Chiropractic Management of Neck Pain .

24 Nov

Neck pain is a very common condition that drives many patients to seek chiropractic care. Treatment planning typically includes four primary goals: 1) Pain Management; 2) Structural Realignment; 3) Functional Restoration; and 4) Maintenance / Prevention.
1) PAIN MANAGEMENT: Getting rid of pain is the primary focus of ALL patients in the early stages of a neck injury. If we use the acronym “PRICE” (Protect, Rest, Ice, Compress, and Elevate), the first three apply when it comes to neck pain. We “protect” our neck by avoiding or changing the way we go about doing things such as our sleep position (this often prompts a “proper pillow discussion”), adjusting the outside rearview mirrors of our car (if you flair the outside mirrors outwards, it opens up the “blind spots” and may prevent a collision, especially if you cannot rotate your neck very far), and modifying other ADLs (activities of daily living). The bottom line is: if an activity creates a sharp pain sensation, it is a “warning sign” to modify or stop WHATEVER it is that you’re doing. Wearing a cervical collar for a SHORT duration of time can qualify for both “Protect” and “Rest.” Try resting your neck on a pillow when reading or watching TV, as it allows the neck muscles to rest. A cervical traction device can help reduce muscle spasm, improves flexibility (range of motion), and reduce pain. Alternating “Ice” and heat can be even more effective, as it “PUMPS” out inflammation or swelling. Heat is also a good natural muscle relaxant and ice reduces swelling (inflammation), both of which can help reduce pain. There really is no hard and fast rule as to how long you should continue using ice (days, weeks, or months) – if it helps, use it (unless you are hypersensitive and frostbite easily, in which case limit the ice time). However, heat can worsen a condition if it’s applied too soon or too long. Anti-inflammatory herbs like ginger, turmeric, boswellia, and others are very effective and actually may be BETTER than ibuprofen, Aleve, or aspirin. Recent studies indicate that there may be a delay in healing when over-the-counter pain medications are used, and the recommendation is to AVOID these drugs so healing won’t be delayed!

2) STRUCTURAL REALIGNMENT: The goal here is to improve (to the best of our ability) faulty bony misalignments that frequently exist in the neck, upper, middle back as well as the low back, as all can contribute to neck pain. This is also a great long-term goal, as it may help PREVENT future episodes of neck pain. There is a natural process of aging called osteoarthritis that none of us can avoid, but allowing faulty curves and bony misalignments to persist may actually accelerate this degenerative process! Your Chiropractor may have you lie on a tightly rolled up towel (a frozen water bottle often feels even better) placed behind the neck and when it’s comfortable, performing this on the edge of the bed is a great way to re-educate a reversed cervical curve (and, it feels GREAT!). Even a heel lift in the shoe of a short leg can help the neck! Spinal manipulation, manual mobilization techniques, and trained exercises all address this treatment goal quite effectively!

We will continue this conversation next month discussing the third and fourth topics: 3) Functional Restoration; and 4) Maintenance / Prevention, so STAY TUNED!

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, we would be honored to render our services.

Fibromyalgia and Vitamin D Deficiency

20 Nov

Utilizing dietary approaches to help with fibromyalgia (FM) management has been our main topic these past two issues and serves as GREAT background information for this month’s topic: Vitamin D and its role in the management of pain associated with FM. Let’s take a look!

Vitamin D is found in foods such as fish, eggs, fortified milk, cod liver oil, and more. The sun also helps the body produce vitamin D with as little as 10 minutes of exposure reported to be enough to prevent deficiency. There are several different forms of vitamin D, of which two are important in humans: vitamin D2 (made by plants), and D3 (made by human skin exposed to sunlight). Foods may be fortified with either type, and supplements are available in both forms (D3 is preferred). The main role of vitamin D is to maintain normal blood levels of calcium and phosphorus. Calcium and vitamin D are often taken together to improve bone health and reduce fractures. Research has also shown that vitamin D may protect against osteoporosis, high blood pressure, cancer, and other diseases. “Classic” vitamin D deficiency diseases include bone softening conditions such as rickets (in children) and osteomalacia (in adults). People at high risk include the elderly, individuals who are obese, and those with limited sun exposure. Individuals with conditions such as cystic fibrosis (mucous build-up in the lungs) or inflammatory bowel disease are also at risk for vitamin D deficiency. With that background information, can vitamin D help FM patients with chronic pain?

In a February 2014 study (journal: Pain 2014, Feb 01;155(2)261-268), the first known randomized, placebo-controlled trial was conducted on 30 FM women with serum D3 levels below 32ng/mol/L (80nmol/L). Half were assigned to either vitamin D replacement or a control group that received a placebo (NOT vitamin D). The two groups were re-evaluated again after 24 weeks. The main hypothesis was that those treated with vitamin D3 would have less pain (as measured on a 0-100 pain scale and several additional questionnaires). The study found that there was a marked reduction in pain perception in the FM women treated with D3. Though a larger scale study was recommended to solidify these findings, the authors conclude, “This economical therapy with a low side effect profile may well be considered in patients with FMS.” This study is important, as dosing of vitamin D3 (preferred over D2 commonly prescribed) was based on deficiency levels and provided at 1200 to 2400 IU/day. By the end of three months, those receiving D3 improved from an average of 20 ng/ml to almost 50 ng/ml and reported a 20 point decrease in pain on a 0-100 scale. Further, about 20-25 weeks after discontinuing D3, their levels dropped back to ~26 ng/ml with a corresponding increase in pain levels (by 30%).

WebMD reports similar chronic pain benefits with D3 replacement. In 2003, they reported that D3 deficiency is high “among all U.S. ages, races, and ethnic groups over the past two decades.” They add that a then-recent study found that out of 150 chronic pain patients, 93% of them had “extremely low” D3 levels!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Keep Your Stem Cell Telomeres Long!

18 Nov

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.

Since this series started, we’ve given you several easy-to-adopt tips to Staying Young. This month, we want to talk to you about recovering from cancer and the importance of keeping your telomeres from fraying.

With cancer or any structural damage — like a heart attack or even arthritis — your body sends in stem cells to repair the damage and regenerate your tissues. Even seven years ago, we didn’t know that stem cell replenishment was true for most organs, but now we know that every one of your organs seems to recruit backup stem cells from your bone marrow to resuscitate itself, when needed. These emergency relief worker cells lay the groundwork for re-creating your organs. But, if the telomeres of your stem cells get a little too short, then you may have a problem making more stem cells…

Which begs the question, how do you maintain the telomeres of your stem cells so you can make more stem cells? A little background… Your chromosomes, the little rascals, have small substances on the ends called telomeres. Think of them as being like those little plastic tips of shoelaces (which are called aglets, in case you want to show off in your next Scrabble competition). Every time a cell reproduces, that telomere gets a little shorter, just as the shoelace tip wears off with time. Once the protective covering on the tip is gone, your DNA and shoelace begin to fray and are much harder to use. That’s what causes your stem cells to stop dividing to repair your injuries. But your body also has a protein—called telomerase—that automatically replenishes and rebuilds the ends of the chromosomes to keep your stem cells able to reproduce.

The amount of telomerase you have depends on your genetics, but we’re now starting to see that you can influence the size of those little tips, the telomeres. For example, researchers have found that mothers with chronically ill children have shortened telomeres, indicating that chronic stress can have a huge influence on how cells divide—or fail to. The telomeres of people who feel more stressed are almost 50 percent shorter than people who say they’re less stressed. Since scientists have a rough idea what the average telomere length is for a specific age, they can estimate how much older the higher-stress group is biologically: a whopping nine to seventeen years! In fact, in our studies of RealAge, stress is the greatest ager, increasing your risk of heart disease, memory loss, cancer, infections, accidents, and broken hips. Bottom line: stress is a substantial cause of stem cell telomere shortening.

In a study reported this month from University of California Medical School at San Francisco, among middle-aged and older women, those who did a little regular exercise, ate healthfully (avoided the five food felons of added sugar, syrups, any non-100% whole grain, trans fats, and saturated fats), and slept well, increased their telomerase production substantially, and had longer telomeres. In a study reported last year, daily meditation to prevent or ameliorate stressful responses was associated with lengthening of telomeres. By our calculations, daily walking, healthy eating, sleep, and meditation can make your telomeres’ (and your) RealAge more than 12, and maybe as many as 27, years younger.

Those lifestyle effects trump the effect of almost any drug ever reported. It’s not that statins or insulin or blood pressure meds aren’t healthful—they are. It’s just that the benefits of maintaining a healthy lifestyle (diet, exercise, stress management, your environment, sleep) are so powerful that you may not need the other drugs. You get a Do-Over—no matter how old you are. Until you are six feet under, you get to change the quality of your life. But you have to take the opportunity. That’s the real point: the daily lifestyle choices you can adopt easily are the most important for keeping your stem cell repair mechanisms functioning as well as possible.

And that might just get you to get to that magic year of 2024 (we’ll talk next month about why that year may be so magic).

Thanks for reading. And feel free to send more questions, you can always send us questions at 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 (and get updates on the latest and most important medical stories of the week) on twitter @YoungDrMike.

Feel free to continue to send questions to youdocs@gmail.com. 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 a new web site: YOUBeauty.com and its companion BeautySage.com the only site we know of where you can find skin products proven to meet the claims (opened for business on June 1st, 2012), and a new book: 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.healthradio.net Saturdays from 5-7 p.m . E-mail him questions at YouDocs@gmail.com. He is the co-author of 4 #1 NY Times Best Sellers including : YOU Staying Young and YOU: The Owner’s Manual. He is Chief Medical Consultant to the two year running Emmy award winning Dr Oz show– The Dr Oz show is #2 nationally in daytime TV. See what all the fun is about, and what he, The Enforcer, is up to. Check local listings or log onto DoctorOz.com for channel and time. And for more health info, log onto youbeauty.com anytime.

Carpal Tunnel Syndrome and Musicians.

17 Nov

Carpal Tunnel Syndrome (CTS) affects MANY individuals from all walks of life and in many occupations. Today’s discussion centers around CTS in musicians, and most importantly, what can be done about it.

It’s thought that CTS affects musicians because of their rapid, repetitive finger movements. The “formula” for CTS risk includes: Repetition + Speed + Force = CTS. This means highly repetitive movements at a fast pace using forceful movements significantly increase a person’s risk for developing CTS. If we add other risk factors of CTS including, but not limited to obesity, age over 50, female, the presence of diabetes, arthritis (especially rheumatoid), thyroid disease and others, then the risk increases dramatically. We can modify certain factors by losing weight, reducing practice time, changing the speed at which we practice (mixing it up between fast vs. slow tempos), taking mini-breaks from practicing, and more. However, we may not be able to change other factors like the presence of diabetes, arthritis, thyroid disease, and other hormonal imbalances. So the question arises, what can chiropractic do for CTS?

Chiropractic management focuses on the goal of treating what causes CTS – which frees up the nerve from being compressed. It is well established that compression of the median nerve ALONG ITS ENTIRE COURSE from the neck to the hand can create CTS or CTS-like complaints. Therefore, we determine the location(s) of compression by placing pressure over the points of common nerve entrapment, which include the wrist’s carpal tunnel, the forearm near the elbow (pronator tunnel), the inner upper arm near the elbow (Struther’s ligament), the shoulder and the arm pit area (behind the pectoralis minor muscle), as well as under the collar bone, and importantly, between the anterior and medial scalene muscles in the front/side of the neck (frequently missed). Chiropractic treatments may include manual release techniques such as Active Release Technique (ART), myofascial release (MFR), trigger point therapy (TPT), joint manipulation of the wrist, forearm, elbow, shoulder, neck and/or home self-applied treatment which includes activity modifications, using a night time splint, and exercises (which we teach you how to do). Nutritional considerations are also important (see last month’s Health Update)!

Treatment may also include exercises like the Carpal Stretch and the First Rib Stretch. The Carpal Stretch (median nerve flossing) involves standing sideways to a wall with your elbow straight, fingers pointing down with palm against the wall at shoulder height. Feel for the deep stretch in the forearm palm-side muscles. Follow this by bending your head sideways away from the wall. Using your opposite hand, gently pull your head over further sideways (no sharp pain allowed). Hold for up to 30 seconds and repeat two to three times or until you feel it loosen up. This can be repeated multiple times a day. If you don’t have a wall, do the same thing but with the arm extended forwards from the body (rather than sideways). Reach under your hand and gently pull your thumb back feeling for a similar deep stretch through the carpal tunnel (palm side wrist) and forearm. To perform the First Rib Stretch, place a towel over the shoulder close to the neck. Reach behind with the opposite hand and grasp the towel pulling downwards while the other hand grasps the front of the towel also pulling down. Drop your head sideways to the opposite side to increase the stretch. We can OFTEN help you avoid surgery so PLEASE try these exercises and our treatments BEFORE granting permission for surgery!

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 in the Adult.

13 Nov

Last month, we addressed low back pain (LBP) in the younger patient (age 30-60), so it only seems appropriate to continue the discussion for those over the age of 60. As previously mentioned, back pain does NOT discriminate when it comes to age. In fact, chiropractors see many children and teenagers with LBP as well as 90+ year-olds! Let’s take a look at the “usual” differences…

In the younger adult, facet syndrome and disk derangement are common conditions, and though this can still occur in the older adult, it becomes less common after age 60. The primary reason is because our disks become dehydrated or “dry up” as we age, making them less likely to herniate compared to a young, well-hydrated disk. During this “dehydration” process, the disks gradually narrow and bulge outwards. Therefore, in the 60+ year-old adult, disk-related pain is typically NOT from the soft liquid center herniating through the tough outer “annular” layer as it does in the younger patient. Rather, it’s from a combination of conditions. These conditions combine together and result in narrowing of the openings through which the nerve root exits the spine (called the neuroforamen).

The multiple conditions that contribute to this process include (but are not limited to): narrowing and bulging of the disk, osteoarthritis, or spurring extending off the vertebral endplates where the disk attaches, facet joint arthritis resulting in “hypertrophy” or enlargement, calcification of ligaments, and more. WHEN the neuroforamen narrows to the point of pinching the nerve root, symptoms occur. This condition is called “spinal stenosis” (SS), which literally means, “narrowed spinal canals” with entrapment of the spinal cord and/or nerves. Classic symptoms associated with SS include low back pain and stiffness. Most importantly, SS causes a gradual reduction in the amount of time that people with this condition can tolerate walking. Restricted mobility is initially subtle, but after months and years, walking may become more and more limited. That is, every time a certain time frame is reached (like 5 or 10 minutes of walking), the symptoms become significant to the point they force the SS patient to stop and sit or bend over often for one to two minutes, after which time they are able to resume walking for a similar amount of time.

Another common feature is that bending forwards HELPS (because it opens up the neuroforamen), and many SS patients walk bent over as their “norm.” When walking in a grocery store, they may lean forwards on the grocery cart because it allows for a longer, less painful walk. Other symptoms common with osteoarthritis (which always precedes SS), include morning stiffness, stiffness and pain when rising from sitting, decreased range of spinal motion or flexibility, localized painful joints, and others. As mentioned previously, degenerative joint disease or osteoarthritis is a slow, smoldering process that can often be traced back over the past 5, 10, and even 20 years.

As chiropractors, we can improve spinal joint flexibility and slow this process down. Give chiropractic a try as back pain in our elderly years DOES NOT have to be disabling!

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.

The One Question You Should Ask Yourself Every Day Before You Do Anything…

11 Nov

Did you know there is one question you should ask yourself every day before you do anything? There is a good chance that asking yourself this question will have a dramatic effect on your life. In just a moment, I’m going to tell you what that question is. But first, let me tell you about this little brain teaser…

Not too long ago, you may have seen a commercial featuring a very well-known and wealthy sports star trying to sell an unhealthy beverage product. Since the target audience for this commercial was mostly children and young adults, one could say this sports star was in fact helping to make countless children and young adults less healthy.

When this realization was posted on the internet, many people stood up for the athlete. When pressed for a reason why they were defending him, most said it was okay because of all the money the company paid him to be in the commercial.

So, even though this sports star already makes tens of millions of dollars each year, his actions were still justifiable because he was going to make more, even if there was a potential that endorsing this product could be harmful to the public.

Which brings us to the one question you should ask yourself every day before you do anything: WHY AM I DOING THIS?

Sure, it’s simple… but it can be a very powerful question.

Are you doing whatever you are doing because it will have a positive impact on yourself and the world? Or are you doing it simply for selfish reasons that will negatively impact one or more people?

This question is not just about money. It is about every aspect of your life, even your relationships.

If you ask yourself this question today, your answer may not be virtuous. No one is perfect. But at least you will have an opportunity to be a much better person with much better relationships and have a much better QUALITY of life that no amount of money can buy.

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