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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.

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Women with Back Pain… The Silent Majority? Part 1

28 Aug

Because humans are bipeds—that is, two-legged animals—our spines tend to experience greater loads than those our four-legged friends. This leads to men and women experiencing degenerative conditions such as osteoarthritis much earlier in life compared with lions, tigers, and bears (and your dog or cat). Also, the majority of us (about 90%) have one leg that’s shorter than the other (average 5.2mm or ¼ inch), which can tilt the pelvis downward on the side with the shorter leg, which increases the risk for both back pain and neck pain. Fortunately, this can be rectified with a heel lift in the shoe.  However, women also face unique anatomical, physiological, and social challenges when it comes to back pain…

Females have a wider pelvis, which aids in childbearing. This results in a greater Q-angle or “knock-knee” measurement in females than males (the “normal” angles are <22 degrees and <18 degrees, respectively). The greater the Q-angle, the less stable the pelvis, as it’s similar to folding the legs of a card table inward, which makes the table unsteady.

Another obvious anatomical difference includes breast size (weight and mass). Large breasts can place a great deal of stress on the mid-back as well as the neck and low back. Wearing a high-quality support bra or having a breast reduction may be appropriate management options for this population.

Hormone levels and variability represents a physiological difference between genders, as levels vary significantly more throughout a woman’s life than a man’s. This is particularly true of estrogen, especially from the time menstruation starts (called menarche), sometime between ages 9-14 years, and menopause. Menopause typically occurs between 49-52 years of age, which is triggered by a decrease in hormone production by the ovaries. (Note: a total hysterectomy— which includes removal of the ovaries—creates premature menopause.)

During adolescence, growth spurts are common and idiopathic scoliosis or an abnormal curvature of the spine can develop. The term “idiopathic” means the cause is unknown, and why women are three-times more likely to develop scoliosis than men is also a mystery. Treatment may range from a “wait and watch” approach to specific manual therapies and posture correction options that may include heel lifts for a short leg, foot orthotics for hyper-pronation of the ankles, as well as specific exercises for forward head carriage. Bracing may be needed if curves exceed 40 degrees although this varies on a case-by-case basis.

We will continue this important discussion next month—stay tuned!

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

Chiropractic Care and Its Many Benefits

31 Jul

Primarily, chiropractic focuses on the diagnosis and treatment of neuromuscular disorders with an emphasis on treatment utilizing manual adjustments and other types of manipulation and/or mobilization of the spine. Chiropractic is classified as a form of primary care, as anyone can choose to see a doctor of chiropractic without a referral.

A 2010 meta analysis reviewed a number of published studies to determine the strength of scientific evidence regarding the effectiveness of manual treatment for both musculoskeletal (MSK) and non-musculoskeletal (non-MSK) conditions.

Lead author Dr. Gert Bronfort reviewed 49 relevant systematic reviews and 16 evidence-based clinical guidelines and concluded that he and the other authors of the analysis found SMT/mobilization to be effective in adults for the following: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; and several extremity joint conditions. Interestingly, Dr. Bronfort and his team noted thoracic manipulation/mobilization as effective for acute and subacute neck pain, but the evidence available at the time was inconclusive for cervical manipulation/mobilization alone for neck pain of any duration.

The evidence was also inconclusive for SMT/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Additionally, they found SMT/mobilization was not effective for asthma, dysmenorrhea (when compared to sham SMT), or stage 1 hypertension when added to an antihypertensive diet. In children, the evidence was inconclusive regarding the effectiveness of SMT/mobilization for otitis media and enuresis, and they also noted SMT/mobilization was not effective for infantile colic and asthma when compared with sham SMT.

In a 2014 follow-up study, lead author Dr. Christine Clar confirmed most of the previously “inconclusive” or “moderate” evidence ratings of the 2010 evidence report. However, the availability of new research motivated Dr. Clar to note moderate evidence for these conditions: manipulation/mobilization (with exercise) for rotator cuff disorders, spinal mobilization for cervicogenic headache, and mobilization for miscellaneous headache.

These two meta-analyses are significantly helpful for those considering chiropractic care for specific conditions. Reviews like this are planned for the future, and the list of conditions that respond well to chiropractic care should expand as areas that need further study are determined and more research is published.

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 Importance of the Cervical Curve

26 Jun

When looking at the neck from the left side, the cervical curve should look “C-shaped”, or lordotic. This develops when infants learn to lift and hold their head up while laying on their stomach and continues to progress when a child starts moving around on all fours.

When we bend our head forward and backward, the most active cervical vertebrae are the C4, C5, and C6 vertebrae that make up the mid-lower cervical spine. Therefore, this region normally “wears out” first, resulting in degenerative joint disease (DJD) and degenerative disk disease (DDD). This is part of the normal, natural aging process, and can flatten and/or reverse one’s cervical curve. However, trauma can significantly accelerate degeneration.

Among some practitioners and researchers, there has been speculation that abnormal cervical curvature may result in altered blood flow from the heart to the back of the brain.

A 2015 study looked specifically at the hemodynamics (the dynamics of blood flow) through the vertebral arteries in individuals with a normal vs. a flat or reversed cervical curve. The research team found an association between the loss of the normal cervical curvature and an alteration of the normal blood flow through the vertebral arteries that travel through small holes in the cervical vertebrae. In their conclusion, they commented on the importance of correcting the cervical curve in order to restore the altered flow of blood.

Altered blood flow through the vertebral arteries has also been implicated AS A risk FACTOR IN vertebral-basilar insufficiency (VBI) stroke. In addition, a flat or reversed cervical curve can increase tension on the vertebral arteries which may lead to weakening of the arterial wall making them more susceptible to injury and inflammation, which can cause the arteries to narrow, limiting blood flow to the back part of the brain.

One of the goals of chiropractic is to improve posture, which can include restoring the cervical lordotic curve. To accomplish this, your doctor of chiropractic may utilize several in-office and home-based therapies; however, please be patient as cervical lordosis retraining can take time!

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.

How You May Prevent a Stroke… Especially if You Experience Headache, Neck Pain, Chest Pain, and/or Visual Disturbance

29 May

We all know it’s smart to write down our symptoms before a visit to our healthcare provider, but most of us simply don’t take the time. In many cases, it may be only subtle symptoms that trigger a proper diagnosis. This is certainly true when it comes to stroke.

There are basically two types of stroke: hemorrhagic stroke and ischemic stroke. A ruptured aneurism, or a leak in an artery, can result in a hemorrhagic stroke while a blood clot that blocks an artery can give rise to an ischemic stroke. Both types often give immediate and obvious nervous system signs and symptoms that typically prompt a call for emergency services.

There is however, a less common and quite subtle type of stroke that is far less discussed and understood. This is called vertebral-basilar insufficiency (VBI) stroke, which is caused by vertebral artery dissection (VAD). This type of stroke is very rare and only occurs 0.75-1.12 times per every 100,000 person years. In VAD/VBI, there may not be ANY history of trauma or event that the person can identify, and it’s most common in 30-50 year olds (not in older-aged people like the other more common types of stroke), which also makes VAD/VBI far less suspect. Symptoms of VBI can be subtle but may include headache, neck pain, chest pain, and perhaps some transient or short-term visual disturbance (blurred vision or double vision, for example). The KEY is a sudden and/or “different” kind of headache, especially if it’s accompanied by some other unusual symptom.

In one case study, a 30-year-old female experienced an “unusual headache” and a short-term loss of her peripheral vision in her left eye with eyelid numbness. This patient also had a history of migraines that typically occurred at menstruation, which led to an inaccurate diagnosis of “ocular migraine”, and she was sent home from the ER. Soon after, she developed right-sided neck pain with a transient right-sided visual disturbance prompting her to visit a chiropractor. The “unusual type of headache” and the visual complaints that she didn’t previously have with her typical migraines caught her chiropractor’s attention. He then ordered a consult and an urgent MRA (magnetic resonant angiography) and MRI of the head confirmed the diagnosis of VAD. With a proper diagnosis and prompt treatment, her symptoms quickly resolved, and the follow-up MRA at the three-month point showed resolution of the VAD.

Neck pain and headaches are COMMON complaints for which people seek chiropractic care. In fact, chiropractic adjustments are strongly recommended in a number of current treatment guidelines. Had “a typical” chiropractic adjustment occurred and the diagnosis of VAD NOT been made, the patient may have progressed to a VBI stroke (which was already in progress BEFORE she even scheduled her chiropractic appointment). Other studies show that neck pain and headaches related to VAD precede visits to both doctors of chiropractic and medical doctors equally and subsequent treatments are typically NOT the cause, as the problem is already present. The good news is that VAD is very uncommon and will hopefully be caught by your doctor and promptly treated so stroke can be avoided.

 

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.

Are Daily Cold Showers Good for You?

24 Apr

Since ancient times, as far back as the days of Hippocrates (the father of medicine), people have taken cold baths in the belief it could both treat serious illness and maintain one’s good health.

In a 2016 study conducted by a team of Dutch researchers, a group of roughly 2,800 participants were split into four groups: three of which were asked to take a 30, 60, or 90 second shower every day for a month while the last group avoided cold showers to serve as a control group.

Nearly 80% of participants completed the study, of which two-thirds continued to take regular cold showers after their initial 30-day commitment had ended. Outcome assessments revealed those in the experimental groups experienced an increase in quality of life as well as a 29% reduction in sick days from work that researchers did not observe in the control group. Some participants even noted their cold showers increased their energy in a manner similar to drinking a caffeinated beverage. Of note, the results were consistent across all three groups, suggesting a 30-second cold shower was just as beneficial as a 60- or 90-second cold shower.

Presently, the authors of the study can only speculate on why the study participants benefited from cold showers. Possible explanations include: the shivering induced by cold exposure increases hormones in the body that can affect the immune system; cold exposure creates some type of neurological benefit; or the effect among participants was entirely psychological, as they had volunteered for a study about how cold showers might improve one’s health.

Lastly, the researchers even speculate that routine cold showers may affect the body in the same manner as engaging in regular physical activity, thus improving the participants’ fitness levels. They write, “In the present trial, reduction of sickness absence of a routine cold shower (29%) was comparable to the effect of regular physical activity (35%).” Of course, more research is necessary to understand why frequent cold exposure has been historically observed as having healthy benefits.

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