Neck Pain – The MOST Important Exercises (Part 2)

27 Jul

As stated last month, exercises that focus on improving posture, flexibility, strength, and coordination are important for creating a well-rounded cervical rehabilitation program. Our discussion continues this month with stretching and strengthening exercises.

STRETCHING: Since our neck muscles have to hold up our 12 pound (~5.5 kg) head, it’s no wonder why our neck muscles seem to be tight almost all the time. Here are two ways to stretch the neck: 1) You can simply drop the chin to the chest, look at the ceiling, try to touch your ear to your shoulder (without shoulder shrugging) on both sides, and rotate the head left to right and vice versa (six directions). 2) You can use gentle pressure with your hand and assist in the active stretch by gently pulling into the six directions described in #1 by applying “over-pressure” at the end-range of motion (staying within “reasonable pain boundaries”).

STRENGTHENING: Most people have a forward head carriage, meaning their head normally rests in front of their shoulders. The further forward the head sits, the greater the load on the muscles in the back of the neck and upper back to hold it up. This position promotes a negative spiral or “vicious cycle” that can lead to many complaints including (but not limited to) neck pain, headaches, balance disturbances, and in the long-term, osteoarthritis. There are two important groups of muscles that require strengthening: the deep neck flexors and deep neck extensors.

1)    The deep neck flexors are muscles located directly on the front of the cervical spine and are described as being “involuntary” or unable to be voluntarily contracted. Hence, we have to “trick” the voluntary outer “extrinsic” (stronger) muscles into NOT WORKING so the deep, intrinsic ones will contract. You can do this by flexing your chin to the chest and pushing your neck (not head) back over your shoulders into resistance caused a towel wrapped around the back of the neck. If you feel your chin raise towards the ceiling, you’re doing it WRONG! Keep the chin tucked as close to the chest as possible as you push your neck (not your head) backwards. If you’re doing it correctly, your chest should raise towards the ceiling as you push your chin down and neck back. Try it!

2)    The deep neck extensors are strengthened in a very similar way EXCEPT here you DO push the back of HEAD back into your towel while keeping your chin tucked tightly into your chest. Do three reps, holding each for three to five seconds and switch between the two for two to three sets.

We will finish this discussion next month with important coordination exercises!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

Fibromyalgia – “How Do I Know I Have It?”

23 Jul

Fibromyalgia (FM) is a condition where widespread generalized pain limits a person’s ability to function, sometimes to the point of complete disability. This month, we’ll look at identfying markers that may be used to determine whether a patient has FM or not.

Chronic pain that arises from the muscles and joints affects nearly 20% of the adult population, with the highest percentages found among females and those in lower income brackets. It is very challenging to determine “the cause” of chronic pain, probably because it is influenced by and interacts with various physical, emotional, psychological, and social factors. Several studies have reportedly shown that the levels of certain neurotransmitters (chemicals that help our nerves transmit information) including serotonin, glutamate, lactate, and pyruvate are elevated in patients with localized chronic myalgias (like FM) and therefore may be potential biomarkers for various conditions causing chronic pain. Unfortunately, elevations in these potential markers are not specific or unique to FM.

However, researchers have identified muscle alterations in in fibromyalgia / chronic widespread pain patients. More studies are needed to confirm these findings before they have the potential for use as a diagnostic criteria for FM.

For the time being, in order to establish a diagnosis of FM, we must rely on the following:

1)             The presence of widespread pain by using the “Widespread Pain Index” or WPI.

2)             Determining the severity of the symptoms by using the “Symptom Severity Score” or SS score of which there are two parts:

  •  Scoring fatigue, waking unrefreshed, and cognitive symptoms using a 0-3 scale, 3 representing the most severe or disturbing of these daily functions.
  • Adding up additional symptoms associated with FM, resulting in a 0-3 range depending on the number of the “other symptoms.”

Using the WPI and the SS scores, FM can be identified if one of the following two situations has been presend for three or more months:

WPI score > 7 and SS score > 5
WPI score between 3 and 6 and SS score > 9
If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

The Most Important Principles for Staying Young: Sweet Solutions to Sugar Addiction

21 Jul

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.

Nearly 13% of North American adults’ caloric intake comes from high fructose corn syrup (HFCS) and sugar. That adds up to 152 pounds (~69 kg) of sugars a year — that’s another whole person! No wonder so many people are fighting obesity, metabolic disorders, high blood pressure, and heart disease.

Ever since the book Sugar Blues came out in 1975, researchers have debated if sugar really can trigger an addiction’s “gotta-have-it-and-have-it-now” response.

Now it seems it really does. Scientists at MIT say mice will cross an electrified zone to get to sugar even when they’re completely full and eating the sugar stimulated the same areas of the brain in the same manner as other addictive substances (both legal and illegal). So, if you have a sweet tooth that just won’t quit, it’s time to use proven detox methods. Talk to your doctor about reducing your sugar intake and/or set up an appointment with a nutritionist or coach (check out Dr. Mike’s Cleveland Clinic Wellness Center online) who can offer you nutritional guidelines, emotional support, and a plan. Get a buddy to do the added-sugar elimination with you so you can offer each other support and cook healthy foods together.

Thanks for reading. And 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).

Best,
Young Dr. Mike Roizen (aka, The Enforcer)

Carpal Tunnel Syndrome and Neck Pain – The Great Mystery!

19 Jul

Carpal Tunnel Syndrome (CTS) develops when the median nerve is pinched at the palm-side of the wrist causing numbness in the index, third, and thumb-side half of the ring/fourth finger. Since the median nerve passes through the neck, it’s possible that dysfunction in the neck can interfere with the median nerve, resulting in carpal tunnel syndrome-like symptoms. Sometimes the median nerve can be “pinched” in both the neck and the wrist in what’s known as double crush syndrome.

Though many patients benefit from both surgical and non-surgical CTS treatment approaches, it is not uncommon for the results to fall short of a total resolution of symptoms. In these unsuccessful cases, it’s possible the median nerve is “pinched” at one or more locations other than the area the treatment focused on. In some cases, the hand symptoms and other signs of CTS can improve following treatment to relieve cervical dysfunction. The opposite can also be true with neck pain and related symptoms improving when the carpal tunnel is treated.

The concept of “differential diagnosis” has to do with considering multiple possible causes that can create similar symptoms, and one by one, ruling “in” or “out” each diagnosis by performing various tests with the ultimate goal of coming away with one solid diagnosis. Of course, the problem with this is that there is often more than one diagnosis at play, and in such cases we must determine which one is primary vs. secondary.

Taking our topic this month as an example, a chiropractor may often see cervical spine x-ray findings such as degenerative disk spaces, osteoarthritic spurring, or narrowing of the foramen that the spinal nerves pass through in route to the arm and hand. However, they may not be sure if these findings are “clinically important” or even contribute to a “cervical radiculopathy” or pinched nerve in the neck. It’s possible to see these same x-ray findings in patients with no radiating arm symptoms whatsoever. Similarly, patients with radiating arm / hand complaints may have NONE of these findings! The same holds true with bulging and/or herniated disks in the neck because these may or may NOT cause any radiating symptoms. When a chiropractor is able to reproduce arm and hand symptoms during an examination of the neck that are similar to CTS, this increases the doctor’s suspicion that at least a portion of the hand complaints may be attributed to nerve compression from the neck. When both neck and wrist findings co-exist, tests like EMG (electromyography) and NCV (nerve conduction velocity) can really help in some cases, but in other instances, the degree of nerve loss (the amount of damage) may not be enough to be accurately assessed with such diagnostic tools.

The “bottom line” is that all health care practitioners start “conservative” and wait until all approaches have been exhausted prior to recommending surgery. As described in previous articles, there are MANY non-surgical approaches that chiropractors can provide and you owe it to yourself to try these conservative approaches first!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Low Back Pain – When is it DANGEROUS to Wait?

14 Jul

Low back pain (LBP) typically results from relatively “benign” causes, meaning it’s usually safe to wait and try conservative / non-emergency care first. However, there are a handful of times when prompt medical emergency management is appropriate, and it’s important that everyone is aware of these uncommon but dangerous and sometimes deadly causes of LBP, hence the purpose of this article.

“Red flags” trace back to the 1980s and 1990s, so this is not a “new” topic. In fact, guidelines for the care of LBP that have been published around the world ALL commonly state the anyone exhibiting these “red flags” needs to be promptly diagnosed and referred for emergent care. The common conditions cited in these guidelines include (but are not limited to): 1) Cancer, 2) Cauda equine syndrome, 3) Infection,  4) Fracture. The patient’s history can sometimes uncover suspicion of these four conditions BETTER than a routine physical examination, though a definitive diagnosis is usually made only after special diagnostic tests have been completed including (but not limited to) imaging (x-ray, MRI, CT, PET scans), blood tests, bone scans, and more.

1) Cancer: a) Past history of cancer. b) Unexplained weight loss (>10 kg within 6 months). c) Age over 50 or under age 18. d) Failure to respond to usual care (therapy). e) Pain that persists for four to six weeks. f) Night pain or pain at rest.

2) Infection: a) Persistent fever (>100.4º F). b) Current/recent URI (upper respiratory tract infection like pneumonia) or UTI (urinary tract or kidney infection). b) History of intravenous drug abuse. c) Severe back pain. d) Lumbar spine surgery within the past year. e) Recent bacterial infection (cellulitis or persistent wound – e.g., a decubitus ulcer or “pressure sore” in the low back region). f) Immunocompromised states such as those caused by systemic corticosteroids, organ transplant medications, diabetes mellitus, human immunodeficiency virus (HIV).

3) Cauda Equina Syndrome: a) Urinary incontinence or retention. b) Saddle anesthesia. c) Anal sphincter tone decrease or fecal incontinence. d) Bilateral lower extremity weakness or numbness. e) Progressive neurologic deficit or loss – major muscle weakness or sensory deficit.

4) Fracture: a) Prolonged corticosteroid use. b) Age >70. c) History of Osteoporosis (poor bone density). d) Mild trauma over age 50. e) Major trauma at any age (such as a fall).

Another red flag is an Abdominal Aortic Aneurism. Signs include: a) Abdominal pulsations. b) Hardening of the arteries (atherosclerotic vascular disease). c) Pain at rest or night time pain. d) Age >60.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Do You Crave Late Night Snacks?

13 Jul

You should be in bed but instead you are wandering around the kitchen searching for something to eat.  How many times are you going to open the refrigerator door hoping something new and delicious is going to appear that was not there 30 seconds ago? If this description fits you, then you are not alone.  Countless people are the victims of late night cravings.

In a newly published study, exercise science professors and a neuroscientist at Brigham Young University used MRIs to measure how people’s brains respond to high and low-calorie food images at different times of the day.  The results showed that images of food, especially high-calorie food, can generate spikes in brain activity, but those neural responses are lower in the evening.

Lead study author Dr. Travis Masterson notes, “You might over-consume at night because food is not as rewarding, at least visually at that time of day… It may not be as satisfying to eat at night so you eat more to try to get satisfied.”  In other words, when you eat at night, your brain is just not as satisfied as when you eat at other times during the day.  Just knowing your brain is “tricking” you and that you do not actually need more food may help you avoid late night binges, weight gain, and the associated health risks.

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