The “Aging” Lower Back – Part 1 lower back pain

Lower back pain (LBP) can arise from many causes. Nearly everyone has or will suffer from LBP at some point in time, though it is most common in the 30-year-old to 50-year-old group and it affects men and women equally. However, what about the elderly population and low back pain? Let’s discuss back pain unique to the geriatric population…

We’ve all heard of the “wear and tear” factor as it applies to clothing, automobiles, shoes, and tires, but it affects our bones and joints too! A condition that none of us can fully avoid is called osteoarthritis (OA). OA is the “wear and tear” factor on our joints, particularly the smooth covering called hyaline cartilage located on the surfaces of all moving joints. It’s the shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when we separate it from the thigh. Osteoarthritis is the wearing away of that shiny, smooth surface and it can eventually progress to “bone-on-bone” contact where little to no movement is left in the affected joint. Bone spurs can also occur and be another potential generator of back pain. OA is NOT diagnosed by a blood or lab test but rather by an accurate history, physical examination, and ultimately, an x-ray. However, when the low back is affected by OA, it may not even hurt! Yes, in some cases, there may be a significant amount of OA on an x-ray and that patient may not have significant problems. Or the opposite can occur and some patients with very little arthritis can have a lot of back trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is that, in and of itself, it does not always generate pain. This is why the history, physical examination, and the response to treatment (chiropractic adjustments, exercise, and possibly some lifestyle changes in diet and activity) are MORE important than the amount of arthritis found on the x-rays. Ultimately, we will ALL get OA sooner or later. It’s usually a slow, gradual process that may slowly change our activity level. Ironically, KEEP MOVING is the best advice we can give to the patient with OA.

There are a number of conditions associated with OA that affect the spine and respond well to chiropractic treatment. Degenerative disk disease (DDD) is one of those conditions found in association with OA. In fact, another name for OA is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and a central “nucleus” that is more liquid-like and allows the IVD to function like a shock absorber. As we age, the water content gradually “dries up” and the shock absorbing quality is lost.

As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE treatments but most important (in many cases) is the use of spinal manipulation or adjustments. “Exercising the joint” with manipulation and mobilization reduces the tightness and stiffness associated with OA and DDD. Exercises are also important and can give the OA/DDD patient a way of controlling this condition on their own. Diet, activity modification/encouragement, and periodic adjustments help a lot! Next month, we will continue this discussion!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Chiropractic & Exercise vs. OTC Medication for Neck Pain?

“Boy, my neck is killing me! Honey, where is the ibuprofen?” Isn’t this the FIRST thing people think of when they have an ache or pain? The general public does NOT usually think, “….boy, do I need to see my chiropractor – my neck is killing me!” So, the question of the month is, which one is better, chiropractic or over-the-counter (OTC) medication? Let’s take a look.

Though this question has been discussed for years (just search: “chiropractic vs. NSAIDs”), a recent study looked specifically at this question, which will be the main focus of this Health Update. The study points out that it has been estimated that 75% of Americans will experience neck pain at some point in their life. For years, spinal manipulation has been criticized as being ineffective or providing limited benefits. Meanwhile, ads on TV, in magazines, and almost everywhere you look, show someone reaching for aspirin, ibuprofen, or even narcotics to manage their pain.

However, this new research clearly supports that seeing a chiropractor and/or engaging in light exercise can bring neck pain relief more effectively than relying on pain medications! Researchers even found that the benefits of chiropractic adjustments were still favored A YEAR LATER when comparing the differences between the spinal manipulation and medication treated groups! Moderate acute neck pain is one of the most frequent complaints prompting appointments at primary care/medical clinics and is estimated to account for millions of doctor visits per year. In some cases, pain and stiffness occurs without a known cause and there is no “standard” medical treatment. Though physical therapy, pain medication, and chiropractic have all been utilized for neck pain, until now no one had compared the benefits of each in a single study.

The study consisted of 272 neck pain subjects split up into three groups: 1) Chiropractic group (approximately 20-minute treatments an average of 15 times); 2) Pain medication group (meds included acetaminophen, and in some cases stronger prescription meds including narcotics and muscle relaxants); 3) Physical Therapy group (consisting of meeting twice and receiving advice and exercise instruction at 5-10 repetitions up to eight times a day).

At the end of three months, the chiropractic and exercise group did significantly better than those who took drugs. Approximately 57% of those receiving chiropractic management and 48% of those who did the exercises reported at least 75% reduction in pain vs. 33% of people in the medication group. A year after the treatment period ended, the numbers decreased to 53% in the chiropractic and exercise groups, compared to 38% in pain medication group. The chiropractic group received the highest scores in patient satisfaction at all time points. An interesting downside noted in the medication study group was that the subjects had to use a progressively greater amount of medication at a progressively increased frequency to manage their pain. Stomach trouble is the most common side effect of NSAIDs (leading to ulcers) as well as liver and kidney problems. Another interesting finding was that the subjects in the medication treated group felt less empowered, less active, and less in control over their own condition compared with those in the other two groups.

This study points out the benefits of two treatment approaches that chiropractors commonly utilize: spinal manipulation and exercise training/advice!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain, we would be honored to render our services.

The Many Faces of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) was first reported in the late 1800’s and the first surgery was noted in 1933. In the beginning, CTS surgery was rarely performed, reportedly because the nerve pinch was present somewhere before the median nerve reached the wrist or carpal tunnel. In brief, possible compression sites include the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the elbow, in the proximal and/or mid forearm, and finally at the wrist / carpal tunnel.

Estimating the frequency of CTS is challenging due to the fact that the pinch or entrapment may include more than one area before the wrist resulting in double and multiple crush syndromes. One European study reported the incidence of CTS at 5.8% in women and 0.6% in men while another reported 3.4% in the United States. Even the causation of CTS is all over the board. For example, the annual incidence of CTS in automobile workers ranges between 1-10%, while in a fish processing plant, it was reported to be as high as 73%! To make this even more challenging, the cause of CTS is commonly associated with other conditions such as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and those who are pregnant have a 2% incidence. Even harder to report is the incidence of median nerve pinching proximal to the wrist as this ranges between as little as 1% to as high as 75% for pronator tunnel syndrome in already symptomatic women. Gender is also a factor as women are reported to be four times more likely to develop CTS than men. If there is NO other condition associated with CTS, the term “idiopathic” is applied, and this reportedly occurs 43% of the time.

Another issue making CTS a challenge to diagnose is the many risk factors associated with it, and sometimes studies are published that contradict one another about the possible risk factors. There are studies that report CTS is more likely to occur with conditions including: 1) Jobs or activities associated with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3) Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study reported the highest incidence to occur in those with previous wrist fracture (Colles’ fracture), and common conditions included rheumatoid arthritis, hormonal agents or ovary removal, diabetes, and pregnancy. Another study reported obesity and hypothyroid as being risk factors, but not all studies support that theory. Certain medications have been reported to be associated with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3) Metformin; and 4) Thyroxin.

As doctors of chiropractic, we perform a thorough history, examination, and offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder, elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3) Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm and hand; 5) Work station / ergonomic evaluations; 6) Dietary counseling for various conditions listed previously; 7) Co-management with primary care, rheumatology, neurology, orthopedics, and others.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Fibromyalgia in Men?

Fibromyalgia (FM) can’t occur in men because it’s a woman’s disease, right? In fact, if a man claims to have FM, then he is simply lying (probably just trying to get out of working and/or on disability), right? Unfortunately, that’s what MANY people (and even some doctors) believe!

Though it is true that FM is primarily a woman’s disease, actually nine times more likely, it does INDEED affect men. FM affects 2-4% of the population (an estimated 5 million adults) in the United States (US) with as few as 10% of victims being men. But, that’s still 500,000 men in the US alone, and that doesn’t include an estimated 20% that go undiagnosed (mostly because “men are men”)! The onset, like that for women, can occur, “….out of the blue.” Case studies show a man (or woman), can be highly engaged in an active lifestyle that may include golfing, bowling, or working on a hobby car, when suddenly and for no apparent reason, intense chronic pain can arise and, “…take over the life” of this previously very healthy, vibrant, active man.

We’ve all learned that FM is diagnosed primarily by excluding other disorders after running many tests including x-rays, various scans, lab tests, and more. When all the tests come back negative, the diagnosis of FM is even then only sometimes entertained. The word, “SOMETIMES” should be strongly emphasized as MANY doctors, as well as the general public, STILL have a hard time wrapping their heads around the diagnosis of fibromyalgia. This happens even more when a male patient presents with the FM cluster of symptoms. A male patient may attend a FM support group and be the only man in the room. The National Fibromyalgia Association has only one male board member who reportedly was not initially welcomed! This particular male reported that a neurologist refused to see him, as he did not support the diagnosis and openingly accused him of trying to get disability payments. He stated that it was particularly challenging to find professional care as well as community support. Even his best friend, a doctor, told him that men couldn’t get FM!

The cause of FM remains elusive. Why do so few men compared to women suffer from FM? Though certain types of viral infections, trauma after car accidents, and emotional stress have all been reported to trigger FM, it can also strike without warning. According to Dr. Muhammad B. Yunus, MD (professor of medicine at U. of Illinois, College of Medicine), FM is characterized by an imbalance of brain chemicals described as, “…a neurochemical disease.” He found that FM patients have higher than average levels of substance P (a neurotransmitter that signals pain), and lower levels of serotonin (a neurotransmitter that inhibits pain). Genetics and hormones (particularly estrogen, which is higher in women) also play a role both with causing the disease and with the gender discrepancy found in FM. Estrogen has also been found to reduce pain thresholds, a problem associated with FM, thus making women more susceptible to the disease. Like in women, men can have similar complications including (but not limited to) chronic fatigue, difficulty sleeping, headaches, irritable bowel syndrome, restless leg syndrome, and memory and concentration problems. But, it has been reported that men with FM usually have less wide-spread or, “…hurt all over” pain and may not suffer from as much fatigue, but in some cases, can still be more disabled from FM than women. Depression and suicidal thoughts are reportedly common in men with FM. Prompt diagnosis and treatment continues to be the recommended course in order to obtain ideal management results!

As chiropractors we can offer management, treatment, exercise training, dietary consultation, and coordinate care.

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Whiplash Anatomy

Whiplash is an injury commonly associated with motor vehicle collisions (MVC) caused by a rapid forward and backward “whipping” of the neck. What varies between each case is the degree of injury and what anatomical parts of the neck are actually injured. Let’s take a look at the spine so we can better understand where the pain actually comes from…

The cervical spine is made up of seven moving vertebrae. The top vertebra (C1) is called the atlas and is shaped like a ring. This ring shape allows the head to rotate left and right so we can check traffic, carrying on conversation with someone sitting off to the side, and so on. It pivots around a peg called the “dens” of C2, or the axis, and the function of these first two vertebrae is very important. This is because the upper most three nerves that exit through this part of the cervical spine innervate the head and dysfunction here may be the cause of some headaches. Chiropractic adjustments concentrate a great deal on restoring function to this area. The C4-6 vertebrae make up the most mobile region of the spine in the forward and backwards directions. Generally, the greater the mobility, the lesser the stability, and because of this, injury to this area is quite common. We often see arthritis in this region first and we focus on keeping the areas that are less mobile (areas above and below C4-6) as mobile as possible. The upper back/lower neck area includes the rib / vertebrae joints, which are also commonly involved in whiplash injuries. Chiropractic adjustments applied to this region also help to restore function and mobility. The thoracic spine is made up of 12 vertebrae and includes the rib cage as well as the shoulder blades (scapulae). This area is sometimes neglected during treatment as the main focus is often placed on the more painful areas of injury like the neck. The lumbar spine consists of five vertebrae and is also frequently overlooked as an injured area due to the distance away from the neck. However, seat belts frequently injure the breast, chest, mid-back, and/or low back regions.

There are several tissues that could be injured. The ligaments—the tough, non-elastic tissue that holds bone to bone—function to maintain stability between the vertebrae. The articular capsule is also made of ligaments and is a frequently injured area, which generates pain with movement of the head and neck. Musclesand the tendon attachments are elastic and function to move the structures. Stability is facilitated by good muscle tone and strength and is a strong focus of treatment. Injury to these structures are called, “…soft tissue injuries,” and make up the majority of whiplash associated disorders (WAD II category).

The intervertebral disks are made up of a fibroelastic cartilage on the outside and a more liquid-like center that functions as shock absorbers between the vertebrae. Injury to the disk includes tears, cracks, and/or fissures where the liquid center part can migrate through and can rupture. Injury to the nervous tissues includes the free nerve endings when the articular capsule is “sprained.” Nerve root injuries are most commonly “pinched” or compressed by a “ruptured disk” and send pain, numbness, and/or muscle weakness to specific areas of the arm and/or hand. These injuries are classified as WAD III injuries and usually carry a worse prognosis than WAD II injuries.

Determining which tissues are injured, managing the acute, subacute, and chronic stages of healing and facilitating self-management strategies are the primary goals of chiropractic treatment of the whiplash injured patient.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.