Tension-Type Headaches – Management Strategies.

1 Sep

Headaches (HA) can significantly alter a person’s quality of life. Moreover, they can interfere and sometimes even prevent an individual from performing important activities such as going to work, attending school, or participating in group activities such as sports, music programs, holiday gatherings, and more. The focus of this month’s Health Update is on Tension-Type Headaches (TTH), a common “primary headache” with tremendous socioeconomic impact.

Compared with migraine headaches, tension-type headaches are actually more common and can be equally as disabling. A recent study reviewing popular treatment approaches for TTH reported that establishing an accurate diagnosis is important prior to beginning treatment and finding “…non-drug management is crucial.” Recommendations regarding treatment also include becoming educated about TTH, obtaining reassurance, and identifying trigger factors that can precipitate a TTH. Psychological treatments with scientifically-proven benefit include relaxation training, EMG biofeedback, and “cognitive-behavioral therapy” (CBT). Physical therapy, chiropractic, and acupuncture are widely used, but further research supporting these approaches is needed. The researchers state “simple analgesics” are the primary drug choice for TTH, but they strongly oppose the use of combination analgesics, triptans, muscle relaxants, and opioids, “….and it is crucial to avoid frequent and excessive use of simple analgesics to prevent the development of medication-overuse headache.” They state that the tricyclic antidepressant amitriptyline is “drug of first choice” when treating chronic TTH, but they point out side effects can be significant, thus hampering their use. The researchers conclude that the treatment of frequent TTH is often difficult, and multidisciplinary approaches can be helpful. THIS IS WHERE CHIROPRACTIC FITS IN! These researchers state that non-drug approaches as well as medications “…with higher efficacy and fewer side effects [are] urgently needed.” They advise that future studies need to focus on optimizing treatment programs to best suit the individual patient utilizing psychological, physical, and pharmacological-treatment approaches.

So, what can chiropractic bring to the table in this “team” treatment approach? First of all, it is non-drug oriented, the need of which clearly was emphasized in this study. Second, the presence of muscle tension at the base of the skull/top of the neck can be addressed VERY SPECIFICALLY with spinal manipulation of the cervical spine, active release, myofascial release, trigger point therapy, manual cervical traction, and more! Third, the use of NON-PRESCRIPTION nutrients such as ginger, tumeric, boswellia, Bromelain, white willow bark, fish oil/omega-3 fatty acids are all non-drug (with fewer potential side effects) options that facilitate in controlling inflammation. Using a home cervical traction device can also be VERY HELPFUL! Specific exercise training aimed at muscle relaxation, stretching, and strengthening (especially the deep neck flexors) can ALL BE MANAGED by a doctor of chiropractic!!!

Fibromyalgia: Exercise is “Key.”

28 Aug

Fibromyalgia (FM) is now considered a central nervous system (CNS) disorder rather than a musculoskeletal condition. FM is managed best from a balance of different approaches including chiropractic adjustments, soft tissue therapies, modalities, exercise, diet, supplementation, sticking to a schedule, taking naps, stress management, cognitive behavioral therapy, and more. Common symptoms of FM include chronic fatigue and mental fog. The focus this month is on exercise and the benefits of exercise as it relates to improving quality of life!

Recent research has been published about the benefits of walking – not just for the FM sufferer, but for EVERYONE! Dr. Marily Oppezzo, a Stanford University doctoral adjunct professor in educational psychology and Dr. Daniel Schwarz, a professor at Stanford, have published very convincing evidence that walking is not only physically good for the body, but it’s also mentally good for the brain! In fact, they’ve discovered walking actually improves CREATIVITY! The study found that walking either indoors on a treadmill or outdoors BOTH similarly boosted creative thinking in participants! Hence, for those stranded indoors during climactic weather, whether snowbound in Wisconsin or heat bound in Florida, equal benefit can be obtained from indoor walking, even if it’s not as much fun as being outdoors! Though past research has shown that aerobic exercise generally protects long-term cognitive (brain) function, until this study, the benefits of walking when compared to sitting had not been considered as important. These authors point out that TWICE AS MANY creative responses were produced by subjects when they walked (whether on a treadmill facing a blank wall vs. walking outdoors in the fresh air) than when they sat from a prolonged period of time. This surprised the authors who thought thinking outdoors would easily be favored. They also found that these creative juices continued to flow when the person sat back down shortly after a walk! Now that we know that walking not only facilitates our bodies but also our brain, are there other exercises that can help the quality of life for the FM sufferer?

Dr. Lesley Arnold, a psychiatrist and FM expert at the Univesity of Cincinnati, College of Medicine in Ohio, recommends “a slow but steady pace” when starting a program, making sure that pain and fatigue are under control prior to introducing aerobic exercise. She recommends an initial assessment of the person’s current fitness level and then starts patients at one to two levels below that level, gradually building up stamina to a goal of 20-30 minutes of moderate aerobic activity 5-6 days/week. Exercises that emphasize low-impact, high-aerobic output are the best, and water-based exercises really fit that ticket due to the buoyant nature of water. Running in water against or without a resisting current and simply swinging the arms and legs against the resistance of water are extremely effective. A study published in Arthritis Research & Therapy reported improved health-related quality of life in women with FM for those participating in water aerobics. The soothing benefits of warm water is a good starting point, and classes are often group-based, adding social benefits of camaraderie and motivation, which creates a fun experience that participants can look forward to. Since FM is a CNS vs. a muscle condition disorder, another “brain” stimulating exercise includes simply balancing. Depending on the age, agility, and comfort of the person, try adding balance-challenging exercising to the mix. A good program to try can be found here: http://beta.webmd.com/fitness-exercise/ss/slideshow-off-balance-core-moves

Why optimism can make it more likely you’ll live longer and with less disability.

27 Aug

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.

It is easy to postulate that if you are optimistic, then you’ll do more things to improve your health. For example, optimism can help you stay on track with exercise and lower your odds for dying within five years after a cardiac event by a whopping 40%! But there are many additional benefits that come from practicing optimism. They include:

Improved decision-making. Optimism enhances your ability to make good decisions under stress, a skill that can help you say “no thanks” to a coffee-break doughnut during a tough day at work, and “yes” to exercise (rather than chips, the couch and the TV remote) when you’re tense. And that means you’ll be better at solving whatever challenges life throws your way.

Stronger immunity. A bright outlook boosts an important defense against disease called “cell-mediated immunity.” How important is it? Very! It controls your body’s ability to fight invading bacteria and virus and helps battle some cancer cells.

A healthier ticker. Even if you’re at high risk for heart disease because of a genetic predisposition, family history, high LDL (bad) cholesterol, or elevated blood pressure and blood sugar, living with a sense of hope and well-being can lower your odds for heart disease by 30-50%.

Stroke protection. A hopeful outlook can cut your risk for a life-threatening, mind-damaging ‘brain attack’ by 10% or more. Why? Because positive people are more likely to eat a healthy diet, sleep better, and feel less stressed. But it may be something more than that. Optimism all by itself bolsters health in ways that remain mysterious.

PLEASE TURN OVER…

A younger RealAge. A healthy old age isn’t just a result of good genes. New data shows that North America’s longest-living citizens share a zest for life. They’re easy-going, upbeat, and social. So if you’re ready to gain those benefits of optimism, here are a few easy-going steps that can help you over to the sunny side.

Keep it real. Having unrealistically positive expectations or glossing over problems instead of solving them can backfire, triggering low moods.

See positive challenges instead of threats. Resilient people attack problems in everyday life, like a plumber who knows she’s got a well-stocked toolbox and plenty of experience dealing with similar problems when she’s called on to fix a leaky pipe. The job may be wet and dirty, but she has the confidence to meet the challenge and leave things dry and clean. Try to consciously make this positive mind shift when you feel defensive, threatened, or worried about failure. Just reminding yourself to think more positively is often all it takes, or so the science says.

Think loving thoughts. A short “loving kindness” meditation (focusing on feelings of love and compassion for yourself and others) increases optimism and makes you feel more connected to others. Spending time with friends is another important mood-booster.

Feeling good? Go deeper. People who pay attention to and enhance into their positive emotions are more able to overcome tough times. Perhaps turning up the volume on good feelings builds a reservoir of joy to see you through. Try noticing when you feel playful, serene, or spiritually uplifted and then ask yourself how you can heighten that feeling. It’s fun!

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 – What Can I Do to Help? (Part 1)

26 Aug

Carpal Tunnel Syndrome (CTS) can arise as a result of a number of different causes and as such, treatment is guided by the specific needs of the individual and tailored to each individual case. With that said, there are specific treatment strategies that chiropractors provide that address three primary goals: 1) Physical management strategies; 2) Chemical management strategies; and 3) Self-management strategies. All three goals include a component that we, the doctor, control AND a component that you, the patient, can control or manage. This combined effort or “team approach” ALWAYS works best, especially over the long-term. So, let’s break these three management strategies down along with the two components: my job (as your chiropractor) and your job (as my patient)!

1) Physical management strategies: This category addresses the mechanical nature of CTS. That is, compression of the median nerve at ALL of the possible sites, not JUST the wrist/carpal tunnel area. Since the median nerve arises initially from the neck or cervical spine, nerve root compression of C6-T1 (and a little of C5) can give rise to CTS signs and symptoms. As discussed last month, this area can be one of the “great imposters” of CTS and/or it may contribute as a co-conspirator and combine with CTS, which magnifies or increases the CTS signs and symptoms, the so-called “double-crush syndrome.” Other “mechanical” sites of compression can be reviewed in last month’s Health Update, but in brief, these may include the thoracic outlet (shoulder area), Struther’s ligament (just above the elbow), the pronator tunnel (just below the elbow), the anterior interosseous membrane (forearm), as well as at the carpal tunnel itself.

MY JOB (as your chiropractor) is to reduce the pressure on the nerve at any and/or ALL these locations (remember, each case is unique). This can be done by using manual therapies including (but not limited to) manipulation of joints in the neck, shoulder, arm, elbow, forearm, wrist, hand, and fingers. Mobilization of muscles and other soft tissues may include active release techniques, friction massage, trigger point therapy, stretching with and without resistance, traction, and more. Various modalities might be used to reduce muscle tightness, swelling, or inflammation.

A nighttime wrist splint keeps the wrist in a neutral position, as the carpal tunnel’s pressure goes up A LOT when the wrist is bent. Since you cannot control the position of your wrist while you sleep, the brace can REALLY HELP! A BIG part of my job includes teaching YOU about CTS so that you understand the underlying causes, thus allowing you to identify jobs, hobbies, or situations where you may be inadvertently harming yourself. If you can, PROMPTLY identify offending wrist positions and STOP the repetitive injurious movement and then MODIFY your approach to the task, whether it means taking “mini-breaks,” changing the work station set up, or some other approach. Along with this “teaching concept” is exercise training. It is also VERY IMPORTANT for you to properly perform the carpal tunnel stretches and other exercises (see Part 2 next month) on a regimented/regular basis.

YOUR JOB includes wearing the brace (don’t forget or procrastinate), most importantly at night. You can wear it during the day while driving or doing something where you are not “fighting” the brace. In some cases, the brace can bruise you if you are moving your wrist against it repetitively or too hard, and it can actually do more harm than good in those situations. Your job is also to identify ways to do your job and/or hobbies with less torque or twisting of your wrist.

Next month’s discussion will start chemical strategies (#2 on the list above), which includes several very effective and safe approaches in the CTS management process. We will then address #3, “Self-management strategies,” which will include various CTS-specific exercises.

Low Back Pain – What To Do Immediately (Part 1)

25 Aug

Low back pain (LBP) will most likely strike at some point for all of us, at least that’s what statistically happens. How we “deal with it” initially can be critical in its progression or cessation. Here are some “highlights” of what to do “WHEN” this happens to you.

STOP: The most important thing you can do is STOP what you are doing. That is, IF you’re “lucky enough” to be pre-warned BEFORE the crisis point of LBP strikes. This step can be critical, as once it hurts “too much,” it may be too late to quickly reverse the process. The “cause” of LBP is often cumulative, meaning it occurs gradually over time, usually from repetitive motion that overloads the region. As stated previously, “IF YOU’RE LUCKY” you’ll be warned BEFORE LBP becomes a disabling/preventing activity. Typically, when the tissues in the low back are over-stressed and initially injured, the nerve endings in the injured tissue trigger muscle guarding as a protective mechanism. This reflex “muscle spasm” restricts blood flow resulting in more pain creating a vicious cycle that needs to be STOPPED!

REACT: This is the “hard part” as it requires you to perform something specifically, but once you prove to yourself that this approach really works, you won’t hesitate. You’ll need to determine your “direction preference”, or the position that reduces LBP. Once established, you can perform exercises to help mitigate your back pain. To make this work, you must be able to perform these exercises in public without drawing too much attention so you can feel comfortable doing them at any time at any place.

EXERCISE A: If BENDING FORWARD feels relieving, the exercise of choice is to sit and a) cross one leg over the other, b) pull that knee towards the opposite shoulder, and c) move the knee in various positions so the area of “pull” changes. Work out each tight area by adding an arch to the low back, rotate your trunk towards the side of the flexed knee (sit up tall and twist – if it doesn’t hurt) and alternate between these positions (10-15 seconds at a time) until the stretched area feels “loosened up.” A second exercise is to sit and rotate the trunk until a stretch is felt. Again, alternate between different degrees of low back arching during the twists, feeling for different areas of stretch until it feels looser, usually 5-15 seconds per side. A third exercise is to sit and bend forward, as if to tie a shoe, and hold that position until the tightness “melts away.”

EXERCISE B: If BENDING BACKWARDS feels best, exercise options include placing your fists in the small of your back and leaning backwards over the fists, or bending backward and holding the position as long as needed to feel relief (usually 5-15 seconds). From a sitting position, try placing a rolled-up towel (make one with a towel rolled tightly like a sleeping bag held with rubber bands) in the small of the back to increase the curve. Lying on your back with the roll and a pillow under the low back can also feel great!

We will continue this discussion next month!

Stop Doing This if You Want to Be Happier and Live Longer…

21 Aug

Do you want to be happier and live longer?

That may seem like a dumb question, but if you really pay attention to the way many people conduct their lives, then you may start to wonder if the question is even dumb at all.

For example, in this month’s newsletter, we discuss the results of a new study concluding that being nagged by a spouse can increase a person’s risk of premature death. It also claims that men are slightly more at risk than women.

Now, this is not a man vs. women thing. Either way you look at it, it is not good and is totally preventable.

It seems like this all boils down to…

Stress and How
You Handle It

It is a fact, stress kills and it does not discriminate. It does not matter who or what the source is, whether it is a nagging spouse or an over-demanding job. Stress is bad for you.

Well, let’s clarify that. Your reaction to stress is bad for you.

You see, there is some stress you can decrease or even eliminate from you life. For example, if you have a pain-in-the-you-know-what friend, you can choose to have less interaction with him or her or even get rid of them completely. Yes, you can actually do that.

But other stresses are simply out of your control. No matter where you live and what you do for a living, there will always be some stress in your life.

What you can change DRASTICALLY is how you deal with stress.

There is a popular saying, “Embrace the grind.” You can also, “Embrace the stress.”

Motivational speaker Wayne Dyer is quoted as saying, “When you change the way you look at things, the things you look at change.”

This is why two people can live the exact same life and one can be happy and the other miserable.

Choose to be the happy one.

Sincerely,

Dr. Binder

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