Neck Pain – Drugs or Chiropractic?

8 Oct

When you have neck pain, do you instinctively reach for that bottle of ibuprofen or Tylenol? If so, is that the best option? Who can we trust for the answer? Since between 10-20% of the population suffer from chronic or persistent neck pain, this is a VERY IMPORTANT question!

If we look at the literature published in peer reviewed journals by authors who have no financial incentives in the outcome of the study, we can find accurate, non-biased information to answer this question. So, let’s start with a landmark study published in SPINE, a leading medical journal that reviewed ALL the publications printed between 2000 and 2010 on neck pain – a total of 32,000 articles with over 25,000 hours of review. (Haldeman S, Carroll L, Cassidy JD, et. al. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine 2008,33(4S):S5-S7). This resulted in a 220 page comprehensive report from a multidisciplinary International Task Force involving seven years of work from 50+ researchers from 19 different clinical scientific disciplines worldwide looking at the MOST EFFECTIVE approaches available (both surgical and non-surgical) for patients suffering from neck pain.

Highlights from the study include the following: 1) Manipulation/mobilization are safe, effective, and appropriate treatment approaches for most patients with disabling neck pain (both traumatic and non-traumatic); 2) Neck pain patients should be informed of ALL effective treatment options so they can choose effectively; 3) The very rare risk of vertebrobasilar artery (VBI) stroke is NO DIFFERENT when comparing patients consulting a doctor of chiropractic verses a primary care medical physician as the stroke event, in most cases, has occurred prior to the visit; 4) The treatment option(s) available should consider the potential side effects and personal preferences of the patient; 5) For most neck pain patients, treatments that were found to be safe and effective include manipulation, mobilization, exercise, education, acupuncture, analgesics, massage, and low-level laser therapy; 6) For non-neurological neck pain, ineffective treatments (poor choices) include surgery, collars, TENS (transcutaneous electrical nerve stimulation), most injection therapies (including corticosteroid injections and rhizotomy); 7) For neck pain WITH nerve compression, there is very little research published on non-surgical care. Here, in the absence of serious pathology or progressive neurological loss, start with the most conservative (like chiropractic!) followed by more invasive treatments like epidural steroid injections (ESI’s) and surgery; 8) Whiplash patients should follow similar guidelines as described above; 9) Some benefit from the chosen treatment should be seen within the first two to four weeks of care; and, 10) Be realistic about treatment goals – neck pain is often recurrent (comes and goes) as most people (50-80%) will NOT experience complete resolution of symptoms and will have neck pain again one to five years later.

Another study published in The Annals of Internal Medicine (“Spinal Manipulation, Medication, or Home Exercise with Advice for Acute and Subacute Neck Pain: A Randomized Trial. 3 January 2012, Vol.156, No. 1, Part 1) reports similar information favoring spinal manipulation and exercise, as these were found to be SUPERIOR to medication use. Another study reported excellent results for 27 patients utilizing chiropractic care who had herniated cervical disks WITH spinal cord compression verified on MRI (70% improved after an average of 12 visits)! TRY CHIROPRACTIC 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 neck pain, we would be honored to render our services.

Fibromyalgia: Dietary Considerations

7 Oct

For many sufferers, Fibromyalgia (FM) is equivalent to fatigue and muscle pain. Though there are MANY symptoms associated with FM, these two are standouts! The topic this month centers around diet and its role in the management of FM. Last month, we discussed the importance of exercise (particularly walking), and prior topics have focused on the need for a multi-modal treatment plan that is individualized for YOU. Coordinate your dietary strategies with your chiropractor’s office and they will guide you in your personalized nutritional planning as it pertains to FM.

Because we are all truly chemically unique, there is no one “recipe” for every FM sufferer. This is why we recommend making a list of the various approaches AS YOU TRY THEM in order to sort out those most vs. least effective, and most importantly, foods that should be avoided altogether. Patient histories tell us that certain foods can create reactions such as cramping, diarrhea, constipation, and more and that list often includes MSG, certain preservatives, eggs, gluten, dairy, and other high “allergy-based” foods. In a survey published in the journal Clinical Rheumatology, 42% of FM patients reported that certain foods make their symptoms worse. Hence, keep a daily FOOD JOURNAL and grade how different foods make YOU feel on a 0= ”good”, 5= “no change,” and 10= “bad” scale. In as little as two weeks, you will start to see a pattern and avoidance of the “bad” foods makes a big difference! Write down any and all of your symptoms, pro or con, and include things like headache, indigestion, fatigue, aching, etc.

Once you see a “trend” for vs. against certain foods, ELIMINATE the ones that upset your irritable bowel, headaches, fatigue, etc., and avoid these foods for six to eight weeks. Then, to “challenge” your list of foods, you can then ADD ONE food back into your diet at a time to determine consistency and if it TRULY is a culprit FOR YOU! From experience, Dr. Ginevra Liptan, MD, medical director of the Frida Center for Fibromyalgia, in Portland, Oregon and author of Figuring Out Fibromyalgia: Current Science and the Most Effectve Treatements, dairy and gluten appear to be consistent culprits with fatigue, irritable bowel, and leaky gut symptoms like bloating and constipation. We will guide you in this process and/or help coordinate these services with an allergist and/or dietitian when it’s appropriate.

Some preliminary studies are showing that certain medicinal herbs and natural supplements may help manage FM related symptoms – remember to WRITE DOWN your experience with these various options: 1) 5-HTP (5- Hydroxytryptophan): This is a “building block” of serotonin which is a POWERFUL brain chemical associated with sleep and depression. It is thought that serotonin plays a significant role in reducing fibromyalgia suffering, particularly by increasing deep sleep and reducing pain. Studies show improvement in depression, anxiety, and insomnia as well! Though not ALL studies support its benefits, it’s worth a try given its limited side effects and potential for helping! 2) Melatonin: This is a “natural hormone” used to improve sleep patterns, which is a perfect fit for the sleep problems and fatigue associated with FM! Most people tolerate this well but a few may experience drowsiness, and for those, caution is appropriate when driving! 3) Probiotics: This is “…the new kid on the block,” as it’s showing up on labels of everything from yogurt to granola bars! These contain “friendly bacteria” we want in our digestive systems. Certain “strains” or types of “good-guy” bacteria aid in many conditions including irritable bowel, traveler’s diarrhea, reducing inflammation, boosting the immune system, and more! Note, there are MANY strains of probiotics, which we will discuss in PART 2 next month as we continue this “healthy” discussion of dietary approaches in the management of FM!

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

Protect Your Own Health from Tick Borne Diseases.

6 Oct

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.

Today we are tackling a problem, but first a question: What do Evander Holyfield and tick-born infections have in common? They can land you flat on your back very quickly. And this year tick-ologists are predicting a particularly intense bite season. Reports of Lyme disease — a nasty rash and potential arthritis and much more including mental dysfunction caused by ticks that transmit Borrelia bacteria — could hit record numbers.

The reason? Not the mild winter, that’s a myth. It’s the lack of acorns! Turns out, when the acorn crop is down (it is), then there are fewer of the ticks’ favorite meal plan out and about: white-footed mice. We kid you not! Without as many little rodents running around, the ticks cruise for a substitute: you.

So, what’s a nature-loving, pet-hugging person to do? Here’s your basic 6-point plan to take the bite out of tick season:

#1 DEET U– Use insect repellant with DEET. Insect repellents with 20 to 30 percent DEET repel ticks. Follow the instructions and apply carefully, avoiding your hands, eyes, and mouth. We’re convinced the benefits far outweigh the risks, if there are any risks at all. The Centers for Disease Control and Prevention does say young kids and pregnant women should avoid the pesticide. Oil of lemon eucalyptus (or PMD, for para-menthane-3,8-diol, the synthesized version) is another option. Or, you can always treat your clothing with products containing a chemical called permethrin, applying it to the outsides of boots, pants, socks, and tents. It should remain active through several washings.

#2 HIDE– Cover up with long sleeves and pants tucked into your socks when in grassy or wooded areas and wear light colored clothing to spot any hop-alongs.

#3 CHANGE YOUR LOCATION—Stay away from places where ticks are likely to lurk. The more you can avoid wooded or heavily shrubbed areas, the better — especially ones with high grass and leaf litter. If you’re planning to go hiking in the woods, wear long pants, do the nerdy thing of wearing socks that go over your pants—two pairs of socks are best, and do a thorough tick check after your outing. Repellents are not the only way to guard against ticks. The Centers for Disease Control and Prevention suggests making your yard a “tick-safe zone” with smart landscaping changes like a three-foot barrier of wood chips between forested areas and your lawn.

#4. INSPECT, GET NAKED SO YOU DON’T BRING THEM INSIDE, & USE WATER — Shower when you get home and you may wash be able to wash them off (ticks don’t always bite immediately). Even the best efforts may not be enough to stop ticks, so be sure to thoroughly check your clothes, your body, and especially your pets when you get home from an outing. Showering soon after you return can help you locate ticks or tick bites.

#5 HEAT IT UP, BABY—Once you get naked (take your cloths off before you are far into your home) and inspect your body, take all cloths and put them in a hot dryer. Drying clothes on high heat for an hour can kill any ticks that may have burrowed into your clothing.

#6 DON’T FORGET ROVER — Check you pets! Ticks hidden in fur and hair can easily infect you — and your family’s best friend.

#7 KNOW YOUR DOC’S NUMBER — If you ever see signs of Lyme disease (like a bull’s-eye-shaped rash around a bite), consult your doctor as soon as possible. Faster treatment makes a difference in regards to LYME disease putting you out of commission or not.

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.

Some Facts About Water Fluoridation…

6 Oct

Most people living in developed nations do not fluoridate their water. For example, in Western Europe only 3% of the population consumes fluoridated water. While 25 countries have water fluoridation programs, in 11 of these countries, less than 20% of the population consumes fluoridated water: Argentina (19%), Guatemala (13%), Panama (15%), Papa New Guinea (6%), Peru (2%), Serbia (3%), Spain (11%), South Korea (6%), the United Kingdom (11%), and Vietnam (4%).
There are only 11 countries where more than half of the population drinks fluoridated water: Australia (80%), Brunei (95%); Chile (70%), Guyana (62%), Hong Kong (100%), the Irish Republic (73%), Israel (70%), Malaysia (75%), New Zealand (62%), Singapore (100%), and the United States (64%).
In total, 377,655,000 million people worldwide drink artificially fluoridated water, that’s about 5% of the world’s population. Interestingly enough, there is no difference in tooth decay between the Western nations that fluoridate their water and those that do not.

Carpal Tunnel Syndrome – What Can I Do to Help?

1 Oct

Carpal Tunnel Syndrome (CTS) management strategies were introduced last month, which we will conclude this month with Part 2. In part one, we cited three primary goals of CTS management that include the following: 1) Physical management strategies; 2) Chemical management strategies; and 3) Self-management strategies. All three goals include a component that we as doctors of chiropractic control AND (most important), a component that you the patient controls. We will continue this discussion this month with chemical management strategies.

2. Chemical management strategies: Here, MY JOB includes guiding you in methods to reduce swelling or inflammation. The first method involves the use of ice. Different cooling approaches include the use of ice cup/massage (applied directly on the skin until numb, which takes about five minutes) and/or ice packs (takes about 10-15 minutes). We can also offer assistance in choosing various anti-inflammatory herbs (such as ginger, tumeric, boswellia) and vitamins (such as vitamin B6 or pyridoxine; magnesium, fish oil / omega 3 fatty acids, vitamin D) with anti-inflammatory properties. Recently, probiotics have also been demonstrated to reduce inflammation! YOUR JOB is to follow these recommendations that you and I agree upon to help reduce the inflammatory effects of CTS. Other “chemical strategies” may include adding the primary care physician to “the team,” as prescriptions for various conditions such as diabetes, hypothyroidism, rheumatoid arthritis, and others may be appropriate in certain CTS cases.

3) Self-management strategies: Though we have already looked at “MY JOB” and “YOUR JOB” as it pertains to 1) Physical management and 2) Chemical management strategies, overlap exists between all three CTS management goals. In other words, as the name implies, “self-management strategies” includes the need for you to comply with the recommendations. For example, wearing the cock-up wrist splint primarily at night (when sleeping and less commonly at times during the day), following instructions regarding job modifications, nutritional strategies and, when applicable, pharmaceutical intervention are things you can do to alleviate symptoms. One of the MOST IMPORTANT self-help strategies is the training of carpal tunnel specific exercises, as well as exercise in general. Maintaining a proper weight (a BMI between 20-25) is also a goal that will help CTS, as obesity is a risk factor for this condition and a host of other conditions, including diabetes!

EXERCISE #1: Stand near a wall. Place your palm on the wall at shoulder height pointing the fingers down towards the floor, keeping the elbow straight. Reach across with the opposite hand and pull your thumb back as you stretch the palm-side forearm muscles. Hold 5-10 seconds until you feel the muscle “melt.” Repeat three times per side, five times a day. You can use the edge of a counter top rather than a wall, if you like.

EXERCISE #2: Bend the elbow 90 degrees. “Dig” your thumb DEEP into the palm-side forearm muscles close to the elbow. Slowly straighten the elbow and maintain the deep pressure into the muscle until the elbow is completely straight. REPEAT this multiple times moving your thumb one inch closer to your wrist from the last pressure point until you are one to two inches from the wrist (or, until you don’t feel much tenderness). You can vary the speed at which you straighten the elbow but generally, slower is better than fast movement, and the deeper the pressure, the better.

Repeat these two exercises on BOTH sides so you can feel the difference between the two, regardless if you have problems on both sides. Since the neck and shoulder can be involved, we will also show you how to stretch these areas, as keeping the whole “kinetic chain” stretched is very important for long-term benefits.

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 – What To Do Immediately (Part 2)

30 Sep

Low back pain (LBP), as previously stated, will affect most (if not all) of us at some point in time. Knowing what to do when the warning signs occur is essential to avoiding a disabling level of LBP. Last month, we started the discussion about offering ways to manage the LBP using exercises with the objective of stopping and reversing a potentially serious level of LBP. We offered ways of stretching from a sitting position that can be done in public. Here are some standing exercise options.

1. EXERCISE C: THE HAMSTRING & GROIN STRETCH: From standing 1) Place your foot up onto a seat, bench, chair, pipe of a railing, or anything about knee level (it doesn’t have to be very high). If your balance isn’t very good, make sure to hold onto a wall or counter to keep your balance. 2) Keep your knee bent 20-30 degrees and arch your lower back by sticking out the buttocks until you feel the pull or stretch in the hamstrings (back of the leg). 3) Slowly straighten your knee (keep the buttocks poked out and the low back arched) and you will feel the hamstrings gradually get tighter. 4) Change the angle of the knee and/or the amount of l ow back arch/pelvic tilt to modify the pulling intensity in the hamstrings. Continue this stretch for 15-30 seconds or until you feel the muscles loosening up. 5) Stay in that EXACT SAME POSITION and rotate your torso inwards (towards the leg you’re standing on) until you will feel the pull change from the hamstrings to the groin (inside thigh) muscles. You can also go back and forth between the hamstrings and the groin (adductor) muscles and continue the exercise until the back of the leg and groin feel adequately stretched (usually 5 to 15 seconds/leg).

2. EXERCISE D: THE HIP FLEXOR STRETCH: From standing: 1) Step forwards with one leg and stand in a semi-long, stride position (one foot ahead of the other). 2) On the back leg side, rotate the pelvis forwards until the hip lines up with the forward leg hip (or, the pelvis is square). 3) Add a posterior pelvic tilt (tuck in your buttock/pelvis or, flatten your low back). 4) Lean backwards (extend the low back) holding the above position. As you extend back, feel for the pull deep inside the upper front part of the thigh/groin area. You can alter between the third and fourth steps to release and re-stretch the hip flexor. Continue the stretch for 5-15 seconds or until you feel it’s stretched out and repeat on the opposite side. This one takes a little work but once you feel it, you will see why it’s so good!

3. EXERCISE E: THE ADDUCTOR STRETCH: As an alternative to the second part of EXERCISE C (step 5 of the standing hamstring stretch), stand with your legs spread apart fairly wide. Shift your pelvis from side to side (left then right) and feel for the stretch on the inner thigh/groin region. You can increase the stretch by adding a lean to the side you’re shifting the pelvis. Try holding the stretch for 5-15 seconds, alternating between sides 5-10 times.

These exercises are meant to be done in public WHEN you need to stretch. Stop the vicious cycle from getting out of control by STOPPING, STRETCHING, and then resuming your activity if you can!

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.

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