Knee Pain – Do I Need a Replacement?

About a quarter of adults experience frequent knee pain, which results in limited function, reduced mobility, and impaired quality of life. Osteoarthritis (OA) is the most common cause of knee pain in those over 50 years of age, and it is the #1 reason for total knee replacement (TKR). The rate of TKR in the United States and the United Kingdom has increased substantially in recent decades, which many have written off as a consequence of our aging populations. But is that really the case?

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One study reviewed long-term data from the National Health and Nutrition Examination Surveys (NHANES) and the Framingham Osteoarthritis (FOA) study. The research team concluded that advancing age is indeed a factor behind the increase in TKR since the 1970s, but it doesn’t tell the whole story. The researchers also found that obesity is a risk factor for symptomatic osteoarthritis of the knee, and as you know, obesity rates have skyrocketed in the last four decades.

So, what can be done to reduce your risk for a total knee replacement? There isn’t anything you can do about getting older, but there’s a lot you can do to maintain a healthy weight. Begin by switching to a more anti-inflammatory diet such as the Mediterranean diet or the Paleo diet. You don’t have to change everything you eat all at once. Start by eating an extra serving of vegetables and one less serving of processed food a day. As you notice yourself starting to feel better, it will give you the confidence to make further dietary modifications.

Because the primary way for the cartilage in your joints to get nutrients is through movement, you’ll need to become more active. Increase the number of steps you take per day and raise the intensity over time. You should also engage in balance and strength training exercises.

Of course, you’ll also need to ensure your knee isn’t subjected to abnormal movements both above and below that can compromise the tissues that make up the joint. For example, ankle pronation can overload the medial compartment of the knee. Similarly, a problem in the hip, pelvis, or lower back can also place stress on the knee, which can impair its function. That’s why doctors of chiropractic evaluate the whole patient to identify any and all contributing factors to a patient’s chief complaint. Otherwise, the patient may not experience a satisfactory outcome.

 

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.

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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.

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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.

Low Back Pain: What Can I Do for It?

Back-Pain-PNG-FileLow back pain (LBP) is the second most common reason for doctor visits in the United States and it is a condition that most of us will at some point in our lives. Last month, we reviewed the wide acceptance of spinal manipulation as the treatment of choice for both acute and chronic LBP. This month, let’s take a look at what you can do outside the doctor’s office to self-manage acute and chronic low back pain.

One of the best self-management protocols for LBP is exercise that targets the lower back. It appears that the optimal time to engage in exercises for the lower back is during the work day since doing so may help alleviate some of the overuse and repetitive strain contributing to one’s LBP. Let’s focus on exercises you can perform from either a sitting or standing position during short work breaks…

RULES: Perform slowly to a full/firm stretch without pain; take three slow deep breaths for each; only do exercises that “fit” your job and time limits—this might be only one every fifteen minutes; make it work!

SITTING EXERCISES: 1) Sitting Forward Bends – bend forward and reach for the floor (as far as reasonably tolerated). 2) Sitting trunk rotations – twist slowly left, then right. 3) Cross Leg Stretch – cross one leg over the other; grasp and pull the crossed leg knee to the opposite shoulder while arching the back to its maximum until a firm stretch is felt in the buttocks.

STANDING EXERCISES: 1) Hamstring Stretch – place one foot on an elevated surface (like a chair seat, foot stool, or guard rail); perform an anterior pelvic tilt by arching your low back until you feel a firm stretch in the hamstrings. Switch sides and repeat. 2) Groin Stretch – do exactly the same steps as the hamstring stretch but this time, rotate your trunk to the side of the standing leg (away from the stretched leg) until you feel the stretch in the inner thigh or groin muscles. 3) Backward Bends – place your fists behind your low back and slowly bend backwards to a maximum tolerated point.

These “portable” exercises can be performed frequently throughout the work day, whenever you can spare 30-60 seconds. The most important point is to do these exercises on a regular basis. It may help keep your LBP from worsening during your workday.

Low Back Pain: Spinal Manipulation vs. NSAIDs

lbpLow back pain (LBP) is the single greatest cause of disability worldwide and the second most common reason for doctor visits. Overall, LBP costs society more than $100 billion annually when factoring in lost wages, reduced productivity, and legal and insurance overhead expenses.

Studies regarding the use of spinal manipulation(SM)—a form of treatment offered by doctors of chiropractic—for LBP are plentiful and have led to the strong recommendation that SM should be considered as a FIRST course of care for LBP. The American College of Physicians and the American Pain Society both recommend SM for patients with LBP who don’t improve with self-care.

In 2010, the Agency for Healthcare Research and Quality (AHRQ) reported that SM is an effective treatment option for LBP – EQUALLY effective as medication in reducing LBP and neck pain.

A 2013 study compared SM and non-steroidal anti-inflammatory drugs (NSAIDs) and found that SM was MORE effective than diclofenac, a commonly prescribed NSAID, for the treatment of LBP. Patients in the SM group also reported NO adverse side effects. More importantly, a 2015 study found that NSAID use can actually slow the healing process and even accelerate osteoarthritis and joint deterioration!

Doctors of chiropractic utilize SM on many conditions, including LBP— more than any other healthcare profession including osteopathy, physical therapy, medical doctors, and others. Chiropractors also combine other synergistic forms of care, such as patient-specific exercise training, to help patients learn how to self-manage their LBP, as recurrence is such a common issue.

How Do MDs View Chiropractic?

In the mid-1980s, a political event spurred a change regarding the medical community’s outward disrespect of chiropractors when the AMA (American Medical Association) was sued for anti-trust violations and the chiropractors won!

For the first time, the public, open anti-chiropractic slander that appeared on billboards, in magazine articles, and in TV/radio advertisements against the chiropractic profession was prohibited.

In fact, prior to this, it was against the AMA by-laws for a Medical Doctor (MD) to publicly socialize with a chiropractor! This all seems pretty extreme but was truly occurring prior to the mid-1980s… BUT NOT ANYMORE!

In 1994, the United Kingdom and the United States almost simultaneously published official guidelines for the treatment of acute low back pain.

BOTH DOCUMENTS REPORTED THE USE OF SPINAL MANIPULATION, A PRIMARY FORM OF CHIROPRACTIC TREATMENT, AS A FIRST CHOICE IN THE TREATMENT FOR ACUTE LOW BACK PAIN.

Now, for the first time, a non-chiropractic group had recommended chiropractic based on researched data that overwhelmingly supported spinal manipulation as an effective, safe, and less expensive form of care when compared to all the other treatment approaches that the healthcare consumer can choose from.

Research has continued to pour in and recently, similar recommendations were made in the treatment of chronic low back pain. Also, when reviewing the research pool, continued support of the 1994 guidelines for acute low back pain was again found to be valid with little change required.back-pain-lg[1]

According to the published guidelines, ALL patients with acute AND chronic low back pain should see chiropractors FIRST.

If this guideline was followed by everyone, there would be such a shortage of chiropractors, it would become one of the most desirable professions to seek vocationally.

Unfortunately, many MDs do not know enough about chiropractic to strongly recommend it to their inquiring patients. That is why our office goes out of its way to educate MDs in our community about the benefits of Chiropractic care.

Also, some programs at medical schools are now including “alternative medicine” courses in the curriculum of the undergraduate MD programs and, rotations in alternative or complimentary health services currently offered at some university / hospital settings as a post-graduate option.

This is reflected by an increasing population of MDs who actively seek out chiropractors to work with when their patients present with conditions like acute or chronic low back pain, neck pain, and/or headaches.

The MD/DC relationship is truly improving as noted by the inclusion of chiropractic into hospital programs, integration into the military bases and VA hospitals, routine coverage by most insurance companies, etc.

So rest assured, you’ve made a smart decision to choose Chiropractic care.

What Type of Doctor Should You See For Acute or Chronic Back Pain?

Have you ever considered which type of doctor is best suited to treat back pain?

Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.

To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention.

 

Over a four-year time frame, researchers followed 2,780 low back pain patients who were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).

Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education.

Medical therapies included prescription drugs, an exercise plan, self-care advice, and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients.

The authors of the study reported that chiropractic was favored over medical treatment in the following areas:

  • pain relief in the first 12 months (more evident in the chronic patients);
  • when LBP pain radiated below the knee (more evident in the chronic patients);
  • chronic LBP patients with no leg pain (during the first 3 months)

Similar trends favoring chiropractic were observed in regards to disability but they were of smaller magnitude.

All patient groups saw significant improvement in both pain and disability over the four-year study period.

Acute patients saw the greatest degree of improvement with many achieving symptom relief after three months of care.

This study also found early intervention reduced chronic pain and, at year three, those acute LBP patients who received early intervention reported fewer days of LBP than those who waited longer for treatment.

While both MD and DC treatment approaches helped, it’s quite clear from the information reported that chiropractic should be utilized first.

These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your LBP.

The Healthy Way to Wear a Backpack

It’s back to school time for all the young scholars and with it comes the daily ritual of lugging school supplies around in a backpack. You may not realize it but ill fitting backpacks can put a significant amount of stress on your child’s body.
The long-term stress of wearing a poorly designed and/or excessively heavy backpack can lead to a back aches, neck stiffness, burning shoulders, headaches, tingling in the arms/hands, fatigued muscles and a stooped posture. These aches and pains can be a major distraction to your child’s focus in the school room, hamper their enjoyment of everyday childhood activities and increase the likelihood of future back problems later in life.

Loading a Backpack

  • Your child’s backpack should not exceed 15% of their body weight.
  • back pack2Load the heaviest items closest to your child’s back. Pack the bumpy or sharp edged items furthest away from the back. Arrange the school gear so it won’t shift and slide as they walk.
  • Many parents are shocked to discover just how heavy their child’s backpack truly is. To calculate how much the pack weighs have your child stand on a weigh scale with and without the pack on and subtract the difference.
  • On heavy backpack load days have your child hand carry a heavy book or item.
  • Pack up the bag on a table or ledge that is waist high as opposed to leaning forward over a pack on the floor.

Wearing the Backpack

  • Always use the two straps to spread out the weight evenly. Carrying a heavy load with one strap can lead to unwanted curvatures and abnormali
  • ties in the developing spine and musculature.
  • Make sure the straps are well padded (2 inches wide) to protect the blood vessels and nerves in the neck and shoulder region. Prolonged pressure in these areas can lead to pain and tingling in the neck, arms and hands.
  • Adjust the straps so that pack fits snugly against your child’s back. You should be able to slide one hand between the pack and your child’s back. Loose packs can pull your child back causing muscle strains.
  • The back of the pack should never rest more than 4 inches below the waist line.
  • Wearing a waist strap can take as much as 50 – 70% of the weight off the shoulders and spine helping to distribute the weight more evenly.
  • Teach your child to put on their backpack properly. Place the pack on a table and do up both straps before moving as opposed to twisting and reaching back or swinging the pack around the shoulder.Backpack21

It is important to be aware of your child’s daily burden because it could be detracting from their school experience. If they complain of back pain, headaches, numbness or weakness in their arms seek help to ease their discomfort and prevent future problems.