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.

New Research: How Video Games Change You In The Real World!

22 May

If you play video games, you are not alone. According to the Entertainment Software Association, as of 2013, 58% of Americans play video games. There is an average of two gamers in each game-playing household in the United States (US). The average US household owns at least one dedicated game console, PC, or smartphone. Fifty-one percent of US households own a dedicated game console, and those who do, own an average of two. The average age of a game player is 30 years old and there are more people over the age of 36 playing video games (36%) than between the ages of 18-35 (32%), with 32% being under the age of 18. With so many people playing, and with such a wide age group, the finding of a new study could be very important.
The study reported by the Association for Psychological Science found that how you represent yourself in video games may affect the way you behave and treat others in real life. They reported, “Our results indicate that just five minutes of role-play in virtual environments as either a hero or villain can easily cause people to reward or punish anonymous strangers.” One experiment studied 194 undergraduates. The participants were randomly assigned to a villain, hero, or neutral avatar in the game. They played the game for five minutes. During that five minutes, their avatar (their identity in the game) fought against enemies. After the five minutes ended, the participants took part in a taste test that they believed was not part of the study. In this taste test, they were asked to taste both a chocolate and a chili sauce and then decide which one and how much to give to the next participant.
According to the Association For Psychological Science, “The results were revealing: Participants who played as [the hero] poured, on average, nearly twice as much chocolate as chili sauce for the ‘future participant.’ And they poured significantly more chocolate than those who played as either of the other avatars. Participants who played as the villain, on the other hand, poured out nearly twice as much of the spicy chili sauce than they did chocolate, and they poured significantly more chili sauce compared to the other participants.”
A second, similar experiment of 125 graduates confirmed these finding. According to the lead author of the study, “In virtual environments, people can freely choose avatars that allow them to opt into or out of a certain entity, group, or situation… Consumers and practitioners should remember that powerful imitative effects can occur when people put on virtual masks.”

The Many Faces of Carpal Tunnel Syndrome.

21 May

Carpal Tunnel Syndrome (CTS) was first reported in the late 1800’s and the first surgery was noted in 1933. In the beginning, CTS surgery was rarely performed, reportedly because the nerve pinch was present somewhere before the median nerve reached the wrist or carpal tunnel. In brief, possible compression sites include the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the elbow, in the proximal and/or mid forearm, and finally at the wrist / carpal tunnel.

Estimating the frequency of CTS is challenging due to the fact that the pinch or entrapment may include more than one area before the wrist resulting in double and multiple crush syndromes. One European study reported the incidence of CTS at 5.8% in women and 0.6% in men while another reported 3.4% in the United States. Even the causation of CTS is all over the board. For example, the annual incidence of CTS in automobile workers ranges between 1-10%, while in a fish processing plant, it was reported to be as high as 73%! To make this even more challenging, the cause of CTS is commonly associated with other conditions such as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and those who are pregnant have a 2% incidence. Even harder to report is the incidence of median nerve pinching proximal to the wrist as this ranges between as little as 1% to as high as 75% for pronator tunnel syndrome in already symptomatic women. Gender is also a factor as women are reported to be four times more likely to develop CTS than men. If there is NO other condition associated with CTS, the term “idiopathic” is applied, and this reportedly occurs 43% of the time.

Another issue making CTS a challenge to diagnose is the many risk factors associated with it, and sometimes studies are published that contradict one another about the possible risk factors. There are studies that report CTS is more likely to occur with conditions including: 1) Jobs or activities associated with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3) Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study reported the highest incidence to occur in those with previous wrist fracture (Colles’ fracture), and common conditions included rheumatoid arthritis, hormonal agents or ovary removal, diabetes, and pregnancy. Another study reported obesity and hypothyroid as being risk factors, but not all studies support that theory. Certain medications have been reported to be associated with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3) Metformin; and 4) Thyroxin.

As doctors of chiropractic, we perform a thorough history, examination, and offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder, elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3) Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm and hand; 5) Work station / ergonomic evaluations; 6) Dietary counseling for various conditions listed previously; 7) Co-management with primary care, rheumatology, neurology, orthopedics, and others.

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.

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