20 Fun and Amazing Health Facts.

1 Jan

1.) Women have a better sense of smell than men. 2.) When you take a step, you use up to 200 muscles. 3.) Your ears secrete more earwax when you are afraid than when you aren’t. 4.) The human brain has the capacity to store everything you experience. 5.) It takes twice as long to lose new muscle if you stop working out than it did to gain it. 6.) The average person’s skin weighs twice as much as their brain. 7.) Every year your body replaces 98% of your atoms. 8.) On average, there are 100 billion neurons in the human brain. 9.) The lifespan of a taste bud is ten days.  10.) Dentists recommend you keep your toothbrush at least 6 feet away from a toilet to avoid airborne particles caused by flushing.  11.) Your tongue is the only muscle in your body that is attached at only one end. 12.) Your stomach produces a new layer of mucus every two weeks so that it doesn’t digest itself. 13.) It takes about 20 seconds for a red blood cell to circle the whole body. 14.) The pupil of the eye expands as much as 45% when a person looks at something pleasing. 15.) Your heart rate can rise as much as 30% during a yawn. 16.) Your heart pumps about 2,000 gallons of blood each day. 17.) Your heart beats over 100,000 times a day. 18.) Your hair grows faster in the morning than at any other time of day.  19.) Your body is creating and killing 15 million red blood cells per second. 20.) You’re born with 300 bones, but when you reach adulthood, you only have 206!

Integrative Considerations during the COVID-19 pandemic

27 Mar

March 24, 2020

Greetings Friends, 

The following is advice from top experts in the natural medicine industry. I found the information here to be valuable and hope you do too. I have been following these health officials in addition to the resources being released by the W.H.O. Also, PA.Gov (or your corresponding state) is a valuable resource for checking on potential local breakouts. 

The importance of not only physical but also mental health should be acknowledged. Reducing or eliminating sensationalized media outlets from your mental diet will benefit your overall health. The WHO and state websites are more than proficient for your data acquisition. 

Particular attention should be given to WHAT NOT TO TAKE DURING INFECTION. Remember that symptoms of COVID-19 can be mild. But it is still important not to take anything that promotes it’s virulence in yourself and therefore the community at large. 

Here is the Integrative Health Strategy information that I currently recommend…

Using available in-vitro evidence, an understanding of the virulence of COVID-19, as well as data from similar, but different, viruses, we offer the following strategies to consider. Again, we stress that these are supplemental considerations to the current recommendations that emphasize regular hand washing, physical distancing, stopping non-essential travel, and getting tested if you develop symptoms. 

While the pathogenicity of COVID-19 is complex, it is important to understand the role of inflammation in this disease. The virulence and pathogenicity (including acute respiratory distress syndrome) associated with SARS corona viruses develops as the result of viral activation of cytoplasmic NLRP3 inflammasome. This inflammasome within activated (upregulated NFkB) macrophages and Th1 immune cells releases pro-inflammatory cytokines, namely IL-1B and IL- 18, which dictate the pathogenic inflammation responsible for the virulence and symptoms of COVID-19.1 Understanding this component of COVID-19 infection provides a mechanistic underpinning to several of the following.

RISK REDUCTION:
• Adequate sleep: Shorter sleep duration increases the risk of infectious illness. One study found that less than 5 hours of sleep (monitored over 7 consecutive days) increased the risk of developing rhinovirus associated cold by 350% (odds ratio [OR] = 4.50, 95% confidence interval [CI], 1.08-18.69) when compared to individuals who slept at least 7 hours per night.2 Important to COVID-19, sleep deprivation increases CXCL9 levels. CXCL9 is a monokine, induced by interferon, and which increases lymphocytic infiltration,3 and which is implicated in NLRP3 inflammasome activation.4 Adequate sleep also ensures the secretion of melatonin, a molecule which may play a role in reducing coronavirus virulence (see Melatonin below).
 Stress management: Psychological stress disrupts immune regulation and is specifically associated with increased pro-inflammatory cytokines such as IL-65 Acute stress in mice increases IL-1B via NLRP3 inflammasome activation.6 Various mindfulness techniques such as meditation, breathing exercises, guided imagery, etc. reduce stress, reduce activated NFkB, may reduce CRP and do not appear to increase inflammatory cytokines.7 
• Zinc: Coronavirus appears to be susceptible to the viral inhibitory actions of zinc. Zinc may prevent coronavirus entry into cells8 and appears to reduce coronavirus virulence.9 Typical daily dosing of zinc is 15mg – 30mg daily with lozenges potentially providing direct protective effects in the upper respiratory tract.
• Vegetables and Fruits +/- isolated Flavonoids: Many flavonoids have been found, in vitro, to reduce NLRP3 inflammasome signaling, and consequently NFkB, TNF-a, IL-6, IL-1B and IL-18 expression.10

Some of the specific flavonoids which have been shown to have this effect, and which can be found in the diet and/or dietary supplements include: 

  •  baicalin11 and wogonoside12 from Scutellaria baicalensis (Chinese skullcap);
  •  liquiritigenin13 from Glycyrrhiza glabra (licorice)
  • dihydroquercetin14 and quercetin15 found in onions and apples. Of note, quercetin also functions as a zinc ionophore, chelating zinc and transporting it into the cell cytoplasm.16 This could, theoretically, enhance the anti-viral actions of zinc.
  •  myricetin17 found in tomatoes, oranges, nuts, and berries
  • oapigenin18 (found in Matricaria recutita (Chamomile), parsley and celery.
  • ocurcumin19,20 (found in turmeric root)
  • epigallocatechine gallate (EGCG) from green tea. EGCG has been found to have antiviral activity against a wide range of DNA and RNA viruses, especially in the early stages of infection by preventing viral attachment, entry and membrane fusion.21 EGCG, link quercetin, is a zinc ionophore22, thereby potentially enhancing the antiviral actions of zinc.

At least 5 – 7 servings of vegetables and 2-3 servings of fruit daily provide a repository of flavonoids and are considered a cornerstone of an anti-inflammatory diet.

 Vitamin C: Like flavonoids, ascorbic acid inhibits NLRP3 inflammasome activation.23 Clinical trials have found that vitamin C shortens the frequency, duration and severity of the common cold and the incidence of pneumonia.24 Typical daily dosing of vitamin C ranges from 500mg to 3000mg daily with even higher doses utilized during times of
acute infection.

• Melatonin: Melatonin has been shown to inhibit NFkB activation and NLRP3 inflammasome activation.25 In fact, the age-related decline in melatonin production is one proposed mechanism to explain why children do not appear to have severe symptoms and older adults do. Melatonin also reduces oxidative lung injury and inflammatory cell recruitment during viral infections.26 Typical dosing of melatonin varies widely from 0.3mg to 20mg (the latter used in the oncological setting).

• Sambucus nigra (Elderberry): There is preclinical evidence that elderberry inhibits replication and viral attachment of Human coronavirus NL63 (HCoV-NL63)27, different than COVID-19, but a member of the coronavirus family. Sambucus appears most effective in the prevention or early stage of corona virus infections.28
******Of note, Sambucus significantly increases inflammatory cytokines, including IL-B129 so should be discontinued with symptoms of infection (or positive test). An evidence-based systematic review of elderberry conducted by the Natural Standard Research Collaboration concluded that there is level B evidence to support the use of elderberry for influenza30 which may or may not be applicable to COVID-19 prevention. Typical dosing of 2:1 elderberry extract is 10mL -60mL daily for adults and 5mL-30mL daily for children.

• Vitamin D: In certain conditions, vitamin D has been found to decrease NLRP3 inflammasome activation31 and vitamin D receptor activation reduces IL-1b secretion.32 However, 1,25(OH)vitamin D has also been found to increase IL-1b levels,33,34 and should, therefore, be used with caution and perhaps discontinued with symptoms of infection.

DURING SYMPTOMS OF INFECTION OR POSITIVE TEST FOR COVID-19:
To Avoid: Given the integral role of inflammatory cytokines (namely IL-1B and IL-18) in the pathogenicity of COVID-19, as well as the impossibility of predicting which individuals are susceptible to the “cytokine storm”, technically called secondary hemophagocytic lymphohistiocytosis, or sHLH, it appears to be prudent to avoid high and regular use of immunostimulatory agents that increase these cytokines.

Again, in the absence of human clinical data, caution is warranted with the following immune-activating agents due to preclinical evidence of increased IL-1B and/or IL-18 production in infected immune cells:
! Sambucus nigra (Elderberry)35
! Isolated polysaccharide extracts from medicinal mushrooms or mycelium36,37
! Echinacea angustifolia and E. purpurea38,39
! Larch arabinogalactan40
! Supplemental vitamin D41,42


Likely Safe: Other commonly used natural immunostimulatory and antiviral agents including the following do not appear to increase IL-1B or IL-18 as a part of their immunomodulatory actions. Several of these, in fact, reduce these cytokines and may restore immune homeostasis. These are, therefore, likely safe to use both prior to, and during, COVID-19 infection. Whether these agents mitigate the symptoms or virulence of COVID-19 is unknown and therefore the benefit of these agents during COVID-19 infection is unknown.
• Allium sativum (garlic)
• Quercetin
• Astragalus membranaceus
• Mycelium mushroom extracts as well as fruiting body extract of Agaricus blazeii49
• Mentha piperita (peppermint)
• Andrographis paniculata
• Green tea and green tea extracts
• Zinc
• Vitamin A [note: This study found that 25,000iu daily for 4 months in 84 women resulted in lower serum IL-1b and IL-1b/IL-4 ratios in obese women. Oral vitamin A can causes hypervitaminosis A especially at doses greater than 25,000 IU daily for more than 6 years or 100,000iu daily for more than 6 months. Monitoring liver function tests for hepatotoxicity during vitamin A dosing of any duration, even at lower doses, is advised given variable individual sensitivity.]
• Vitamin C

The information and understanding of COVID-19 continue to change rapidly. We encourage you to make integrative recommendations carefully and with consideration of the underlying mechanisms of both the COVID-19 infection and the intended intervention. It is also important to reiterate that there are no clinically evidence-based integrative prevention or treatment strategies for COVID-19 infection. 

Lise Alschuler ND
Professor of Clinical Medicine, University of Arizona College of Medicine Assistant Director, Fellowship in Integrative Medicine,
Andrew Weil Center for Integrative Medicine

Reviewed by:
Ann Marie Chiasson MD
Associate Professor of Clinical Medicine, University of Arizona College of Medicine
Director, Fellowship in Integrative Medicine, Andrew Weil Center for Integrative Medicine

Robert Crocker MD
Assistant Professor of Medicine, University of Arizona College of Medicine
Director, Strategic and Clinical Planning and Implementation,

Andrew Weil Center for
Integrative Medicine3

Randy Horwitz MD PhD FACP
Professor of Medicine, University of Arizona College of Medicine
Medical Director,

Andrew Weil Center for Integrative Medicine
Victoria Maizes MD
Professor of Clinical Medicine, Family Medicine and Public Health, University of Arizona

Andrew Weil Endowed Chair in Integrative Medicine
Executive Director, Andrew Weil Center for Integrative Medicine

Paul Stamets
Mycologist

Andrew Weil MD
Professor of Medicine and Public Health, University of Arizona
Endowed Chair in Integrative Rheumatology, University of Arizona
Founder,

Andrew Weil Center for Integrative Medicine
Media inquires please contact Keith LaBaw, Manager, AWCIM Marketing at
klabaw@arizona.edu

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2 Prather AA, et al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015;38(9):1353-9.

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6 Iwata M, et al. Psychological Stress Activates the Inflammasome via Release of Adenosine Triphosphate and
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9 Han Y-S, et al. Papain-like Protease 2 (PLP2) From Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV):
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10 Lim H, et al. Flavonoids Interfere with NLRP3 Inflammasome Activation. Toxicol Appl Pharmacol. 2018;355:93.

11 Fu S, et al. Baicalin Suppresses NLRP3 Inflammasome and Nuclear Factor-Kappa B (NF-κB) Signaling During
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12 Sun Y, et al. Wogonoside Protects Against Dextran Sulfate Sodium-Induced Experimental Colitis in Mice by
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13 Zhu X, et al. Liquiritigenin Attenuates High Glucose-Induced Mesangial Matrix Accumulation, Oxidative Stress,
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14 Ding T, et al. Kidney Protection Effects of Dihydroquercetin on Diabetic Nephropathy Through Suppressing ROS
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15 Choe J-Y, et al. Quercetin and Ascorbic Acid Suppress Fructose-Induced NLRP3 Inflammasome Activation by
Blocking Intracellular Shuttling of TXNIP in Human Macrophage Cell Lines. Inflammation. 2017;40(3):980.

16 Dabbagh-Bazarbachi H, et al. Zinc Ionophore Activity of Quercetin and Epigallocatechin-Gallate: From Hepa 1-6
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17 Chen H, et al. Myricetin Inhibits NLRP3 Inflammasome Activation via Reduction of ROS-dependent Ubiquitination
of ASC and Promotion of ROS-independent NLRP3 Ubiquitination. Toxicol Appl Pharmacol. 2019;365:19.

18 Yamagata K, et al. Dietary Apigenin Reduces Induction of LOX-1 and NLRP3 Expression, Leukocyte Adhesion, and
Acetylated Low-Density Lipoprotein Uptake in Human Endothelial Cells Exposed to Trimethylamine-N-Oxide. J
Cardiovasc Pharmacol. 2019;74(6):558.

19 Yin H, et al. Curcumin Suppresses IL-1β Secretion and Prevents Inflammation through Inhibition of the NLRP3
Inflammasome. J Immunol. 2018;200(8):2835.

20 Wen CC, et al. Specific plant terpenoids and lignoids possess potent antiviral activities against severe acute
respiratory syndrome coronavirus. J Med Chem. 2007;50(17):4087.

21 Kaihatsu K, et al. Antiviral Mechanism of Action of Epigallocatechin-3- O-gallate and Its Fatty Acid Esters.
Molecules. 2018;23(10):2475.

22 Dabbagh-Bazarbachi H, et al. Zinc Ionophore Activity of Quercetin and Epigallocatechin-Gallate: From Hepa 1-6
Cells to a Liposome Model. J Agric Food Chem. 2014;62(32):8085-93.

23 Choe J-Y, et al. Quercetin and Ascorbic Acid Suppress Fructose-Induced NLRP3 Inflammasome Activation by
Blocking Intracellular Shuttling of TXNIP in Human Macrophage Cell Lines. Inflammation. 2017;40(3):980.

24 Hemila, H. Vitamin C Supplementation and Respiratory Infections: A Systematic Review. Mil Med.
2004;169(11):90.

25 Hardeland, R. Melatonin and inflammation – Story of a Double-Edged Blade. J Pineal Res. 2018;65(4):e12525.

26 Silvestri M and Rossi GA. Melatonin: its possible role in the management of viral infections – a brief review. Ital J
Pediatr. 2013;39:61.

27 Weng J-R, et al. Antiviral Activity of Sambucus FormosanaNakai Ethanol Extract and Related Phenolic Acid
Constituents Against Human Coronavirus NL63. Virus Res. 2019;273:197767.

28 Chen C, et al. Sambucus Nigra Extracts Inhibit Infectious Bronchitis Virus at an Early Point During Replication.
BMC Vet Res. 2014:10:24.

29 Barak V, et al. The Effect of Sambucol, a Black Elderberry-Based, Natural Product, on the Production of Human
Cytokines: I. Inflammatory Cytokines. Eur Cytokine Netw. 2001;12(2):290.

30 Ulbricht C, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the
Natural Standard Research Collaboration. J Dietary Suppl. 2014;11(1):80.

31 Lu L, et al. Vitamin D 3 Protects Against Diabetic Retinopathy by Inhibiting High-Glucose-Induced Activation of
the ROS/TXNIP/NLRP3 Inflammasome Pathway. J Diabetes Res. 2018:8193523.

32 Rao Z, et al. Vitamin D Receptor Inhibits NLRP3 Activation by Impeding Its BRCC3-Mediated Deubiquitination.
Front Immunol. 2019;10:2783.

33 Verway M, et al. Vitamin D Induces interleukin-1β Expression: Paracrine Macrophage Epithelial Signaling
Controls M. Tuberculosis Infection. PLoS Pathog. 2013;9(6):e1003407.

34 Tulk SE, et al. Vitamin D3 Metabolites Enhance the NLRP3-dependent Secretion of IL-1β From Human THP-1
Monocytic Cells. J Cell Biochem. 2015;116(5):711.

35 Barak V, et al. The Effect of Sambucol, a Black Elderberry-Based, Natural Product, on the Production of Human
Cytokines: I. Inflammatory Cytokines. Eur Cytokine Netw. 2001;12(2):290.

36 Yang Y, et al. Protein-bound polysaccharide-K induces IL-1β via TLR2 and NLRP3 inflammasome activation. Innate
Immun. 2014;20(8):857.

37 Ma XL, et al. Immunomodulatory activity of macromolecular polysaccharide isolated from Grifola frondosa. Chin
J Nat Med. 2015;13(12):906.

38 Burger RA, et al. Echinacea-induced Cytokine Production by Human Macrophages. Int J Immunopharmacol.
1997;19(7):371.

39 Senchina DS, et al. Human Blood Mononuclear Cell in Vitro Cytokine Response Before and After Two Different
Strenuous Exercise Bouts in the Presence of Bloodroot and Echinacea Extracts. Blood Cells Mol Dis. 2009;43(3):298.

40 Hauer J, Anderer FA. Mechanism of Stimulation of Human Natural Killer Cytotoxicity by Arabinogalactan From
Larix Occidentalis. Cancer Immunol Immunother. 1993;36(4):237.

41 Verway M, et al. Vitamin D Induces interleukin-1β Expression: Paracrine Macrophage Epithelial Signaling
Controls M. Tuberculosis Infection. PLoS Pathog. 2013;9(6):e1003407.

42 Tulk SE, et al. Vitamin D3 Metabolites Enhance the NLRP3-dependent Secretion of IL-1β From Human THP-1
Monocytic Cells. J Cell Biochem. 2015;116(5):711.

43 Arreola R, et al. Immunodulation and Anti-Inflammatory Effects of Garlic Compounds. J Immunol Res.
2015;2015:401630.

44 Mlcek J, et al. Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016;21(5):623.

45 He, X, et al. Inhibitory Effect of Astragalus Polysaccharides on Lipopolysaccharide-Induced TNF-a and IL-1β
Production in THP-1 Cells. Molecules. 2012; 17(3): 3155.

46 Li H, et al. Astragaloside Inhibits IL-1β-induced Inflammatory Response in Human Osteoarthritis Chondrocytes
and Ameliorates the Progression of Osteoarthritis in Mice Immunopharmacol Immunotoxicol. 2019;421(4):497.

47 Davis R, et al. Differential Immune Activating, Anti-Inflammatory, and Regenerative Properties of the Aqueous,
Ethanol, and Solid Fractions of a Medicinal Mushroom Blend. J Inflammation Res. 2020;13:117.

48 Benson KF, et al.The mycelium of the Trametes versicolor (Turkey tail) mushroom and its fermented substrate
each show potent and complementary immune activating properties in vitro. MC Complementary and Alternative
Medicine. 2019;19:342.

49 Tangen J-M. Immunomodulatory Effects of the Agaricus blazei Murrill-Based Mushroom Extract AndoSan in
Patients with Multiple Myeloma Undergoing High Dose Chemotherapy and Autologous Stem Cell Transplantation:
A Randomized, Double Blinded Clinical Study. BioMed Res Int. 2015;2015:718539.

50 Li Y, et al. In Vitro Antiviral, Anti-Inflammatory, and Antioxidant Activities of the Ethanol Extract of Mentha
piperita L. Food Sci Biotechnol. 2017;26(6):1675.

51 Chandrasekaran CV, et al. In Vitro Comparative Evaluation of Non-Leaves and Leaves Extracts of Andrographis
Paniculata on Modulation of Inflammatory Mediators. Antiinflamm Antiallergy Agents Med Chem. 2012;11(2):191.

52 Ge M, et al. Multiple Antiviral Approaches of (-)-epigallocatechin-3-gallate (EGCG) Against Porcine Reproductive
and Respiratory Syndrome Virus Infection in Vitro. Antiviral Res. 2018;158:52-62.

53 Ahmed S, et al. Green Tea Polyphenol epigallocatechin-3-gallate Inhibits the IL-1 Beta-Induced Activity and
Expression of cyclooxygenase-2 and Nitric Oxide synthase-2 in Human Chondrocytes. Free Radic Biol Med.
2002;33(8):1097.

54 Han Y-S, et al. Papain-like Protease 2 (PLP2) From Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV):
Expression, Purification, Characterization, and Inhibition. Biochemistry. 2005;44(30):10349.

55 Farhangi MA, et al. Vitamin A Supplementation and Serum Th1- And Th2-associated Cytokine Response in
Women. J Am Coll Nutr. 2013;32(4):280.

56 Penniston KL and Tanumihardjo SA. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006;
83(23):191.

57 Choe J-Y, et al. Quercetin and Ascorbic Acid Suppress Fructose-Induced NLRP3 Inflammasome Activation by
Blocking Intracellular Shuttling of TXNIP in Human Macrophage Cell Lines. Inflammation. 2017;40(3):980.

Sleep and Chiropractic Care

27 Feb

The American Sleep Association reports that 50-70 million adults in the United States (US) have a sleep disorder. Poor sleep is associated with several adverse health outcomes, including an elevated risk for musculoskeletal pain.

Though the exact mechanisms are not fully understood, the current research suggests the relationship between musculoskeletal pain and sleep disturbance is bi-directional. That is, individuals with a sleep disorder are more likely to develop a pain condition and people with pain are more likely to have trouble sleeping.

Chiropractic care has been studied in many populations where sleep deprivation is common—particularly in patients with fibromyalgia, a condition characterized by sleep disturbance, fatigue, and pain in several sites across the body. One such study published in 2000 reported that fibromyalgia patients who received 30 chiropractic treatments experienced substantial improvements with respect to pain intensity, fatigue, and sleep quality.

In a systematic review, researchers identified 15 studies that associated chiropractic care with benefits for patients with insomnia. For low back pain and neck pain, which are two of the most common sleep interfering chronic conditions, chiropractic management not only helps but it is RECOMMENDED as a first levels of care in clinical guidelines worldwide.

Chiropractic offers the following to help with sleep troubles: manual therapies such as manipulation, mobilization, and soft-tissue work that can help relax the nervous system; nutritional approaches, including the use of supplements like melatonin, L-theanine, 5-HTP (5-hydroxy-tryptophan), and valerian root; weight management (obesity is a risk factor for insomnia); and education/advice on sleeping position, napping, relaxation methods (breathing exercises, mindful meditation), no “screen-time” prior to bed, pillow placement and size, and more. TAKE HOME MESSAGE: Chiropractic care helps manage pain arising from MANY conditions. Pain interferes with sleep. Sleep is NECESSARY to avoid chronic, disabling conditions (like FM) and maintain a high quality of life, so seek chiropractic care FIRST and sleep well tonight!

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.

Chiropractic Care for Whiplash Injuries

24 Feb

Whiplash associated disorders (WAD) describes a constellation of symptoms that can arise following a motor vehicle collision (MVC), sports collision, or slip and fall. The typical initial treatment approach for WAD is non-surgical care, but what does the research say is the best non-surgical approach?

To start, most (if not all) studies on WAD center around the concept of preventing chronicity of WAD. In other words, the GOAL of care is to restore function and get the patient back to their normal lifestyle (work and play), which has been emphasized as being most important, even more so than pain resolution, though the two often go hand-in-hand. What are the best treatments in the initial stages—acute (less than two weeks) and sub-acute (two to twelve weeks)—of healing that can best reduce the risk of a patient developing chronic WAD (over twelve weeks)?

To answer the question, researchers reviewed studies from a 30-year time frame (1980-2009) and published their findings in a five-part series.

The first article in the series offered an overview and summary of the entire work. The second focused on the acute stage which included 23 studies that met the inclusion criteria. The researchers concluded that EXERCISE and MOBILIZATION treatment approaches had the strongest research support—two services STRONGLY EMBRACED by chiropractic.

The third article in the series focused on the subacute stage (2-12 weeks), which included 13 studies. The authors described research support for “the use of interdisciplinary interventions and chiropractic manipulation” but stated that the level of evidence was not strong for ANY treatment approach in the sub-acute stage. Investigators concluded that more research was needed with respect to this stage of care.

The fourth article in the series centered on the chronic stage (more than three months), of which 22 studies were included. Here, EXERCISE programs were reported to offer relief, at least over the short-term, while nine studies supported effectiveness for an interdisciplinary approach. Manual joint manipulation and myofeedback training were also reported as useful for pain relief.

The authors also stated that there was strong evidence to suggest that immobilization with a soft collar was not only ineffective but may impede recovery.

Do you see the “theme” of this research series? Services offered by chiropractic (exercise training, manipulation, and mobilization) are recommended at each stage of WAD 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.

Myofascial Trigger Points and Headaches

20 Feb

A myofascial trigger point (TP) is a hyper-irritable area in skeletal muscle that is commonly detected by palpating (feeling with the fingers). Although more sophisticated ways exist for locating TPs—ultrasound, microdialysis, electromyography, infrared thermography, and MRI—palpation remains the most utilized due to its simplicity, efficiency, and low cost. For patients with migraine and tension-type headaches, TPs are commonly found at the base of the skull/upper neck, paraspinal neck muscles, the upper trapezius, and/or the levator scapulae musculature.

In one study that included 34 headaches sufferers (20 had migraine headaches without aura and 14 had tension-type headaches) and 34 non-headache controls, researchers looked at what happened when they used a specific technique to recreate the effect of a trigger point on muscles in the upper neck and in the arm.

When the researchers stimulated the upper neck, 8 of the 14 (57%) members of the non-headache control group, all 14 TTH subjects, and 19 of the 20 migraine sufferers reported headache-related symptoms. On the other hand, when the same technique was used on the arm of each participant, none reported headache-like symptoms.

The authors concluded that the high incidence and accuracy of headache reproduction from upper neck stimulation supports the importance of evaluation and treatment of trigger points in the upper neck region in those with TTH and migraine headaches. Doctors of chiropractic commonly perform manual techniques to the upper neck region and train their headache patients in identifying and self-managing TPs located in the upper neck muscles.

Several methods can be used to self-treat TPs in the upper neck region. Perhaps the easiest approach is to reach back with your thumb to the muscle attachments along the base of the skull and apply deep (but tolerated) pressure, feeling for areas that are most sensitive and sliding the thumb up/down and across the sore TP until it becomes less tender. Work the left side with the left thumb and vice versa. Doing the same with small head movements—up/down, left/right rotations, etc. helps.

Another method is to sit in a straight-back chair, slide down so that you cradle your upper neck over the top edge of chair back and then roll your head left to right. When you find a sore TP, add a nodding type of head motion while “digging in” over the chair-back edge (within tolerance) until it loosens and hurts less. If you suffer from headaches, your doctor of chiropractic can train you in these and other effective exercises and render treatment to improve cervical function that can be highly effective at reducing both the frequency and intensity of headaches.

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.

Non-Surgical Care for Rotator Cuff Tears

17 Feb

While the anatomy of the shoulder allows for a wide range of motion and movement, it comes at the cost of a less stable joint, especially for those who routinely perform activities that require lifting the arms. This is likely why shoulder pain is one of the leading reasons patients seek chiropractic care, trailing behind low back and neck pain. The most common cause of shoulder pain is from tearing of the rotator cuff muscles (RCMs), particularly muscles that rotate the shoulder outward.

The “typical” rotator cuff tear patient is typically over 50 years of age with shoulder pain that has slowly worsened over time. A 2018 study found that as many as 96% of people over age 50 have RCM abnormalities, of which MANY are asymptomatic or non-painful. The study also reported that 24% of a random sample of 46 young people with an average age of 23 years old with no symptoms and no history of past injury, had degenerative changes in the RCMs. This finding supports the notion that rotator cuff injuries may occur early in adulthood and progress slowly until the symptoms drive a patient to seek care.

In a study involving 167 patients with rotator cuff tears, researchers observed no difference in outcomes one year after participants received either conservative care or surgery. This led the authors to recommend that non-surgical care, such as chiropractic care, should be considered as the PRIMARY method of treatment for rotator cuff tears of non-traumatic origin.

One study looked at impingement syndrome in a case series of four patients who received multimodal chiropractic care that included shoulder manipulation, shoulder girdle exercises, and ultrasound. In all four cases, the patients reported complete resolution of their shoulder pain and disability with five treatments. When researchers followed up with the patients four to eight weeks later, the participant’s symptoms had not returned.

A systematic review of data from 200 articles found evidence for the following non-surgical treatment options—which are commonly provided in chiropractic clinics—for shoulder pain: exercise training (specific favored over general), manual therapy, laser, extracorporeal shockwave, pulsed electromagnetic field (PEMF), transcutaneous electrical nerve stimulation (TENS), myofascial trigger point therapy, acupuncture, and microwave and light therapy. For a patient with a rotator cuff tear, conservative chiropractic care is an excellent option for reducing pain and improving function in the affected shoulder!

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.

Manual Therapy vs. Surgery for Carpal Tunnel Syndrome

13 Feb

When people suspect they have carpal tunnel syndrome (CTS), it’s typical that their first thought is that their condition will require surgery and a lengthy recovery. While surgery may be warranted in emergency situations, treatment guidelines encourage patients to seek non-surgical options first. So how do non-surgical approaches like manual therapy interventions —provided in a chiropractic setting—compare with surgery to treat CTS?

In 2018, a team of European researchers reviewed data from ten studies that compared the effectiveness of surgery vs. non-surgical care for the treatment of CTS. While the results favored non-surgical approaches at three months and surgery at six months, the available data show no difference in outcome one year later. Thus, the research team concluded that conservative treatment should be preferred unless otherwise indicated.

If both surgery and non-surgical options produce similar outcomes at the one-year mark, can CTS improve on its own?

In one study that involved 22 patients (19 of whom had CTS in both hand), researchers incorporated a twelve-week waiting period into the experiment to see if symptoms worsened, stayed the same, or improved. Questionnaires completed by the participants who abstained from manual therapy interventions showed that their symptoms worsened during the twelve-week non-treatment period.

The treatment phase of the study involved six sessions twice a week for three weeks and incorporated manual therapies to address the soft tissues of the hand and wrist and the carpal bones. The patients reported that treatment resulted in improvements with respect to both pain and function. This led the researchers to recommend manual therapy interventions as a valid non-surgical treatment approach for CTS. Doctors of chiropractic specialize in manual therapy techniques and employ these regularly for many neuromusculoskeletal conditions, including CTS and related conditions that may contribute to a patient’s hand and wrist symptoms—something that a carpal tunnel release procedure cannot address. To achieve optimal results, it’s important to seek PROMPT assessment and non-surgical treatment for CTS.

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.