The Pelvic Floor & Low Back Pain

3 Jun

The pelvic floor is the muscular “hammock” that carries the weight of the viscera located in the pelvis. If these muscles become too loose or too tight, an individual may experience urinary (or fecal) urgency or incontinence, sexual dysfunction, pelvic organ prolapse, as well as pain in the pelvic region and even in the lower back.

This condition, known as pelvic floor dysfunction (PFD), most commonly affects women (95% of PFD patients are female) with advancing age and a history of multiple childbirths. Many women have PFD but often do not complain about it due to embarrassment or “just accepting it as part of having babies” or “just part of aging.” However, the condition can be addressed so that its effect on quality of life is reduced, and a doctor of chiropractic may play a role in managing the condition.

Patients with weak pelvic floor muscles (hypotonic PFD) often benefit from Kegel-type exercises where the patient “pulls-up” (or “draws inwards”) the perineum, as if to stop or prevent urination and/or defecation. Unlike classic Kegel exercises with a short hold time (more rapid frequency), PFD exercises should be done with 10 second holds and gradually increase the number of reps to 30 to obtain muscle fatigue. Although some doctors recommend doing these exercises virtually anywhere and anytime, the KEY is to do them very consciously (using visualization)!

It is important to AVOID abdominal bracing (tightening up the abdominal muscles) because this INCREASES the pressure against the pelvic floor. Keep the stomach, buttocks, and inner leg muscles relaxed, and don’t hold your breath. Try exhaling as you do the exercise. When you sense a sneeze or cough coming, squeeze the pelvic floor to support the bladder.

For patients with tight (hypertonic) pelvic floor muscles, studies recommend manual therapy, scar tissue manipulation, modalities (ultrasound or e-stim), massage, breathing re-training, cognitive behavioral therapy, and meditation.

Both hypotonic and hypertonic PFD may be co-managed with an OB/GYN or the patient’s medical physician with supporting care provided by their doctor of chiropractic. A doctor of chiropractic can address musculoskeletal issues in the pelvic region and lower back with manual therapies (including manipulation and mobilization) to reduce pain and relieve pressure on the pelvic floor. The good news for individuals with PFD is that the condition is manageable, and you don’t have to accept it as a normal consequence of life!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Smartphones and Neck Pain, a Different Approach

27 May

In the last decade, the increased use of smartphones, tablets, and other electronic devices has resulted in more and more individuals taking on a slumped posture as they spend excessive amounts of time looking down to check email, browse the web, play games, or use social media. This forward head posture can place added strain on the neck and mid-back, increasing the risk for pain in these areas.  That’s hardly news to anyone. However, is it possible these same devices can be used to manage one’s neck pain?

In 2017, researchers conducted a study using a smartphone app designed for office workers with neck pain. Based on the users’ responses to questions about the nature of their neck pain, the app provided an individualized neck exercise program to be used for ten to twelve minutes a day, three days a week, for eight weeks. At the conclusion of the program, the participants reported significant improvement in neck pain intensity and disability and improved quality of life. However, the app did not appear to improve fear avoidance behavior or cervical range of motion.

An experiment conducted in 2020 with an app that promotes neck pain self-management through stretching and deep breathing exercises found that this approach resulted in improvements with respect to pain intensity, muscle tension, pressure pain threshold, and cervical range of motion. 

Because there’s an abundance of research showing that neck-specific exercises can benefit patients with neck pain, these results aren’t very surprising. However, apps have the ability to remind users to perform their exercises and track their progress, which is important since exercise protocol adherence is often an issue.

For individuals with neck pain who are unable to manage their condition with exercise alone, chiropractic care can be an excellent choice. Doctors of chiropractic are trained to diagnose the root causes of a patient’s mechanical neck pain and to deliver manual therapies to restore motion to the affected joints, which can reduce pain and disability. Treatment may also involve nutritional recommendations to aid the healing process and the prescription of specific exercises to strengthen weakened deep neck muscles and reduce the risk for neck pain recurrence.

While devices have become a part of life and advice to limit screen time will go unheeded, there are steps that can be taken to reduce one’s risk for device-related neck pain. For example, avoid looking downward when using an electronic device. Instead, hold it at eye level so you can maintain good posture. Additionally, get regular exercise as the stress of movement is how the joints in the body (including those in the neck) are nurtured and hydrated. Since low grade inflammation in the body may increase the risk for neck pain, get plenty of sleep, manage stress, and eat more fruits and vegetables (and less processed food). If you have any questions on which neck-specific exercises may be most beneficial for your individual case, ask your doctor of chiropractic at your next visit.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Whiplash and Mid-Back Pain

25 May

When it comes to whiplash associated disorders (WAD), injury to the cervical spine is generally the focus, but what about the mid back? Can this area be injured in a whiplash event?

According to the available research, not only can the mid back become injured in an automobile accident, slip and fall, or sports collision, but it’s surprisingly common. A review of data concerning 6,481 patients who had been involved in a motor vehicle collision found that 66% reported mid-back pain (MBP) and 23% still experienced pain in this region a year later.

The mechanism of injury helps us understand how MBP may happen and why it is so common.  The head weighs an average of 12 lbs (or ~5.4 kg)—similar to a bowling ball. The sudden acceleration and deceleration of the neck that occurs during whiplash can place significant strain on the soft tissues that connect the base of the skull with the mid and upper back.

A review of 38 studies that included over 50,000 WAD patients found that not only is MBP common following an automobile collision (over 60% based on the authors’ criteria), but mid-back pain intensity is higher in more severe WAD cases. Additionally, WAD patients experience heightened muscle activity in the neck and mid-back/scapular muscles, have an elevated risk for pinching the nerves that innervate the arm at both the neck and shoulder, are more likely to have myofascial pain and trigger points in the neck and mid-back muscles, and exhibit altered mid-back posture and reduced thoracic spine mobility.

Even if injury is isolated to the cervical spine, the mid back is not out of the woods. The thoracic spine can contribute to up to 33% and 21% of head-neck movement during cervical flexion and rotation, respectively. If mobility is reduced in the neck, then the thoracic spine must take on more of the load, which can increase the risk for overuse and injury.

Proper management of WAD requires treating the whole person and not restricting focus to just one area of the body, such as the neck. Doctors of chiropractic are trained to take this approach when evaluating a patient. Once a thorough examination has been completed, care often involves a multimodal approach that combines spinal manipulation, mobilization, and other manual therapies, along with specific exercises and nutritional recommendations to support the healing process.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Scapular Dyskinesis

20 May

The shoulder joint is really four joints—glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular—that all work in a coordinated manner to maneuver the upper arm. The shoulder blade, or the scapula, is an important player in normal shoulder movement because important muscles and related tissues are anchored in this bone. However, an issue with the scapula is easy to miss when diagnosing a patient seeking care for shoulder pain.

The main reason the scapula is overlooked is that when its position or motion is affected—a condition referred to as scapular dyskinesis—the patient may not initially experience pain or discomfort. However, though the condition may start in an asymptomatic manner, abnormal scapular movement can affect the motion of the rest of the shoulder, which can lead to the type of painful condition that drives a patient to their medical doctor or chiropractor’s office.

Indeed, the available research shows that patients with rotator cuff tears, glenohumeral instability, impingement syndrome, and labral tears often have scapular dyskinesis as well. One review found that between 67% and 100% of athletes with shoulder injuries have scapular dyskinesis. The same review noted that 54% of athletes in sports that require overhead motions had scapular dyskinesis.

Researchers have also observed abnormal scapular kinematics in sedentary, non-athletic individuals due to poor posture that places excessive strain on the upper back and neck to keep the head upright.

What can be done if a patient with shoulder pain exhibits scapular dyskinesis? First, treatment in a chiropractic setting might focus on manual therapies to restore normal motion to the affected joints. A doctor of chiropractic may also provide recommendations with heat and ice or nutrients to reduce inflammation. The patient will also be encouraged to perform at-home exercises as part of the recovery process.

A good starter exercise is to sit up tall by holding the head in line with the thorax (retract the chin), and “kiss” the scapula together followed by rolling the shoulders forward to separate the scapula WITHOUT shrugging the shoulders upward. Repeat this slowly, initially in front of a mirror, and concentrate on moving both sides rhythmically and equally. Eventually, do the same while on all fours or from a push-up position for something more difficult. Exercises that address forward head posture may also be recommended to reduce the load on the scapula caused by slouching.

As with many musculoskeletal conditions, the sooner a patient seeks care, the more likely they will achieve a successful treatment outcome—often in fewer visits—using conservative treatment approaches like chiropractic care.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Reducing Carpal Tunnel Syndrome in the Office

13 May

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed or restricted as it passes through the wrist. Because repetitive wrist and hand motions can inflame the tissues in the wrist and place pressure on the median nerve, workers in jobs that require such movements—such as those seated at a computer workstation all day—tend to have an elevated risk for the condition. That said, what can be done to minimize the risk?

A January 2021 study looked specifically at 1,000 office workers under age 50 from 30 workplaces in China. Participants completed a questionnaire that included information on demographics, work type, related physical and psychosocial factors, and wrist and hand symptoms using a body chart and a rating of the intensity of symptoms, nocturnal symptoms, and aggravating activities. Then, participants were clinically evaluated, and CTS was confirmed using standard testing protocols.

The authors reported that 22% of participants had wrist symptoms and 15% had hand symptoms, with 9.6% meeting the clinical criteria for CTS. Further analysis identified the following risk factors for CTS among office computer users: smoking, working with hand/wrist pain, prolonged computer use time, and working without breaks.

Mandatory breaks spread throughout the workday may be an effective strategy for reducing the risk for CTS among office workers. There is also strong research supporting the health benefits of integrating exercise with meditation during such breaks.

Meditation has been found to reduce stress and anxiety, as well as reduce chronic neck pain—another common complaint in the office environment. Incorporating physical activity during a short break will not only help lower the risk for CTS, but it may also reduce the risk for chronic ailments like cardiovascular disease and diabetes that are associated with high levels of sedentary behavior.

While it may not be possible to eliminate one’s risk for CTS, if hand and wrist symptoms are present, it’s important to seek care sooner rather than later because earlier intervention improves the odds for a satisfactory result. Doctors of chiropractic are trained to examine the whole person and look for all contributing factors in a patient’s chief complaint. With suspected CTS, it’s not uncommon to find additional areas along the course of the median nerve (the neck, shoulder, elbow, forearm) that need to be addressed to resolve the patient’s pain, numbness, tingling, and weakness symptoms.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

A Look at Resveratrol

11 May

Polyphenols are a group of over 500 phytochemicals, which are naturally occurring organic compounds produced in plants, that can reduce oxidative stress and inflammation in the body. Consumption of polyphenols has been reported to improve and help manage digestive disorders, obesity, diabetes, neurodegenerative conditions, and cardiovascular diseases.

In recent decades, a great deal of research has focused on a polyphenol called resveratrol that is found in over 70 plant species (most notably in the skins of red grapes) and of varying amounts in tea, pomegranates, nuts, dark chocolate, and many berries. However, because the body quickly metabolizes resveratrol, it’s generally taken in supplement form in order to achieve a dose high enough to provide a therapeutic effect.

A 2017 study reported that resveratrol can increase insulin sensitivity and improve blood glucose control, which may reduce the risk for diabetes and help type 2 diabetics manage their disease. It also improves blood vessel flexibility, which can help control hypertension or high blood pressure. A 2020 study reported that elderly women who took resveratrol experienced improved blood flow in the brain, which improved cognitive function.

Is resveratrol something that every adult should take as part of a healthier lifestyle? Unfortunately, no. As more studies are conducted on resveratrol, some adverse effects and interactions have come to light.  A 2020 study reported that like many antioxidants, resveratrol can have a pro-oxidant effect in some situations, which could in theory have negative consequences, although human volunteers in resveratrol studies have not reported serious issues or side effects. Taking resveratrol prior to exercise may counteract some of the health benefits associated with physical activity. Other reported side effects can include diarrhea, nausea, itchy bottom, and allergic reactions.  There have been some anecdotal reports of tendonitis such as ankle pain, swelling, and tennis elbow, although this side-effect is difficult to find in scientific literature.

Importantly, resveratrol has been observed to interact with the anti-blood clotting medication warfarin, which can result in unexpected anticoagulation and potential bleeding. Hence, it’s important that anyone taking resveratrol supplements should consult with a pharmacist to check for potential drug interactions.

As with any vitamin or supplement, inform yourself on the potential risks and benefits before deciding on adding them to your health regimen. With resveratrol, there are clearly a lot of health benefits to be obtained, but there are some individuals who should avoid its use. Your doctor of chiropractic can assist you when making decisions about a healthy diet and natural anti-inflammatory approaches for maintaining health and reducing the risk for chronic diseases that can interfere with your quality of life.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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