What Causes Low Back Pain?

9 Apr

Low back pain (LBP) is VERY common condition, and research shows that up to 50% of the adult population in the United States will experience LBP in any three-month time frame over the course of a year. Worse, low back pain can persist for months, years, and even longer, significantly reducing one’s ability to work, play, and enjoy life. So, let’s take a look at where LBP can come from…

ANATOMY: There are five lumbar vertebrae located just below the last rib and extending down to the sacrum. The FRONT of the vertebral column is made up of large box-shaped “vertebral bodies” that are strong and made to bear heavy weight. Between the vertebral bodies are shock-absorbing “intervertebral disks” that have a tough outer layer that surrounds a liquid-like center, giving it the ability to absorb vertical loaded pressure.

The spinal cord runs through the MIDDLE of the vertebra through the spinal canal. Nerves also exit the spine at each spinal level.

The BACK of the vertebra is made to protect the spinal cord. There are two gliding joints on the either side (called facet joints) of the vertebrae, which allow us to bend sideways, backwards, forward, or a combination of movements.

Below the lumbar spine sits the sacrum. The sacrum is wedged between the left and right wings of the pelvis, the ilia, forming the sacroiliac joint (SIJ). For many years, anatomists didn’t believe the SIJ could move and thus, could not be a pain generator. More recent research has concluded that not only is there movement in the SIJ but it may be the primary pain generator in up to 30% of lower back pain cases.

CASE STUDIES: Each of the above anatomical structures can be potential causes of LBP, and the presenting patient’s symptoms and clinical signs can help a doctor of chiropractic figure out what’s going on. For example, when a patient states, “My back kills me and the pain shoots down my leg when I bend over and feels better when I bend backwards and leg pain disappears,” this is most often caused by a herniated disk pinching a nerve in the low back.

In the above case, it’s important to examine the nerves that run down the leg, as the nerve can become damaged if too much pressure is exerted on the nerve for too long. Here, your doctor will ask you to walk on your toes and heels, check your reflexes at your knee and heel, and test your ability to feel sensations on the skin. If any of these tests reveal loss of function, the first goal of care will be to remove the pinch on the nerve to restore leg feeling and strength.

On the other hand, when a patient feels better bending over and worse bending backwards, the facet joints and/or the SIJ may be the culprit.

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.

Which is Better: HIGH or LOW Cholesterol?

29 Mar

While many of us have been told we need to take steps to lower our cholesterol levels, it turns out that having high cholesterol may actually be a good thing.

As far back as 1994, Dr. Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University reported that older people with low cholesterol died TWICE AS OFTEN from a heart attack as those with high cholesterol. While this finding sparked debate due to being inconsistent with the belief that high cholesterol levels lead to atherosclerosis, there are now several studies that challenge the lipid hypothesis of heart disease. In fact, a Medline database search revealed 11 studies that concluded high cholesterol did not predict all-cause mortality in older adults (about 90% of all cardiovascular disease occurs in people over the age of 60).

Even better, in 6 of the 11 studies, researchers observed an inverse relationship between all-cause mortality and high total cholesterol or LDL (bad) cholesterol OR BOTH. Other studies have noted that having low triglycerides and low HDL (good) cholesterol levels are also tied to an increased mortality rate.

So how does high cholesterol improve longevity? It appears that high cholesterol helps improve the immune system, protecting us from infections. In 19 large-scale studies including 63,000 deaths, a research group from the University of Minnesota, Division of Epidemiology reported that low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases.

Were the patients’ low cholesterol levels caused by an infection or did having low cholesterol predispose the patients to infection? To find out, researchers followed more than 100,000 healthy subjects for 15 years. At the conclusion of the study, those who had lower cholesterol had more hospital admissions due to an infectious disease vs. those with high cholesterol.

In two very large-scale studies of men infected with the HIV virus, the mortality rate in those with low cholesterol (<140) was four times higher than it was in those with high cholesterol (>240). A range of 200-240 and even higher in older women appears to be a good target for improving longevity.

Other studies have found that chronic low-grade inflammation may be the real culprit when it comes to atherosclerosis. In other words, worrying about cholesterol levels may not be more important than engaging in a lifestyle aimed at reducing inflammation: get regular exercise, don’t smoke, get plenty of sleep, and eat an anti-inflammation diet, among other things.

 

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.

Whiplash – What Will X-Ray Tell Me?

26 Mar

Although whiplash injuries arising from motor vehicle collisions (MVC) are very common, there doesn’t seem to be consistency in the evaluation one receives at an emergency room (ER) or later in an outpatient setting when it comes to the utilization of x-ray and other imaging. So, what are the pros and cons of imaging a whiplash patient?

A review of published guidelines suggests that if a person involved in a MVC presents to the ER awake, alert, with no neurological deficit or other distracting injury, with no neck pain or midline tenderness, and has a full range of neck motion, then x-ray is not considered necessary. If a fracture is suspected, an x-ray and/or CT (Computerized Tomography) scan is appropriate. Magnetic resonance imaging (MRI) has a role when a soft tissue injury such as a ligament tear, spinal cord injury, and/or arterial injury is suspected by clinical impression and/or prior imaging.

The major concern involving trauma to the neck is fracture, but this is actually quite uncommon as a result of an MVC. Some ERs routinely x-ray all trauma cases to rule on the presence or absence of fracture, though CT scan is much more sensitive than x-ray, especially in subtle or the not-so-obvious types of fracture.

Doctors and hospitals utilize treatment guidelines in an effort to provide the best possible care while limiting potentially unnecessary testing. For example, the Canadian C-Spine Rule (CCR) is an assessment to help determine who does vs. does not need x-rays in trauma cases.

According to the CCR, those over 65 years of age or those who have significant trauma and/or numbness in the extremities should receive x-rays. Situations in which x-rays are not needed include a simple rear-end MVC; if the patient can walk around; delayed (not immediate) onset of neck pain; or the absence of midline neck tenderness.

Another study reported that more than 800,000 patients in the United States (US) receive a cervical x-ray each year. Minimizing x-ray use is important, not just because of patient exposure to radiation, but because more than 97% of x-rays are interpreted as negative, and costs associated with x-ray exceeds $175,000,000 per year! Hence, there is a definite need for better guidelines in the US like the CCR!

Doctors of chiropractic see many whiplash patients either soon after an injury or later, though sometimes it may be years before a patient with whiplash presents for care. For patients under age 65 who have a full range of cervical motion, no neurological deficits or complaints, no other distracting injuries, and no midline tenderness, in most cases, x-rays can wait.

 

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.

Does Slouching Cause Neck and Shoulder Pain?

22 Mar

In a 2015 study, Swedish researchers compared the effect of a slouched vs. normal body posture with regards to performing lifting tasks.

In particular, investigators wanted a better understanding of how a slouched posture affects neck and shoulder function and muscle activity in three large muscle groups—the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA)—during arm elevation to see if it affects range of motion, muscle activation patterns, maximal muscle activity, and total muscle work.

Study participants—non-injured, young adult males—perform maximum arm elevations in upright and slouched postures that researchers observed using a combined 3D movement and EMG (electromyography) assessment system. This measured the arm range of motion, velocity, and spine curvature simultaneously with EMG activity in the UT, LT, and SA muscles.

The research team found that participants in the slouched position experienced significantly less arm elevation and decreased movement velocity both upwards and downwards, in addition to increased peak muscle activity (that is, the muscles had to work harder) in all three muscles tested.

It appears that increased thoracic kyphosis (slouching) leads to a marked increase in physical requirements when performing simple arm movements. Over time, such changes in function could place added stress on the muscles, tissues, and joints of the neck and shoulder, leading to pain and injury. These findings add to a growing body of research regarding the detrimental long-term effects of poor posture as well as an understanding of how exactly faulty postures increase the risk of musculoskeletal disorders.

In their conclusion, the authors of the study write, “[Patients] suffering from neck-shoulder pain and disability should be investigated and treated for defective thoracic curvature issues.”

 

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.

Common Hip Injuries

19 Mar

Hip pain is a very common cause for lost time in sports, and it can also interfere with one’s daily activities—including work! So, what are some of the more common injuries of the hip?

MUSCLE STRAINS: This is probably the most common injury to the hip and groin because of the weight bearing “job” the hips have when running, cutting, jumping, climbing, twisting, etc. Strains occur more often with “eccentric” muscle contractions (when the muscle lengthens) vs. when the muscle shortens. Examples of eccentric muscle contractions include the lowering of a weight during a biceps curl, running DOWN a hill or steps, or lowering a bar to the chest in a bench press.

BURSITIS: A bursa is a fluid-filled sac located where muscles attach to bone to help lubricate muscles and tendons as they slide back and forth on each other during activity. We have bursae in several joints but especially in the hip, shoulder, elbow, and knee. Injury to the bursa can be the result of overuse, a trauma, or a post-surgical complication.

CONTUSIONS: A direct blow to the hip and/or pelvis can bruise the area, which is called a “contusion.” This is a common cause of bursitis and when located on the side of the hip, it is often called a “hip pointer.”

STRESS FRACTURE: These are usually seen in long distance runners and in women more often than men. Individuals with a nutritional deficiency (like those with an eating disorder) and older athletes—especially those with poor bone density—also have an elevated risk for stress fracture.

LABRAL TEAR: The labrum is a thick, fibrous ring that borders the hip socket adding depth and support to the hip joint. If the labrum tears, a patient may experience pain, stiffness, and mobility issues.

FEMOROACETABULAR IMPINGEMENT: When bone spurs form on the rim of the hip joint socket (acetabulum), they can cause pinching as the hip is moved to its end-ranges of motion. This can lead to osteoarthritis and is often due to a torn labrum and/or capsule.

OSTEITIS PUBIS: Repetitive pulling of muscles that attach to the pubic bone often seen in runners, soccer, and hockey players. Childbirth can also result in osteitis pubis.

SPORTS HERNIAS: These injuries are frequently seen in athletes from sports that require repetitive twisting/turning at high speeds (like hockey players) and are thought to be caused by an imbalance between strong thigh muscles and weaker abdominal muscles.

 

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: How Much Protein Should I Eat? Plus Your BP and Salads…

15 Mar

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.

  1. A 54-year-old guy who says he reads these articles religiously asks, “How much protein should I have in a day?”

The answer is: we really do not know.  However, for optimal growth and to delay aging and chronic disease, the current research suggests that you need more protein both before the age of 25 and after the age of 70. Conversely, you should eat much less protein—especially much less animal and milk protein—between 25 and 70 years of age.   Protein, especially from animals, stimulates Insulin Growth Factor-1 (IGF-1), which is needed for growth in the young (until about age 25) and to prevent decline in function after age 80.  But data from Dr. Valter Longo’s laboratory at USC (presented in lay fashion in his recent book, “The Longevity Diet” and in many scientific papers) shows that, like sugar, this protein-induced increase in IGF-1 elevates your risk of heart disease, stroke, and many tumors and cancers.  So, he and others in the optimal aging field recommend consuming at most 1 gm of protein for every 2 pounds of weight (best in morning like a morning filet of salmon or a dish with quinoa) each day for those under 25 or over 70.  If you weight train, then perhaps 50% more protein each day is appropriate.

  1. Lower Your Blood Pressure to Up Your Brain Power…

A new study in JAMA Neurology followed over 1,600 seniors for ten years. Those with a systolic blood pressure (the top number) higher than 150mm/Hg experienced much more cognitive decline than those whose systolic blood pressure was below 150.  Folks cruising along under 120mm/Hg had the least cognitive decline.

So aim to work with your primary care doc to bring your systolic blood pressure down below 120mm/Hg for body and mind. If it usually hovers just above that, in the 121-139 range, you can probably lower it using regular exercise and a healthy diet.

  1. Have a Salad (and Only a Salad) for Dinner Every Day…

A new study in Neurology involving 960 older folks—average age 81—found that participants who ate more than 1.3 servings of leafy greens each day had brains that functioned about 11 years younger than the brains of the those who almost never ate greens.

We don’t know the specific nutrients in green leafy veggies—spinach, collard greens, kale, bok choy, turnip greens, dark green leafy lettuce, watercress, arugula, and mesclun—that are the brain boosters, but the key nutrients could be vitamin K, lutein, beta carotene, nitrate, folate, the flavonol kaempferol, or one or more of the several forms of vitamin E.

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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