What Treatments Work Best for Neck Pain?

18 Jun

Experts estimate that up to 70% of people will experience an episode of neck pain in their lifetime. Though there are many potential forms of treatment available, little has been published comparing the various treatment options available to the neck pain patient.

A 2012 study that involved 272 neck pain patients compared three treatment options: chiropractic, medication, and exercise. After twelve weeks of treatment, the patients who received either chiropractic care or exercise instruction reported the greatest reduction in pain. The researchers followed up with the participants for up to a year and found that the patients in the chiropractic and exercise groups continued to report less pain than those in the medication group, and these benefits persisted until the end of the study. The researchers concluded that participants from both the chiropractic care and exercise therapy groups had more than double the likelihood of complete pain relief than with the patients in the medication group.

Quality studies on the short- and medium- term benefits of exercise and manual therapies applied to the cervical spine for patients with neck pain have been published since the 1980s. However, the benefits over the long term are not as well documented. With this in mind, a 2002 study followed 191 patients with chronic neck pain for two years comparing spinal manipulation (SM) with and without one of two types of exercises: low-tech (and low cost) rehabilitative exercise (LTEx) or high-tech MedX (machine assisted) rehabilitative exercises (HTEx).

The research team randomly assigned the 191 patients to eleven weeks of one of three treatments: SM only; SM + LTEx; or SM + HTEx. The investigators evaluated the patients at the start of the study, again after five weeks of treatment, and finally following the conclusion of the treatment phase of the study at eleven weeks. They followed-up with the patients three, six, twelve, and 24 months later as well.

The results showed that SM + LTEx and SM + HTEx were both superior to SM alone at both one- and two-year time points. Overall, the patients in the SM + LTEx group reported the greatest pain reduction and satisfaction with care. This finding is even more important, as the care delivered to the SM + LTEx group costs less than care involving specialized, more expensive equipment.

It’s clear that chiropractic care that includes spinal manipulation and/or mobilization with exercise training yields the best long-term outcomes. Add to that the use of soft tissue therapies such as myofascial release, active release technique, and various modalities, and chiropractic is CLEARLY the best choice for patients with acute or chronic neck pain.

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.

Hip Exercises to Help Knee Pain – Seriously?

14 Jun

The hip and knee are anatomically very close to one another. Functionally, there are several muscles that attach above the hip and below the knee joint. Hence, depending on the position and/or activity, the same muscle can move the hip and/or the knee. This close relationship crosses over in dysfunction as well, as patients with knee pain move differently, and the hip joint is ultimately affected. But which one is the real culprit, the chicken (hip) or the egg (knee)?

In a quest to answer that question, one study asked patients with patellofemoral pain (PFP) and without hip pain to perform either knee exercises or hip exercises. Each group consisted of nine men and nine women. The knee exercise group performed quadricep or knee strengthening exercises while the hip exercise group engaged in hip strengthening exercises. The specific hip exercises included hip abduction (outward resistance) and hip external rotation muscle strengthening exercises. Both groups performed their exercises three times per week for a total of eight weeks. All participants experienced improvements in pain and function; however, the patients in the hip exercise group reported greater improvements than those in the knee exercise group. These results persisted for the next six months.

Why did hip exercises help patients with PFP knee pain MORE than knee-specific exercises? Weight-bearing dynamic imaging studies (x-rays) have shown that patients with PFP knee pain frequently have a lateral or outward displacement of the knee cap as well as lateral tilt due to femur/hip internal rotation (IR) rather than just abnormal patella motion due to muscle imbalance (the “old” theory).

Other recently published biomechanical studies have reported that persons with PFP demonstrate excessive internal rotation and adduction (inwards positioning) of the hip that isn’t generally observed in pain-free subjects. Further, those with PFP tend to have weak hip abductors, extensors, and external rotator muscles than pain-free individuals.

Chiropractic care focuses on whole body care, and patients are often surprised that doctors of chiropractic frequently treat hip, knee, ankle, and foot conditions. Posture and gait assessments, which may be included in an initial patent examination, frequently reveal abnormal movement patterns, leg length discrepancy, pelvic rotation, and lower lumbar spine dysfunction that may contribute to a patient’s chief complaint. Often, treatment must address these issues for the patient to achieve a successful 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: Veg Out to Keep Your Brain Young!!!

11 Jun

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.

In previous articles, I’ve told you that the only organ in your body where size matters is your hippocampus—the memory relay center in your brain.  For those of you who would simply like to improve your memory and keep your cognitive powers as sharp as possible, a study—across ten different countries where folks eat various diets—may offer a simple solution: eat a plant-based diet, starting at as young an age as you can.

Basically, it works like this… To recall information, your neurons need to communicate with each other.  When your neurons make a connection, it creates a bridge, so to speak. The more information travels on those bridges, the more robust they become, the bigger your hippocampus gets, and the better your mind works. On the other hand, if you don’t constantly send and receive messages, those bridges won’t get traveled on, nobody will maintain them, and they’ll eventually crumble and fall apart. (This is the main reason for the “use it or lose it” mantra you hear so much about. When you stop using your brain, your neural “muscles” atrophy.)

Here’s the other thing about those bridges of information: they can get enhanced—or compromised—by all kinds of elements and influences. That’s where this new study about food comes in.  The wrong kind of food can lead to your inflammatory mediators tearing the bridges down. The right kind of food, as you also might imagine, works as bridge-builders and bridge-protectors (like two coats of paint covering the bridge structures)—keeping your hippocampus big and working, and working faster.

We want to be clear here: We’re not suggesting that an apple a day will prevent Alzheimer’s (there are genetic and environmental predispositions and even lifestyle choices—like smoking—that can increase your risk), but the whole point of this column is that you can –and should—leverage food in your favor. In this case—and especially if you have a family history of memory problems or have genetic tests that indicate you are at increased risk of these problems—food is a great opportunity to have what goes into your mouth influence what goes on between your ears.

That’s where these new data reinforce prior data. Researchers, writing in the Journal of the American College of Nutrition, found that “the most important dietary link to Alzheimer’s disease appears to be meat consumption, with eggs and high-fat dairy also contributing.”

So, to protect your brain and heart while slashing your risk of dementia, eat plenty of whole grains, legumes, and fresh produce—foods packed with polyphenols that help reduce inflammation. Add a healthy exercise routine of 10,000 steps a day or the equivalent.  And if you want to really rev-up your cognitive processing skills, practice the brain game Double Decision from BrainHQ. You can try it at no charge and then decide if you want to be a gamer.

Next month, we’ll talk about another choice that keeps your brain young:  don’t hold it in.

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.

What Isn’t Carpal Tunnel Syndrome?

7 Jun

Numbness in the hand is a common problem that we’ve all had at one time or another, and unless it becomes frequent, we usually don’t worry too much about it. When it starts to wake us up at night, that SHOULD get our attention! Since carpal tunnel syndrome (CTS) is one of the most common causes of hand numbness, that must be it, right? Not necessarily!

CTS is caused by pinching of the median nerve as it travels through a sometimes too tight boney tunnel made up of the eight small carpal bones at the wrist. But there are two other nerves that arise in the neck and travel down the arm to the hand that may be the culprit, one of which is the ulnar nerve (the other is the radial nerve).

When the ulnar nerve is entrapped near the humorous, it creates a condition called cubital tunnel syndrome (CuTS). It’s during the examination that a doctor of chiropractic can determine if the culprit behind a patient’s hand symptoms is the median nerve, the ulnar nerve, or even both nerves.

Diagnosis can become tricky, as there are other causes of whole hand numbness such as diabetic neuropathy or an injury to a network of nerves closer to the neck called the brachial plexus. More commonly, cutting off the blood supply in the upper, inner arm will make the whole arm (not just the hand) numb and feel “dead” until it “wakes up,” which may take a few minutes for the blood to percolate back into the arm and hand.

CuTS can occur from repeatedly applying pressure to the pinky-side of the elbow, such as leaning on the elbow against a hard surface, keeping the elbow bent too long (such as talking on a cell phone), resting the arm or elbow on the sill of a car door with driving, and/or maintaining prolonged awkward positions, like playing a musical instrument such as a flute or violin. Baseball pitchers throwing too many sliders and curve balls are also at increased risk of developing CuTS.

Like with CTS, the longer you wait before seeking treatment for CuTS, the longer it may take to recover (or in some cases, full recovery may not be possible) so if you’re feeling numbness, tingling, or pain in one or both hands, please consult with a doctor of chiropractic right away!

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: Who Will Respond Best to Care?

4 Jun

Is it possible to identify which low back pain patients might experience the most benefit from spinal manipulation combined with exercise? In a 2011 study, researchers identified which patients might respond best to this combination of care and which patients might need a more aggressive approach.

Directional preference (DP) describes a situation in which it feels better for the patient to move in one direction versus another. For example, if a patient feels worse bending forwards (which is quite common) and feels better bending backwards, then “extension-biased exercises” are preferred.

If leg pain is present, the DP that reduces or eliminates the leg pain (called centralization, or CEN) is the exercise-biased direction, and it’s important to avoid any exercise that increases leg pain (peripheralization).

In the study, which involved 584 patients with low back pain, the researchers found that 60% of the participants had a DP and of those patients, 60% had CEN. The researchers found that the patients with a DP that reduced CEN responded the best to care (in this case, spinal manipulation combined with exercise) in regards to improved pain and function. On the other hand, the patients who had no DP experienced the least overall improvement.

The value of using a classification system like this allows a doctor of chiropractic to determine which exercises will help each individual LBP patient the most.  It also provides them with the ability to identify those most likely to respond favorably and those patients who may need a more comprehensive treatment.

So, if you feel best bending backwards and/or leg pain lessens, the preferred exercises include bending backwards (extension) from standing, prone press-ups (“saggy” push-ups) or hugging a gym ball, and/or extending your back over a gym ball or a stack of large pillows. Of course, there are many additional exercises but ANY position that reduces LBP and/or leg pain will help.

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.

Are Probiotics Necessary? (PART 1)

28 May

We all know that bacteria can cause disease, so it makes sense to be at least a little leery about taking a supplement that is loaded with bacteria. There is however, a growing volume of scientific support that probiotics (PBs) can both treat as well as prevent quite a few illnesses.

Probiotics literally means “for life” (pro biota), which suggests these must be “good” bacteria and indeed, our digestive system’s health depends on maintaining a balance between the good and bad flora. Since the 1990s, clinical studies have shown that PBs can effectively treat a number of condition such as irritable bowel syndrome (IBS), ulcerative colitis, Crohn’s disease, H. pylori (causes ulcers), bladder cancer recurrence, C-Diff (Clostridium difficile)—a dangerous gut infection associated with antibiotics, pouchitis (post-surgical complication after colon removal), eczema in children, and more.

Probiotics are not all the same, as different strains of bacteria have different functions and therefore, help us in different ways. For example, some organisms protect our teeth from getting cavities but can’t survive in the highly acidic environment of the stomach.

Solid evidence exists for probiotic therapy in the treatment of diarrhea. Lacotbacillu GG can shorten the course of infectious diarrhea in infants and children (but not adults). The Harvard.edu website describes two large review studies that suggest PBs can reduce antibiotic-associated diarrhea by 60% when compared with a placebo.

Vaginal health is also improved by PB use, as it can reduce and/or eliminate recurring yeast infections. Lactobacilli can help treat bacterial vaginosis, which can potentially complicate pregnancies and lead to pelvic inflammatory disease (PID). This bacteria can also be used to treat UTIs, especially in women.

Come back next month for more much-needed information regarding probiotics…

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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