Low Back Pain: Is It Your Feet?

The foot and ankle are unique in that their range of motion includes not only the front-to-back, hinge-like motion we associate with walking but also the lateral or side-to-side movement needed to change directions quickly. A problem in the foot can have a “domino effect’ that alters the biomechanics or the ankles, knees, hips, pelvis, low back, and even the neck—potentially increasing the risk of injury in each these areas.

Back in 1995, Rothbart and colleagues reported that hyperpronation—or excessive rolling inwards of the foot and ankle—is a leading cause of pelvic repositioning and mechanical LBP. Just watch people from behind as they walk in a mall, airport, or grocery store and you’ll notice almost everyone’s ankle rolls inwards as they step downward. To maintain proper foot posture, the use of foot orthotics is the most practical approach— coupled with wearing well-fitted, comfortable shoes, of course.

painhealth-low-back-pain-white-bg

In a 2017 study, researchers recruited 225 adults with chronic LBP (more than three months) and randomly assigned them into one of three treatment groups: shoe orthotic (SO)-only, a “plus” group (SO + chiropractic manipulation/CM), or a waitlist group. The research team measured each participant’s pain and function/disability initially, after six weeks (the length of the treatment period), and then three, six, and twelve months later.

After six weeks, only members in the intervention groups reported any improvement in function. When comparing the waitlist and SO-only groups, the SO-only group demonstrated significantly greater improvements in both pain and function. The researchers also noted that members of the SO+CM group experienced even greater levels of clinically significant functional improvement.

This large-scale study supports the importance of examining the whole patient to identify and treat all factors that may contribute to a patient’s chief complaint.

Advertisements

Carpal Tunnel Syndrome: Don’t Wait!

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it passes through the wrist. Researches estimate that the average person has a one-in-ten chance of developing the condition in their lifetime, and the risk is higher for individuals in certain professions (such as those using heavy, vibrating tools) and with medical conditions (like diabetes). The symptoms associated with CTS involve pain, numbness, tingling, and weakness in the hands and fingers, typically sparing the pinky and outer half of the fourth digit.carpal tunnel

Given that some of us are more likely than others to develop CTS, what should we do if we start to encounter symptoms associated with the condition?

Is it important to seek treatment right away or is it safe to wait?

Generally speaking, the faster a patient seeks care, the quicker they will respond to conservative treatment options like those offered in a chiropractic clinic. Delaying treatment may mean a longer recovery or even having to consider more invasive options, like a surgical procedure. But why is that?

Like many cells in the body, the nerves are provided nutrients by way of blood vessels. When even a small amount of pressure is applied to the median nerve, it can damage those blood vessels. Unless the vessels are given a chance to heal, the nerve can suffer. If the nerve damage is severe enough, even surgery may not be an option, and a patient may have to learn to live with their pain or find other ways to mask their symptoms.

One big problem with CTS is that patients rarely wake up with severe wrist pain that prompts them to seek treatment. Often, the condition is subtle with pain, numbness, and tingling that comes and goes. Individuals with CTS may find it more of an annoyance than anything and tend to put off treatment until the symptoms cause too much of an impact on their quality of life to ignore and they’re forced to call the doctor.

The good news is that patients often respond well to conservative care. Chiropractors often diagnose CTS and can effectively manage it without the need for more invasive surgical intervention, but the prognosis for an effective treatment outcome declines with the greater the degree of nerve damage. Hence, patients are encouraged to seek treatment sooner rather than later when it comes to CTS. Care often includes manual therapies (manipulation/mobilization), education (rest, ice, brace, exercise), nutrition (anti-inflammatory in nature), and more.

Chiropractic and Hypertension

In a blood pressure reading, the higher number (“systolic”) represents the pressure that blood exerts against the arterial walls when the heart beats. The lower number (“diastolic”) represents the pressure blood exerts against the arterial walls when the heart rests between beats (measured in millimeters of mercury or mmHg). The definition of hypertension (HT), like so many other aspects of health, has been defined and redefined over the years. Let’s take a look at the current definition and what (if anything) chiropractic provides to help this VERY common condition.

The American Heart Association defines (as of November 2017) “NORMAL” as beinghypertension-and-diabetes-often-go-together <120/ and <80; “ELEVATED” as 120-129/ and <80; STAGE 1 HT: 130-139/ or 80-89; STAGE 2 HT: >140/ or, >90; HYPERTENSIVE CRISIS: >180/ and/or >120. Between the two numbers, the systolic blood pressure (BP) is generally given the most attention as a major risk factor for cardiovascular disease for people over age 50. A gradual increase in systolic BP normally occurs with increasing age as arteries gradually stiffen due to plaque build-up. Recent studies report that the risk of death from ischemic heart disease and stroke DOUBLES with every 20mmHg systolic or 10mm Hg diastolic BP increase in people from age 40-89.

So, CAN chiropractic help patients with hypertension? The answer is YES… at least in some cases. A placebo-controlled study published in 2007 (and spotlighted on “WebMD”) reported a specific type of chiropractic adjustment applied to the Atlas (C1) vertebra that

SIGNIFICANTLY lowered both systolic (by 14 mm Hg) and diastolic BP (by 8 mm Hg) in 25 patients with early-stage HT. This improvement did not occur in 25 control patients who received a sham procedure. This beneficial effect persisted for eight weeks during which time the patients took no medication for their condition.

Dr. George Bakris, the director of the University of Chicago hypertension center and lead author of the 2007 study wrote, “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.”

happy-older-couple

Case studies of chiropractic treatment lowering BP date back to the 1980s, and higher quality, larger scaled studies have been published in the last decade. One explanation on how chiropractic adjustments help to lower BP is that adjustments applied to C1 (the Atlas) affect the parasympathetic nervous system, which tends to lower the diastolic BP (lower number), while mid-thoracic manipulation—which stimulates the sympathetic nervous system—tends to lower the systolic BP (upper number) to a larger degree. Chiropractic care includes not only spinal manipulation, but also dietary counseling, and more—all WITHOUT the potential for the sometimes significant side-effects associated with medications.

Concussion and Whiplash – Is There a Connection?

Whiplash or whiplash associated disorders (WAD) represent a constellation of symptoms that are very similar to those reported by patients who have sustained a concussion or minor-traumatic brain injury (mTBI). These shared symptoms include (but are not limited to): headache; neck pain; nausea/vomiting; dizziness; balance issues; vision problems; and difficulty concentrating. Chiropractic care focused on the cervical spine has been demonstrated to benefit patients with WAD. Is it possible that the same form of treatment can help the mTBI patient as well?

Delayed-Whiplash-Injury

In the March 2015 issue of the journal The Physician and Sportsmedicine, researchers looked at case studies involving five patients with concussion symptoms that did not resolve within 30 days and had become chronic. The mechanism of injury in three of the cases was sport-related, while the other two stemmed from a slip and fall and a motor vehicle collision. Treatment focused on the cervical spine and included the use of either spinal manipulative therapy (SMT) or mobilization; active release technique (ART) to stretch tight neck muscles; and exercises aimed at strengthening the deep neck flexor muscles and/or other surrounding neck musculature.

Case 1: A 25-year-old professional mixed martial arts male injured from sparring presented four months after the injury. After three treatments, he reported a significant reduction in symptoms, with full resolution after eight treatments.

Case 2: A 59-year-old female who hit the back of her head on the ground after a fall presented with 31-month duration of symptoms that reportedly improved significantly within three months of twice-per-week treatments.

Case 3: A 19-year-old male junior hockey player presented two years after the initial injury and reportedly experienced an 80% improvement in his symptom after four treatments spread out over a three-week time frame.

Case 4: A 19-year-old male injured in a car accident presented 14 weeks after the injury and reported a nearly 50% reduction in symptoms after one treatment and full resolution after eight treatments.

Case 5: A 51-year-old female hockey player who was struck on the left side of the head presented five weeks post-injury and reported a full resolution of symptoms after three treatments per week for six weeks.

The important point here is that treatment was aimed ONLY at the cervical spine, not the concussion, with excellent results in each case. These findings indicate the need for larger studies concerning the use of conservative chiropractic care for cases of mTBI that do not resolve within a month’s time.