Predicting Whiplash Outcomes

19 Oct

With up to 50% of whiplash associated disorder (WAD) patients experiencing long-term symptoms, is there a way to predict which patients are likely to recover following a whiplash injury? To answer this question, a team of researchers analyzed findings from twelve systemic reviews to identify prognostic factors that could help predict patient outcomes following a whiplash associated disorders (WAD) injury.

The authors concluded that the outcome of acute whiplash was dependent more on the association between initial pain and anxiety and less with physical factors such as MRI or x-ray findings, motor examination findings, and collision factors (impact direction, car speed at impact, seatbelt or headrest use, or the extent of vehicular damage).

What can be done for the patients who are at greatest risk for ongoing issues? A 2020 study investigated the potential benefits that a multimodal rehabilitation (MMR) program had for sub-acute (six to twelve weeks) and chronic (more than twelve weeks) WAD patients with soft tissue injuries and no nerve injury or bone fractures. The participants were first examined by a multi-professional team that included a pain and rehabilitation specialist (PM&R), a psychologist, an occupational therapist (OT), a physiotherapist (PT), a social worker, and a nurse. This same team then treated the patients over a five-week timeframe.

The investigators then compared standardized questionnaires completed by participants both before and after the treatment period and then one year later. The researchers reported that participants achieved significant long-term improvements with respect to overall physical and mental health, pain intensity, ability to carry out everyday activities, anxiety, and depression.

Many chiropractors utilize a multi-modal approach when treating WAD patients to address three goals: pain management, functional restoration, and self-management strategies to minimize the need for long-term professional care.  When needed, a coordinated care approach is set up between allied healthcare professions that may include PT, OT, clinical psychology, and/or others.

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.

Neck Pain and Workstation Options

15 Oct

Neck pain is commonly associated with sitting in front of a computer for prolonged periods of time. So is there a “best” or “ideal” type of desk to use when working at a computer all day?

The sit-stand desk has gained significant popularity in recent years, especially with an 83% increase in sedentary jobs since the 1950s. In a 2018 study, researchers compared the effect of using a sitting and standing desk for 90 minutes among 20 healthy adults. Researchers monitored typing task performance and discomfort, vascular/blood flow, and muscular changes in the neck, shoulders, and arms and found that standing desk use resulted in greater engagement of the shoulder girdle stabilizing muscles (a good thing), less strain on the lower trapezius muscles, less upper body pain, and better typing performance. The authors of the study recommend further studies to identify how standing affects more complex computer tasks over longer work sessions in symptomatic workers.

Another type of desk that is available is a treadmill desk. In one study, researchers found that treadmill desk use resulted in less upper limb pain when compared with  seated desk use, as well as healthier muscle performance from the low back paraspinal muscles, wrist extensor muscles, external abdominal obliques, lower trapezius, and anterior deltoids.

What about the trend of having a small cycling device under the desk? In a 2019 study, researchers observed that participants performed better on typing tasks when cycling, especially at greater intensity. Doctors of chiropractic are frequently asked about sit/stand desk options, with or without lower limb exercising. A common answer is to mix it up, sit or stand as needed, and vary the level of under-the-desk exercise depending on how you feel. These studies support that standing, walking, and/or cycling may be a healthier option than the traditional sit-only, sedentary desk.

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.

Things to Consider Before Knee Joint Replacement

12 Oct

When it comes to a condition like chronic knee pain, there are many treatment options available to reduce pain and improve function, including chiropractic care. However, there are cases when a patient may opt for total knee arthroplasty (TKA). In some instances, they may be able to resume their everyday activities, but a segment of patients may not achieve a satisfying outcome. What can we learn from these patients that can inform us on when to and when not to consider surgery for knee pain?

In one study, researchers examined TKA patients one year after their procedure to assess their progress with respect to knee range of motion and function, as these are important for performing activities of daily living (ADLs) such as the ability to put on shoes and socks, squat down to pick things up off the floor, get up and down from sitting, climb and descend steps, etc. The research team found that patients with poor range of motion before surgery, as well as those with poor knee alignment (the tibial-femoral angle), were less likely to have a satisfactory outcome.

Several studies have demonstrated how hyperpronation of the ankle can affect the alignment of the knee, placing added stress on the joint, as can impaired hip function. These issues should be addressed before considering TKA. This is why it’s important for doctors to assess the whole patient for a musculoskeletal condition because the cause or contributing factors for the issue could be from outside the area of chief complaint. In many cases, a combination of manual therapies and specific exercises provided by a doctor of chiropractic can restore proper motion to the affected hip or ankle, which can then benefit the knee.

Manual therapies can also break up adhesions and scar tissue that may affect knee range of motion. When the knee can move as intended, the pressure from normal movement can help provide nutrients to the remaining cartilaginous tissue, reducing inflammation and pain. 

The take-home message is that there may be a time when a TKA is the only option available to a patient with knee pain, but if the knee is poorly aligned or its range of motion is restricted, then TKA may not be the answer. Luckily, these are issues that can be addressed with chiropractic care, which may delay or even reduce the need for an eventual surgical procedure.

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.

Nerve Mobility and Carpal Tunnel Syndrome

8 Oct

According to the American Medical Association Guides on the Rating of Permanent Impairment, if one loses the use of their thumb, index finger, and middle finger, they’ve lost 80% of the use of their hand. It’s no wonder why carpal tunnel syndrome (CTS)—a condition characterized by symptoms of numbness, tingling, pain, and weakness that affects these digits (in addition to half of the ring finger)—can be such a debilitating condition!

Peripheral nerves—such as the median nerve that travels from the neck to the hand—are arranged in a spiral manner, which provides them the ability to lengthen when the limb (arm or leg) is straightened without damaging the nerve fibers within the nerve. In a July 2020 study, researchers reported that median nerve mobility is restricted in patients with CTS, which suggests that the condition can be caused by factors that restrict the nerve’s ability to lengthen in accordance with normal movement. Thus, treatments that are geared toward improving nerve mobility are likely to benefit the CTS patient, and that’s precisely what one systemic review found.

Using data from four published studies, researchers reported that including nerve gliding exercises, also known as nerve flossing, with standard care for CTS led to better outcomes with respect to both symptom severity and hand function than standard care alone. Nerve gliding exercises are intended to move the nerve back and forth inside the tunnel and along its course to reduce pressure and friction.

Here is a sample nerve gliding exercise (one of several that your doctor of chiropractic can teach you) that can improve median nerve mobility:

  1. Stand sideways to a wall and place the palm of your hand on it, fingers pointing downward, elbow partially bent.
  2. Slowly straighten the elbow, feeling for the forearm to tighten up.
  3. Bend your neck sideways toward the wall when the elbow is straight and away from the wall when the elbow is bent and repeat.

Doctors of chiropractic often treat CTS patients with a multimodal approach that includes manual therapies, nerve gliding exercises, nocturnal wrist splints, activity modification, and supplemental/dietary changes. These approaches are all aimed at reducing pressure on the median nerve and to allow for nerve mobility to return to normal. If the patient history indicates that other issues—such as diabetes, hypothyroidism, and other conditions—may contribute to the patient’s symptoms, then co-management with a primary care doctor or other specialist may be required to achieve a successful treatment 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.

Low Back Pain and Cycling

5 Oct

Cycling is regarded as a highly enjoyable and effective form of exercise. However, there is some confusion about how posture while riding can affect the lower back and whether cycling is helpful for recovery from lower back pain.

Bicyclists ride with either a round-back, flat-back, or curved-in back, which is based on the degree of pelvic rotation and spinal flexion. It appears that the choice of posture when riding a bike is primarily related to seat height, seat angle or tilt, and handlebar type.  Some handlebars offer multiple options as to where you can place your hands, such as on the grips (most upright), on the bar closer to the stem (middle position), or on the drops—the lowest option offered on the curl under/racing type of handlebars.

One might think that flat-back posture would be best for the lower back, simply because it avoids the two extremes. However, this position is associated with increased wind resistance and will likely be avoided by more serious cyclists who are looking to ride as efficiently as possible. One pilot study looked at the lumbar spine angle of young adult recreational cyclists as they utilized all three postures in ten-minute intervals with different bike configurations and found that the “curve-in back” position caused by gripping the drops resulted in the greatest increase in spinal flexion over time. For individuals with a low back condition, this increased spinal flexion could result in increased pain and related symptoms over time.

Another study looked at how a bike is fit, the position of the cyclist, and the perception of comfort, fatigue, and pain. Here, twenty cyclists rode in three of nine potential positions for 45 minutes at 50% of their peak aerobic power output. The three positions were defined by two parameters: knee flexion angle (20°, 30°, 40°) and trunk flexion angle (35°, 45°, 55°), in a random order. The results showed that having the trunk upright (not bent forward) and the seat height adjusted so the knee flexion angle was 30° was the most comfortable position for participants. Additionally, the researchers found that tilting the seat forward lessened low back pain in those with the condition.

As part of the recovery process for low back pain, doctors of chiropractic often encourage patients to exercise. Because of it’s low-impact nature, as well as being highly enjoyable, cycling is a great option. However, it’s important to make sure your bike it fitted so that you can comfortably ride with good posture and as to not exacerbate your condition.

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.

Energy Boosting Tips

28 Sep

When fatigue hits during the day, many people will reach for a sugary snack or a caffeinated beverage. While these practices may lead to a quick, short burst of energy, the crash afterwards can leave one feeling even more tired. Let’s look at healthier methods to improve energy levels.

1) EAT BREAKFAST: Studies have shown that people who eat breakfast have less fatigue and stress than those who skip it. Avoid white flour/sugary options, like donuts. Instead try fruit and fiber-rich foods, like oatmeal, which help maintain satiety longer.

2) EXERCISE: A simple 5- to 10-minute walk or any quick bout of exercise can increase blood flow to the brain and enhance cognitive function.

3) SING/TALK: Singing opens specific brain pathways that can both elevate emotions and reduce stress hormone levels. Try it while driving or anytime you feel those eyelids dropping, but perhaps NOT at an office meeting! Like singing, talking stimulates areas of the brain to make us more alert.  

4) DRINK WATER: Feeling lethargic is a common symptom of dehydration. Consider drinking water throughout the day (such as eight 8-oz. glasses per day) as some experts have stated that by the time you feel thirsty, you may already be in a state of mild dehydration, which can also impair cognitive function and increase the risk for headache.

5) SUNSHINE: Spending time in the sun stimulates the production of energy-boosting vitamin D. A recent study showed that exposure to sunlight throughout the workday not only led to better sleep but also improved performance on cognitive tests.

6) SNACK: Try eating almonds and peanuts, which are high in magnesium and folic acid and essential for energy and cell production. Consuming protein and slow-burning carbs like bananas, peanut butter, or granola with fresh berries can also help maintain blood sugar levels. A scented spice, like cinnamon or peppermint, can also fight fatigue and make us more alert.

7) LAUGH: Listen to comedy or think of a recent funny experience and laugh out loud, if possible—it’s amazing how that stimulates certain centers in the brain to give you an energy boost.

8) GET MORE SLEEP: It seems obvious but sleeping less than seven hours a night is unhealthy and reduces the energy you have available during the day. Quality of sleep is important as well, so if you toss and turn or wake up a lot at night, consider a sleep study to assess for sleep apnea.

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.
← Older Entries
Newer Entries →