What Leads to Chronic Whiplash?

20 Aug

Whiplash associated disorder (WAD) is a very common injury that can occur in a variety of ways, but it’s most commonly associated with motor vehicle collisions. The symptoms associated with WAD have been classified as follows:

  • WAD I: Pain, stiffness, or tenderness of the neck as the only complaint with no physical exam findings (full range of motion and no muscle guarding or tenderness on examination).
  • WAD II: Pain, stiffness, or tenderness of the neck with soft tissue injury signs loss of range of motion (ROM) and/or point tenderness of the neck (e.g., a sprain/strain neck injury).
  • WAD III: Pain, stiffness, or tenderness of the neck along with neurological signs sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes.
  • WAD IV: Pain, stiffness, or tenderness of the neck along with dislocation or fracture with or without spinal cord injury.
  • Other symptoms including deafness, dizziness, tinnitus (ringing in the ears), headache, memory loss, dysphagia (difficulty swallowing), and jaw pain can be present in all grades (WAD I-IV).

About 50% of WAD patients continue to report neck pain one year after the injury occurred. These long-term symptoms and signs can vary from mild to completely disabling.

There are prognostic factors that may help predict who is at risk of developing long-term, chronic (lasting longer than three months) WAD, which include the following (partial list): women more than men, age over 50 years, lower educational attainment, those who had pre-injury neck pain and/or headaches, the higher the WAD grade (comparing WAD I-III), those reporting more frequent or severe post-injury symptoms with greater pain intensity, poor coping at six weeks post-injury, depression, feeling helpless regarding pain control, fear of movement or activity, catastrophizing, anxiety, and high frequency pre-injury healthcare utilization.

There is evidence that WAD-injured individuals can develop widespread body pain or fibromyalgia in the year following their injury. This occurs more frequently in women and in those with poor prior health, greater initial symptoms (including pain intensity), and more symptoms of depression.

Among available treatment options, manual therapies such as mobilization and manipulation—the primary form of treatment delivered by doctors of chiropractic—often receive the highest ratings from patients in regards to overall satisfaction with 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.

When and When Not to Worry About Headaches…

16 Aug

Most people will experience some form of headache during their lifetime. The good news is that most headaches are related, at least in part, to the neck or cervical spine (a cervicogenic headache or CGH) and can be easily managed with chiropractic care.

Although the exact mechanism of CGH is still under debate, there are two possible explanations that are backed by research.  The first includes irritation of the sensory nerves in the upper cervical region that communicate with the fifth cranial nerve (the trigeminal nerve) and its nucleus, which is located in the upper cervical region of the spine. This irritation results in referred pain that radiates into the frontal aspect of the head. The second possible mechanism involves irritation of the greater occipital nerve by connective tissue bridges between the spinal cord covering (the dura) and the muscles located at the base of the skull.

Chiropractic treatment regarding CGH includes a combination of spinal manipulation; soft tissue therapies, such as myofascial release; active release techniques of the tight suboccipital muscles; manual and/or home cervical traction; and posture correction.

Unfortunately, the origin or cause of the headache may not be so benign and uncomplicated.  Warning signs of a complicated type of headache include (but are not limited to) the following: a very intense, unusual headache that comes on suddenly; significant visual and/or auditory problems; and other neurological signs and symptoms such as balance disturbance, dizziness, weakness, paralysis, speech difficulties, mental confusion, and nausea or vomiting. Until proven otherwise, the following types of headaches should be considered as potentially dangerous: a headache that progressively worsens over 24 hours; a headache that follows head trauma; and headaches that wake one up from sleeping, and/or last greater than 48 hours.

Doctors of chiropractic care are trained to evaluate and treat patients with headaches, and guidelines recommend chiropractic as an initial form of care based on its efficacy and safety.

 

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 Causes Shoulder Pain?

13 Aug

Each year, Americans make 7.5 million doctor visits related to shoulder/upper arm pain. After neck and back pain, shoulder pain is one of the top reasons patients seek chiropractic care. So, why are shoulder injuries so prevalent?

Though there are many possible explanations that address this question, there’s a simple answer: anatomy. There are essentially three joints that make up the shoulder: 1) scapulothoracic joint, 2) the glenohumeral joint, and 3) the acromioclavicular joint. These joints work simultaneously and in harmony to carry out the many tasks we throw at our upper extremities from swimming to swinging a tennis racket or even reaching up to hang a curtain or change a light bulb. The overall structure of the shoulder favors mobility over stability and as a result, there is a greater chance for injury. So, what can we do to prevent shoulder injuries?

Perhaps the most important strategy is to think before you act; that is, don’t take unnecessary chances such as over-lifting in especially awkward positions. Try asking someone else for help instead. Also, use proper form and stay conditioned. Research shows that a strong core (back and belly) can help prevent shoulder injuries.

Common shoulder conditions include (but are not limited to): inflammation (bursitis and tendinitis), instability (“sloppy” joints), arthritis (bone/cartilage injury/wear), fracture, and nerve injuries. Injuries can be acute (from an obvious cause) or more commonly, they can be chronic from wear and tear and can occur gradually over time (from no obvious, single cause).

It’s important to understand that a shoulder complaint may be the end result of dysfunction throughout the body, just as a knee problem can place added stress on the hip (or vice versa). So in addition to direct treatment of the shoulder, your doctor of chiropractic may identify and treat problems elsewhere in the body (forward head carriage, poor core strength, leg length deficiency, etc.) that likely contribute to your shoulder pain complaint. In order to promote a speedy recovery, your chiropractor may also recommend certain food or vitamins/supplements with the aim of reducing inflammation.

 

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: Two More Reasons to Take a Daily Probiotic!

9 Aug

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.

From your passage through the birth canal to your first taste of breast milk, encounter with your pet dog or cat, and handful of not-so-tasty dirt in the backyard, you built your gut biome—that super-dense world of trillions of microbes that live in your gastrointestinal system (as well as on your skin and in your mouth). And you want them in and on there!

If you don’t already take a daily probiotic, a new study just came out that gives even more data to encourage you to do so because, as it turns out, a daily probiotic can also help strengthen your bones. Thicker bones help prevent hip fractures and decrease low back pain (especially when combined with spongier discs that often are part of the same process).

Swedish researchers looked at the impact of giving a daily dose of the lactobacillus bacteria as a probiotic for one year to 90 women age 76 or older and found it reduced their bone loss by 50 percent! And unlike medications given for osteoporosis (brittle bone disease), the probiotics had no undesirable side effects.

It is estimated that around 8.2 million women and 2 million men in the United States have osteoporosis, and an additional 27.3 million women and 16.1 million men have low bone mass (osteopenia). Fractures of the hip are a common result of osteopenia and osteoporosis when a fall occurs. Hip fractures severely compromise independent living and increase risk of premature death.

So take note: If these data prove relevant to all of us (not just older men and women), then to strengthen our bones, we should all consider starting a daily regimen of probiotic supplements (we like Culturelle—which has lactobacillus as was the species in the study—I am on the company’s scientific advisory board—and Digestive Advantage—both are designed to survive the trip through corrosive stomach acids) and enjoy fermented foods like sauerkraut, kefir, kimchi, and kombucha. Plus, eat lots of prebiotic foods that nurture theour gut bacteria. That includes garlic, onions, leeks, Jerusalem artichokes, bananas, walnuts, wheat bran, asparagus, and all high-fiber 100 percent whole grains, veggies, and fruits.

There are other substantial benefits of the specific strain of bacteria used in the study mentioned above.  Lactobacillus is one of the bacteria charged with keeping a proper balance between competing microbes in your gastrointestinal system, so you can maintain good digestion, steady blood glucose levels, a healthy immune system, and avoid over-the-top, body-wide inflammation.  If you’re short on lactobacillus, you may trigger or worsen ulcerative colitis and other gastro-inflammatory problems.

New research has also revealed that lactobacillus may play a role in maintaining a healthy blood pressure. Writing in the journal Nature, the researchers explain that lactobacillus can restore the proper balance of salt in your system. When these researchers fed certain lab rodents a high-salt diet, it raised their blood pressure to hypertension levels. But when the researchers gave the animals lactobacillus, low and behold, their blood pressure dropped. So if you’re combating HBP and are feeling frustrated with your efforts to get it under 120 over 70, or fighting low bone mass, or osteopenia, that’s another reason to give a regimen of lactobacillus supplements a try.  As we stated, you can also get smaller lactobacillus doses from yogurt and kefir, but you have to eat more than several quarts a day of those to get the same number of Lactobacillus colonies.

There are other choices you make that help or hurt your gut biome; those choices not only influence you gut and whether it acts up, and your blood pressure and bone mass, but also they’re essential for everything from a healthy immune system, to controlling your weight and glucose levels, to helping prevent acne, and for helping maintain a positive mood. When they’re out of whack because of an unhealthy diet, chronic stress, overuse of antibiotics, or chronic infection and inflammation, lack of physical activity, you’re at risk for some cancers, heart disease, depression, obesity, and autoimmune conditions such as Crohn’s or irritable bowel disease (IBD).

Next month, we’ll tell you of five choices to avoid and five to make to keep your microbes keeping you younger.

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.

Can Carpal Tunnel Syndrome Be Caused By Your Job?

6 Aug

Carpal tunnel syndrome (CTS) is a common complaint, with symptoms ranging from subtle numbness to extreme pain and disability in the hand/wrist that can force a change in a worker’s vocation. According to the current research, the cause of CTS is the compression of the median nerve as it travels through the carpal tunnel at the wrist, which can be the result of repetitive motions involving the wrist, physical injury, and/or conditions like inflammatory arthritis, diabetes, pregnancy, and more. In other words, anything that reduces the tunnel’s size can result in median nerve compression and hence, carpal tunnel syndrome.

Researchers have found that industrial jobs that require repetitive, forceful work—those that involve heavy tools, for example—increase the risk for CTS, but the evidence isn’t as clear regarding jobs that involve repetitive motions with limited force, such as typing on a keyboard.

According to one Danish study that monitored the wrist health of 5,600 technical assistants, computer keyboard use may not be a likely cause of CTS. While the study did find that 11% of the workers experienced tingling or numbness in one or both hands, only 5% were considered to have developed CTS based on their overall description of symptoms—which is similar to what would be found in the general population. The study did find that using a mouse for twenty or more hours per week increased the risk for CTS.

However, that is not to say that working at a computer all day does not cause pain or strain in the hand/s, wrist/s, forearm/s, shoulder/s, or the neck. As mentioned above, just over half of the workers who experienced symptoms like tingling or numbness in the hands did not meet the diagnosis criteria for CTS.

Dysfunction anywhere along the course of the median nerve from the neck, shoulder, and elbow to the wrist can place pressure on the nerve and result in symptoms that mimic CTS. Doctors of chiropractic are trained to evaluate and treat the whole person in order to identify problems that either mimic or contribute to the symptoms associated with carpal tunnel syndrome. In many cases, a patient may not experience satisfying and lasting results unless problems elsewhere in the neck, shoulder, elbow, or lower arm are also addressed.

 

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: What Can I Do for It?

2 Aug

Low back pain (LBP) is the second most common reason for doctor visits in the United States and it is a condition that most of us will at some point in our lives. Last month, we reviewed the wide acceptance of spinal manipulation as the treatment of choice for both acute and chronic LBP.  This month, let’s take a look at what you can do outside the doctor’s office to self-manage acute and chronic low back pain.

One of the best self-management protocols for LBP is exercise that targets the lower back. It appears that the optimal time to engage in exercises for the lower back is during the work day since doing so may help alleviate some of the overuse and repetitive strain contributing to one’s LBP. Let’s focus on exercises you can perform from either a sitting or standing position during short work breaks…

RULES: Perform slowly to a full/firm stretch without pain; take three slow deep breaths for each; only do exercises that “fit” your job and time limits—this might be only one every fifteen minutes; make it work!

SITTING EXERCISES: 1) Sitting Forward Bends – bend forward and reach for the floor (as far as reasonably tolerated). 2) Sitting trunk rotations – twist slowly left, then right. 3) Cross Leg Stretch – cross one leg over the other; grasp and pull the crossed leg knee to the opposite shoulder while arching the back to its maximum until a firm stretch is felt in the buttocks.

STANDING EXERCISES: 1) Hamstring Stretch – place one foot on an elevated surface (like a chair seat, foot stool, or guard rail); perform an anterior pelvic tilt by arching your low back until you feel a firm stretch in the hamstrings. Switch sides and repeat. 2) Groin Stretch – do exactly the same steps as the hamstring stretch but this time, rotate your trunk to the side of the standing leg (away from the stretched leg) until you feel the stretch in the inner thigh or groin muscles. 3) Backward Bends – place your fists behind your low back and slowly bend backwards to a maximum tolerated point.

These “portable” exercises can be performed frequently throughout the work day, whenever you can spare 30-60 seconds. The most important point is to do these exercises on a regular basis. It may help keep your LBP from worsening during your workday.

 

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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