Low Back Pain: Spinal Manipulation vs. NSAIDs

2 Jul

Low back pain (LBP) is the single greatest cause of disability worldwide and the second most common reason for doctor visits. Overall, LBP costs society more than $100 billion annually when factoring in lost wages, reduced productivity, and legal and insurance overhead expenses.

Studies regarding the use of spinal manipulation(SM)—a form of treatment offered by doctors of chiropractic—for LBP are plentiful and have led to the strong recommendation that SM should be considered as a FIRST course of care for LBP. The American College of Physicians and the American Pain Society both recommend SM for patients with LBP who don’t improve with self-care.

In 2010, the Agency for Healthcare Research and Quality (AHRQ) reported that SM is an effective treatment option for LBP – EQUALLY effective as medication in reducing LBP and neck pain.

A 2013 study compared SM and non-steroidal anti-inflammatory drugs (NSAIDs) and found that SM was MORE effective than diclofenac, a commonly prescribed NSAID, for the treatment of LBP. Patients in the SM group also reported NO adverse side effects. More importantly, a 2015 study found that NSAID use can actually slow the healing process and even accelerate osteoarthritis and joint deterioration!

Doctors of chiropractic utilize SM as many conditions, including LBP— more than any other healthcare profession including osteopathy, physical therapy, medical doctors, and others. Chiropractors also combine other synergistic forms of care, such as patient-specific exercise training, to help patients learn how to self-manage their LBP, as recurrence is such a common issue.

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 2)

25 Jun

As discussed previously, probiotics can benefit patients with gut complications such as enteritis, constipation, and irritable bowel syndrome (IBS). Probiotics may also help decrease allergic inflammation, treat nonalcoholic fatty liver disease (NAFLD), and fight immune deficiency diseases. Ingesting probiotics can improve calcium absorption and bone calcium accretion to treat osteoporosis in postmenopausal women. They may even have a role in the management of obesity and type-2 diabetes.

Most probiotics are oligosaccharides and can be synthesized or obtained from natural sources including asparagus, artichoke, bamboo shoots, banana, barley, chicory, leeks, garlic, honey, lentils, milk, mustards, onion, rye, soybean, sugar beets, sugarcane juice, tomato, and wheat. Foods rich in probiotics include kefir, kimchi, yogurt, sweet acidophilus milk, miso, tempeh, sauerkraut, aged soft cheese, and more.

Some probiotics include an ingredient called a “prebiotic.” This is a non-digestible carbohydrate that acts as food for both the probiotic and the good bacteria already residing in the gut. Prebiotic stimulates the growth and/or activity of one or a limited number of genus/species in the gut, making the probiotic more effective and longer lasting.

Here are some of the various types of probiotics…

  1. Lactobacillus naturally occur in our digestive, urinary, and genital systems and can treat a wide variety of diseases and conditions.
  2. Bifidobacteria are found mostly in the colon. They help improve blood lipids and glucose tolerance and can alleviate IBS and IBS-like conditions such as pain, bloating, and urgency.
  3. Saccaromyces boulardii is the only yeast probiotic. It’s used to treat C-Dif (an antibiotic complication), traveler’s diarrhea, acne, and more.
  4. Streptococcus thermophilus helps prevent lactose intolerance.
  5. Enterococcus faecium supports the intestinal tract.

Are there side effects? Generally, side effects are rare and if they occur, they tend to be mild and usually relate to the digestive system and include symptoms such as gas or feeling bloated.

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 Injury – A “Must Read” About Important FACTS!

21 Jun

Whiplash-associated disorders (WAD) is defined as “an acceleration-deceleration mechanism of energy transfer to the neck.” WAD may result from rear-end or side-impact motor vehicle collisions (MVCs), diving and other sports-related injuries, as well as from falls, assaults, and more. Because many bones and soft tissues may be involved in WAD, there are a variety of clinical signs and symptoms associated with the disorder.

In 1995, the Quebec task force coined the term WAD and broke it down into five divisions: WAD 0 includes no pain or exam findings; WAD I includes neck pain, stiffness, or tenderness as the only complaint with no exam signs; WAD II includes pain, stiffness, or tenderness with exam findings such as decreased range of neck motion and/or point tenderness of the neck; WAD III includes all of WAD II plus altered nerve function (sensory deficits and/or muscle weakness or altered deep tendon reflexes); and WAD IV includes fracture or dislocation with or without spinal cord injury.

WAD is usually seen in rear-end, low-impact collisions with about 90% of cases occurring at speeds of <14 mph. In a rear-end collision, the trunk of the body is initially forced back into the seatback followed by hyperextension of the neck and head, which then recoil forwards—all within about 600 msec, which is much faster than the 1,000 msec needed to voluntarily brace our muscles.

Studies support that the source of neck pain arises more often from injured joints than injured muscles. In about 60% of cases, neck pain is due to injury of the small facet joints, which are located on the sides of the neck, especially at levels C2-3 and C5-6. This can give rise to upper neck pain and/or headache (from C2-3), and/or lower neck pain radiating to the shoulder blades (C5-6) or worse, into the arms.

Fortunately, most acute WAD injured patients recover within three months. Unfortunately, about 40% do not improve and are then classified as having “chronic whiplash” (cWAD). Risk factors for WAD developing into cWAD include the following: 1) rapid and severe onset of neck pain and stiffness symptoms; 2) neurological deficit with arm pain (WAD III); 3) headaches; and 4) when urgent hospital admission is necessary. Older patients, those with pre-existing neck or low back pain, and individuals with slender necks have an elevated risk for a poor recovery. Depression, anxiety, and mood disorders are common in those with cWAD as well.

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 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.
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