Whiplash Anatomy.

28 May

Whiplash is an injury commonly associated with motor vehicle collisions (MVC) caused by a rapid forward and backward “whipping” of the neck. What varies between each case is the degree of injury and what anatomical parts of the neck are actually injured. Let’s take a look at the spine so we can better understand where the pain actually comes from…

The cervical spine is made up of seven moving vertebrae. The top vertebra (C1) is called the atlas and is shaped like a ring. This ring shape allows the head to rotate left and right so we can check traffic, carrying on conversation with someone sitting off to the side, and so on. It pivots around a peg called the “dens” of C2, or the axis, and the function of these first two vertebrae is very important. This is because the upper most three nerves that exit through this part of the cervical spine innervate the head and dysfunction here may be the cause of some headaches. Chiropractic adjustments concentrate a great deal on restoring function to this area. The C4-6 vertebrae make up the most mobile region of the spine in the forward and backwards directions. Generally, the greater the mobility, the lesser the stability, and because of this, injury to this area is quite common. We often see arthritis in this region first and we focus on keeping the areas that are less mobile (areas above and below C4-6) as mobile as possible. The upper back/lower neck area includes the rib / vertebrae joints, which are also commonly involved in whiplash injuries. Chiropractic adjustments applied to this region also help to restore function and mobility. The thoracic spine is made up of 12 vertebrae and includes the rib cage as well as the shoulder blades (scapulae). This area is sometimes neglected during treatment as the main focus is often placed on the more painful areas of injury like the neck. The lumbar spine consists of five vertebrae and is also frequently overlooked as an injured area due to the distance away from the neck. However, seat belts frequently injure the breast, chest, mid-back, and/or low back regions.

There are several tissues that could be injured. The ligaments — the tough, non-elastic tissue that holds bone to bone — function to maintain stability between the vertebrae. The articular capsule is also made of ligaments and is a frequently injured area, which generates pain with movement of the head and neck. Muscles and the tendon attachments are elastic and function to move the structures. Stability is facilitated by good muscle tone and strength and is a strong focus of treatment. Injury to these structures are called, “…soft tissue injuries,” and make up the majority of whiplash associated disorders (WAD II category).

The intervertebral disks are made up of a fibroelastic cartilage on the outside and a more liquid-like center that functions as shock absorbers between the vertebrae. Injury to the disk includes tears, cracks, and/or fissures where the liquid center part can migrate through and can rupture. Injury to the nervous tissues includes the free nerve endings when the articular capsule is “sprained.” Nerve root injuries are most commonly “pinched” or compressed by a “ruptured disk” and send pain, numbness, and/or muscle weakness to specific areas of the arm and/or hand. These injuries are classified as WAD III injuries and usually carry a worse prognosis than WAD II injuries.

Determining which tissues are injured, managing the acute, subacute, and chronic stages of healing and facilitating self-management strategies are the primary goals of chiropractic treatment of the whiplash injured patient.

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 Whiplash, we would be honored to render our services.

Fibromyalgia in Men?

27 May

Fibromyalgia (FM) can’t occur in men because it’s a woman’s disease, right? In fact, if a man claims to have FM, then he is simply lying (probably just trying to get out of working and/or on disability), right? Unfortunately, that’s what MANY people (and even some doctors) believe!

Though it is true that FM is primarily a woman’s disease, actually nine times more likely, it does INDEED affect men. FM affects 2-4% of the population (an estimated 5 million adults) in the United States (US) with as few as 10% of victims being men. But, that’s still 500,000 men in the US alone, and that doesn’t include an estimated 20% that go undiagnosed (mostly because “men are men”)! The onset, like that for women, can occur, “….out of the blue.” Case studies show a man (or woman), can be highly engaged in an active lifestyle that may include golfing, bowling, or working on a hobby car, when suddenly and for no apparent reason, intense chronic pain can arise and, “…take over the life” of this previously very healthy, vibrant, active man.

We’ve all learned that FM is diagnosed primarily by excluding other disorders after running many tests including x-rays, various scans, lab tests, and more. When all the tests come back negative, the diagnosis of FM is even then only sometimes entertained. The word, “SOMETIMES” should be strongly emphasized as MANY doctors, as well as the general public, STILL have a hard time wrapping their heads around the diagnosis of fibromyalgia. This happens even more when a male patient presents with the FM cluster of symptoms. A male patient may attend a FM support group and be the only man in the room. The National Fibromyalgia Association has only one male board member who reportedly was not initially welcomed! This particular male reported that a neurologist refused to see him, as he did not support the diagnosis and openingly accused him of trying to get disability payments. He stated that it was particularly challenging to find professional care as well as community support. Even his best friend, a doctor, told him that men couldn’t get FM!

The cause of FM remains elusive. Why do so few men compared to women suffer from FM? Though certain types of viral infections, trauma after car accidents, and emotional stress have all been reported to trigger FM, it can also strike without warning. According to Dr. Muhammad B. Yunus, MD (professor of medicine at U. of Illinois, College of Medicine), FM is characterized by an imbalance of brain chemicals described as, “…a neurochemical disease.” He found that FM patients have higher than average levels of substance P (a neurotransmitter that signals pain), and lower levels of serotonin (a neurotransmitter that inhibits pain). Genetics and hormones (particularly estrogen, which is higher in women) also play a role both with causing the disease and with the gender discrepancy found in FM. Estrogen has also been found to reduce pain thresholds, a problem associated with FM, thus making women more susceptible to the disease. Like in women, men can have similar complications including (but not limited to) chronic fatigue, difficulty sleeping, headaches, irritable bowel syndrome, restless leg syndrome, and memory and concentration problems. But, it has been reported that men with FM usually have less wide-spread or, “…hurt all over” pain and may not suffer from as much fatigue, but in some cases, can still be more disabled from FM than women. Depression and suicidal thoughts are reportedly common in men with FM. Prompt diagnosis and treatment continues to be the recommended course in order to obtain ideal management results!

As chiropractors we can offer management, treatment, exercise training, dietary consultation, and coordinate care.

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

Chiropractic & Exercise vs. OTC Medication for Neck Pain?

26 May

“Boy, my neck is killing me! Honey, where is the ibuprofen?” Isn’t this the FIRST thing people think of when they have an ache or pain? The general public does NOT usually think, “….boy, do I need to see my chiropractor – my neck is killing me!” So, the question of the month is, which one is better, chiropractic or over-the-counter (OTC) medication? Let’s take a look.

Though this question has been discussed for years (just search: “chiropractic vs. NSAIDs”), a recent study looked specifically at this question, which will be the main focus of this Health Update. The study points out that it has been estimated that 75% of Americans will experience neck pain at some point in their life. For years, spinal manipulation has been criticized as being ineffective or providing limited benefits. Meanwhile, ads on TV, in magazines, and almost everywhere you look, show someone reaching for aspirin, ibuprofen, or even narcotics to manage their pain.

However, this new research clearly supports that seeing a chiropractor and/or engaging in light exercise can bring neck pain relief more effectively than relying on pain medications! Researchers even found that the benefits of chiropractic adjustments were still favored A YEAR LATER when comparing the differences between the spinal manipulation and medication treated groups! Moderate acute neck pain is one of the most frequent complaints prompting appointments at primary care/medical clinics and is estimated to account for millions of doctor visits per year. In some cases, pain and stiffness occurs without a known cause and there is no “standard” medical treatment. Though physical therapy, pain medication, and chiropractic have all been utilized for neck pain, until now no one had compared the benefits of each in a single study.

The study consisted of 272 neck pain subjects split up into three groups: 1) Chiropractic group (approximately 20-minute treatments an average of 15 times); 2) Pain medication group (meds included acetaminophen, and in some cases stronger prescription meds including narcotics and muscle relaxants); 3) Physical Therapy group (consisting of meeting twice and receiving advice and exercise instruction at 5-10 repetitions up to eight times a day).

At the end of three months, the chiropractic and exercise group did significantly better than those who took drugs. Approximately 57% of those receiving chiropractic management and 48% of those who did the exercises reported at least 75% reduction in pain vs. 33% of people in the medication group. A year after the treatment period ended, the numbers decreased to 53% in the chiropractic and exercise groups, compared to 38% in pain medication group. The chiropractic group received the highest scores in patient satisfaction at all time points. An interesting downside noted in the medication study group was that the subjects had to use a progressively greater amount of medication at a progressively increased frequency to manage their pain. Stomach trouble is the most common side effect of NSAIDs (leading to ulcers) as well as liver and kidney problems. Another interesting finding was that the subjects in the medication treated group felt less empowered, less active, and less in control over their own condition compared with those in the other two groups.

This study points out the benefits of two treatment approaches that chiropractors commonly utilize: spinal manipulation and exercise training/advice!

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.

The “Aging” Lower Back – Part 1.

26 May

Low back pain (LBP) can arise from many causes. Nearly everyone has or will suffer from LBP at some point in time, though it is most common in the 30-year-old to 50-year-old group and it affects men and women equally. However, what about the elderly population and low back pain? Let’s discuss back pain unique to the geriatric population…

We’ve all heard of the “wear and tear” factor as it applies to clothing, automobiles, shoes, and tires, but it affects our bones and joints too! A condition that none of us can fully avoid is called osteoarthritis (OA). OA is the “wear and tear” factor on our joints, particularly the smooth covering called hyaline cartilage located on the surfaces of all moving joints. It’s the shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when we separate it from the thigh. Osteoarthritis is the wearing away of that shiny, smooth surface and it can eventually progress to “bone-on-bone” contact where little to no movement is left in the affected joint. Bone spurs can also occur and be another potential generator of back pain. OA is NOT diagnosed by a blood or lab test but rather by an accurate history, physical examination, and ultimately, an x-ray. However, when the low back is affected by OA, it may not even hurt! Yes, in some cases, there may be a significant amount of OA on an x-ray and that patient may not have significant problems. Or the opposite can occur and some patients with very little arthritis can have a lot of back trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is that, in and of itself, it does not always generate pain. This is why the history, physical examination, and the response to treatment (chiropractic adjustments, exercise, and possibly some lifestyle changes in diet and activity) are MORE important than the amount of arthritis found on the x-rays. Ultimately, we will ALL get OA sooner or later. It’s usually a slow, gradual process that may slowly change our activity level. Ironically, KEEP MOVING is the best advice we can give to the patient with OA.

There are a number of conditions associated with OA that affect the spine and respond well to chiropractic treatment. Degenerative disk disease (DDD) is one of those conditions found in association with OA. In fact, another name for OA is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and a central “nucleus” that is more liquid-like and allows the IVD to function like a shock absorber. As we age, the water content gradually “dries up” and the shock absorbing quality is lost.

As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE treatments but most important (in many cases) is the use of spinal manipulation or adjustments. “Exercising the joint” with manipulation and mobilization reduces the tightness and stiffness associated with OA and DDD. Exercises are also important and can give the OA/DDD patient a way of controlling this condition on their own. Diet, activity modification/encouragement, and periodic adjustments help a lot! Next month, we will continue this discussion!

America May Have Reached the Tipping Point and is Now Making Healthier Choices.

23 May

You have 20,000 to 26,000 genes that, left to their own devices, would determine how long and well you lived. But they are never left to their own devices. As we have related in a past column or two, most of your DNA consists of switches that control -turn on or off – your genes and your food choices, activities, even how often you meditate control which of your genes are turned on or off. That’s why we say you have lots of control over how long and well you live. Now, three headlines that make me think America has hit a tipping point for better health:

1. “Healthcare costs the same in 2012 as in 2011 (as a percent of GDP)”,
2. “CVS to discontinue selling tobacco products in October 2014”
3. “Americans’ Eating Habits Take a Healthier Turn (Study Finds)”

Why the tipping point? The third headline, from the USDA, was followed by a story on calorie consumption, saturated fat consumption, and vegetable consumption. Americans ate more calories every year between 1983 and 2005 (a whopping 900 calories more per day per person in the USA in 2005 versus 1983). No wonder we got overweight! But from 2005-6 to 2009-10, we ate 118 fewer calories per day! Saturated fat consumption declined 5.9%, and vegetable intake increased over that five-year period. WOW!

The second headline also implies Americans are making healthier choices. If CVS is saying “good bye” versus “good buy” to Tobacco sales ($2.5 billion dollars a year for them and related items purchased by smokers) and its profits, they must have found from focus groups that America is willing to invest in preventing chronic disease.

Since chronic disease from tobacco, physical inactivity, food choices, portion size, and unmanaged stress accounts for over 70% of our health costs, this tipping point for
tobacco is huge for us as a society (assuming we don’t replace this vice with something just as bad or worse).

And America is going to be more competitive (the first headline) because we’re spending less on health (17.3% of GDP is enough). Whether due to cost transparency, better outpatient management (a decline in over 5% in hospital admissions also occurred, WOW), or to less chronic disease, America will be more vibrant for jobs.

Maybe we’ve reached a tipping point. Maybe all this discussion about Healthcare reform and the dollars each of us will be spending on illness care has motivated us to make healthier choices.

Thanks for reading,

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.

Eye Charts and Vision.

23 May

The Snellen eye chart was created by Herman Snellen, a Dutch eye doctor, in the 1860s. Another popular chart used during eye exams is the Tumbling E chart which features capital letter E’s facing in different directions. This chart comes in handy when young children who don’t know the alphabet are being tested, or for people who don’t know the English alphabet. Rather than say a letter, they can pick the smallest line of E’s that they can see, and say or point which way the “arms” of the E in that line are facing. Numerous studies have shown that this chart and the Snellen chart come up with nearly the same results.
Around one million people aged 40 and older in the United States (US) are considered legally blind. To obtain a driver’s license in the US, you need to have at least 20/40 vision or better. If you can read the fifth line of text on the Snellen chart from 20 feet away, you are considered to have 20/40 vision.
Cataracts, the clouding of the lens inside the eye which leads to decreased vision, affects 22 million Americans aged 40 and older. Around half of Americans will have suffered from cataracts by age 80. The medical costs relating to cataract treatment nationwide is estimated at $6.8 billion every year.

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