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A Pain in the Hip?

12 Dec

When you ask people to point to their hip joint, it’s very interesting to see the vast number of places where people point—the low back, side of the pelvis, front of the pelvis, in the groin, and more! If one were to draw a line between the back and front pocket, that’s basically the hip joint.

So keeping the hip joint in mind, picture the squat exercise. According to Dr. Stuart McGill, director of the Spine Biomechanics Laboratory at the University of Waterloo, Ontario, Canada, to safely perform a squat, one must FIRST consider genetics and the role it plays, especially in performing a deep squat.

Genetics, according to Dr. McGill, helps us to determine whether the hip joint can handle squatting. For example, genetically shallow hip sockets predispose people to hip dysplasia (arthritis). The highest rate of hip dysplasia in the world is in Poland as individuals of Polish descent are genetically predisposed to be develop shallow hip sockets. However, because of these shallow sockets, the range of motion of their hips (prior to dysplasia, of course) is greater and also more powerful in the deep squat position.

Hence, it should not be surprising that the great Olympic weight lifters come from Poland, Bulgaria, and Ukraine due in part to this uniquely shaped and shallow hip socket (called the Dalmatian hip). In contrast, the shape of the hip in those of Scottish descent is deep, which has a great advantage for walking, standing, and rotation power, but the deep sockets are terrible for producing power at the bottom of a deep squat.

Similarly, Celtic and French populations have deep sockets, and that is the most logical reason why exercises that require a wide range of motion, like yoga, can result in impingement pain in a high percentage of people of such ancestry.

So, how does this relate to hip pain? Depending on your genetic makeup, if you are of the descent where shallow hip sockets are common, it might be best to avoid deep squats and/or occupations that require a lot of weight-bearing and bending over, especially those with heavy lifting. Even though you might win a squatting competition due to less hip impingement, the shallow sockets tend to wear out faster.

Bottom line, when engaging in an exercise class, running, cycling, or the like, if there is pain (a “bad” or sharp lancinating pain), DON’T DO THAT EXERCISE! Stay within “reasonable pain boundaries” and you should generally be safe. DON’T try to keep up with the person next to you, as they may be genetically “better matched” for the activity that you’re engaging in.

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

What Does Paul Bunyan Have to Do with Pain As You Age?

8 Dec

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, let’s talk about foot pain, why seniors are more vulnerable, and how you can prevent it early with your shoe choices.  We know chiropractic treatment is the least expensive and quickest way to return to normal function if you have back pain. But if foot pain or bunions are present AND you have back pain, you may also need to address your shoes.

Paul Bunyan and his sidekick Babe, the Blue Ox, were characters in lumberjacks’ folklore for years before William Laughead composed a direct mail pamphlet for the Red River Lumber Company in 1916. Then, the duo became a sensation across the United States, and with his massive boots and enormous stride, Bunyan seemed unstoppable.

But anyone with the Bunion Blues will tell you that real bunions can stop you in your tracks. Today,  according to a review of the 2009 Framingham Foot Study, bunions affect  23 percent of people aged 18 to 65, and 36 percent of those older than 65.

What is a bunion? A bunion (hallux valgus) is a painful, bony bump at the base and side of the big toe. It often happens when the top of big toe is consistently pushed against the toe next to it, forcing the bottom joint to stick out. Women’s narrow-toed, high-heeled shoes are a major cause; though toe shape and arthritis can also play a role.

And seniors have more pain from the same stimulus as those who are younger, which offers another reason to change your shoes now. George Burns said it best. As he approached his eleventh decade, the great vaudeville, radio, film, and television comedian said, “I was brought up to respect my elders, so now I don’t have to respect anybody.”

But until you live to such a ripe old age, it’s a good idea to respect your elders and offer them a bit of extra attention and understanding.  That’s because in addition to being older and wiser, the elderly also have to contend with pain that’s more pronounced and lasts longer.

Researchers from the University of Florida tested the pain response of a group of volunteers (average age = 21) and an older group with an average age of 68. They found that while both groups were exposed to similar levels of pain, in older adults, levels of cytokines—immune system markers of inflammation that indicate the presence of pain—were higher and stayed elevated longer. The researchers recommend older adults should not tough it out, but treat pain early. Even better, prevent it. So here is our take on bunions…

If you have a bunion, here’s what to do: Wear more comfortable shoes. (Duh! YES, the earlier you abandon high heels, the less likely a problem that requires surgery will develop. And abandon them not just for a day, but for a while; wider shoes help too!)

Discuss treatment options with a podiatrist or other healthcare professionals. Treatment options include padding or an orthosis (corrective shoe insert), ice, ibuprofen, cortisone injection and, lastly, surgery. Osteotomy is surgery performed to realign the joint; exostectomy removes the bump.

If avoiding surgery isn’t enough of an incentive to get you to put away those stilettos (stick with 2-inch heels, or no heels, even better), taking better care of your feet can also help you dodge nerve damage, lower back pain, a shortened Achilles tendon, and sciatica, and that makes your RealAge younger not just now, but for the long term.

Thanks for reading. Feel free to send questions—to youdocs@gmail.com, and some of them we may know enough to answer (we’ll try to get answers for you if we do not know).

Young Dr Mike Roizen (aka, The Enforcer)

 

 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 tow 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.  And, the new book by Dr Mike Roizen: This is YOUR Do-Over

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.

A “Self-Help” Guide to Carpal Tunnel Syndrome

5 Dec

Carpal Tunnel Syndrome (CTS) has a bad reputation for coming and going, sometimes for years, depending on many factors such as 1) age; 2) profession (fast, repetitive, with forceful gripping); 3) general health (diabetes, hypothyroid, and inflammatory arthritis (like rheumatoid), pregnancy, on birth control pills, or taking hormone replacement therapy); 4) hobbies (worse if it’s knitting, crocheting, prolonged use of a computer, or using hand tools a lot); and 5) obesity.

Here is a list of things that YOU can do to self-help when CTS rears its ugly head:

  1. Rest/Activity: CTS symptoms often improve when taking “mini-breaks”, as it STOPS the vicious cycle from getting out of control. For example, if you are a musician, rest every 15 minutes or even one to two minutes when practicing. REST during any activity that requires heavy use of the hands, such as forceful gripping and/or fast repetitive movements, can REALLY help!
  2. Lose weight: Obesity increases the likelihood of CTS, especially if you’re over age 50 and female. It is recommended that you check your BMI and keep it under 30!
  3. Night Splints: The use of a night splint can REALLY help, as we cannot control our hand/wrist position at night when we sleep. ANY position outside of a neutral position increases the pressure inside the wrist and can wake us up with numbness, burning sensations, and pain. The discomfort can also prevent us from returning to sleep. When CTS symptoms are present when driving, the use of a splint can be highly relieving!
  4. Exercise: In general, exercise is good for everyone but it can help in specific conditions like CTS. Yoga has specifically been cited as a potential CTS remedy, pending the yoga pose does not aggravate a painful arthritic wrist. So use your good judgment—if an exercise produces a sharp pain, it’s probably NOT good for you!
  5. CTS Specific Exercises: There are very specific stretches that can be done that helps CTS. Stand at arms-length from a wall, keep the elbow straight and place your palm on the wall with your fingers pointing downward. Slowly bend the wrist to 90° (so that you feel a strong stretch in the forearm), then reach across with the opposite hand and pull your thumb back off the wall. Hold this five to ten seconds and repeat on the opposite side if needed. This can be repeated MANY times a day.
  6. Workstation Ergonomic Modifications: It’s often easier to change a workstation than it is to change the worker, so make sure the computer monitor is directly in front of you, keep the mouse in a comfortable location such as level with the keyboard on a pullout under-the-desk shelf, change the tool design to prevent wrist bending and/or firm gripping, rotate between several job tasks more often, allow for sit/stand options, and more. Carefully assess your work area and use the goal of preventing extreme wrist positions!
  7. Manage health co-morbidities: Keep your diabetes, thyroid deficiency, hormone levels, and inflammatory conditions under control. This may require the proper medication(s) and/or nutritional support. Your chiropractor can help you with nutritional counseling!
  8. Manipulation: When you cannot adequately control your CTS symptoms or if you are getting worse despite your good efforts, seek care from a doctor of chiropractic. Manipulation, mobilization, modalities, and additional exercise training can prevent surgery in many cases! But don’t wait too long, as it’s more difficult to treat if CTS has persisted a long time.

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

Circadian Clocks and Low Back Pain?

1 Dec

According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes that roughly follow a 24-hour cycle, responding largely to environmental light and darkness. Most living things possess this trait including animals, plants, and many microbes.

So how does this relate to low back pain? Recent studies reveal that the intervertebral disk (IVD)—the “shock-absorbers” located between our vertebrae in our spine—contain intrinsic circadian clocks that are regulated by age and cytokines and are linked to degeneration. This means we have a 24-hour rhythm producing various changes in an organized way throughout the day in each of the disks in our spine!

Researchers have found at least 600 genes with 24-hour patterns of expression representing several essential pathways associated with disk pathology. In experiments on mice, scientists have observed that when the normal expression of these genes is disrupted, disk degeneration may occur. The study concludes, “These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.”

So what can we do about this? These findings support an important concept that improves overall health, quality of life and longevity: our sleep habits! We know our circadian rhythms influence sleep-wake cycles, hormone release, body temperature, and many other important bodily functions and are linked to various sleep disorders.

Researchers have linked abnormal rhythms with obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder (SAD), to name a few. We also know how we feel when we fly from California to New York and the alarm rings at 7am in NYC but our biological clock says 4am!

The importance of sleep cannot be overstated. Longevity is shortened when sleep duration is altered (either too little OR too much sleep) and we know quality of life is negatively affected in swing-shift workers. Now, we’ve learned that the cells in our disks also have a circadian rhythm, and alteration of that rhythm can lead to disk degeneration resulting in low back pain!

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

 

What About Taking Opioids to Manage Pain?

29 Nov

In the United States: 1) seniors represent over 13% of the population but consume 40% of prescription drugs and 35% of over-the-counter drugs; 2) on average, people 65-69 years old take nearly 14 prescription drugs per year, and those 80-84 take an average of 18; 3) 15-25% of drug use in seniors is considered unnecessary or inappropriate; 4) adverse drug reactions & non-compliance are responsible for 28% of hospitalizations of the elderly; 5) 36% of all reported adverse drug reactions involve an elderly person; 6) annually, 32,000 seniors have hip fractures related to medication-related problems.

Regarding pain control, let’s look at opioid use and the impact it has on our overall health. One recent study investigated problems associated with chronic low back pain (cLBP) and its effect on daily function. The authors specifically focused on the sleep patterns in patients with cLBP and then looked to see if there were differences between those taking opioid vs. non-opioid medication.

The study compared ten healthy “controls” and 21 cLBP patients where six were taking non-opioid meds and fifteen were taking an opioid medication. Using questionnaires and sophisticated sleep study equipment, the researchers found that patients in both cLBP groups—regardless of medication type—had significant sleep and wake disturbances, decreased sleep quality, increased symptoms of insomnia, increased fatigue, spent more time in bed, took longer to fall asleep, and had higher variability in other measurements compared to the control group.

However, those taking opioids (>100 mg morphine-equivalent/day) had distinct abnormal brain activity during sleep unlike the others. It’s well known that sleep disturbance can gravely affect our overall health and longevity, and the use of opioids only makes sleep problems worse!

When compared with a placebo, opioid side effects include: constipation, nausea, somnolence, dizziness, itching, and vomiting. Medications to treat the primary opioid side effect of constipation (such as Movantik) have their own side-effects when compared to a placebo including abdominal pain, diarrhea, nausea, flatulence, vomiting, headache, and sweating. These side-effects may prompt yet another medication to try to counteract the above, thus creating a dangerous vicious cycle!

As a disclaimer, we realize that many people HAVE TO take certain meds to stay alive or to achieve an acceptable quality of life.

The “take-home” message here is to minimize the amount of medication taken as much as possible making sure the benefits truly outweigh the risks! For conditions like musculoskeletal pain, consider non-drug, non-surgical options like chiropractic care. Many studies show chiropractic care is not only highly safe but it can get patients out of pain fairly quickly. Additionally, the benefits may persist long after treatment ends, something that doesn’t typically happen if you cease taking a medication for such conditions.

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

 

Why You Should Seek Treatment for Whiplash ASAP!

22 Nov

Even though whiplash or whiplash associated disorders (WAD) is very common, it remains poorly understood. Recent studies report that up to 60% of people may still have pain six months after their injury. Why is that?

Investigations have shown there are changes in the muscle and muscle function in the neck and shoulder regions in chronic WAD patients. Symptoms often include balance problems as well as increased sensitivity to a variety of stimuli including pressure, light vibration, and temperature.

Interestingly, this hypersensitivity not only occurs in the injured area, but also in areas away from the neck such as the front of the lower leg or the shin bone. This can only be explained by some type of neurobiological processing of pain within the central nervous system, which includes the spinal cord and brain.

It’s not surprising that when pain continues for lengthy time frames, people with these symptoms may also experience psychological distress. The confusing thing is that not every WAD injury case has this “central sensitization” and when it’s present—its intensity is highly variable.

Current research into WAD is focused on the following: 1) developing better treatments in the early or acute whiplash injury stage with the goal to PREVENT development of these chronic symptoms; 2) determining what factors can PREDICT slower recovery following a WAD injury; 3) investigation into how the stress response associated with motor vehicle crashes influence pain, other symptoms and recovery, and how to best address and MANAGE the stress response; 4) research into the effect a WAD injury has on daily life function; and 5) developing improved assessment methods for healthcare providers so that EARLY treatments can be more targeted and effective.

A Swedish study is currently looking at the importance of reducing the acceleration of the occupant during an automobile collision by redesigning the body of the vehicle and its safety systems. In rear-end crashes, the main issue is to design a seat and head restraint that absorbs energy in a controlled way and gives support to the whole spine. In frontal crashes, the air bag, seat belt pretensioner, and load limiter must work together in a coordinated way to reduce the acceleration between the vertebrae of the spine and occupant.

What is known is that a “wait and watch” approach may NOT be appropriate in a lot of cases. It appears there is a relatively short window of time, the first three months, when treatment seems to be most effective. Doctors of chiropractic are trained to identify and treat these types of injuries, so PLEASE, don’t delay your initial visit—time is truly of the essence.  Don’t waste it!

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

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