Neck Pain – Is It Arthritis?

23 Oct

There are many different types of arthritis, with the most common being osteoarthritis (OA), also known as degenerative joint disease (DJD). Osteoarthritis is often referred to as the “wear-and-tear” type of arthritis, as the smooth, cushion-like, shiny cartilage covering the joints that allows for a nice gliding surface wears down. This can cause pain, swelling, loss of motion, and spurs that further limit motion. According to the Arthritis Foundation, OA/DJD affects about 27 million Americans and is most commonly found in the knees, hips, low back, neck, small joints of the fingers, and base of the thumb and big toe.

In one study, researchers reviewed cervical x-rays and detected spondylosis—degeneration of the intervertebral disks, which rest between the vertebrae of our spine—in approximately 60% of non-symptomatic persons more than 40 years old and in 95% of men and 70% of women over age 60. Similarly, cervical spine MRIs of individuals without neck pain frequently show a disk bulge or herniation.  According to the AMA Guides to the Evaluation of Permanent Impairment (5th edition), 30% of us who have never had neck or back pain will test positive for a herniated disk and 50% or more will have bulging disks on a CT or MRI!

So, if you have neck pain and your doctor takes images that show arthritis or a disk problem is present, how do you know whether or not DJD is to blame? The answer is: it varies and must be clinically determined on a case-by-case basis.

Though frustrating, the ability to determine what is truly generating a patient’s pain can be a challenge. This is why a careful, detailed history and examination of the patient, as well as tracking their response to treatment, is so important. Doctors of chiropractic approach these conditions with various forms of manual therapies including (but not limited to): joint manipulation; mobilization; massage; trigger point therapy; exercise training; activity modifications; self-management strategies, such as traction; the use of specially designed pillows; modalities such as electrical stimulation, ultrasound, and laser therapy; and nutritional counseling to reduce inflammatory markers. Guidelines published around the world recommend joint manipulation for neck pain and headaches as one of the first courses of care because it is both safe and effective.

 

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.

Knee Pain – Do I Need a Replacement?

22 Oct

About a quarter of adults experience frequent knee pain, which results in limited function, reduced mobility, and impaired quality of life.  Osteoarthritis (OA) is the most common cause of knee pain in those over 50 years of age, and it is the #1 reason for total knee replacement (TKR). The rate of TKR in the United States and the United Kingdom has increased substantially in recent decades, which many have written off as a consequence of our aging populations. But is that really the case?

One study reviewed long-term data from the National Health and Nutrition Examination Surveys (NHANES) and the Framingham Osteoarthritis (FOA) study. The research team concluded that advancing age is indeed a factor behind the increase in TKR since the 1970s, but it doesn’t tell the whole story. The researchers also found that obesity is a risk factor for symptomatic osteoarthritis of the knee, and as you know, obesity rates have skyrocketed in the last four decades.

So, what can be done to reduce your risk for a total knee replacement? There isn’t anything you can do about getting older, but there’s a lot you can do to maintain a healthy weight. Begin by switching to a more anti-inflammatory diet such as the Mediterranean diet or the Paleo diet. You don’t have to change everything you eat all at once. Start by eating an extra serving of vegetables and one less serving of processed food a day. As you notice yourself starting to feel better, it will give you the confidence to make further dietary modifications.

Because the primary way for the cartilage in your joints to get nutrients is through movement, you’ll need to become more active. Increase the number of steps you take per day and raise the intensity over time. You should also engage in balance and strength training exercises.

Of course, you’ll also need to ensure your knee isn’t subjected to abnormal movements both above and below that can compromise the tissues that make up the joint. For example, ankle pronation can overload the medial compartment of the knee. Similarly, a problem in the hip, pelvis, or lower back can also place stress on the knee, which can impair its function. That’s why doctors of chiropractic evaluate the whole patient to identify any and all contributing factors to a patient’s chief complaint. Otherwise, the patient may not experience 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.

The Most Important Principles for Staying Young: Do Physical Activity Outdoors

18 Oct

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 both the quality and length of your life.

This month, we want to talk about an important and wonderful study done in Philadelphia that you can advocate for (or copy) no matter what city you are in. It involves how to make you happier if you live near a vacant lot or abandoned home. Now, there are a lot of benefits from the great outdoors for the body and soul. Research shows a walk in a park or woods can decrease arterial stiffness, improve lung function, lower blood pressure, and reduced levels of the stress hormone cortisol. And in a new study, researchers found being around even a bit of green can transform your outlook.

In the study, researchers tracked the mental health of over 300 Philadelphians after doing one of three things with an abandoned plot of land near their residence: by clearing trash and planting trees and grass and keeping the area maintained in 37 abandoned plots of land; by only removing trash and maintaining grass in 36; and by leaving 37 vacant lots as they were. Over three years, the research team observed that the participants living near the spaces with new plantings of grass and trees experienced a 40%+ decline in depressive symptoms and a sense of worthlessness.

So, advocate for converting vacant land into a garden. And bring plants indoors too. They boost your mood by reducing stress, and NASA says they can remove 87 percent of air-borne toxins in 24 hours.

Now, moving plants inside relates to moving your exercise plan indoors as the winter approaches or when smog from forest fires decreases the value of exercise outdoors. If you enjoy gardening, walking, cycling, or other warmer-weather activities, it’s hard when a serious chill, snow storm, or smog from a fire or other cause makes it impossible to relish your outdoor activity as much. Fortunately, there are many indoor activities like indoor gardening, jumping rope, swimming, strength training, yoga, aerobics classes, and using the treadmill or other exercise equipment that can take the place of enjoying physical activity outdoors—keeping you fit, happy, and looking great and getting healthier.

To encourage you to embrace working out during winter (inside or outside, when you can), here’s some info that will help you gain the body-and-soul benefits that come from daily physical activity. They’ll give you a younger RealAge, a better love life, improved stress management, less wrinkles, a stronger ticker, and reduce your risk for many cancers, diabetes, some cancers, depression, dementia, and a roster of maladies from constipation to insomnia.

Outdoor Benefits in the Winter

One 2011 study found that “compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization and positive engagement, decreases in tension, confusion, anger, and depression, and increased energy.” The researchers did caution there weren’t a lot of high quality studies on the topic, but you know how great it makes you feel!

Outdoor Risks in the Winter

To help you feel more positive about exercising indoors in the winter, here are some potential health hazards associated with outdoor winter exercising:

  • Cold air can be hard on the lungs and cardiovascular system (not smart if you have asthma, heart disease, poor circulation, or Reynaud’s disease).
  • Falling on icy patches can cause serious injury.
  • If you get too cold, hypothermia is a 911 emergency. It happens when the body automatically starts shuttling blood from your skin to your vital organs to keep them warm. It’s signaled by shivering, slurred speech, lack of coordination, and fatigue.
  • Frostnip and frostbite are always a danger. Frostnip says “Get inside!” Frostbite is a medical concern; tissue can be damaged permanently. A wind chill of minus 16.6 F can cause frostbite in less than 30 minutes.
  • Cold air traps particulate matter and other pollutants close to the ground, so air quality can suffer (air pollution is worse in Denver and Beijing in the winter, for example). You can check http://www.airnow.gov for air quality in your area before you head out.

The Benefits of Indoor Physical Activity in the Winter

  • Even if you’re resistant to exercising indoors, we’re betting we can convince you of its virtues!
  • Think about how much less time it takes if you’re at home, where you’re going to do that 45-minute yoga routine or sweat along with a Jillian Michaels video.
  • At a gym, you get the reinforcement and socialization that comes with going to a designated place for a specific committed workout.
  • And at home or at the gym, it’s so easy to mix up your routines. One day you can jog or walk the treadmill or ride the stationary bike. The next you’re doing an aerobics or stretch class, and after that there’s strength training with bands or hand weights!

But Indoors or Out, Be Aware of Air Quality

Exercising means you’re breathing more often and more deeply than usual and taking more air into your lungs, so if air quality is poor, you may breathe in more harmful pollutants. Also breathing through our mouth (it’s only natural when you exercise) doesn’t filter air like breathing through your nose. More pollutants enter your airways and smaller inhaled particles can get deeper into your lungs. The more pollutants you breathe in, the more likely you are to experience their negative effects.  You can learn more about how spices and foods you can grow can help you have better lungs, see Dr Roizen’s upcoming book to be published by Ntl Geo entitled “What To Eat When”.

So make sure you workout or garden (and gardening is working out) in well-ventilated environments with low pollution levels— whether at home or the gym. Everything from animal hairs to dust mites and particulate matter from a fireplace or wood-burning stove can provoke allergies and asthma. And remember, when heading outdoors, pay attention to air quality reports—parks are generally better than roadways.

Hope you choose to do these steps now—exercise outdoors if possible, check air quality, convert vacant lots to gardens, exercise indoors (plan now on how to do it) if you can’t do it outdoors and bring plants indoors too—that will help you live at the top of your curve.

 

Thanks for reading. Feel free to send questions to: geProoflife@gmail.com

Dr. Mike Roizen

 

PS: Please continue to order the new book by Jean Chatzky and myself, AgeProof: Living Longer Without Running Out of Money or Breaking a Hip.

 

 

 

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 on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have two newly revised books: The patron saint “book” of this column YOU Staying Young—revised and YOU: The Owner’s Manual…revised —yes a revision of the book that started Dr Oz to being Dr Oz.  These makes great gifts—so do YOU: ON a Diet and 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.radioMD.com Saturdays from 5-7 p.m. He is the co-author of 4 #1 NY Times Best Sellers including: YOU Staying Young.

Carpal Tunnel Syndrome: A Brief Overview

16 Oct

Carpal tunnel syndrome (CTS) is a condition that arises when the median nerve is compressed as it passes through the narrow, rigid carpal tunnel, resulting in numbness, tingling, pain, and/or weakness in the hand and wrist.

The underlying cause of CTS can be obvious and easy to trace, such as an injury to the wrist, or the cause of the condition can be the result of cumulative trauma from months or years or repetitive strain caused by working with vibrating tools or poor ergonomics. Another cause can be the result of swelling/inflammation from conditions like arthritis, thyroid disease, pregnancy, or diabetes. In many patients, there are several factors at play, which all must be treated in order to obtain a successful outcome.

Women are three times more likely to develop CTS than men, mostly due to differences in the shape of the wrist.  This disorder usually occurs in adults (especially over the age of 50), but it can occur at younger ages, such as college music majors who practice their instrument for several hours each day with little time allotted to rest the tissues in the wrist.

After a thorough examination to identify all contributing factors for a patient’s CTS-related symptoms, a doctor of chiropractic may employ the following conservative treatments: a wrist splint to maintain proper posture at night when sleeping; anti-inflammatory measures such as ice; anti-inflammatory nutritional products such as ginger, turmeric, bioflavonoids, and others; work and/or leisure activity modifications that reduce strain on the wrist; manipulation of the small joints of the wrist as well as to joints proximal to the wrist including the elbow, shoulder, and cervical spine;  muscle release techniques to the upper extremity, especially the forearm and hand; stretching exercises;  and the use of some physio-therapeutic modalities can also facilitate in reducing inflammation.

According to the National Institute of Neurological Disorders and Stroke, CTS usually responds well to conservative treatment, especially early in the course of the condition. However, in some cases, surgical intervention may be necessary.

 

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.

The “Red Flags” of Low Back Pain

15 Oct

Treatment guidelines published around the world note that ruling out “red flags” is a healthcare provider’s number one responsibility, which is in line with the decree exhorted by all healthcare professionals when first entering practice to do no harm. When detected, red flags prompt a doctor to stop and immediately send the patient to the appropriate healthcare provider or emergency department to avoid a catastrophic outcome, which may include death.

The four main red flags cited for low back pain include: cancer, fracture, cauda equine syndrome, and infection. In 1992, Dr. Richard Deyo reported that the patient’s history is more important for identifying red flags than a routine physical exam, especially in the early stages of these conditions. This is partially why new patients need to fill out so much paperwork on their initial visit. These are the factors that suggest red flags when it comes to low back pain:

Cancer: a past history of cancer, unexplained weight loss, failure to improve with a month of therapy, no relief with bed rest, and duration of pain over one month. However, when the combination of age over 50 years, past history of cancer, unexplained weight loss, and failure to improve with one month of therapy exists, the sensitivity or “true-positive” reaches 100%—in other words, IT IS CANCER until proven otherwise!

Cauda equine syndrome: acute onset of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, “saddle” anesthesia, and global or progressive motor weakness in the lower limbs.

Infection: prolonged use of corticosteroids (such as organ transplant recipients); intravenous drug use; urinary tract, respiratory tract, or other infection; and immunosuppressant medication and/or condition.

Spinal fracture: history of significant trauma at any age; minor trauma in persons over 50 years of age; patient over 70 years of age with a history of osteoporosis (with or without trauma); and prolonged use of corticosteroids.  A checklist that includes these important historical questions can be easily applied in any practice, which is highly recommended.

All healthcare providers—including chiropractors—managing patients in a primary care setting are obligated to rule out red flags in order to ensure patient safely when rendering treatment for LBP. The good news is that most cases of low back pain aren’t caused by these red flags and respond well to conservative 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.

Chiropractic and Hypertension

27 Sep

In a blood pressure reading, the higher number (“systolic”) represents the pressure that blood exerts against the arterial walls when the heart beats. The lower number (“diastolic”) represents the pressure blood exerts against the arterial walls when the heart rests between beats (measured in millimeters of mercury or mmHg). The definition of hypertension (HT), like so many other aspects of health, has been defined and redefined over the years. Let’s take a look at the current definition and what (if anything) chiropractic provides to help this VERY common condition.

The American Heart Association defines (as of November 2017) “NORMAL” as being   <120/ and <80; “ELEVATED” as 120-129/ and <80; STAGE 1 HT: 130-139/ or 80-89; STAGE 2 HT: >140/ or, >90; HYPERTENSIVE CRISIS: >180/ and/or >120. Between the two numbers, the systolic blood pressure (BP) is generally given the most attention as a major risk factor for cardiovascular disease for people over age 50. A gradual increase in systolic BP normally occurs with increasing age as arteries gradually stiffen due to plaque build-up. Recent studies report that the risk of death from ischemic heart disease and stroke DOUBLES with every 20mmHg systolic or 10mm Hg diastolic BP increase in people from age 40-89.

So, CAN chiropractic help patients with hypertension? The answer is YES… at least in some cases. A placebo-controlled study published in 2007 (and spotlighted on “WebMD”) reported a specific type of chiropractic adjustment applied to the Atlas (C1) vertebra that SIGNIFICANTLY lowered both systolic (by 14 mm Hg) and diastolic BP (by 8 mm Hg) in 25 patients with early-stage HT. This improvement did not occur in 25 control patients who received a sham procedure. This beneficial effect persisted for eight weeks during which time the patients took no medication for their condition.

Dr. George Bakris, the director of the University of Chicago hypertension center and lead author of the 2007 study wrote, “This procedure has the effect of not one, but two blood pressure medications given in combination. And it seems to be adverse-event free. We saw no side effects and no problems.”

Case studies of chiropractic treatment lowering BP date back to the 1980s, and higher quality, larger scaled studies have been published in the last decade. One explanation on how chiropractic adjustments help to lower BP is that adjustments applied to C1 (the Atlas) affect the parasympathetic nervous system, which tends to lower the diastolic BP (lower number), while mid-thoracic manipulation—which stimulates the sympathetic nervous system—tends to lower the systolic BP (upper number) to a larger degree. Chiropractic care includes not only spinal manipulation, but also dietary counseling, and more—all WITHOUT the potential for the sometimes significant side-effects associated with medications.

 

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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