Month of: October 2016
Chad Abramson, D.C.
Low Back Pain
Chronic Low Back Pain:
Which Treatment Is More Effective?
For patients with chronic low back pain (cLBP), treatment guidelines recommend
a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to
avoid an initial surgery unless it’s absolutely indicated. That means, unless there is loss of
bowel or bladder control or retention (which represents a medical emergency) or if there
is progressive neurological motor and sensory loss, one can safely avoid surgery and
conservatively manage the condition.
Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up!
Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone.
The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care.
The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone.
The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.”
What Is Causing My Knee Pain?
It’s easy to focus on the knee when it hurts, but is the pain truly arising from the knee? There are
many studies that link knee pain to problems with the lower back, hips, ankles, and feet. This month, let’s
focus on the role the foot and ankle play in preserving knee health!
Because we are all bipeds—we walk on two legs—EVERYTHING from the ground up affects the rest of the body. The first “link” of this “kinetic chain” is our feet, and the last link is the head. If any of the links are altered lower down in the kinetic chain, it will affect the links that follow—usually in a negative way!
For example, a flat foot and/or pronated ankle (where the foot and ankle rolls inward) can create a “knocked knee” effect. The next time you’re in the mall or grocery store, look at people from behind and watch how many roll their ankle(s) inwards when they walk. This is especially noticeable among those wearing shorts and flip flops. It’s estimated that 80% of us are over-pronating by the age of 30, and many of us are born with congenital flat feet, so this behavior is not uncommon in kids.
There are many tissues in the knee that can generate pain. In the over-pronation scenario, the medial, or inside compartment, of the knee is overloaded by opening up excessively while the lateral, or outer compartment, over-compresses or jams together. We often find medial and/or lateral compartment pain in the over-pronated ankle/knocked-knee side.
The front of the knee houses the knee cap that glides in a groove, and the knocked-knee results in overloading on the outside of the knee cap/groove creating a condition called lateral patellofemoral pressure syndrome and/or chondromalacia patella.
When you present for a chiropractic evaluation, your doctor will pay great attention to your gait or walking rhythm and look for over-pronation vs. supination (an outward shift of the ankle), the degree the knee “knocks” inwards (genu valgum) vs. outwards (genu varum or “bow-legged”), respectively. You can correct the pronation effect and unload the compartment that is literally getting “beat up” (hopefully BEFORE arthritis occurs) by placing a medial (or lateral) heel wedge into a foot orthotic.
The next topic is exercise! It is SO important to keep the muscles around the knee stretched and strong! There is ONE particular muscle (vastus medialis oblique or VMO) that connects our upper/inner knee cap to the medial/inside leg. It is the ONLY muscle that counteracts the outward pull by the other quadriceps muscles that attach to the kneecap. Your doctor of chiropractic can show you how to specifically exercise and isolate the VMO, if necessary.
Collisions & Concussions – New Data!
Are you of the belief that you have to hit your head in order to have a concussion or that
concussions are easily diagnosed and managed? If so, then you are not alone! In fact, traumatic brain
injury (TBI)—the proper term used when bleeding occurs within the skull occurs—and mild traumatic
brain injury (mTBI)—the term applied when no bleeding occurs—remains poorly understood by many
healthcare providers. This is partly due to not having any definitive method of testing that yields an
Another problem is the under-reporting of concussion, as close to 40% of people who experience an mTBI do not report it to their doctor. Because of the significant negative consequences regarding the outcome and whole life ramifications associated with concussion, the importance of improving on the ability to diagnose or identify and treat concussion is huge!
We know that mTBI results from the transfer of energy from environmental forces to the brain by a sudden acceleration followed by a sudden deceleration that literally slams the brain into the inside bony skull.
The clinical work-up must include a review of body systems, with a special emphasis on the nervous system, including cognitive and behavioral symptoms. A partial list of post-concussion syndrome symptoms includes headache, balance problems, nausea and/or vomiting, vision problems, dizziness, brain fog (problems with attention, concentration, and speed of mental processing), memory problems, fatigue/drowsiness, light/noise sensitivity, and more.
The good news is that many mTBI sufferers fully recover, but the bad news is up to 25% do not! Promising newer technologies such as Diffuse Tensor Imaging can identify injury to the neural structures (axonal shearing) in those who've experienced a head trauma (such as from a car accident, sports injury, or slip and fall). The Sports Concussion Assessment Tool 2 (SCAT2) has been adopted by numerous sports leagues and others, but many healthcare practitioners do not utilize a structured tool such as this.
One promising tool is a blood test that measures brain-derived neurotrophic factors (BDNF)—a chemical hormone that helps maintain the health of neurons (nerve cells)—which can help diagnose mTBI conclusively and with good reproducibility! Blood levels of BDNF typically are low in patients with TBI or mTBI, and studies have shown patients with very low levels of BDNF are more prone to an incomplete recovery.
Put simply, this type of blood test can help a doctor diagnose, determine the severity, and determine the likelihood of recovery of TBI/mTBI! Doctors of chiropractic are frequently sought out by those with mTBI and understand the importance of careful management of this common and often poorly identified condition.
Carpal Tunnel Syndrome
The Thyroid and Carpal Tunnel Syndrome – Are They Related?
What does the thyroid gland have to do with carpal tunnel syndrome (CTS)? The short answer is,
a lot! But the “how” requires a more detailed explanation…
The carpal tunnel is made up of eight small bones in the wrist that form a tunnel, with the “floor” of the tunnel located on the palm side of the wrist. CTS is caused by the median nerve getting pinched as it travels through the carpal tunnel, which results in numbness and tingling into the middle three fingers (index, third, and fourth) initially, and usually weakness of the grip later.
The thyroid gland is located at the base of the neck just below the “Adam’s Apple” (which is really thyroid cartilage). There are two “lobes” located on either side of the windpipe (trachea), and a small bridge of thyroid tissue crosses over the front connecting the two lobes (called the “isthmus”) in most of us.
The thyroid belongs to the endocrine system, which is controlled by the pituitary or “master” gland that is located inside the head. These glands secrete hormones into the bloodstream that influence the body in a variety of ways. Some of the other “members” of the endocrine system include the adrenals, the parathyroid, the gonads (testicles or ovaries), the insulin producing part of the pancreas, the mammary glands, and more. Think of the endocrine system as a “team” and the pituitary gland as the “coach.”
The thyroid’s role on the endocrine “team” is to release hormones (primarily T3 and T4) that regulate our metabolism/metabolic rate (digestion, heart rate, breathing, body temperature, etc.).
It’s been known for a long time that thyroid disease—particularly low thyroid function—increases one's risk for developing CTS. One thought is that the type of swelling that occurs with hypothyroid (called “myxedema”) places enough pressure on the median nerve to pinch it, resulting in the classic signs and symptoms of CTS.
More recently, researchers used ultrasound to measure the size of the median nerve (called the cross-sectional area or CSA) in 30 patients with newly diagnosed primary hypothyroidism and comparable “normal” controls (similar size/BMI, similar gender, and age). In those with hypothyroidism, the cross sectional size of the median nerve was larger than those measured in the normal group, and four of the hypothyroid patients already began experiencing CTS signs and symptoms. After receiving treatment to restore their thyroid levels, both the size of the median nerve was reduced and the symptoms that were present resolved within three months.
This study points out the significant relationship between the thyroid and its effect on CTS. Doctors of chiropractic treat the mechanical causes of CTS very successfully, but they may rely on the expertise of a “team” of healthcare providers to treat the patient when necessary.
My Aching Neck! Can Chiropractic Help?
Similar to back pain, neck pain affects almost all of us at some point in life, and the
severity can range from a mild stiffness to complete incapacitation. Chiropractic care offers a
non-drug, non-surgical method of treatment that MANY neck pain sufferers utilize and benefit
from. The following is a description of what you can expect when treated with an evidence-based
Let’s first discuss the different types of neck pain. One classification system divides neck pain into two main groups: acute and chronic. In the acute group, there is an onset of pain that comes on quickly and resolves in less than three months. Chronic neck pain represents the patients who continue to have neck pain longer than three months.
Studies show that patients experience immediate benefits—including pain reduction and mobility/range of motion (ROM) improvement—following cervical spinal manipulation, especially when administered on the same side as the neck pain. Short and medium-term benefits include pain reduction and ROM improvement when administered bilaterally (on both sides).
Multiple manipulations may be better than unsupervised stretching alone. However, studies show that stretching the neck muscles both before and after manipulation can improve a patient's outcome. The combination of three-point traction and multiple manipulations can improve pain in the medium and long-term as well.
Other approaches commonly used by chiropractors that immediately improve pain include mobilization, traction, trigger-point therapy (applying pressure over myofascial trigger points for 90 seconds), cervical pillows, and some modalities that include electric stimulation, ultrasound, low-powered laser, and pulsed electromagnetic field.
Active care or care that can be taught to patients includes exercise intended to improve pain and ROM in the medium and long-term. Exercises that emphasize strength and endurance can also be beneficial. Ongoing light and intensive exercise improves pain in the long-term and intensive exercise is favored in the medium-term.
Whole Body Health
Can We Be "Too Clean?"
The concept of cleanliness has been a topic of great debate for many years. On one side of the
fence, frequent cleaning reduces the number of bacteria and viruses that cause illness. On the other side,
some experts argue that our body’s immune system has to work harder when regularly exposed to
pathogens and allergens, which can improve our autoimmune response against the various bugs we might
encounter during our day-to- day lives. So, what does the evidence say?
In a recent study, researchers found that children who bit their nails or sucked their thumb— habits frequently discouraged by parents—were half as likely to have allergies at age 32! It's suspected the children’s immune systems strengthened due to frequent exposure to the bacteria that were under the nails or on the hands.
This new discovery—coined the hygiene hypothesis—may explain why allergies are more common now than they were during the Victorian era—a time when hygiene was much worse.
There has been a steady rise in allergies over the past twenty years, yet no one can fully explain why. For example, in the United Kingdom, one-in- four people suffer from an allergy at some point in life, with an increase in the number each year. Though some research supports germ exposure concepts, experts stress that other VERY important factors including diet, exercise, environmental factors, antibiotic use, and a family history of allergies may also play a larger role in allergy development.
Of course, maintaining good personal and home hygiene standards is very important! Avoiding and preventing the spread of infection to others by covering your mouth when you sneeze (especially if you’re sick) or washing your hands after using the toilet are solid practices! The KEY is NOT to be obsessive about cleanliness!
The available evidence seems to support the following:
- Children raised on a farm develop fewer allergies (possibly due to farm animal exposure).
- Chemicals found in household cleaning products are NOT linked to a rise in allergies.
- The frequency of bathing or showering is NOT linked to increased allergy risk.
- Antibiotic use IS linked to allergy (by disturbing the body’s balance between good and bad bacteria).
- Vaccines are NOT directly linked to the rise in allergy.
- Diet changes, especially in childhood, have been linked to the rise in allergy. Introducing “high allergy” foods like nuts, seeds, milk, soy, wheat/gluten, and egg AFTER at least six months of exclusively breastfeeding (during the weaning process) can reduce the number of children developing allergies in later childhood.
- Chiropractic adjustments support the immune system and may offer relief for some children suffering from allergies.
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.