Back Pain: Does Maintenance Care Work?

Non-specific low back pain (nsLBP) is one of the most common and costly healthcare problems affecting society, and it is also the leading cause of activity limitation and work absence around the world. 

Following a course of treatment to reduce pain and improve function for patients with a musculoskeletal complaint—such as back pain—doctors of chiropractic commonly make recommendations to reduce the risk of a future episode (or at least minimize its severity should one occur). These recommendations may include adopting a fitness routine, dietary modifications, specific exercises, foot orthotics, and/or routine “maintenance” chiropractic adjustments, such as once a month or every six weeks. 

Though further research is necessary to more clearly understand precisely how maintenance care (MC) works to reduce the risk of future episodes of back pain, researchers currently hypothesize that such treatments may improve any biomechanical or neuromuscular dysfunctions before they become symptomatic. 

Studies published in both 2004 and 2011 note that patients with chronic low back pain who received maintenance care for nine months reported less pain and disability than participants who did not receiving ongoing care. 

In a 2018 study that included 328 nsLBP patients, researchers found that those who received ongoing maintenance care following their initial course of treatment experienced 12.8 fewer days with LBP over the following year. Compared with patients who were advised to return for further care on an as-needed basis, the participants in the MC group only made an average of 1.7 additional chiropractic visits during the study. 

The authors of this study concluded, “For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”

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Chiropractic Care for Headache Relief?

Woman Suffering From A HeadacheHeadaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

Great Exercises for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is caused when the median nerve is compressed as it passes through the tight bony carpal tunnel at the wrist. The condition can result in pain, numbness, tingling, and weakness in the hand, and it can affect one’s ability to carry out everyday life and work tasks. Here are a few GREAT exercises for CTS that require no equipment and can be done anytime and anywhere:

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PRAYER: Place your hands in a “prayer” position. Touch the palm-side finger pads together and slowly push the palms into one another while keeping the elbows up as much as possible as you feel a strong stretch in the hands, fingers, and palm-side of the forearms.

SHAKE: Shake your hands for 10-15 seconds as if you just washed them and you’re trying to air dry them off.

WRIST FLEXION STRETCH: Hold your arm out in front of you with the elbow straight, palm facing down. With the opposite hand, bend the wrist as far downward as possible so the fingers point to the ground. This will produce a strong stretch in the muscles located in the back or top of the forearm. Repeat five to ten ties holding each stretch for 15–20 seconds (as tolerated).

These exercises can be repeated multiple times a day, as often as once per hour. It is often very helpful to set a timer on your cell phone to remind you to take a stretch break. A “good pain” (stretch) is considered safe while sharp or radiating pain may be potentially harmful. However, if you experience sharp, lancinating, or radiating pain, then stop or modify the exercise.

Frequently, CTS involves more than just the wrist, and exercises that target the neck, shoulder, and elbow can often hasten recovery. This is especially true when there is “double crush syndrome” where the median nerve is entrapped in more than one location such as the neck, shoulder, elbow, or forearm (as well as the wrist).

Chiropractic management of CTS can include manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck. Muscle release techniques are often employed as well as the use of physical therapy modalities such as laser, electric stimulation, ultrasound, and others. The use of night splints to keep the wrist straight when sleeping is a “standard” used by most healthcare providers. Co-management with primary care may be appropriate if diabetes, inflammatory arthritis, or other complicating conditions are present

Can Exercise Prevent Low Back Pain?

While it’s not possible to totally prevent low back pain (LBP), individuals who regularly exercise appear to have a reduced risk for LBP. Additionally, fit adults who develop back pain may experience it less often, at a reduced intensity, and for a shorter duration than those who lead a more sedentary lifestyle.low backWhich type of exercise is the best? A general rule is to keep trying different activities, starting with those MOST appealing to you. After all, you should enjoy exercise, so start with your favorites: walking (one of the best), walk/run combinations, running/jogging, bicycling, swimming/water aerobics, yoga, Pilates, core strengthening, balance exercises, tennis, basketball, golfing, etc.

Specific exercises for the low back can be individualized by determining your “position preference”, or the position that feels best to your low back. For example, bend forward as if to touch your toes. How does that feel? Do you feel a good stretch or pain? Does it shoot pain down your leg? If it feels good, then that might be your preferred position and the one to emphasize with exercise. Examples of exercises that fit this scenario include (but are not limited to): posterior pelvic tilts (flatten your low back by rocking your pelvis forward); single and double knee to chest; and bending forward from a chair (as if to touch the floor).

If bending backward feels good (better than flexion and especially if the presence of leg pain lessens or disappears), then “extension-biased” exercises fit that scenario. Examples include standing back extensions (place your hands behind the low back and bend backward); prone “press-ups” (lift the chest off the floor while keeping the pelvis down); and laying back-first over a Bosu- or Gym-ball.

Pelvic dysfunction and core weakness can also increase the risk for LBP. Try these exercises: abdominal crunches (bend one knee, place your hands behind your low back, and raise the breast bone toward the ceiling only a few inches and hold); front and side planks (start from the knees if necessary); supine bridges (supine, knees bent, lift the buttocks off the floor); “bird-dog” (kneel on all fours and raise the opposite leg and arm, keep good form, and alternate); and the “dead-bug” (on your back, bend the hips and knees at 90 degrees with your arms reaching toward the ceiling; slowly lower your right arm and left leg and return them to their starting position; repeat with the other arm/leg).

When lifting, bend the knees and hips but NOT your low back; keep weights close to you and lift with your legs. Don’t attempt lifts that you know are too heavy.

If you have a history of low back pain, research shows that receiving maintenance chiropractic care can help reduce the number of days in which low back pain may hinder your activities.

Nutrition and Exercise for Hypertension

Hypertension is usually a silent disease that leads to cardiovascular, cerebrovascular, and renal morbidity and mortality. This condition can seriously affect quality of life, reduce life expectancy, and place significant burdens on the healthcare system. Classic medications used to treat hypertension can involve side effects including headache, nausea, vomiting, stomach pain, constipation, diarrhea, weakness, fatigue, and erectile dysfunction. Hence, many patients with elevated blood pressure look for other means to help manage their condition with fewer, if any, side effects.

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In a previous post, we discussed a 2007 study in which patients who received a specific cervical chiropractic adjustment experienced a reduction in their blood pressure that persisted for at least eight weeks. Lead author Dr. George Bakris, “This procedure has the effect of not one, but two blood pressure medications given in combination. And it seems to be adverse-event free. We saw no side effects and no problems.”

Herbal and dietary supplements have been used by patients to help manage hypertension (HT) for many years. A series of literature reviews have found the following may provide better and safer substitutes to conventional drugs: cod liver oil, garlic, coenzyme Q-10, beta glucan, lipoic acid, whole grains, potassium, magnesium, sodium, vitamin E, vitamin B6, vitamin C, polyphenol, various botanicals/herbs, and vanadium (see Table 1, https://bit.ly/2QVpcY7 ).

Regarding exercise, a 2018 research review found that aerobic exercise can reduce blood pressure in hypertensive patients by 5-7 mmHg and that dynamic resistance exercises can lower blood pressure in adults with hypertension by 2-3 mmHg—which may rival the results achieved with first-line meds for hypertension.

While exercise, improving your nutrition, and getting regular chiropractic care are all part of living a healthier lifestyle, which can result in a healthier blood pressure reading, it’s important not to discontinue taking any medications unless instructed to by your treating physician.

What Is Frozen Shoulder?

Adhesive capsulitis (also known as “frozen shoulder”) is the end result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the humeral head or “ball” part of the ball and socket joint. Adhesive capsulitis dramatically reduces the range of motion of the affected joint, which can severely impact one’s ability to carry out their normal daily activities. A frozen shoulder may or may not be associated with shoulder pain and tenderness. Though all movements are affected, raising the arm to the side is often the most impaired movement of the shoulder.

Conditions such as tendinitis, bursitis, and rotator cuff injury can lead to adhesive frozen-shouldercapsulitis, especially if the person refuses to move the shoulder for an extended length of time. Diabetes, chronic inflammatory arthritis (such as rheumatoid) of the shoulder, and chest or breast surgery are known risk factors for adhesive capsulitis.

The condition is diagnosed following a review of the patient’s history for prior trauma caused by over reaching/lifting or from repetitive movements. The examination will look for severe loss of shoulder range of motion (ROM), both active and passive. X-ray, blood tests for underlying illnesses, and other imaging approaches may also be required to make a final determination for adhesive capsulitis.

Treatment for adhesive capsulitis has classically included an aggressive combination of anti-inflammatory medications, cortisone injections, manual therapies (such as joint manipulation, mobilization, and traction), exercise training, ice (if painful), heat (if no pain), and physiotherapy modalities such as ultrasound, electric stimulation, laser, etc.

Exercises performed by the patient are also highly important for achieving a satisfactory outcome. The patient can begin immediately with pendulum-type exercises, long-axis traction (while sitting, grip the chair seat and lean to the opposite direction while relaxing the shoulder muscles to open up the ball-and-socket joint), and eventually strengthening exercises (TheraTube, TheraBand, light weights, etc.).

A recent study involved 50 patients with frozen shoulder (20 males, 30 females, ages 40-70 years) who underwent chiropractic care for a median time frame of 28 days (range: 11-51 days). Researchers looked at patient-reported pain on a 1-10 scale and their ability to raise the arm sideways (abduction). Of the 50 cases, 16 resolved completely (100%), 25 showed 75-90% improvement, 8 showed 50-75% improvement, and 1 experienced less than 50% improvement.