A Vascular Cause of Low Back Pain

6 May

For the older adult, pain that radiates into the leg is a common complaint. This process, called neurogenic claudication, occurs when the spinal cord and/or nerve roots are pinched as they exit the arthritic spine (a condition called spinal stenosis). However, there is another degenerative condition that can cause pain in the legs called peripheral vascular disease, and it can be quite challenging to differentiate between vascular and neurogenic claudication.

Peripheral vascular disease (PVD) is a slow, progressive narrowing, blockage, or spasm in a blood vessel that can affect any blood vessel outside of the heart including arteries, veins, or lymphatic vessels. This hardening of the arteries most often affects the legs and feet, although it can affect any organ, including the brain. The most common cause is atherosclerosis, which is the buildup of plaque inside the vessel wall that narrows the blood vessels in one or both legs. This depletes blood flow, and as a result, oxygen and nutrients can’t easily reach their intended destination. Other causes can include injury to the affected part, irregular anatomy of the muscles and ligaments, and infection.

The first symptom of PVD is typically painful leg cramping during exercise that is relieved with rest. This usually occurs after a certain length of walking time, which gets shorter as the disease progresses. This experience is similar to symptoms reported by patients with spinal stenosis, and as such, individuals with PVD may find themselves consulting with a doctor of chiropractic about what they suspect is a musculoskeletal condition. So how does a doctor of chiropractic differentiate leg pain from PVD from leg pain from spinal stenosis associated with dysfunction in the lumbar spine?

One study that administered questions to patients with either neurogenic claudication (NC) or vascular claudication (VC) found that specific symptoms could help in the diagnostic process. For example, if standing still does not trigger pain, NC could be ruled out. On the other hand, NC is likely if standing triggers or increases pain, bending or leaning forward relieves pain when symptoms are above the knees, and sitting provides relief. Patients with VC are more likely to experience leg pain down to the calf that is relieved by standing still. For a definitive diagnosis, a referral for more advanced diagnostics may be required.

Doctors of chiropractic frequently treat patients with spinal stenosis with neurogenic claudication and will refer a patient to a vascular specialist or their medical physician if PVD is suspected so the patient can be provided with appropriate 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.

Dietary Management of Joint Pain

23 Apr

It’s generally accepted that the normal aging process includes stiff joints and sore muscles. While exercise, stretching, hot/cold packs, and chiropractic care are commonly used tools for the non-pharmaceutical management of joint pain, there’s a growing body of research suggesting that dietary approaches to reduce inflammation may be just as important.

The following list of foods and food additives can promote inflammation and should be avoided as much as possible:

  • Sugar: Though it can be a challenge to resist the temptation of desserts, sodas, and some fruit juices, processed sugars trigger the release of inflammatory messengers called cytokines. But beware, the word “sugar” is camouflaged on many food labels, so watch for any word ending with “-ose”, such as glucose, fructose, and sucrose.
  • Saturated Fats: Studies show that saturated fats trigger adipose inflammation, which worsens arthritis and contributes to heart disease. Saturated fats are commonly found in pizza, cheese, red meat, full-dairy products, pasta dishes, and grain-based desserts.
  • Trans Fats: Since the early 1990s, researchers have warned us about trans fats triggering systemic inflammation. Fast foods and other fried products, processed snacks, frozen breakfast foods, cookies, donuts, crackers, and most margarines are popular culprits. Avoid foods containing partially hydrogenated oils listed in the ingredients.
  • Omega-6 Fatty Acids: Even though we do need SOME of these fats in our diet, a balance favoring omega-3 fatty acids is important. Omega-6 fatty acids can be found in certain oils (corn, safflower, sunflower, grapeseed, soy, peanut, and vegetable), in mayonnaise, and many salad dressings.
  • Refined Carbohydrates: This list includes white flour products including breads, rolls, crackers, white rice, white potatoes (instant mashed or French fries); and many cereals. Refined carbs are widely believed to be a major contributor to obesity, which increases inflammation in the body.
  • MSG (mono-sodium glutamate) is commonly found in foods that utilize soy sauce. It can also be added to many fast foods, soups, salad dressings, and deli meats to enhance flavor.
  • Gluten: Gluten sensitivity is a common health problem that causes joint pain and gut trouble. Gluten is found in wheat, barley, and rye. In those with gluten intolerance or Celiac disease, complete avoidance is necessary as gluten sets off an autoimmune response that damages the small intestine over time resulting in malabsorption of nutrients.
  • Aspartame: This artificial sweetener can trigger an autoimmune response in some individuals, resulting in inflammatory joint pain.
  • Alcohol: Excess intake can damage the liver, which interferes with many important metabolic functions resulting in inflammation.

On the other hand, a diet like the Mediterranean diet that focuses on eating fruits, vegetables, nuts, fish, olive oil, and whole grains while avoiding red and processed meats, dairy, saturated fats, and refined sugars, has been shown to reduce inflammation and reduce the risk for many chronic diseases and promote weight loss. If you have any questions on dietary approaches to reduce inflammation and fight joint pain, don’t hesitate to 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 Dizziness

15 Apr

Whiplash associated disorders (WAD) is a term used to describe the myriad of symptoms that can occur following the sudden acceleration and deceleration of the head and neck. One of these symptoms is dizziness. How does the whiplash process lead to an impaired sense of balance, and are some individuals at greater risk than others?

It’s important to understand that our sense of balance is the result of input from the inner ear, eyes, and nervous system, which is then processed by the cerebellum located in the rear of the brain, just above the spinal cord. Abnormal function in any of these areas can result in the sensation of dizziness, which can dramatically affect one’s quality of life.

In a 2020 study, researchers enrolled 27 older (over 65) adult WAD patients and 32 young adult WAD patients in a battery of tests to determine which, if any, aspects of the balance system were impaired. Researchers concluded that older participants were at increased risk for vertigo and were also more likely to have abnormal proprioception and lesions near the cerebellum. This suggests that the rapid forward and backward motion associated with whiplash resulted in trauma near the area of the brain that may be most important for maintaining balance and affected the ability of the nervous system to efficiently relay sensory information to and from the rest of the body.

One hypothesis is that age-related declines in muscle strength may have reduced the neck’s ability to resist the back-and-forth whiplash motion. This can lead to increased injury to the tissues in the neck and potential injury to the brain, something that is supported by several recent studies linking whiplash and mild-traumatic brain injury.

Cervicogenic dizziness is a term used to describe dizziness caused by dysfunction in the cervical spine. A 2011 systemic review concluded that manual therapies—especially spinal manipulation and joint mobilization—are effective treatment options for this condition. A follow-up systemic review in 2019 affirmed this finding.

Doctors of chiropractic commonly evaluate and treat patients with whiplash associated disorders, including those experiencing dizziness, with a multimodal approach involving manual therapies and specific exercises. If examination findings suggest injury to areas of the body outside the scope of care, chiropractors can co-manage with the patient’s medical doctor or refer to a specialist.

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.

Chiropractic Care and the Headache Patient

13 Apr

According to a 2020 study, up to 1 in 5 new chiropractic patients list headaches as one of their chief reasons for seeking care. Let’s take a look at the features and characteristics that are often found in the chiropractic patient population…

A survey that included input from 224 adult patients with headaches as their chief complaint and 70 doctors of chiropractic revealed that 25% of patients who consult with a chiropractor concerning their headaches have headaches lasting longer than three months, known as chronic headaches, and 42% rate their headache pain as severe.

Based on International Classification of Headache Disorders criteria, 21% of these patients exhibited characteristics of migraine headaches, 17% likely had tension-type headaches, and a third experienced characteristics of two or more types of headaches. However, among the patients who rated their pain as severe, 62% had migraines and two-thirds had more than one type of headache.

A series of studies published in 2020 and 2021 compared multi-modal chiropractic care (ten treatments spread over 14 weeks) and enhanced usual care (medical treatment with migraine education literature) in the treatment of 61 adult women with episodic migraines. The patients in the chiropractic group experienced a near three-fold reduction in migraine days per month (2.9 days vs. 1 day).

Follow-up interviews with the participants in the chiropractic group on their perception of chiropractic care revealed three common themes: 1) over the course of treatment, participants became more aware of the role of muscle tension, pain, and posture in triggering a migraine; 2) participants revised their prior conceptions of chiropractic care beyond spinal manipulation; 3) participants viewed the chiropractor-patient relationship as essential and valuable for effective migraine management.

A study that included 150 patients with chronic tension-type headaches revealed that chiropractic care and the medication amitriptyline provided similar benefits during the treatment phase of the study. While three participants in the chiropractic treatment group reported neck soreness and stiffness, 82.1% of those in the group that took amitriptyline experienced side effects that included drowsiness, dry mouth, and weight gain. Of special note is that once treatment concluded, only the patients who received chiropractic care continued to experience reduced headache intensity and frequency while the participants in the medication group reverted to their initial headache intensity, frequency, and duration levels.

The findings from these and other studies support chiropractic care as an effective treatment option for patients with headaches, with few (if any) side effects and high patient satisfaction.

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.

Ankle Pronation and Knee Osteoarthritis

8 Apr

Knee osteoarthritis (KOA) is a very common condition that is a significant cause of disability in older adults, often resulting in knee replacement surgery. There are several contributing factors to KOA, and perhaps one of the most important issues is excessive force exerted on the knee joint by improper biomechanics of the foot and ankle.

In the normal gait or walking cycle, there are two primary phases called the stance phase and the swing phase. As the names imply, the stance phase refers to the entire time the foot is in contact with the ground and the swing phase occurs when the foot is off the ground.

A 2019 systematic review and meta-analysis reported that the forces across the knee are not transmitted equally during walking, with the inside of the knee joint bearing greater loads than the outer knee joint in most individuals. This leads to breakdown of the cartilage faster on the medial side of the joint, which leads to KOA. One identified cause of this is called ankle pronation, which is an excessive rolling-inward of the ankle that occurs during the stance phase. This results in the knee knocking inward, which is technically called external knee adduction moment, or EKAM.

Fortunately, this can be addressed with the use of lateral wedge insoles or shoe inserts that try to minimize or eliminate the ankle pronation aspect that reduces the EKAM and associated excess loading of the medial knee joint.

When assessing a patient, doctors of chiropractic will expand their examination to regions of the body outside of the area of chief complaint as it’s common for dysfunction in one body part to affect another. In this case, we can see that abnormal motion of the ankle can place added stress on the knee, potentially leading to knee replacement. For the patient to achieve an optimal outcome, such issues need to be addressed.

Chiropractic treatment for the KOA patient can include manual therapies to restore proper motion to the affected joints, specific exercises to strengthen weakened muscles, and nutritional recommendations to reduce inflammation. If ankle pronation is suspected to contribute to the patient’s knee condition, then an orthotic insert may also be necessary. As with many musculoskeletal conditions, it’s better to seek care sooner rather than later. The earlier treatment can be provided, the faster and more likely there will be a satisfactory outcome.

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.

Home Exercises for Carpal Tunnel Syndrome

6 Apr

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy affecting approximately 3% of the general adult population. Individuals with jobs or hobbies that involve fast, repetitive movements and forceful gripping with little-to-no rest may be at increased risk for CTS, as are those with metabolic/hormonal conditions that can lead to increased swelling/pressure/inflammation in the wrist. In most instances, treatment guidelines recommend utilizing conservative treatment approaches, like chiropractic care, before consulting with a surgeon. In addition to workstation modifications, manual therapies, nutritional recommendations to reduce inflammation, nocturnal splinting, and co-management with other healthcare professionals, doctors of chiropractic will also advise patients to perform exercises at home to speed recovery and prevent recurrence.

Below is a description of four CTS-specific exercises recommended by the American Academy of Orthopedic Surgeons (AAOS).

Exercise 1: Wrist Extension Stretch. With the elbow straight (but not “locked”), bend the wrist back (as if saying “STOP”) and use the other hand to apply “over-pressure” to assist to a maximum tolerated stretch. Hold for fifteen seconds. Repeat five times for each wrist.

Exercise 2: Wrist Flexion Stretch. With a straight elbow (but not “locked”) and the palm facing down, bend the wrist downward until the fingers point toward the floor and use the other hand for to achieve the maximum tolerated stretch. Hold for fifteen seconds, repeat five times for each wrist.

Exercise 3: Median Nerve Glides. Make a fist (with the top of the hand facing upward) and then open the hand, but not the thumb, and bend the hand backward toward the forearm and extend the thumb backward. Rotate the palm up toward the ceiling, keeping the wrist/fingers/thumb extended. Grasp the thumb with the other hand and extend back (assist) to tolerance (but not too hard). Hold for three to seven seconds and repeat on the other hand.

Exercise 4: Tendon Glides Type One: Start with the hand pointed outward with the fingers straight out, palm facing down. Bend the fingers upward and then curl them downward into a fist. Tendon Glides Type Two: Start with the hand pointed outward with fingers straight out, palm facing down. Bend the fingers downward touching the end of the fingers to the base of the palm.

The AAOS recommends warming up the hands and wrists with heat for about 15 minutes before performing these exercises and using ice for 20 minutes to cool down afterward. If your symptoms to worsen, cease these exercises and consult with your doctor of chiropractic about modifications.  

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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