Month of: November 2016
Chad Abramson, D.C.
Low Back Pain
Circadian Clocks and Low Back Pain?
According to the National Institutes of Health, circadian rhythms include physical,
mental, and behavioral changes that roughly follow a 24-hour cycle, responding largely to
environmental light and darkness. Most living things possess this trait including animals, plants,
and many microbes.
So how does this relate to low back pain? Recent studies reveal that the intervertebral disk (IVD)—the “shock-absorbers” located between our vertebrae in our spine—contain intrinsic circadian clocks that are regulated by age and cytokines and are linked to degeneration. This means we have a 24-hour rhythm producing various changes in an organized way throughout the day in each of the disks in our spine!
Researchers have found at least 600 genes with 24-hour patterns of expression representing several essential pathways associated with disk pathology. In experiments on mice, scientists have observed that when the normal expression of these genes is disrupted, disk degeneration may occur. The study concludes, “These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.”
So what can we do about this? These findings support an important concept that improves overall health, quality of life and longevity: our sleep habits! We know our circadian rhythms influence sleep-wake cycles, hormone release, body temperature, and many other important bodily functions and are linked to various sleep disorders.
Researchers have linked abnormal rhythms with obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder (SAD), to name a few. We also know how we feel when we fly from California to New York and the alarm rings at 7am in NYC but our biological clock says 4am!
The importance of sleep cannot be overstated. Longevity is shortened when sleep duration is altered (either too little OR too much sleep) and we know quality of life is negatively affected in swing-shift workers. Now, we’ve learned that the cells in our disks also have a circadian rhythm, and alteration of that rhythm can lead to disk degeneration resulting in low back pain!
A Pain in the Hip?
When you ask people to point to their hip joint, it’s very interesting to see the vast number of
places where people point—the low back, side of the pelvis, front of the pelvis, in the groin, and more! If
one were to draw a line between the back and front pocket, that’s basically the hip joint.
So keeping the hip joint in mind, picture the squat exercise. According to Dr. Stuart McGill, director of the Spine Biomechanics Laboratory at the University of Waterloo, Ontario, Canada, to safely perform a squat, one must FIRST consider genetics and the role it plays, especially in performing a deep squat.
Genetics, according to Dr. McGill, helps us to determine whether the hip joint can handle squatting. For example, genetically shallow hip sockets predispose people to hip dysplasia (arthritis). The highest rate of hip dysplasia in the world is in Poland as individuals of Polish descent are genetically predisposed to be develop shallow hip sockets. However, because of these shallow sockets, the range of motion of their hips (prior to dysplasia, of course) is greater and also more powerful in the deep squat position.
Hence, it should not be surprising that the great Olympic weight lifters come from Poland, Bulgaria, and Ukraine due in part to this uniquely shaped and shallow hip socket (called the Dalmatian hip). In contrast, the shape of the hip in those of Scottish descent is deep, which has a great advantage for walking, standing, and rotation power, but the deep sockets are terrible for producing power at the bottom of a deep squat.
Similarly, Celtic and French populations have deep sockets, and that is the most logical reason why exercises that require a wide range of motion, like yoga, can result in impingement pain in a high percentage of people of such ancestry.
So, how does this relate to hip pain? Depending on your genetic makeup, if you are of the descent where shallow hip sockets are common, it might be best to avoid deep squats and/or occupations that require a lot of weight-bearing and bending over, especially those with heavy lifting. Even though you might win a squatting competition due to less hip impingement, the shallow sockets tend to wear out faster.
Bottom line, when engaging in an exercise class, running, cycling, or the like, if there is pain (a “bad” or sharp lancinating pain), DON’T DO THAT EXERCISE! Stay within “reasonable pain boundaries” and you should generally be safe. DON’T try to keep up with the person next to you, as they may be genetically “better matched” for the activity that you’re engaging in.
Whiplash – Is it Muscle, Ligament, or Both?
Whiplash is caused by the rapid back and forth motion that occurs in the classic rear-end collision, in
some sports, and during slip and falls. The initial symptoms associated with whiplash often include muscle
tightness and pain. But where is the pain coming from?
First, the mechanism of injury that is involved in a rear-end collision is important to understand. In the first 50-100 milliseconds, the body below the neck is pushed forward in relation to the neck, resulting in straightening of the neck. Between 100-200 msec, the lower half of the neck extends while the upper half flexes, after which the head accelerates backwards, where it is hopefully stopped by the head rest. This is followed by a forward rebound where the head and neck accelerate forward, hopefully limited by the seat belt and/or air bag. This entire event is completed within 300msec, which is faster than what we can voluntarily brace or guard against, even if we see it coming!
Factors that contribute to injury that are more difficult to calculate include the angle and springiness of the seat back, the position of the headrest, the build of the person (tall slender females are at greater risk than a husky male), whether the head was turned at the point of impact, the slipperiness of the road, the size of the two vehicles, etc.
So what's causing your pain? Is it muscles, ligaments, or something else? There are many symptoms associated with whiplash and hence the term ‘whiplash associated disorders’ or WAD that is applied to these cases. There are four categories of WAD: 1) few symptoms/no exam findings; 2) more symptoms/positive exam findings but no nerve pain; 3) nerve pain—numb/tingling and/or muscle weakness; and 4) fracture/dislocations. The term “cervical sprain/strain” refers to ligament/muscle injury, respectively. Muscles move bones and joints and are more elastic while ligaments firmly hold two bones together at a joint. The muscles attach to bone by tendons, and a strain refers to a muscle and/or tendon injury. Both sprains (ligaments) and strains (muscle/tendon) are graded as one, two, and three or, mild, moderate, and severe, respectively, depending on how much tearing occurs. The rate of healing is dependent on the amount of tearing and how “nice” you are to it after injury. Pain can last a long time if you keep “picking at the cut” or in other words, not respecting the healing process. What makes the neck so unique are the many layers of muscles that exist. Like an onion, there are layers upon layers of muscles that do different jobs, but unlike an onion, these muscles run in many different directions. The muscles on the outside tend to be long, large, and strong while the deep ones are short, small, and are important with fine motor control and coordination. The deep muscles are NOT voluntary (the larger/stronger outside muscles are), so to exercise them, we have inhibit the outside muscles to get the deep ones to work. The deep neck flexor muscles are always weak in those of us with neck pain (from any cause) and need to be isolated and strengthened in order to feel and function better. Doctors of chiropractic are trained to teach you these important, specific exercises in addition to others as well as provide you with pain relief with treatment, education, and job/work modifications.
Carpal Tunnel Syndrome
A "Self-Help" Guide to Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) has a bad reputation for coming and going, sometimes for years,
depending on many factors such as 1) age; 2) profession (fast, repetitive, with forceful gripping); 3) general
health (diabetes, hypothyroid, and inflammatory arthritis (like rheumatoid), pregnancy, on birth control pills,
or taking hormone replacement therapy); 4) hobbies (worse if it’s knitting, crocheting, prolonged use of a
computer, or using hand tools a lot); and 5) obesity.
- Rest/Activity: CTS symptoms often improve when taking “mini-breaks”, as it STOPS the vicious
cycle from getting out of control. For example, if you are a musician, rest every 15 minutes or even
one to two minutes when practicing. REST during any activity that requires heavy use of the hands,
such as forceful gripping and/or fast repetitive movements, can REALLY help!
Lose weight: Obesity increases the likelihood of CTS, especially if you’re over age 50 and female. It
is recommended that you check your BMI and keep it under 30!
Night Splints: The use of a night splint can REALLY help, as we cannot control our hand/wrist
position at night when we sleep. ANY position outside of a neutral position increases the pressure
inside the wrist and can wake us up with numbness, burning sensations, and pain. The discomfort can
also prevent us from returning to sleep. When CTS symptoms are present when driving, the use of a
splint can be highly relieving!
Exercise: In general, exercise is good for everyone but it can help in specific conditions like CTS.
Yoga has specifically been cited as a potential CTS remedy, pending the yoga pose does not aggravate
a painful arthritic wrist. So use your good judgment—if an exercise produces a sharp pain, it’s
probably NOT good for you!
CTS Specific Exercises: There are very specific stretches that can be done that helps CTS. Stand at
arms-length from a wall, keep the elbow straight and place your palm on the wall with your fingers
pointing downward. Slowly bend the wrist to 90° (so that you feel a strong stretch in the forearm),
then reach across with the opposite hand and pull your thumb back off the wall. Hold this five to ten
seconds and repeat on the opposite side if needed. This can be repeated MANY times a day.
Workstation Ergonomic Modifications: It’s often easier to change a workstation than it is to change
the worker, so make sure the computer monitor is directly in front of you, keep the mouse in a
comfortable location such as level with the keyboard on a pullout under-the- desk shelf, change the
tool design to prevent wrist bending and/or firm gripping, rotate between several job tasks more often,
allow for sit/stand options, and more. Carefully assess your work area and use the goal of preventing
extreme wrist positions!
Manage health co-morbidities: Keep your diabetes, thyroid deficiency, hormone levels, and
inflammatory conditions under control. This may require the proper medication(s) and/or nutritional
support. Your chiropractor can help you with nutritional counseling!
Manipulation: When you cannot adequately control your CTS symptoms or if you are getting worse
despite your good efforts, seek care from a doctor of chiropractic. Manipulation, mobilization,
modalities, and additional exercise training can prevent surgery in many cases! But don’t wait too
long, as it’s more difficult to treat if CTS has persisted a long time.
Neck Pain / Headaches
Head Tilt and Headaches – Are They Connected?
We’ve all seen people working on laptops in airports, airplanes, coffee shops, on the train, walking
down the street…you name it! So how does this affect one's neck, and does it contribute to headaches?
A 2016 study compared females with posture-induced headaches vs. healthy, age-matched female control subjects to see if there was any significant difference in their head-tilt and forward head position during laptop use.
The research team measured angles for maximum head protraction (chin-poking forwards), head-tilt, and forward head position at baseline (neutral resting) and while using a laptop. Essentially, they measured how “slumped” the participant’s posture was at rest vs. while working on a laptop.
The results showed that the headache group demonstrated an increased head protraction of 22.3% compared to the control group at rest. When comparing the ratio of forward head position during habitual sitting to the maximum head protraction, the researchers found a significant difference, which was also worse in the headache group. Similarly, laptop work head position was worse in the headache group.
The researchers concluded that the headache group showed worse posture at rest in the two measurements as well as more forward head posture during the laptop task than the control group. They recommended that management/therapy for patients with headaches and/or neck pain include posture retraining exercises as an important aspect of obtaining long-term successful outcomes.
This study illustrates the importance of that and the need to include exercises like chin-retractions, conscious head re-positioning, cervical traction (in some cases), deep neck flexor muscle strengthening, managing scapular stability, and more.
When looking at a person from the side, imagine a perpendicular line that passes through the ear canal should pass through the shoulder, hip, and ankle. In cases of forward head posture, that line will pass forwards of these bony landmarks.
Previous research shows that the head weighs an average of 12 pounds (5.44 kg), and for every inch of forward head positioning, the neck and upper back muscles are burdened with an extra 10 pounds (4.53 kg) of load to keep the head upright. That means a five-inch forward head position adds 50 pounds (22.67 kg) of weight to the neck and upper back area. It’s no wonder this faulty posture leads to chronic neck and headache complaints!
Spinal joint manipulation is one of the most patient-satisfying, fast-acting remedies for neck pain and headaches of several types offered by doctors of chiropractic. But when manipulation is combined with exercise training, studies show this combined approach results in the best long-term benefits or outcomes!
Whole Body Health
Walking vs. Running – What’s the Best?
The focus on aerobic exercise is all around us. You can’t pass a magazine stand without being
inundated with cover pictures of people walking, running, cycling, or doing some form of exercise. So the
question begs, is walking good enough? Let’s take a look!
A GREAT plus about walking is that it can be done virtually anywhere and at any time, indoors or outdoors. It can be mixed into a routine that may include stretching, strengthening, balance training, HIIT (high-intensity interval training), and more. The options associated with combining walking with other forms of exercise are limited only by one’s imagination!
Though walking may not be as “sexy” as some other sports, scientific evidence continues to grow regarding the benefits of walking when compared with other more physically intensive activities.
It appears the trend of walking is catching on! The Centers for Disease Control and Prevention reports that from 2005 to 2010, 20 million more people initiated the habit of walking for at least ten minutes once a week. With this increase, New York, Chicago, Cleveland, and Boston and many other cities have transformed busy traffic routes into pedestrian-friendly pathways. A trend of changing from walking as a sport or separate activity to walking as a necessity such as to get to work, school, or to shops and grocery stores IN PLACE OF driving is gradually becoming more popular!
Doctors, insurance companies, and public health personnel have been promoting walking because, quite simply, “it’s good for us!” Some have described walking as “a wonder drug” without a prescription or cost because of its MANY benefits—a few of which include: 1) weight loss and maintenance; 2) stimulates energy (especially a couple hours after eating due to a drop in blood sugar levels); 3) it lifts our spirits (in just ten minutes, it boosts the mood for up to two hours!); 3) it strengthens our memory (in an elderly study group, 40 min. walks, three times a week resulted in a 2% average increase in the size of the hippocampus vs. a 1.4% loss in size in those that utilized only stretching; 4) heart disease protection (lowers BP by at least 4.2% and heart disease risk by 4.5%); and 5) may reduce cancer risk (in those with colorectal cancer, those that walked for six or more hours a week were 60% less likely to die from the disease than the sedentary patients. One hour of daily walking may reduce a woman’s likelihood of a breast cancer onset by 14%).
If a more intense exercise effect is desired, interspersing short, intense bursts of high-intensity activity for short time periods can add additional health benefits. For example, try walking for five minutes at a leisurely pace (2.5-3 miles/hour on a treadmill) followed by five minutes at a brisk pace (3-3.6 mph)—walk as if you’re late for an appointment, followed by a 30 second really fast walk (4.5 mph) and then taper back down in reverse order. Increase the ‘sets’ gradually as you're able to.
There are so many ways you can walk! The bottom line: Whether you walk, run, or mix it up, the evidence is clear—ALL approaches far outweigh none. Plus, you’ll live a longer and happier life!
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.