Neck Pain and Smoking – What’s the Connection?

3 Feb

There is a lot of convincing peer reviewed literature (research) that supports chiropractic as one of the first and best courses of care to consider when choosing a treatment option for neck pain and headaches. This is because there is low risk, few rare side-effects, and most importantly, IT REALLY WORKS!  But, there are other considerations in the management of neck and headache pain that perhaps we haven’t thought about. One is smoking.

There are several convincing studies that have looked at the exposure to tobacco smoke and smoking in terms of its effect on neck pain. Let’s look at some statistics. One study reported that as many as 213 per 1000 people reported neck pain. The 12-month prevalence of neck pain ranged between 30-50% of which activity-limiting pain was reportedly as high as 11.5%. Women were found to be more at risk than men which peaks in middle age. Risk factors for neck pain include genetics, poor psychological health, and EXPOSURE TO TOBACCO. Interestingly, smoking / exposure to tobacco is listed as a risk factors but disk degeneration is not! Researchers also pointed out that the use of equipment made to prevent injury to the head/neck such as helmets and face shields was NOT associated with increased risk for neck injury in bicycling, hockey or skiing as some have suggested that wearing protective head gear increases vulnerability to injury. THIS IS NOT THE CASE, so wear your helmet! This study concluded that there are some things we can’t modify regarding increased risk of developing neck pain (such as gender, genetics, and age); however, the modifiable risk factors of smoking, exposure to tobacco, and psychological health CAN be helped so that’s the LEAST WE SHOULD DO!

Two new studies show that smoking is directly tied to neck / back pain and the development of arthritis. Interestingly, the Harvard study reported that the risk of developing psoriatic arthritis was twice as high for current vs. past smokers, and both current and past smokers were at greater risk when compared to those who had never smoked. The 2nd study (Paris, France) found that smokers had an earlier onset of inflammatory back / neck pain and a worse course of the disease than non-smokers. Taking these two studies together, the interactions between environmental factors and the onset, the degree of severity and the ultimate outcomes of rheumatic diseases, “…it’s becoming increasingly clear how detrimental the influence of smoking is on most of these diseases.” The worst scenario was found in those who smoked >25 years and, >20 “pack years” (>1 pack/day for 20+ years).  The “bottom line” is that smoking and exposure to smoke have significant negative health affects, not only for present health, but also for future pain, suffering and quality of life. Thankfully, it’s been shown that if you quit smoking, the likelihood of improved health affects is high so of course, QUIT NOW and you’ll be ahead of the curve.

In fact, a conscientious surgeon recommending a spinal fusion may say, “…you must quit smoking or else I will not perform the surgery that you need.” The reason for this insistence is because the risk of fusion failure goes up 500% in smokers (fusions are needed in certain types of back and neck surgeries).

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

Whiplash: Does Chiropractic Work?

3 Feb

The term “Whiplash” is associated with neck injuries that frequently occur as a result of motor vehicle collisions. There is much published about how injury occurs, the most compelling of which is that we simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer. The question this month is, does chiropractic work in managing patients with whiplash associated disorders (WAD)?

To answer this, a study published in the Journal of Orthopaedic Medicine reported that chiropractic was indeed superior to standard medical care. Most importantly, they studied chronic whiplash patients that (typically) are more challenging to treat compared to the acute, more recently injured whiplash patient.  Their article starts out with the statement, “…conventional treatment of patients with whiplash symptoms is disappointing.” The term “conventional treatment” means medical (non-chiropractic) treatment. One of the studies referenced by the authors reported 26 of 28 patients suffering from chronic whiplash syndrome benefited from chiropractic treatment. The term “chronic” means that those injured have had ongoing complaints for longer than 3 to 6 months, and typically are less likely to respond compared to those more recently injured (acute injuries).

The authors interviewed 100 consecutive chiropractic patients being treated for chronic whiplash of which 93 completed the entire study. Those 93 were divided into 3 symptom groups: Group 1 consisted of neck to shoulder area pain, restricted neck movement with no neurological injury; Group 2 consisted of neck pain, restricted movement, and neurological loss; Group 3 consisted of severe neck pain but had full/normal neck movement, no neurological loss, but had unusual symptoms including blackouts, visual disturbance, nausea, vomiting, chest pain, and non-anatomic neurological complaints, which means the pain or numbness does not correlate with exam findings or were inconsistent.  An average of 19.3 chiropractic adjustments over a mean 4.1 month duration were rendered after which time the patients were surveyed and the results are as follows (“asymptomatic” = no pain or symptoms):

Group 1: 24% Asymptomatic, 24% Improved by 2 symptom grades, 24% Improved by 1 symptom grade, 28% No improvement.

Group 2: 38% Asymptomatic, 43% Improved by 2 symptom grades, 13% Improved by 1 symptom grade, and 6% No improvement.

Group 3: 0% Asymptomatic, 9% Improved by 2 symptom grades, 18% Improved by 1 symptom grade, 64% No improvement, and 9% Got worse.

In their discussion, they reported that similar to the study where chronic symptoms improved in 26 of 28 patients (93%), here 69 of 93 patients improved (74%). They identified a “non-responders” group (Group 3), where neck movement was normal in spite of pain, bizarre symptoms, and ongoing litigation. The mean age was lower in this group vs. the other two (29.5 vs. 36.8 years old). They concluded, “The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment highlights the need for a careful history and physical examination before commencing treatment.” Bottom line, try chiropractic FIRST!!!

 

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Low Back Pain and Sleep.

29 Jan

Low back pain (LBP) can arise from a lot of causes, most commonly from bending, lifting, pulling, pushing, and twisting. However, there are other possible causes, including sleep. This not only includes sleeping in a crooked or faulty position, such as falling asleep on a couch, in a chair or while riding in a car, but also from the lack of sleep. So the question is, how much sleep is needed to feel restored and how much sleep is needed to avoid low back pain?

It’s been shown that the lack of sleep, or chronic sleep loss, can lead to serious diseases including (but not limited to): heart disease, heart attack, heart failure, irregular heartbeat, high blood pressure, stroke and diabetes. Sleepiness can also result in a disaster; as was the case in the 1979 nuclear accident at Three Mile Island, the oil spill from the Exxon Valdez, as well as the 1986 nuclear disaster at Chernobyl. With sleep deprivation, our reaction time is slowed down, and hence, driving safety is a major issue. The National Highway Traffic Safety Administration estimates that fatigue causes more than 100,000 crashes per year with 1500 annual crash-related deaths in the US alone. This problem is greatest in people under 25 years old. Job related injuries are also reportedly more frequently, especially repeat injuries in workers complaining of daytime sleepiness which resulted in more sick days. It’s also well published that sleep plays a crucial role in thinking and learning. Lack of sleep impairs concentration, attention, alertness, reasoning, and general cognitive function. In essence, it makes it more difficult to learn efficiently. Also, getting into a deep sleep cycle plays a critical role in “consolidating memories” in the brain, so if you don’t get to a deep sleep stage (about 4 hours of uninterrupted sleep), it’s more difficult to remember what you’ve learned. An interesting study (U. of Pennsylvania) reported that people who slept less than 5 hours/night for 7 nights felt stressed, angry, sad, and mentally exhausted. As shown in another study of 10,000 people, over time, insomnia (the lack of sleep) increases the chances by 5-fold for developing clinical depression. Other clinical studies have published many other negative effects of sleep deprivation, of which some include aging of the skin, forgetfulness, weight gain, and more.

Regarding low back pain, what comes first? Does LBP cause sleep interference or does sleep deprivation cause the LBP (or both)? It’s been shown that sleep loss can lower your pain threshold and pain tolerance, making any existing pain feel worse, so it works both ways. Specific to LBP, in a 28-year, 902 metal industry worker study, sleep disturbances (insomnia and/or nightmares) predicted a 2.1-fold increase in back pain hospitalizations with one and a 2.4-fold increase with both sleep disturbance causes (insomnia and nightmares). Other studies have shown patients with chronic LBP had less restful sleep and more “alpha EEG” sleep compared to controls. Similar sleep pattern differences using EEG (electroencephalogram – measures brain waves) have been shown when comparing chronic LBP patients with vs. without depression compared to controls (non-LBP, non-depressed subjects).

So the BOTTOM LINE, talk to us about how chiropractic helps reduce LBP, stress and facilitates sleep. There are also nutritional benefits from Melatonin, valarian root, and others that we can discuss. Now, go to bed and get a good night’s sleep!

We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

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Carpal Tunnel Syndrome – Prevention Tactics.

29 Jan

Carpal Tunnel Syndrome (CTS) is a very common problem that is often associated with work related activities. Our focus this month is on how to prevent CTS. Of course, if you already have CTS, read this Health Update to learn preventative measures that also work while you receive treatment for CTS.

The concept is to think about prevention as a matter of economics; as you lose time from work because of CTS, if affects your bottom line, and I’m sure you have bills to pay and mouths to feed (…or, at least one)! So please take the advice offered here seriously, as we are genuine about our concern for your well-being and not losing work time is a huge component of all of our “well-being!”

If you’ve experienced sore wrists, hands, sudden sharp jabs of pain up the forearm, noted numbness and/or burning in your fingers (especially the index through 4th / ring finger), wake up at night needing to shake and flick your fingers to “wake them up,” have weakness in your grip strength, are slowing down at work (whether it’s typing/computer work, assembly line work, cooking, waitressing, and so on), you NEED to do the following NOW! The goal here is prevent work loss and surgery (as up to 6 weeks lost work time will be required if surgery is needed).

Anti-inflammatory measures: This starts with a healthy diet. STOP eating foods that inflame such as omega 6 rich foods (“GOOGLE” omega 6 and print out the list of food). Emphasize fruits, vegetables, lean meats, nuts and AVOID grains because of glutens, which many of us have a sensitivity against. Vitamins such as a multiple, magnesium, fish oil (omega 3’s), Vitamin D3, and CoQ10 are GREAT! Freeze water in a small cup and rub it on the wrist/carpal tunnel until it gets numb (takes 3-5 minutes) and do that 2-3 times a day. Consider natural anti-inflammatories such as ginger, turmeric, cercumen, bioflavinoides and others.

Stretch: Bear-claw, fist, “High-5” (opened hand with the fingers fanned out) reps, wrist extensions on the wall/table stretches (elbows straight).

Rest: Cock-up splint, take mini-breaks, and get sound/restoring sleep. IT REALLY HELPS!

Ergonomic modifications: Position your computer keyboard, mouse and monitor so that you are looking straight ahead at a slight downward angle and your elbows are at a 90° or slightly less of an angle when typing. Set an alarm on your computer to go off every 15 minutes as a reminder to “shake and flick” your hands, wiggle your fingers, do your stretches, and/or squeeze a soft ball. Write with a fat pen vs. a skinny one – this helps a lot!

Weight management: Obesity is a common risk factor for developing CTS.

Manage other health issues: Diabetes, thyroid disease, inflammatory arthritis, neck/shoulder or elbow problems can all contribute to or, even cause CTS.

Think of the above measures as minimums and obtain professional care to help you. You have choices between the traditional medical model of cortisone shots, anti-inflammatory medication, and surgery vs. chiropractic: manipulation and mobilization of the fingers, hand, wrist, elbow, shoulder and neck as needed, splinting at night, anti-inflammatory diet and nutrients, ergonomic modification and exercise training, which ALL will help to treat as well as prevent future CTS problems, EVEN IF you’ve had surgery already!

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

 

Breast Cancer and Exercise.

29 Jan

The Most Important Principles For Staying Young: 

Breast Cancer and Exercise

 

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

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 your quality and length of life.

This month, we wonder…

If Exercise Is So Good As A Preventive Strategy, Then Why Do So Many 

Great Women Athletes of the Recent Past Get Breast Cancer?

Arnold said it best: “I don’t know an athlete who hasn’t given up her body for her sport.” Yes, a little intense exercise prevents breast cancer, but too much promotes it. We’ll tell you the appropriate amount for best health and to best prevent breast cancer below (don’t peak). But first, why does intense exercise for prolonged periods cause breast cancer if a little intense or even moderate exercise prevents it?

The key is how many free radicals you produce (exercise produces them inside your cells; longer and more intense exercise produces more free radicals) and how many antioxidants you produce (it is the antioxidants you produce and have inside your cell when you exercise, not that you eat, that are key).

You see, the key to preventing abnormal DNA inside your cells is handcuffing the free radicals you produce as soon as you produce them with antioxidants inside you cell (before those radicals can do damage), and harmlessly escorting the cuffed (or bound to an anti) free radical out of your body. A little intense exercise actually helps your cells learn how to produce more antioxidants, that’s why a little regular, intense exercise is good.

But, too much intense exercise at once (think Olympic training regimen, or marathon) overwhelms most people’s inside the cell antioxidant producing capability. This promotes breast (and other) cancers, free radicals and wear and tear damage elsewhere.

As it turns out, you can run from breast cancer, if you do the right amount of exercise with the right intensity. Run, lift weights, do stretch bands, cycle, walk, swim – any regular, occasionally intense, exercise will slash your risk by up to 30%.  (Some studies show even active housework and gardening can make a difference.) A little vigorous exercise helps your cells learn how to produce antioxidants inside your cells, and you can benefit at any age.

So to answer the question, a little exercise really can fend off the biggies . . . like breast cancer. Bet on it!! Staying active reduces your odds of colon, pancreatic and prostate cancer (for men). Breast cancer rates are at least 33% lower in women who exercise regularly; in fact, two studies show just 20 minutes of daily walking cut them by 34 to 38%.

How does this work? Yes, moderate or intense physical activity helps you produce more antioxidants inside your cells to reduce DNA damage rates, but exercise also lowers specific hormone levels. Exercise also helps you decrease inflammation, which helps make it more likely you’ll live without disability from heart disease, stroke or memory loss. Physical activity also reduces body fat and triggers a chain reaction: Less fat, less estrogen, and less inflammation, and… less cancer risk.

So, what’s the best routine according to the data? #1) General physical activity every day (10,000 steps every day, no excuses). #2) Two days of strength training for just 15 to 30 minutes each of the two days.  It’s form (shoulders back and relaxed, core centered and strong, pelvis tucked in very slightly) and repetitions (3 sets of 12) that get results. #3) 20 minutes of cardio (raising your heart rate to at least 80% of your age-adjusted max) three times a week, with one minute as intense as your doc says you can go every 10 minutes. This triple combo will make you stronger, more relaxed and healthier in many ways, from dodging cancer and heart disease to keeping your mind sharp and your emotions calm.  Remember, there are other things to add, like daily cruciferous veggies, avoidance of getting too big a waist, and two baby aspirins with a half glass of water for maximum prevention of breast cancer (only if your doc agrees).

Thanks for reading.

Young Dr Mike

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fibromyalgia “101”

29 Jan

Fibromyalgia (FM) is a disorder that includes widespread musculoskeletal pain along with fatigue, sleep disturbance, memory changes, mood changes and more. Studies show that FM amplifies or increases painful sensations by changing the way the brain processes pain signals. FM is NOT a psychological disorder that only people with a troubled past or present acquire. Nor is it due to being inactive or lazy. If ANY doctor suggests that, PLEASE find a different doctor who understands the pathogenesis of FM. Unfortunately, this can be a challenge!

FM symptoms can begin after a physical trauma, surgery, an infection and/or after a significant stress experience. It can also just gradually appear over time without an obvious triggering event. Women are more vulnerable to acquire FM than men. Many FM patients have other conditions that may be associated with FM including (but not limited to) headache, TMJ, irritable bowel syndrome, anxiety, depression, thyroid/hormonal imbalances, endometriosis, and more.

Though the cause of FM may not be clearly identified, studies suggest there are a variety of factors that work together resulting in FM. Some of these include genetics, infections and physical and/or emotional trauma. Because FM tends to run in families, there may be certain genes or genetic mutations (changes that occur to genes) that make one more susceptible to developing FM. Infections appear to be a trigger for developing or aggravating FM. Post-traumatic stress disorder and less obvious physical or psychological trauma has been linked to the development of FM.  The amplified or heightened pain response has been termed, “central sensitization,” meaning, increased sensitivity to normal pain stimulation in the central nervous system (brain and spinal cord). Because of this heightened nervous system response, what normally isn’t processed as pain in the non-FM person, does reach and exceed the pain threshold in the FM patient (sort of like when amputation of a limb occurs and the brain still “thinks” there is a limb and “phantom pain” is felt). Studies show that repeated pain signals result in an abnormal increase in certain brain chemicals (called neurotransmitters). As a result, the brain’s pain receptors seem to develop a “memory” of the pain and become “sensitized” or they overreact to the pain signal input and pain is felt at an increased intensity. Certain risk factors come into play with developing FM, some of which include: your sex (female), family history (increased risk if other family members have FM), and rheumatic diseases such as rheumatoid arthritis and lupus.

Tests to establish the diagnosis of FM are few. In 1990, the American College of Rheumatology established 2 criteria for diagnosing FM. The first is widespread pain lasting at least 3 months, and the second is the presence of at least 11 out of 18 positive tender points. Since then, less emphasis has been placed on the exact number of tender points, while ruling out other possible underlying conditions that might be causing the pain is now utilized. There is no lab test to confirm a diagnosis of FM, but blood tests including a complete blood count, an ESR, and thyroid function tests are commonly done to rule out other conditions that have similar symptoms. Treatment is best approached by a “team effort” combining the skills from multiple disciplines including a primary care doctor who “believes in FM” and is willing to work with chiropractors, and others. Exercising, pacing yourself, accepting your limitations, yoga, psychological counseling, nutritional counseling, and having strong family/friend support are all important in the management of FM.

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

 

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