Month of: January 2017
Chad Abramson, D.C.
Low Back Pain
Can Bad Backs Heal Themselves?
Low back pain (LBP) from a herniated disk often leads to surgical intervention. However, there
are patients with this painful malady who can successfully “ride it out” and repeat MRI imaging six to
twelve months later often fails to show little, if any, evidence of the original herniated disk that was
initially very obvious. How is this possible?
The proposed theory is that there must be some unique interplay between molecular signals that might explain why some herniated disks heal themselves while others do not. Researchers at Vanderbilt University Medical Center are investigating this and published a report on their progress in the January 2016 issue of the Journal of Clinical Investigation.
LBP affects 60-80% of Americans during their lifetime, and there are upwards of 300,000 surgeries for herniated disks annually in the United States alone. A disk can herniate when its outer fibers tear or give way, allowing the semi-fluid center to leak out. If the herniated disk material hits the nerve root exiting the spine, the classic sciatica, or pain down the leg, can result.
Dr. Dan Spengler states that about 50% of patients with disk herniation will improve within six weeks, and the actual herniated material may completely resorb over time. What troubles Dr. Spengler and other researchers is why this doesn’t occur with everyone.
Looking specifically at the molecules that are frequently present when disks herniate, researchers have identified a group of proteins called matrix metalloproteinases (MMPs). Certain MMPs have the ability to act like “Pac-Man” and literally chew through other proteins making it highly suspect that MMPs may be at the forefront of why some disks resorb while others do not! Additionally, when a disk herniates, bleeding occurs and white blood cells—specifically macrophages, which are immune system cells in our blood that ingest foreign materials and bacteria—also flood into the area.
What most surprised the authors was the interplay between the macrophages and the MMPs. They found that when the blood/macrophages and one of two specific MMPs interacted in a very specific manner, disk resorption occurred and they were even able to replicate this process in a lab. They concluded the following, “These enzymes are more complicated and interesting than we originally thought. Rather than being big bulldozers, they’re a fine pair of scissors that cut certain things.”
The TAKE-HOME MESSAGE here is unless you are having progressive neurological loss (meaning muscle weakness or sensory pain that is progressing, and/or especially bowel or bladder weakness), there is NO RUSH to run and have surgery! Doctors of chiropractic can offer natural, non- invasive treatments to manage pain while you let your body manage the herniation!
What Happens When a Knee Injury Occurs?
Have you ever wondered what actually happens when a player on your favorite sports
team has a knee injury? Why is this so common, and why is the knee more vulnerable than the
ankle or hip?
One reason is simple anatomy. Unlike the hip, the knee doesn’t have a deep socket, meaning there is less stability and they don't have the added side protection the ankles enjoy. The knee is more like a hinge with little protection when impacts occur from any direction.
In a classic football tackle from the side (or in a “clip”), the runner’s foot is planted with the lower leg rotated inward as the player is cutting a corner when WHAM, a hit occurs. When the tissues in the knee are stretched beyond their limits, they can tear. The order in which the tearing occurs and the amount or degree of the tear is dependent on the exact mechanism of injury or the direction and force of the impact.
The anterior cruciate ligament (ACL) is the innermost structure while the MCL and lateral collateral ligament (LCL) is found on the outside of the joint. If the hit is from the front, the ACL may bear the brunt of the blow while a hit from another direction may first affect the medial collateral ligament (MCL). The meniscus is a C-wedge shaped piece of cartilage that absorbs shock between the joints of the femur and tibia with one on the inside (medial) and outside (lateral meniscus). The meniscus is among the most common of knee injuries, often associated with a twist or torsional stress. This is commonly referred to as a “torn cartilage.”
In one study of 100 consecutive patients with recent ACL tears, there were also 53 MCL, 12 medial, 35 lateral, and 11 bilateral meniscus injuries. The cause included 59/100 injuries due to contact sports, 30/100 in downhill skiing, and 11/100 in other recreational activities, traffic accidents, or at work. It is estimated that there are 100,000 anterior cruciate surgeries in the United States each year!
Doctors of Chiropractic are trained to identify, treat, and rehab knee injuries both pre- and post-surgically. They frequently work with other allied healthcare professionals to optimize outcomes as quickly as possible.
What Are Whiplash-Associated Headaches?
Whiplash and headaches are a very common duo that frequently occur after motor vehicle collisions.
The good news is that most headaches that arise immediately following a head injury (or shortly thereafter)
usually improve after minutes or days. But unfortunately for some, these headaches may persist over the longer
term and even become a permanent part of life.
Researchers use the terms “post-traumatic” and “post-concussive” headache to describe long-term, intractable headaches associated with trauma. Given the back-and- forth, to-and- fro (and every combination in between) mechanism of injury in car crashes, it’s easy to understand why headaches develop. What isn’t so easy to appreciate is why most clear out while others don’t and become chronic.
Mild brain injuries are essentially a concussion (also referred to as mild traumatic brain injury or mTBI). This is usually a brief disturbance of brain function causing loss of consciousness or transient difficulty in thought processes. Mental fog, difficulty completing simple tasks, and losing one's place in the middle of a thought or sentence are common mTBI symptoms.
Because standard neurological exam and imaging techniques (CT, MRI, X-Ray, and EEG) usually come back negative, many physicians have resorted to calling these symptoms “psychological.” However, newer technologies such as diffuse tensor imaging or functional MRI can detect the microscopic injuries to the nerve fibers in the brain that may cause the previously described symptoms.
A unique difference between the classic chronic tension-type headache vs. those associated with post- concussive syndrome are the additional neurological symptoms: dizziness, ringing in the ears, blurred vision, psychological symptoms including depression, anxiety, personality change, sleep disturbance, and impaired libido.
Additionally, patients may also experience difficulty concentrating, poor work efficiency, and difficulty maintaining attention or retaining information—it’s no wonder why disability rates are so high in this patient population. It’s a LOT to deal with!
Treatment of this type of headache and constellation of symptoms has traditionally centered on treating each symptom individually, as there is no “magic pill” that gets to the underlying brain disturbance. However, there is hope that patients can benefit from a multi-disciplinary method of combining several techniques such as transcranial pulsed electromagnetic field, biofeedback, brain stimulating games or exercises, chiropractic management of the cervical spine, cognitive behavioral therapy (CBT), the use of fish oil, vitamin D3 with a gluten-free diet, etc.
Doctors of chiropractic are trained to identify these types of headaches and frequently team up with allied healthcare providers to form a “team” to BEST serve the patient's needs. Though it is fortunate most headaches associated with car accidents gradually taper off by the three- to six-month point, it’s important to NOT lose hope for the less fortunate who continue to struggle with post-concussion syndrome headaches.
Carpal Tunnel Syndrome
WHEN Is Surgery Needed for Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) often responds well to non-surgical care and there is good
evidence supporting chiropractic treatment for CTS. But the question frequently arises, “When
should I consider surgery for my CTS?” Let’s take a look…
CTS is basically the pinching of the median nerve as it travels through a tight tunnel at the wrist. The causes of CTS are many and include mechanical (trauma like fractures, sprains or strains, ganglion cysts, spurs from arthritis, tendonitis from overuse), metabolic (obesity, pregnancy, hormone replacement and birth control pills, diabetes, hypothyroid), inflammatory (overuse, work, playing an instrument, hobbies), and more.
When it comes to surgery, each case MUST BE individually assessed. The factors that increase one's risk for needing surgery to resolve their CTS include: 1) EMG/NCV evidence of axonal degeneration (nerve damage); 2) muscle atrophy or shrinkage of the thumb pad; 3) acute onset after trauma (especially in fracture or dislocation of the wrist); and 4) after ALL non- surgical attempts have been tried.
Many reading this article may be surprised that CTS can actually be treated without surgery, given the popularity of surgery for this condition. Further, many may also be surprised that chiropractic can be VERY effective in managing CTS and studies have often demonstrated such care performs as well as or better than standard medical care, without the potentially serious side effects associated with some medications that may be prescribed for the CTS patient.
Non-surgical treatment offered by chiropractors may include manipulation and mobilization to the wrist (and the neck, shoulder, and elbow if nerve impingement in these areas contributes the CTS symptoms), as well as stretching exercises multiple times during the work day, taking mini-breaks, workstation modifications, an anti-inflammatory diet with supplementation, and more. The BOTTOM LINE is you can always have surgery, so make sure you’ve exhausted ALL your non-surgical options before resorting to surgery!
Neck Pain / Headaches
Neck Pain and Sinusitis – What’s the Connection?
The connection between our sinuses and headaches is well established, but what about the relationship
between neck pain and our sinuses? Is there a connection?
Sinusitis is very common in the spring when pollen counts are high and times when the cold and flu are rampant. It usually manifests with a clear runny nose and pain over the affected sinuses and other “histamine” related symptoms (watery eyes, sneezing, etc.).
The Mayo Clinic states at least two of four primary symptoms of chronic sinusitis (CS) need to be present to confirm a CS diagnosis: 1) thick, discolored nasal discharge or drainage down the back of the throat (post-nasal drip); 2) nasal obstruction due to congestion that interferes with nasal breathing; 3) pain, tenderness, and swelling in the eyes, face, nose, forehead; 4) a reduced sense of taste and smell in adults and a cough in children.
Other CS symptoms can include: 1) ear pain; 2) jaw or teeth pain; 3) cough—often worse at night; 4) sore throat; 5) bad breath (halitosis); 6) fatigue; 7) irritability; 8) nausea; and 9) neck pain. Acute sinusitis has similar signs and symptoms when compared with CS, but they are short-lived. Symptoms that warrant a primary care consideration include: 1) high fever; 2) severe headache; 3) mental confusion; 4) visual changes—double vision, blurriness, etc.; and 5) profound neck pain and stiffness.
Causation of CS include: 1) Nasal polyps; 2) deviated septum; or 3) other medical conditions (cystic fibrosis complications, gastroesophageal reflux or HIV and other autoimmune system-related diseases) that can block the nasal passage.
Risk factors for CS include: 1) nasal passage conditions (polyps, deviated septum); 2) asthma; 3) aspirin sensitivity (due to respiratory problems); 4) immune system disorder (HIV/AIDS or cystic fibrosis); 5) hay fever/allergies; 6) pollutant exposure (air pollution, cigarette smoke).
Complications of CS: 1) meningitis; 2) infection migration such as to the bones (osteomyelitis) or to the skin (cellulitis); 3) sense of smell loss (partial or complete “anosmia”); 4) vision problems (including blindness).
Many are not aware that neck pain and stiffness and jaw or teeth pain are symptoms of CS. Conditions like this are a reminder that it's important for both the doctor and patient to be aware of ALL the symptoms present, even if they seem like they aren't connected. While doctors of chiropractic are trained to look for non- mechanical causes for neck pain when a patient seeks care, it makes it easier if the patient is forthcoming with all their symptoms, even the ones that don't seem relevant.
The good news is that doctors of chiropractic are trained to manage CS and can offer patients advice on lifestyle changes that may reduce the risk of the infection recurring. Furthermore, chiropractors often work with allied healthcare professionals when antibiotics or other measures are needed.
Whole Body Health
How Important is Sleep?
Do you frequently feel sleepy throughout the day? Do you doze off soon after you sit down? Do
you feel “restored” when you wake up in the morning? How much sleep is REALLY needed and how
important is it? Let’s take a look…
The short answer is that sleep is REALLY important! Prior to the 1950s, most authorities thought sleep was just a passive, dormant part of life. However, we’ve come to appreciate that our brains are quite active during sleep, and sleep quality affects our daily functioning and our physical and mental health in ways we’re JUST beginning to understand!
There are five phases of sleep: stage 1-4 and REM (rapid eye movement) sleep. These stages occur in that order creating distinctly different brain wave patterns. We spend about 50% of our sleep in stage two sleep, about 20% in REM sleep, and about 30% in the other stages (this varies with age).
We sleep much lighter in the early stages (one and two) of sleep—meaning it's easy to be woken up by noises or other disturbances. Sleep is much deeper during stages three and four (called delta wave sleep) and if something manages to disturb these stages of sleep, you'll find yourself groggy and disoriented for the first couple minutes upon waking. REM sleep includes rapid, irregular breathing, increased heart rate and blood pressure, and this is often when bizarre, illogical dreams occur.
Infants need require about sixteen hours of sleep, teenagers need nine hours, and adults should sleep seven to eight hours a night (more during pregnancy). Too little sleep leads to “sleep debt,” which must eventually be re-paid. Though we can function on little sleep for a while, our judgment, reaction time, and other functions are impaired. If you feel drowsy during the day, experts say you haven’t had
enough sleep, which unfortunately has become the norm in our society! There are MANY studies that make it clear that sleep deprivation is DANGEROUS! Sleep deprived drivers may be as unsafe on the road as drunk drivers. In fact, experts estimate driver fatigue plays a role in about 100,000 car wrecks and 1,500 deaths each year in the Unites States alone—which is probably a conservative estimate!
While we are still trying to figure out WHY sleep is so important, animal studies show that rats will die within three weeks when they are deprived of sleep and within five weeks if they're only deprived of REM sleep.
Bottom line: getting enough quality sleep each night is important for maintaining your mental and physical health.
FOR YOUR FREE NO-OBLIGATION CONSULTATION CALL: 425.315.6262
Abramson Family Chiropractic
10222 19 th Ave SE, Suite 103, Everett, WA 98208
This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.