A Brief Overview of Whiplash

22 Nov

Whiplash is a non-medical term that represents a large range of injuries to the neck caused by or related to a rapid, sudden movement of the neck often to and beyond the end-ranges of motion that results in injury to soft tissues and sometimes bony tissues in the neck. Cervical acceleration-deceleration (CAD) describes the mechanism of injury while whiplash associated disorders (WAD) describes the signs and symptoms of an anatomical injury.

Aside from injuries in the neck, shoulders, and back, WAD can include trauma to the brain caused the organ impacting the front and back of the inside of the skull (referred to as a coup-contra-coup injury) during the hyperextension followed by hyperflexion phases of the CAD injury. The result is a traumatic brain injury (TBI), which is commonly referred to as a concussion. Symptoms associated with TBI include forgetfulness, short-term memory loss, and “mental fog”.

One explanation for the resulting signs and symptoms associated with WAD injuries is the fact that it takes longer to voluntarily contract a muscle (about 1,000 milliseconds) vs. the time from start to finish of the whiplash process (about 300-500 ms). At about 100 ms after impact, the vehicle is accelerated forward and the seatback pushes into the spine or torso, propelling it away from the direction of the collision while the head stays stationary (due to inertia).

At 150-300 ms, the torso can “ramp up” due to the reclined angle of the seatback. Depending on the headrest position and type, the head can hyperextend over the headrest. The amount of rebound is partially affected by the “springiness” of the seatback and the amount of vehicular damage (or lack thereof), since crushing metal absorbs energy. Thus, injury can occur even when the vehicle receives little to no car due to the energy of the impact being transferred to the contents of the vehicle—including its occupants.

The whole whiplash process is over well before one can contract muscles in preparation to a crash, so it’s virtually impossible to avoid injury.

Research shows that WAD patients can experience better outcomes if they seek prompt treatment focused on restoring motion to the affected areas. Time and time again, chiropractic care has been demonstrated to not only help WAD patients get out of pain and return to their normal activities but it also achieves high scores regarding 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.

Neck Pain – What Is Cervical Spinal Stenosis?

19 Nov

Simply put, spinal stenosis describes a narrowing at the openings of the spine. When spinal stenosis exists in the cervical spine, it’s called cervical spinal stenosis (CSS). This condition is usually the result of wear-and-tear or aging, and hence, is most common over the age of 50. However, CSS can occur at any age if a vertebra in the neck sustains a fracture.

There are two types of CSS: central and lateral CSS. Central CSS is narrowing of the central canal where the spinal cord travels and gives rise to the many pairs of nerves that exit out to the arms, trunk, and legs. Lateral stenosis is narrowing of the side openings (referred to as the lateral recess or the intervertebral foramen) through which the spinal nerves travel outward from the cord and into the left and right arms and legs.

Causes of CSS include the following: osteoarthritis (in which a narrowing of the central and/or lateral canals occurs and crowds the spinal cord and/or spinal nerves); a herniated disk (where the cushions between the vertebra crack or tear allowing the more liquid-like center to leak out and press into the cord or nerves); an injury (fracture); a tumor (growth); Paget’s disease (a condition where the bones grow abnormally large and brittle); and/or a combination of the above.

Symptoms may start out as a vague pain, numbness, and/or tingling in the innervated area(s). If a spinal nerve (lateral CSS) is affected, symptoms can present in the arms, torso, or legs. When the spinal cord itself is compressed (central CSS), symptoms can include loss of bladder or bowel control (in extreme cases); impaired balance; sciatica (pain down the back of the leg), foot drop (weakness standing on the heels), and more. A gradual loss in walking time/distance is common and stopping to sit or bend over is usually relieving (this is called “neurogenic claudication”).

The diagnosis is made by following a careful review of the patient’s history and a thorough examination, which may be aided by x-ray, MRI, and/or CT scans. Though guidelines recommend starting with non-surgical treatments, such as chiropractic care and at-home exercises, if bowel or bladder weakness is present, then surgery may be required to open the narrowed canal(s). The good news is that CSS can often be successfully managed via chiropractic treatment and other conservative options.

 

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.

What Is Frozen Shoulder?

15 Nov

Adhesive capsulitis (also known as “frozen shoulder”) is the end result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the humeral head or “ball” part of the ball and socket joint. Adhesive capsulitis dramatically reduces the range of motion of the affected joint, which can severely impact one’s ability to carry out their normal daily activities. A frozen shoulder may or may not be associated with shoulder pain and tenderness. Though all movements are affected, raising the arm to the side is often the most impaired movement of the shoulder.

Conditions such as tendinitis, bursitis, and rotator cuff injury can lead to adhesive capsulitis, especially if the person refuses to move the shoulder for an extended length of time. Diabetes, chronic inflammatory arthritis (such as rheumatoid) of the shoulder, and chest or breast surgery are known risk factors for adhesive capsulitis.

The condition is diagnosed following a review of the patient’s history for prior trauma caused by over reaching/lifting or from repetitive movements. The examination will look for severe loss of shoulder range of motion (ROM), both active and passive. X-ray, blood tests for underlying illnesses, and other imaging approaches may also be required to make a final determination for adhesive capsulitis.

Treatment for adhesive capsulitis has classically included an aggressive combination of anti-inflammatory medications, cortisone injections, manual therapies (such as joint manipulation, mobilization, and traction), exercise training, ice (if painful), heat (if no pain), and physiotherapy modalities such as ultrasound, electric stimulation, laser, etc.

Exercises performed by the patient are also highly important for achieving a satisfactory outcome. The patient can begin immediately with pendulum-type exercises, long-axis traction (while sitting, grip the chair seat and lean to the opposite direction while relaxing the shoulder muscles to open up the ball-and-socket joint), and eventually strengthening exercises (TheraTube, TheraBand, light weights, etc.).

A recent study involved 50 patients with frozen shoulder (20 males, 30 females, ages 40-70 years) who underwent chiropractic care for a median time frame of 28 days (range: 11-51 days). Researchers looked at patient-reported pain on a 1-10 scale and their ability to raise the arm sideways (abduction). Of the 50 cases, 16 resolved completely (100%), 25 showed 75-90% improvement, 8 showed 50-75% improvement, and 1 experienced less than 50% improvement.

 

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: Intention and Prevention

12 Nov

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, let’s talk about intention and prevention, starting with findings from two recent studies that led to the following dogma-contradicting headline: Data from nearly 20,000 older adults showed that taking aspirin as a preventative measure had no effect on survival rates of healthy, elderly individuals. That conclusion raised eyebrows in the medical community because taking aspirin has been associated with positive health outcomes—fewer heart attacks and strokes, as well as a lower risk for nine cancers. But the “no-benefit” conclusion also raised our eyebrows for another reason: The method used—an “intention-to-treat analysis” in both studies—may be misleading if it’s the only way used to report outcomes of various preventive behaviors such as exercise, smoking cessation, and lowering stress.

Here’s how it works, in simple terms. In an intention-to-treat analysis, you can divide study subjects into various groups. Say you want to measure the effect of exercise on bodyweight. One group is assigned to exercise (the investigators “intend” them to exercise) and one group is asked not to exercise (is “intended” not to exercise). And then researchers would measure bodyweight at the end of the allotted time period and draw conclusions about the effect of exercise on bodyweight.

See the problem? The methodology doesn’t even look at if the study subjects actually even exercised.

So, what happens to the data if many of those who intended to exercise never did and some of those who didn’t intend to exercise decided at some point to sweat their tail off five days a week?

Exactly. The data becomes more mixed up than a vat of jambalaya. And there’s no way to draw any conclusions about what effect actual exercise did or didn’t have on a person’s bodyweight. What’s really measured is how well participants in the study were motivated to follow the behaviors assigned to their group.

This is what happened in these two studies. In the first study, an intention-to-treat analysis involving almost 7,000 people in each group, the researchers concluded that taking a low-dose aspirin provided no benefit in reducing cardiovascular deaths, strokes, or heart attacks. That was the headline.  But the research team also separately examined the data of almost 4,000 people in each group who followed the protocol at least 60 percent of the time. The researchers observed a very significant 47 percent reduction in heart attacks. That was never mentioned in the mainstream news coverage I saw.  (Disclosure:  I have no commercial or equity interest in any company known to produce aspirin.)

The same issue came up in the other study. In the group that intended to take the aspirin, 38 percent of the group intending to take aspirin didn’t do it 80 percent of the time. And in the group that didn’t intend to take it, some—it looks like 8 percent; it is unclear—in the placebo group did take it. This means it’s a jumbled-up batch of data and where, in my opinion, the editors of the New England Journal of Medicine could have insisted the authors analyze the data of those who followed the protocols, as no place in the three articles about that study is there analysis of actual takers or non-takers.

Using only intention-to-treat analysis looks at this question: Did people assigned to preventive measures like exercise, smoking cessation, or taking a daily low-dose aspirin actually do so? However, it may be more useful to ask a question like, “Is exercise or smoking cessation or aspirin effective when done as prescribed?”

It should be noted that the study authors and others maintain that an intention-to-treat analysis is a good way to do studies about preventive medicine, because they say it’s a “real-life scenario” of how well patients follow protocol—sometimes they do, something they don’t do what they’re supposed to do. However, I maintain that—while it may simulate how people follow preventative guidelines—it doesn’t show whether a treatment is effective or not. Preventative lifestyle behaviors only work when you actually carry them out, not if you merely intend to do so.

 Thanks for reading. Feel free to send questions to: AgeProoflife@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.

Great Exercises for Carpal Tunnel Syndrome

8 Nov

Carpal tunnel syndrome (CTS) is caused when the median nerve is compressed as it passes through the tight bony carpal tunnel at the wrist. The condition can result in pain, numbness, tingling, and weakness in the hand, and it can affect one’s ability to carry out everyday life and work tasks. Here are a few GREAT exercises for CTS that require no equipment and can be done anytime and anywhere:

PRAYER: Place your hands in a “prayer” position. Touch the palm-side finger pads together and slowly push the palms into one another while keeping the elbows up as much as possible as you feel a strong stretch in the hands, fingers, and palm-side of the forearms.

SHAKE: Shake your hands for 10-15 seconds as if you just washed them and you’re trying to air dry them off.

WRIST FLEXION STRETCH: Hold your arm out in front of you with the elbow straight, palm facing down. With the opposite hand, bend the wrist as far downward as possible so the fingers point to the ground. This will produce a strong stretch in the muscles located in the back or top of the forearm. Repeat five to ten times holding each stretch for 15–20 seconds (as tolerated).

These exercises can be repeated multiple times a day, as often as once per hour.  It is often very helpful to set a timer on your cell phone to remind you to take a stretch break. A “good pain” (stretch) is considered safe while sharp or radiating pain may be potentially harmful. However, if you experience sharp, lancinating, or radiating pain, then stop or modify the exercise.

Frequently, CTS involves more than just the wrist, and exercises that target the neck, shoulder, and elbow can often hasten recovery. This is especially true when there is “double crush syndrome” where the median nerve is entrapped in more than one location such as the neck, shoulder, elbow, or forearm (as well as the wrist).

Chiropractic management of CTS can include manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck. Muscle release techniques are often employed as well as the use of physical therapy modalities such as laser, electric stimulation, ultrasound, and others. The use of night splints to keep the wrist straight when sleeping is a “standard” used by most healthcare providers. Co-management with primary care may be appropriate if diabetes, inflammatory arthritis, or other complicating conditions are present.

 

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.

Can Exercise Prevent Low Back Pain?

5 Nov

While it’s not possible to totally prevent low back pain (LBP), individuals who regularly exercise appear to have a reduced risk for LBP. Additionally, fit adults who develop back pain may experience it less often, at a reduced intensity, and for a shorter duration than those who lead a more sedentary lifestyle.

Which type of exercise is the best? A general rule is to keep trying different activities, starting with those MOST appealing to you. After all, you should enjoy exercise, so start with your favorites: walking (one of the best), walk/run combinations, running/jogging, bicycling, swimming/water aerobics, yoga, Pilates, core strengthening, balance exercises, tennis, basketball, golfing, etc.

Specific exercises for the low back can be individualized by determining your “position preference”, or the position that feels best to your low back. For example, bend forward as if to touch your toes. How does that feel? Do you feel a good stretch or pain? Does it shoot pain down your leg? If it feels good, then that might be your preferred position and the one to emphasize with exercise. Examples of exercises that fit this scenario include (but are not limited to): posterior pelvic tilts (flatten your low back by rocking your pelvis forward); single and double knee to chest; and bending forward from a chair (as if to touch the floor).

If bending backward feels good (better than flexion and especially if the presence of leg pain lessens or disappears), then “extension-biased” exercises fit that scenario. Examples include standing back extensions (place your hands behind the low back and bend backward); prone “press-ups” (lift the chest off the floor while keeping the pelvis down); and laying back-first over a Bosu- or Gym-ball.

Pelvic dysfunction and core weakness can also increase the risk for LBP. Try these exercises: abdominal crunches (bend one knee, place your hands behind your low back, and raise the breast bone toward the ceiling only a few inches and hold); front and side planks (start from the knees if necessary); supine bridges (supine, knees bent, lift the buttocks off the floor); “bird-dog” (kneel on all fours and raise the opposite leg and arm, keep good form, and alternate); and the “dead-bug” (on your back, bend the hips and knees at 90 degrees with your arms reaching toward the ceiling; slowly lower your right arm and left leg and return them to their starting position; repeat with the other arm/leg).

When lifting, bend the knees and hips but NOT your low back; keep weights close to you and lift with your legs. Don’t attempt lifts that you know are too heavy.

If you have a history of low back pain, research shows that receiving maintenance chiropractic care can help reduce the number of days in which low back pain may hinder your activities.

 

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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