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.

Concussion and Whiplash – Is There a Connection?

24 Sep

Whiplash or whiplash associated disorders (WAD) represent a constellation of symptoms that are very similar to those reported by patients who have sustained a concussion or minor-traumatic brain injury (mTBI). These shared symptoms include (but are not limited to): headache; neck pain; nausea/vomiting; dizziness; balance issues; vision problems; and difficulty concentrating. Chiropractic care focused on the cervical spine has been demonstrated to benefit patients with WAD. Is it possible that the same form of treatment can help the mTBI patient as well?

In the March 2015 issue of the journal The Physician and Sportsmedicine, researchers looked at case studies involving five patients with concussion symptoms that did not resolve within 30 days and had become chronic. The mechanism of injury in three of the cases was sport-related, while the other two stemmed from a slip and fall and a motor vehicle collision. Treatment focused on the cervical spine and included the use of either spinal manipulative therapy (SMT) or mobilization; active release technique (ART) to stretch tight neck muscles; and exercises aimed at strengthening the deep neck flexor muscles and/or other surrounding neck musculature.

  • Case 1: A 25-year-old professional mixed martial arts male injured from sparring presented four months after the injury. After three treatments, he reported a significant reduction in symptoms, with full resolution after eight treatments.
  • Case 2: A 59-year-old female who hit the back of her head on the ground after a fall presented with 31-month duration of symptoms that reportedly improved significantly within three months of twice-per-week treatments.
  • Case 3: A 19-year-old male junior hockey player presented two years after the initial injury and reportedly experienced an 80% improvement in his symptom after four treatments spread out over a three-week timeframe.
  • Case 4: A 19-year-old male injured in a car accident presented 14 weeks after the injury and reported a nearly 50% reduction in symptoms after one treatment and full resolution after eight treatments.
  • Case 5: A 51-year-old female hockey player who was struck on the left side of the head presented five weeks post-injury and reported a full resolution of symptoms after three treatments per week for six weeks.

The important point here is that treatment was aimed ONLY at the cervical spine, not the concussion, with excellent results in each case. These findings indicate the need for larger studies concerning the use of conservative chiropractic care for cases of mTBI that do not resolve within a month’s time.

 

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 Congenital Torticollis?

20 Sep

The Latin terms tortus means twisted and collum means neck, hence the name torticollis. The common name for torticollis is wry neck, which is a dystonic condition defined by an abnormal, asymmetric position of the head and neck.

Congenital torticollis is the most common form of this condition, which is present at birth (incidence rate is 0.3-2.0%). The cause is unclear, but it is most likely the result of birth trauma and/or intrauterine faulty positioning pre-delivery. In a typical presentation of torticollis, damage to the sternocleidomastoid (SCM) muscle that attaches between the sternum and clavicle to the mastoid process behind the ear causes the head to extend back and sideways and rotate to the opposite side.

Congenital torticollis is diagnosed in the first one to four weeks of age and sometimes a firm mass in the SCM muscle can be seen on an ultrasound or even felt by hand. Treatment should commence promptly. Chiropractic treatment initially includes manual therapies such as stretching of the SCM, mobilization, and/or gentle manipulation of the cervical spine. Manual traction and microcurrent and/or ultrasound diathermy have been found to be helpful as well.

Teaching parents/care givers how to stretch the SCM and how to position the baby to reduce the altered posture is very important. Other helpful tips include: adding neck supports to a car seat; using toys, lights and/or sounds to encourage the child to look in the corrective direction; placing the infant in the crib with the affected side by the wall so they must turn to the non-affected side to face out; and lying prone (stomach first) with the affected side down.

It is reported that about 5-10% of cases fail to respond and may require surgery to release the muscle. The good news is that the vast majority of cases of congenital torticollis resolve with conservative 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.

Deep Gluteal Syndrome – What Is It?

17 Sep

The term deep gluteal syndrome (DGS) describes a condition that causes pain in the buttock that may travel down the back of the leg when the sciatic nerve is irritated. There are various structures that can result in sciatic nerve entrapment within the gluteal space which include the following: the piriformis muscle; fibrous bands containing blood vessels; the gluteal muscles; hamstring muscles, the Gemelli-obturator internus (muscle) complex, vascular (blood vessels) abnormalities; and space-occupying lesions.

Unique features within a patient’s history and physical examination can help to differentiate and define the specific site of sciatic nerve entrapment. It is common for patients with sciatic nerve entrapment to have a prior history of trauma, symptoms when sitting, and radiating pain from the low back and/or hip with tingling into the affected leg. If the nerve becomes damaged, diminished reflexes and/or muscle weakness can occur.

Because of the relationship between the lumbar spine (lower back) and the hip, it’s important to examine both regions in order to rule out a lumbar spine pathology as either the cause or a contributing factor to a patient’s symptoms. Failure to do this on a timely basis can lead to chronic pain and reduce quality-of-life based on an inaccurate diagnosis and treatment.

In one study, researchers found that a tight piriformis muscle plays a role in the majority of cases of DGS. The piriformis muscle can be stretched from a seated position. First, cross the leg, grasp the knee of the crossed leg, and pull toward the opposite shoulder (i.e., right knee toward left shoulder and vice versa). Next, arch the low back during this process and twist the trunk to the crossed knee side. Lastly, move the crossed knee in a circular manner to “work” the entire muscle. Do this for 30-60 seconds per side, multiple times a day.

The key to successful management is a prompt, accurate diagnosis followed by conservative care. While conservative treatment approaches to stretch the piriformis muscle and to reduce any pressure on the sciatic nerve are usually enough to reduce pain and improve function in patients with the condition, in some cases more invasive treatments such as injections or surgery 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 Most Important Principles for Staying Young: Five Ways to Help Your Gut Bacteria Keep You Younger!

13 Sep

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.

Last month, we reported on how taking a daily probiotic to improve the health of the gut microbiome resulted in surprising benefits like bone strengthening and better blood pressure control. Maintaining a healthy population of gut bacteria can also benefit the immune system, glucose levels, mood, and even help prevent acne. When your microbiome is out of whack because of an unhealthy diet, chronic stress, overuse of antibiotics, chronic infection and inflammation, or lack of physical activity, then you may face an elevated risk for some cancers, heart disease, depression, obesity, and autoimmune conditions such as Crohn’s or irritable bowel disease (IBD). This month, we’ll talk about five ways to avoid and five choices to make to help your microbes keep you younger.

How to throw off the healthy balance of microbes in your gut…

#1 Eating highly-processed foods that are short on fiber and loaded with chemical additives, sugars and syrups, unhealthy oils (trans fats and saturated fat-containing foods like egg yolks), and emulsifiers. Processed foods starve your good gut bacteria while letting bad ones thrive.

#2 Eating red and processed meat. Red (that includes pork) and processed meats change your gut biome, trigger inflammation, and are associated with everything from heart disease and depression to obesity, mental dysfunction, and cancer (especially breast and prostate).

#3 Eating the same old, same old. A narrow diet limits the diversity of your gut microbiome and its adaptability when battling disease and working to keep you healthy.

#4 Taking un-needed antibiotics—often mis-prescribed for viral infections. At least 30 percent of antibiotics prescribed for outpatients are unnecessary, meaning that no antibiotic was needed at all.

#5 The 3 S’s: Sitting too much; Sleeping to little; Stressing too often. This triumvirate kills off gut diversity, which damages your endocrine and immune systems.

Five ways you can build—or rebuild—a healthy balance of microbes in the gut:

#1 Exercise. A 2017 study in Medicine & Science in Sports & Exercise found that in healthy-weight folks, six weeks of endurance training three days a week, increasing from 30 to 60 minutes a session, created measurable changes in the composition, functional capacity, and metabolic output of gut microbiota—but you have to keep up the exercise to maintain the improvements. So get a buddy and a pedometer and get going—heading for 10,000 steps a day or the equivalent.

#2 Eat Prebiotics. These foods provide fuel for health-promoting gut bacteria. Prebiotic foods include oats and other 100 percent whole grains, legumes, nuts, Jerusalem artichoke, garlic, onions, leeks, and asparagus.

#3 Eat Fermented Foods. Sauerkraut, low-fat, no-sugar added yogurt, and kimchee, for example, deliver probiotics directly to your gut. As we stated in prior articles, you can get probiotics from yogurt and keifer, etc., but you have to eat more than several quarts a day of those to get the same number of Lactobacillus colonies as you get from one of the probiotics we favor (we like Culturelle—I am on the company’s scientific advisory board—and Digestive Advantage—which are both designed to survive the trip through corrosive stomach acids).

#4 Embrace Diversity. Chemical messages from gut bacteria can alter chemical markers throughout the human genome that may help fight infection and chronic diseases. And those messages are produced when bacteria digest fruits and vegetables! So adopt a diverse, plant-heavy diet! You’ll be rewarded, because your gut biome reacts to the input of healthy food pretty quickly.

#5 De-Stress and Sleep Well. Just two days of sleep deprivation can increase the amount of gut bacteria you have that are associated with weight gain, obesity, type 2 diabetes, and slower fat metabolism.  Chronic stress also affects the balance of gut bacteria, allowing for a less vigorous response to disease. So check out the Cleveland Clinic’s free StressFreeNow and Go! To Sleep apps at iTunes.

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.
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