Author: Dr. Robert Speirs DC

New Whiplash Research

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New Whiplash Research 

Motor vehicle crashes cause 50 million injuries worldwide and nearly four million emergency department consultations annually in the US. (1,2) I thought you might be interested in reviewing three new studies concerning the most common non-hospitalized injury resulting from a motor vehicle crash – whiplash associated disorder (WAD). 

1. The first study concluded approximately 50% of individuals with WAD experience on-going pain and disability. (3) This finding concurs with existing research that found only around 50% of those with WAD will fully recover, with 30% remaining moderately to severely disabled; creating significant personal, economic, and social distress. (4)

2. Elsewhere, researchers discovered “Motor impairment was observed (to) a higher degree in patients with chronic WAD. These impairments were linked to self-reported disability and were in most cases associated with pain, fear-avoidance, and symptoms of central sensitization.” (5)

3. The final study found that following a whiplash injury, healthy muscle is replaced by fat: “Development of muscle fat infiltration in the neck muscles is associated with poor functional recovery following whiplash injury. Statistically significant differences in regional fatty infiltration were particularly notable between the severe WAD group and healthy controls.” (6)

Our providers stay abreast of the latest research to help your injured clients recover quickly and to provide you with evidence-based, credible documentation and testimony for challenging cases. We are honored to care for your injuries and will work hard to maintain your trust as an informed and capable partner.

 

References
1. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010;26:1–31. 
2. Tanskanen A, et al.  Impact of multiple traumatic experiences on the persistence of depressive symptoms – a population-based study. Nord J Psychiat. 2004;58(6):459–64.
3. Ritchie C, Ehrlich C, Sterling M. Living with ongoing whiplash associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskeletal Disorders. 2017;
4. Carroll LJ, et al.  Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S83–92.
5. De Pauw, R. et al. Motor impairment in patients with chronic neck pain: does the traumatic event play a significant role? – a case control study. 2018 Jan 19. pii: S1529-9430(18)30011-1. doi: 10.1016/j.spinee.2018.01.009. [Epub ahead of print]
6. Abbott, Rebecca et al.. The Qualitative Grading of Muscle Fat Infiltration in Whiplash Using Fat/Water Magnetic Resonance Imaging. Spine J 2017 Sep 5. pii: S1529-9430(17)30907-5. doi: 10.1016/j.spinee.2017.08.233. [Epub ahead of print]

How Does Chiropractic Help With Headaches?

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How Does Chiropractic Help with Headaches?

Since 9 out of 10 Americans suffer from some form of headache, we tend to think of them as just a nuisance that can be relieved by taking a painkiller or a nap. Those solutions sometimes lighten the pain momentarily, but recurring headaches are a symptom that something else is wrong, and finding the root cause of your headaches is imperative to putting an end to them. 

Fortunately, there’s a proven alternative. According to a new study, chiropractic treatment can provide “immediate relief” for many headache patients.

The majority of primary headaches, including tension headaches and migraines, are frequently associated with muscle tension or joint restrictions in the neck. These problems occur more often than ever before because nowadays we’re sitting in front of the computer for hours at a time or looking down at a phone to surf the web or text. 

Chiropractors work to remove the triggers of these painful problems like stiffness, tightness, inflammation, and nerve irritation in the cervical spine. In addition to performing gentle spinal manipulation and soft tissue release, your chiropractor can also provide nutritional advice to help you avoid common migraine triggers found in your diet.  Many patients also benefit from chiropractic advice on posture, relaxation techniques, and exercises to help prevent future problems. 

So, if you or someone you know suffers from headache, call our office today. And check out this short video for more information about relief for neck-related headaches. 

Pregnancy Related Low Back Pain

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Pregnancy-related LBP

Researchers estimate that between 45-75% of pregnant women will experience low back pain at some stage of their pregnancy.  (1-5) Up to 33% rate their pain as severe. (6) Pregnancy-related low back pain (P-LBP) leads to lower quality of life, restricted activity, and disability – with almost 25% of pregnant women taking sick leave for LBP.  (2,7-11) The recurrence rate for pregnancy-related low back pain is 85-90%.  (11-14) Consequently, almost 1 in 5 women who report P-LBP during an initial pregnancy will avoid future pregnancies due to fear of returning symptoms.  (15) 

Pharmacologic options during pregnancy are limited, however a new study highlights a conservative alternative. A December 2017 systematic review of 102 studies found moderate-quality evidence suggesting manipulation had a significant effect on decreasing pain and increasing functional status in pregnant and post-partum women with LBP. (16)

This concurs with prior research showing that almost 75% of women undergoing chiropractic manipulation report significant pain reduction and clinically significant improvements in disability. (17,18) Postpartum LBP also responds favorably to spinal manipulation – approximately 10 times better than watchful waiting. (19)

Our providers strive to deliver safe and effective evidence-based care for your patients. Incorporating gentle manipulation with the appropriate exercises generally provides significant relief in very few visits.  

 

References
1. Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, et al. Pregnancy related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J 2004;13:575–89.
2. Pierce H, Homer C, Dahlen H, King J. Pregnancy related low back and/or pelvic girdle pain: listening to Australian women. Abstract presented at the XI International Forum for Low Back Pain Research in Primary Care, Melbourne, Australia, 15–18 March 2011.
3. Diakow P.R.P., Gadsby T.A., Gadsby J.B., Gleddie J.G., Leprich D.J., Scales A.M. Back pain during pregnancy and labor. J Manipulative Physiol Ther. 1991;14(2):116–118.
4. Berg G., Hammer M., Moller-Nielsen J., Linden U., Thorblad J. Low back pain in pregnancy. Obstet Gynecol. 1988;71:71–75. 
5. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine . 2005 Apr 15;30(8);983-91. 
6. Hall J, Cleland J, Palmer J. The Effects of Manual Physical Therapy and Therapeutic Exercise on Peripartum Posterior Pelvic Pain: Two Case Reports. Journal of Manual and Manipulative Therapy. 2005;13(2): 94-102 
7. Wellock VK, Crichton MA. Symphysis pubis dysfunction: women’s experiences of care. Br J Midwif 2007;15:494
8. Kristiansson P, Svarsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine 1996;21:702-9.
9. Wu W, Meijer OG, Jutte PC, et al. Gait in patients with pregnancy-related pain in the pelvis: an emphasis on the coordination of transverse pelvic and thoracic rotations. Clin Biomech 2002;17:678-86.
10. Owens K, Pearson A, Mason G. Symphysis pubis dysfunction: a cause of significant obstetric morbidity. Eur J Obstet Gynecol Reprod Biol
11. George JW, Skaggs CD, Thompson PA, Nelson DM,  Gavard JA, Gross GA. A randomized controlled trial comparing a multimodal intervention and standard  obstetrics for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 2013 Apr; 208(4):295.e1-7
13. Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun; 1(2): 137–141.
14. Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain. Implications of a patient survey. Spine. 1996;21(11):1363–70. 
15. Wang SM, DeZinno P, Fermo L, et al. Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med. 2005;11(3):459-464.
16. Franke, Helge et al. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis
Journal of Bodywork and Movement Therapies , Volume 21 , Issue 4 , 752 – 762
17. Shaw G. When to adjust: chiropractic and pregnancy. J Am Chiro Assoc. 2003;40(11):8-16
18. Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic pain treated according to a diagnosis-based decision rule: a prospective observational cohort study. J Manipulative Physiol Ther 2009;32:616-24.
19. Schwerla F, et al. Osteopathic manipulative therapy in women with postpartum low back pain and disability: A pragmatic randomized controlled trial. J Am Osteopath Assoc. 2015 Jul;115(7):416-25.

Lumbar Spondylo-what?

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Your spine is made up of 24 individual vertebrae, all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components- the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of the vertebral arches on its way from your brain to your tailbone.

The term lumbar spondylysis describes a condition where a part of the arch breaks free from its anchor site on the vertebral body. This condition most commonly occurs during adolescence while bones are hardening. When we are young our bones have taken shape but they have not yet become hardened. Think of this as a clay coffee mug that has not yet been fired in the kiln. During adolescence, our bones transform from this softer clay to a more brittle bone.

The condition is sometimes caused by trauma but more often is a “stress fracture” to the arch of the vertebra. This defect is thought to result from repetitive movements, especially hyperextension and rotation. The condition is more common in people who were born with a small or weak arch- think of a coffee mug handle with a very thin brittle attachment.

Lumbar spondylolysis usually affects the lowest lumbar vertebra- L5, or occasionally L4. Most patients are 10-15 years of age when they are diagnosed with the condition, although sometimes symptoms do not present until adulthood. It is more common in those who participate in sports. Some sports predispose children to this problem. Athletes who participate in diving, wrestling, weight lifting, track, football and gymnastics have the highest incidence of spondylolysis.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards. You should limit movements that involve hyperextension, like leaning backwards. Females should avoid wearing high heels.

Your doctor likely performed x-rays or an MRI to make the diagnosis of spondylolysis. If your doctor has determined that your spondylolysis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly.

Positive Expectations in Whiplash Patients Help with Recovery

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“High expectations are the key to everything”

– Sam Walton

Now a new study found that this belief may apply to your health as well: Whiplash patients who have a positive expectation to improve tend to recover better and report less pain than those who harbor negative beliefs like fearing movement and re-injury.

If you or someone you know has been involved in accident, call our office today. Check out THIS VIDEO to learn more about resolving neck pain from auto accidents.

Being Part Of The Solution To The Opioid Crisis.

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You are most likely aware of the JAMA study examining the effect of opioids for patients with chronic hip, knee, or low back pain, wherein the authors concluded: “treatment with opioids is not superior to treatment with nonopioid medications for improving pain-related function. Results do not support initiation of opioid therapy.”

Most physicians are hesitant to initiate opioid therapy, but options for those patients already using opioids are limited. I thought that you might be interested in new research that provides hope. An extensive study (comprised of all New Hampshire adults with at least two clinical office visits within 90 days for a primary diagnosis of low-back pain) concluded that pain relief resulting from chiropractic treatment might allow patients to use lower or less frequent doses of opioids: 

 “The likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients. Average charges per person for opioid prescriptions were also significantly lower among recipients.” 

Chiropractic is certainly not the magic solution for the opioid crisis. However, this research illustrates how patients benefit when medical physicians and chiropractors work toward an integrated model. We are proud to be your partner in co-managing these challenging cases.

 

References
1. Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain. The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872–882.
2. Whedon JM, Toler AWJ, Goehl JM, Kazal LA. Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids. Altern Complement Med. 2018 Feb 22.

6 Things You Should NOT Do If You Want to Avoid Low Back Pain

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Did you know that 80% of adults experience low back pain at some point in their lifetimes? It’s the leading cause of missed workdays and job-related disability. Although it’s incredibly common and potentially debilitating, the good news is that most cases of low back pain originate from mechanical causes, which means they aren’t caused by a disease and can be prevented with healthy habits. If you want to keep your back healthy, take these six tips into consideration.

1. Don’t Slouch.

Poor posture puts a great deal of strain on your back. Be mindful of your posture whether you’re sitting in an office chair at work, driving, or texting on your cell phone. If you’re unsure of what proper posture looks like, watch this video that covers proper sitting posture.

2. Don’t Be A Couch Potato.

People with sedentary lifestyles tend to have more occurrences of back pain. Sitting for prolonged periods of time contributes to many different ailments, including low back pain; so challenge yourself to move your body more often throughout the day. 

3. Don’t Smoke.

Studies show that smoking increases your chance of having low back pain. If you want to quit, SmokeFree.gov can help.

4. Don’t Sleep On Your Stomach.

This position places excessive stress on your spinal joints and muscles. A better option is to sleep on your back with a pillow under your knees or on your side with a pillow between your knees. This keeps the spine elongated and neutral. View our sleep posture tutorial video here.

5. Don’t Ignore Your Core.

Weak abdominal muscles can contribute to low back pain. If your core is weak, then your back muscles have to work harder to support your movements. This extra work often contributes to strain and injury. We commonly prescribe the Dead Bug, Bird Dog, and Side Bridge exercises to help build core strength. If you have back pain, be sure to check with us before starting.

6.  Don’t Avoid Going To The Doctor.

Treating your back pain symptoms with ice and/or heat is a good self-care option for the short-term, but any back pain that persists longer than two weeks should be examined by a professional. A visit with your chiropractor can help determine the underlying cause and develop the most effective treatment plan to get you back to feeling yourself again.  

5 Tips To Staying In Shape While Injured

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5 tips

Dealing with an injury is not only painful but can be frustrating as well when you’re sidelined from your regular fitness routine. If you’ve ever been injured or had to sit out due to illness, you know that deconditioning happens very quickly. In fact, muscles begin to shrink within days, and cardiovascular fitness starts decreasing after two to three weeks without training. The good news is that there are ways you can stay in shape even while recovering from an injury. Here are our suggestions:

1. First things first, see us before getting back into any form of exercise, especially if you have a back or neck injury. We can determine if it’s safe for you to begin physical activity and develop a rehabilitation program to keep you healthy. 

2. Seek alternative methods of exercise. There’s always something you can do to work around your injuries and maintain a level of fitness. Low impact workouts like swimming or aqua aerobics are often good ways to exercise while injured. 

3. Focus on training un-injured areas.  If you have an ankle or leg injury, try a circuit of exercises that don’t require you to stand up and use your lower body, such as chest presses, seated rows, and core workouts you can do on the floor. For an upper-body injury, you can still get a great workout in by using just your legs (think leg presses, lunges, and the stationary bike). 

4. Focus on creating or improving other healthy habits like getting more sleep or eating nutritious foods.

5. Lastly, be patient and give yourself a break. Rest and time are essential parts of the healing process. Take care of yourself physically and emotionally. When you’re able to jump back into your old routine, you’ll have hopefully been able to maintain a reasonable level of fitness by using these tips.

Don’t Get Thirsty!

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Thirsty

The majority of Americans are dehydrated on a daily basis. It’s recommended we get 8 glasses of water a day, which proves to be a challenge for those who regularly consume other drinks, such as coffee, juice, and alcoholic beverages. Not only do these other drinks fill you up and make it harder for you to ingest a healthier beverage (such as water), it’s also counterproductive, as it dehydrates you. If you need help consuming more water throughout the day, consider these tips:

 

 

  • Carry a reusable water bottle with you at all time.
  • Always drink before, during, and after a workout.
  • Add flavor to your water with lemons, limes, or cucumbers.
  • Create a schedule for you to remember to drink water, such as drinking a glass at the top of every hour.

What is Lumbar Stenosis? 

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The term stenosis means “narrowing” of a tube or opening. Spinal stenosis means that the tube surrounding your spinal cord and nerve roots has become too small, and your nerves are being compressed. Stenosis can arise in different ways. Sometimes, people are born with a spinal canal that is too small. Other times, the canal may have been narrowed by surgery or conditions like disc bulges. Most commonly, spinal stenosis arises from chronic arthritic changes that narrow the canal. This type of stenosis usually develops slowly over a long period of time, and symptoms show up later in life.

Patients with stenosis often report pain, tingling, numbness or weakness in their legs. Lower back pain may or may not be present, but leg symptoms are usually more bothersome. You may notice increasing symptoms from standing or walking and relief while sitting because the available space in your spinal canal decreases when you stand, walk or lean back and increases when you sit or flex forward. Walking down hill is usually more uncomfortable than walking up hill. You may notice that when you walk with a shopping cart or lawn mower, you are more comfortable, as this promotes slight flexion. Sleeping on your side in a fetal position with a pillow between your knees may be most comfortable.

The natural course of spinal stenosis is variable. Most patients notice their symptoms stay about the same over time, while others are divided into fairly equal groups who either improve or worsen. Be sure to tell your doctor if you notice that your legs become cold, swollen or change color. Likewise, tell us if you notice a fever, unexplained weight loss, flu-like symptoms, excessive thirst or urination, numbness in your groin or loss of bladder control.

While there is no non-surgical cure for stenosis, we offer potent treatments to help ease your symptoms. Treatment is focused on helping improve your mobility so that you can walk and function better. You will be given exercises to help with conditioning. You should avoid activities that increase your pain, including heavy lifting or those that cause you to extend your back, like prolonged standing or overhead activity. When you are forced to stand, you may find relief by slightly elevating one foot on a stool or bar rail. You may find relief while washing dishes if you open your cabinet door and alternately rest one foot on the inside of the cabinet to provide a little bit of flexion. Recumbent cycling is often a more tolerable alternative to walking or running. Some patients report relief by using an inversion table.