuned!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Chronic Whiplash Injuries and Pain Thresholds

21 Aug

Researchers have observed a phenomenon called “central sensitization” (CS) that is common in patients who have long-term, chronic pain following trauma such as whiplash. With CS, the patient’s ability to feel pain is abnormally high or hypersensitive, so when pain from pressure, temperature, electrical, or other sources are applied to the skin, they feel it sooner and more intensely than individuals without CS.

Why is this so important? Well, if we can find a way to raise the pain threshold in patients with CS, then this could reduce the intensity and frequency of their sometimes intense and debilitating chronic pain.

Researchers have found that pain thresholds improve after an anesthetic agent is injected into myofascial trigger points (MTrP)—those tight, sore “knots” commonly found in muscles after injuries such as whiplash trauma. It has been proposed that these MTrP may act as “thermostats” controlling the manner in which the brain perceives and relays pain.

To test this theory, a 2017 double-blind study randomly assigned chronic pain whiplash patients to either a group receiving the “real” anesthetic agent or a “sham” or fake injection of the MTrP. The researchers measured pain (on a 0-10 scale), pressure perception, grip strength, and the range of motion (ROM) of the jaw in subjects from both groups before and after each intervention.

As postulated, only the group receiving the “real” anesthetic agent had improved pressure pain tolerance in addition to increased jaw ROM. Unexpectedly, both groups experienced similar improvements when rating their pain on a 0-10 scale. This study concluded that the pain threshold associated with CS can be modulated by injecting myofascial trigger points (with or without an anesthetic agent), although only the anesthetized group had objective improvement (jaw ROM and pressure sensitivity improvement). Interestingly, the treatment of painful trigger points has LONG been a common form of care utilized by chiropractic, known as trigger point therapy or TPT. Myofascial release is another soft-tissue technique commonly utilized over MTrP by chiropractors.

This study may help explain why so many patients benefit from chiropractic care following whiplash trauma as well as other injuries. The added benefits from spinal manipulation and modality use over trigger points are two additional ways chiropractic care can benefit those suffering from both acute and chronic pain associated with whiplash trauma.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Chiropractic Care and Migraine Headaches

17 Aug

Migraines affect approximately 15% of the general population and are usually managed by medication. However, this traditional treatment approach is not well tolerated by some migraine sufferers due to side effects. Additionally, some people prefer to avoid the risks associated with taking some medications over the long term.

A systematic literature review of randomized controlled trials (RCTs) involving the use of manual therapies to treat migraines found that chiropractic spinal manipulative therapy (SMT) is equally as effective as the medications propranolol and topiramate in the management of such headaches.

One case report featured the successful outcome of a 24-year-old pregnant female who had a history of migraine headaches starting at age twelve. She had previously tried other forms of care including osteopathy, physical therapy, massage therapy, and medication including a non-steroidal anti-inflammatory with codeine. Due to her pregnancy, she turned to chiropractic care in hopes of achieving relief without the use of medications. The application of spinal manipulative therapy along with other manual therapies led to a satisfying outcome which allowed her to cease using her medication.

Another case study featured a 72-year-old woman with a 60-year history of migraine headaches that included nausea, vomiting, photophobia (light sensitivity), and phonophobia (noise sensitivity). Prior to treatment, the patient averaged one to two migraines per week, which lasted one to three days in duration. Following a course of chiropractic care, her headaches resolved completely, which eliminated the need for any migraine medication. A follow-up seven years later confirmed her continued migraine-free status.

In a case involving a 49-year-old female patient suffering from migraine headaches following a car accident, a twelve-week course of chiropractic care utilizing SMT along with both active and other passive therapies led to significant improvements in the patient’s migraine-related disability and pain.

In another case, a 17-year-old boy fell on his head while pole vaulting and began to experience bipolar disorder symptoms, seizures, sleeping problems, and migraine headaches. After failing to respond to various treatment approaches from numerous physicians, he sought treatment from a doctor of chiropractic at age 23. After four months of chiropractic care, his migraine frequency dropped from three times a week to twice a month. He reported a full recovery after seven months of care, which was sustained at an 18-month follow-up.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Shoulder Pain

14 Aug

Shoulder pain can arise from a multitude of places—from joints, muscles, tendons, and bursa in and around the shoulder region as well as from more distant locations like the neck, upper back, or even referred pain from the gall bladder. The onset of shoulder pain is highly variable as it can arise without an obvious cause or be related to a specific mechanism of injury such as a work or sports injury. Shoulder pain can also occur as a result of repetitive trauma over time, such as a job requiring overhead reaching. Neurological injuries such as stroke or a pinched nerve in the neck can cause shoulder pain as well. Experts estimate that as much as half of the population experiences shoulder pain each year, though many people often decide to “just live with it” and therefore, don’t seek treatment. However, shoulder and neck disorders do account for 18% of disability payments for MSK pain.

These following factors contribute to shoulder pain, either alone or in combination with each other:

  • Inflammatory conditions: Tendonitis, bursitis (the bursa are the fluid-filled sacs that lubricate the surrounding tissues), osteoarthritis (the “wearing out” kind), and rheumatoid arthritis (the autoimmune kind). Inflammatory conditions are a common cause of shoulder impingement (see below).
  • Excessive Motion: Instability can arise from tearing of the joint capsule, tendons, and/or ligaments that become lax after healing. The terms “strain” and “sprain” refer to tears of muscles and/or tendons (strains) vs. ligaments (sprains). Trauma typically results in instability in one direction vs. congenital (or “born with”) problems where instability can be multi-directional. This can result in a subluxation and/or a dislocation of the shoulder.
  • Limited Motion: This occurs when the joint capsule and ligaments are tight and restrict freedom of movement. This can happen after prolonged immobilization (use of a sling) and can result in impingement and/or “frozen shoulder” (adhesive capsulitis).
  • Muscle Weakness/Imbalance: The muscles in front, on top, behind, and those that connect from below must be in proper balance for the ball and socket joint of the shoulder to function properly. Weakness in any of these muscles can alter the normal balance and result in shoulder pain due to poor, inefficient shoulder motion. A common example of this is forward head posture with shoulder protraction (forward, rounded shoulders) that many of us “suffer” from as a result of using electronics (smartphones, computers, television). Overtraining of any of these muscles (like the chest muscles), stroke, or pinched nerves can also alter muscle balance.

Impingement is a common cause of shoulder pain that arises from swelling or inflammation of the tendons and/or bursae. Here, the ability to raise the arm is limited. Chiropractors are trained to diagnose and treat shoulder conditions using the standard approaches like mobilization, exercise, ice, job modifications, and anti-inflammatory measures (modalities and nutritional approaches), as well as those unique to chiropractic such as shoulder joint manipulation, which can reduce impingement.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

The Most Important Principles for Staying Young: Think Before You Ink and How Rosemary Can Improve Your Thinking…

10 Aug

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.

In recent months, I’ve shared secrets from of our new book AgeProof: Living Longer Without Running Out of Money or Breaking a Hip, released February 28th, 2017).  Some of you must have bought it as the book made it to #10 on the NY Times list and #3 on the Wall Street Journal List.  Thank you.  This month, I want to share two tips that may help you live younger and become more Age Proof…

TIP 1 — Think Before You Ink: In 2006, Lucky Diamond Rich was declared “the world’s most tattooed person.” Ink covers every inch of his body—private parts included. For him, it’s too late to think about the downsides, but for those just starting out —or still tattoo-free—this recent Food and Drug Administration (FDA) warning is worth paying attention to.

If the tattoo parlor isn’t sanitary, you may be at risk for contracting an infection, which may require months of antibiotics or hospitalization to treat. Even the cleanest of places, says the FDA, may use unsterile water to dilute pigments or they may have pigments (marked sterile and sealed) that are nonetheless contaminated with mold or bacteria. (It happens more often than you’d think.)

And then there are the inks themselves… Some contain pigments used in printer toner and car paint. The FDA hasn’t approved any pigments for injection into the skin for cosmetic purposes—so it’s the Wild, Wild West when it comes to knowing exactly what’s being pumped into your body. You also risk an allergic reaction to the inks—and allergic rashes can persist for years. Experts also say allergic reactions can pop up—seemingly out of the blue—years after getting a tattoo.

Tattoos can also make you allergic—and sensitized—to other products, such as hair dyes, if they both contain phenylenediamene (PPD). PPD was designated the contact allergen of the year in 2006 by the American Contact Dermatitis Society!

So think before you ink—your skin has to last a lifetime!

TIP 2 — Enjoy the Fragrance of Rosemary and You May Get Smarter: Rosemary has long been thought to have memory-boosting properties, and now modern science is backing up this theory. In a study presented recently to the British Psychological Society, researchers found that children in a room scented with rosemary did significantly better on memory tasks than those who didn’t get a whiff of the herb. These findings line up with an earlier study the team did that found when adults were exposed to higher concentrations of rosemary aroma, they performed better on cognitive tests. Scientists think a compound called 1,8-cineole found in the plant might help boost an important neurotransmitter in the brain.

If you want to see if you benefit from this aromatic herb, you can make rosemary oil by adding a sprig of rosemary to a bottle of olive oil. Use on salads and chicken. Or grow a houseplant or outdoor bush and enjoy the fragrance. Or get an aromatherapy diffuser and use only an essential oil (no phthalates, please). However, pure rosemary essential oil should be used carefully. If applying topically, first dilute in a carrier oil to avoid skin irritation. Pregnant and breastfeeding? No essential rosemary oil for you. And never ingest it!  The essential oil can be toxic if taken internally, even at low doses.

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

Dr. Mike Roizen

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.

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