Management Strategies for Chronic Low Back Pain

2 Oct

Chronic LBP (cLBP) is a BIG problem in our society, accounting for about 33% of work-related disability. So, what is the best management strategy for cLBP?

One study looked at the effectiveness of spinal manipulation therapy (SMT) using three groups of patients with cLBP. Each group received either: 1) “sham” spinal manipulation (twelve treatments of sham or “fake” SMT) over a one-month timeframe and then discontinued; 2) “real” SMT (high-velocity, low-amplitude thrust) twelve times during a one-month timeframe and then discontinued; and 3) the SAME as the second group but with additional SMT treatments every other week for nine additional months.

As expected, the first group saw no benefits from sham SMT with the second and third groups reporting similar benefits after one month of care. However, ONLY the third group reported continued benefits at the tenth month. The study concluded that in order to obtain long-term benefits for patients with cLBP, patients should receive maintenance care after an initial intensive care plan. It’s also worth noting that this 2011 study was not only published in the illustrious journal SPINE but it was authored by two medical doctors.

More recent studies have consistently validated that SMT is a safe, effective method of managing cLBP, especially when it is repeated on a maintenance basis.

Doctors of chiropractic also include exercise training for flexibility and core strengthening as standard recommendations in the management of LBP patients, in addition to advice to remain active and avoid prolonged bed rest. If you haven’t utilized chiropractic care for cLBP, you owe it to yourself to give it a chance – the evidence supports it!

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.

Women with Back Pain… The Silent Majority? Part 2

25 Sep

Last month, we discussed four factors that increase a woman’s risk for back pain: a wider pelvis (resulting in greater pelvic instability due to knock-knee effect); breast size, mass, and weight; hormone levels and variability during menstruation and menopause; and adolescent growth spurts that can trigger idiopathic scoliosis three-times more commonly in women than men. We’ll continue the discussion this month…

During the first trimester (three months) of pregnancy, the fetus’ rapid growth combined with the hormonal, physical, and emotional changes that occur can be quite an adjustment! However, it’s during the second and third trimesters when an expectant mother’s risk for back pain can increase the most. During this time, the growth of the baby shifts the center of gravity forward, increasing the low back curve or “lordosis” to maintain balance. This new posture can create inflammation in the facet joints, the sacroiliac joints, and/or the coccyx (tailbone), which can result in pain and general discomfort. Common self-help approaches include ice or heat (ice is typically preferred over heat), rest, special cushions or supports, and specific exercises. Manual therapies provided in a chiropractic setting, like mobilization and/or manipulation, can also provide relief.

Though the mechanism may not be fully understood, women who have undergone menopause have an elevated risk for reduced bone density, which is called osteopenia. You may be more familiar with the term osteoporosis, which describes a fracture that occurs in the presence of reduced bone mass. Management can be successful with non-surgical approaches. However, if non-surgical approaches fail, a doctor may recommend a procedure, called kyphoplasty, in which he or she injects a cement-like substance into the fractured vertebral body.

Another factor that can increase a woman’s risk for back pain is wearing high heels. A 2015 study found that wearing heels over two inches tall (or ~50mm) can increase the curve of the lumbar spine by about ten degrees, placing added pressure on the two lower lumbar disks (L5/S1 and L4/L5). This may be one explanation as to why low back pain complaints are more common among women who regularly wear high heels compared with those who do not. Additionally, other studies have shown that wearing heels also alters the curvature of the thoracic and cervical spine, which can increase the wearer’s risk for neck and upper back problems.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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 Injuries and Neck Strain

21 Sep

The terms “whiplash” and “neck strain” are often used interchangeably, though there’s debate about whether this is appropriate. Let’s take a closer look at the differences between these two common descriptions of neck pain…

The term “strain” technically means a stretch injury to a muscle and/or the tendon that attaches muscle to bone. The terms mild, moderate, and severe offer a classification approach commonly used by healthcare providers to describe the degree of injury. As implied, a mild strain is just that—little to no muscle fiber or tendon tearing has occurred and thus, the injury will have a faster recovery time than a moderate strain. Moderate strains include partial tissue tearing and take longer to mend. Severe strains described complete tearing and in certain muscles in our body, surgery may be needed to repair the tear.

There are many muscles and tendons in the neck that overlap each other to allow for various functions or movements to occur. The deep “intrinsic” muscles are described as “fine movers” and allow for the individual cervical vertebra to move in a very specific manner and direction. The superficial muscles are larger, stronger, and utilized in global/large movements and help to protect the neck and the deeper, more delicate structures.

It can take a total of about 600 msec for the head to “whip” forward and backward in a classic rear-end collision, which is faster than we can voluntarily contract a muscle. This explains why an injury is difficult (if not impossible) to avoid in a motor vehicle collision, even if you “see” that an accident is about to happen.

To further differentiate the whiplash injury from a simple muscle strain, the brain is suspended by ligaments and cushioned further by fluid inside the calvarium (or skull) and can easily get bruised by literally slamming into the walls on the inside of the skull in a whiplash injury. This results in “traumatic brain injury” (TBI) or concussion. Interestingly, it’s been reported that one does NOT have to directly hit the head on a hard object to suffer TBI.

The symptoms associated with TBI include mental fog; fatigue/tiredness; slow mental functioning, such as having difficulty formulating thoughts, staying on task, and/or expressing one’s self; visual complaints; memory loss; and/or headache. The term “Whiplash Associated Disorder” or WAD is preferred, as it encompasses the many different symptoms associated with whiplash.

Doctors of chiropractic are trained to evaluate, diagnose, and treat patients who have sustained a whiplash injury. Generally, the sooner treatment commences after the injury, the more favorable the outcome or prognosis. Therefore, don’t delay in obtaining care following a collision!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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 Care vs. Medication for Neck Pain

18 Sep

Neck pain can arise from a multitude of causes, from trauma like sports injuries and car accidents to just sleeping in an awkward position. It can also arise from non-traumatic causes like stress, anxiety, or depression. In the past, we’ve noted how forward head posture can increase the risk of neck pain and headaches. Suffice it to say, neck pain can arise from almost anything, and many times it’s very challenging to figure out the origin!

A recent study involved 272 nonspecific neck pain patients between the ages of 18-65 years who received twelve weeks of one of three treatments: spinal manipulative therapy (SMT); medication; or home exercise with advice (HEA). The primary method of assessing change involved tracking self-reported pain levels at 2, 4, 8, 12, 26, and 52 weeks and secondary measures included self-reported disability, global improvement, medication use, satisfaction, general health status, and adverse effects.

The results showed that SMT had a statistically significant advantage over medication regarding pain relief after 8, 12, 26, and 52 weeks, and HEA was superior to medication at 26 weeks. The study concluded that SMT was more effective than medication in both the short and long term for those with acute and subacute neck pain.

The research team added that 60% of participants in the medication group reported side effects—of which gut irritation and drowsiness were the most common. The SMT group experienced no significant adverse effects, but 46% of the SMT and HEA groups equally reported short-term soreness or achiness.

Another study showed for that for chronic neck pain patients, the COMBINATION of SMT and HEA yielded the best long-term outcomes compared to either one alone, with SMT favored in the acute stage (initial stage) of care. The challenge for doctors is to get people to continue with their exercises after their pain subsides, as studies show the dropout rate can be as high as 90%!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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 Pain and Iliotibial Band Syndrome

14 Sep

WHAT IS IT? Iliotibial band syndrome (ITBS) is one of the most common causes of hip and/or knee pain among athletes. The pain is caused from swelling or inflammation of a muscle group (including the tensor fascia lata or TFL, gluteus medius, and minimus muscles), the tendons that attach muscles to the knee or hip, and/or the bursa that surrounds the attachments at the hip and/or knee.

How common is it? Experts estimate that the prevalence of ITBS may be as high as 12% among participants in sports that involve running. This is also common during basic training—with ITBS reported by between 5.3% to 22.2% of United States Marine Corps recruits.

What is the clinical presentation? Typically, ITBS presents with a history of pain with activity (walking, running, cycling, etc.), with soreness at the outside of the knee just above the joint. Pain can radiate up or down and include the hip and/or ankle. Climbing steps and running downhill are common irritating activities. Rest can help alleviate symptoms in the short term but isn’t a long-term remedy.

What are some physical exam findings? ITBS patients may exhibit an abnormal gait or walking pattern in which knee flexion (bending) is avoided. They may also have tenderness to touch above the knee joint on the outside and/or along the iliac crest (where the TFL inserts). Squatting can reproduce pain, and lying on the side with the leg extended backward and dropped toward the floor from a bench often reproduces pain (called “Ober’s Test”).

Treatment Options: Because these are “overuse” injuries, changing the frequency, intensity, and/or duration of the sport or injury-causing activity is often necessary. Consider changing up your routine by cross training. If your athletic shoes are worn down, replace them and stay within the rated mileage of the shoe.

For those with ankle pronation (where the ankle shifts inwards), a foot orthotic with a measured rearfoot post can “make or break” a successful, long-term outcome. Similarly, if one leg is measurably shorter compared to the other, a heel or heel-sole combination lift is also very helpful.

If the muscles that move the hip are weak or if there is altered/abnormal muscle activity, then proper exercises to improve the neuro-motor pattern and/or strengthen the weak muscle group are a must! The inclusion of a gait/walking and running assessment can also reap great benefits for long-term success. Your doctor of chiropractic can help you with this assessment.

Chiropractors are trained to evaluate and treat ITBS and other hip/knee conditions, whether they are sports-related or not.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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: Know Your Family History

11 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 on 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.

Question: Every time I see a medical professional, I am asked about my parents’ diseases.  I even see ads on TV about getting my genes tested to know my family history. Why the attention to family, and don’t the diseases they have stay the same? Can’t they just get that from the record? And why would they ask me about my spouse since she’s not a blood relative?—Craig, from Dallas

Answer: Let’s first deal with why we care about your family history and why your spouse counts. And although November is Family Health History Month, any holiday (Labor Day, Thanksgiving, Christmas, President’s Day, even a party on a non-holiday) is the perfect time to gather the information you and your healthcare team need to craft a roadmap for preventing disease. Your doctor asks about family history repeatedly because your family may have developed new problems (especially living brothers and/or sisters) or you may have remembered other ones you didn’t tell them about. And they ask about your spouse because your spouse lives with you (at least we hope so) and thus shares the same environmental exposures and likely, similar risks. Yes, she or he is a non-blood relative, but you serve as each other’s personal coal mine canary. Also, even though you don’t share DNA, your spouse influences your health far more than your aunt Sadie in Perth Amboy.  Auntie may have a cholesterol count that would bring a Guinness World Records rep to her door, but she isn’t filling your day-to-day life with cigarette smoke, bacon, beer, and lost-sock arguments.  The only thing worse for your health and longevity than having a spouse is not having one, in fact.

Knowing funny stories about your relatives makes for great fun at family gatherings — but knowing that three of your ancestors had diabetes or that your grandmother had breast cancer at an early age may help you and your children live longer healthier lives. That is right: When you know what you are most likely to get, you can tailor preventive care for conditions such as diabetes, osteoporosis, and cancers of the breast, colon, and prostate.

The Surgeon General’s My Family Health Portrait website (familyhistory.hhs.gov) helps you here. Start with the info you know off-hand. You want to record each relative’s birth date and (if applicable) death date, the jobs they performed (as certain occupations can strongly affect health), and—most important—any diseases they had that may have a genetic link.  Your doctor can clarify this if you aren’t certain about the disease or if it was never diagnosed.  Just list the symptoms the person had (memory loss, for example).  While you’re at it, you might as well jot down any other interesting tidbits in case your kids get curious about their roots one day.

If you’re like most people, it’ll be about 14 percent complete when your brain is tapped.  You’ll need to do some investigating, Columbo-style, so see the ideas (below) for the family interrogation protocol. Hopefully, you won’t have to interrogate more than a handful of relatives in this manner.

If you hail from a litter of fourteen and have more aunts than a cartoon picnic, however, just remember to keep your radar sharp for two factors:  serious illness or death before age sixty and potentially fatal conditions.  Either can be more important than how close you and your relative are in the bloodline.  For example, your uncle’s pancreatic cancer at age fifty-three would likely be more alarming to us than your mother’s heart fibrillations at age seventy.  At a bare minimum, you need to know why your parents and grandparents died, if they’re now gone.

No family picnic or Thanksgiving bash? No problem. First search for your family’s historian.  Most families have at least one great storyteller—a grandfather or an aunt who knows all about the family’s past. Identify that person, and ask him or her to give you details about medical conditions that are common in your family.

No family historian and no bash?  Still no problem. Shaking down family for health details needn’t always be a horribly awkward task.  Remember that half will always talk about the other half, so go the gossip route if it’s easier.  If you want to be direct, just grab your reporter’s pad and pen, dial the phone or meet the relative at the early-bird diner, and repeat this checklist (feel free to ad-lib).  You might consider an opener like this:

“Hello, (relative).  I know you haven’t heard from me since (year), but I’m putting my family health history together to see if I’m at risk for anything genetic, and I thought you could tell me a few things I just can’t find anywhere else.  (Another relative he or she dislikes) said you probably wouldn’t help me or wouldn’t be able to remember, but I thought I’d try anyway.”

  • When were you born?
  • Have you been diagnosed with any diseases? When?
  • What kind of treatment did you get?
  • Any cancers? Diabetes?  Heart problems?  High blood pressure?  Do you take any medications or supplements?  If so, why?
  • Any surgeries? When, and for what?
  • Ever have a bout of depression, anxiety, or other emotional health problems? (Ask relative this family member dislikes for an immediate answer.)
  • Any miscarriages, stillbirths, or infant deaths? 
  • Any heart attacks or strokes? (Pretend you suddenly remember and ask if the flowers made it.) 
  • How’s your hearing? (Whispered.)
  • Do you or did you smoke or drink?
  • What jobs did you have?
  • Has your memory deteriorated?
  • So, that thing growing on (another relative)—is that skin cancer or what?

Once you have a good family history in place, don’t keep it to yourself—talk to your healthcare team about it—it is a springboard for discussions about your and your family members’ health.  In the old days, you couldn’t do much about your family health history but wring your hands and worry. Now, because of research, you can take action. Genetic counselors and genetic physicians can evaluate you for risks, diagnose diseases early and seek appropriate treatments or preventive measures. Family health history can and should be empowering.

And your bottom-line question to your doctor is always the same:  If there’s a genetic link associated with this condition, how can I prevent it? Genetic testing will get more accurate but isn’t there yet.  Until it is, a robust and accurate family history can help, but remember it is you that have to do the work to prevent the potential problem.  But believe us, prevention works, and it is fun.

Thanks for reading. Feel free to send questions—to AgeProoflife@gmail.com.

Dr. Mike Roizen

 

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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