The Red Flags of Low Back Pain

Treatment guidelines published around the world note that ruling out “red flags” is a healthcare provider’s number one responsibility, which is in line with the decree exhorted by all healthcare professionals when first entering practice to do no harm. When detected, red flags prompt a doctor to stop and immediately send the patient to the appropriate healthcare provider or emergency department to avoid a catastrophic outcome, which may include death.how-to-tell-if-your-back-pain-is-serious

The four main red flags cited for low back pain include: cancer, fracture, cauda equine syndrome, and infection. In 1992, Dr. Richard Deyo reported that the patient’s history is more important for identifying red flags than a routine physical exam, especially in the early stages of these conditions. This is partially why new patients need to fill out so much paperwork on their initial visit. These are the factors that suggest red flags when it comes to low back pain:

Cancer: a past history of cancer, unexplained weight loss, failure to improve with a month of therapy, no relief with bed rest, and duration of pain over one month. However, when the combination of age over 50 years, past history of cancer, unexplained weight loss, and failure to improve with one month of therapy exists, the sensitivity or “true-positive” reaches 100%—in other words, IT IS CANCER until proven otherwise!

Cauda equine syndrome: acute onset of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, “saddle” anesthesia, and global or progressive motor weakness in the lower limbs.

Infection: prolonged use of corticosteroids (such as organ transplant recipients); intravenous drug use; urinary tract, respiratory tract, or other infection; and immunosuppressant medication and/or condition.

Spinal fracture: history of significant trauma at any age; minor trauma in persons over 50 years of age; patient over 70 years of age with a history of osteoporosis (with or without trauma); and prolonged use of corticosteroids. A checklist that includes these important historical questions can be easily applied in any practice, which is highly recommended.

All healthcare providers—including chiropractors—managing patients in a primary care setting are obligated to rule out red flags in order to ensure patient safely when rendering treatment for LBP. The good news is that most cases of low back pain aren’t caused by these red flags and respond well to conservative chiropractic care!

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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.

ADHD and Chiropractic Care?

Attention-deficit/hyperactivity disorder (ADHD) is a controversial diagnosis, as there are no clear objective clinical tests that can establish whether or not a patient has the condition. ADHD belongs to a spectrum of neurological disorders with no physiological basis (no clear lab tests exist) and often include other conditions such as learning disabilities, obsessive-compulsive disorder (OCD), or Tourette’s syndrome. Early-onset mania or bipolar mixed state can be difficult to differentiate from ADHD or they may co-exist with ADHD.

To complicate matters with regard to diagnosing ADHD, some kids may simply be at the high-end of the normal range of activity or have difficult temperaments. Poor attention may be caused by altered vision or hearing, seizures, head trauma, acute or chronic illness, poor nutrition, insufficient sleep, anxiety disorders, depression, and/or the result of abuse or neglect. Various drugs (such as phenobarbital) may interfere with attention ADHDas well.

Since the 1990s, the number of prescriptions to treat ADHD has skyrocketed 700%, possibly due to the increased awareness of the symptoms associated with ADHD and/or an increase in the diagnoses for ADHD, often demanded by frustrated teachers and/or parents. The classic medical model has embraced the use of Ritalin (methylphenidate) to treat ADHD. For parents who would like to explore other avenues of treatment, what can Chiropractic offer?

In a recent study involving 28 children aged 5-15 years with a primary diagnosis of ADHD, investigators randomly assigned 14 participants to a spinal manipulation (SM) group with conventional care and the other 14 to a control group (conventional care only). The researchers found the patients in the SM group experienced better outcomes based on several assessments and that a larger scale study would be necessary to verify their findings.

Nutrition may also have a role to play in the management of ADHD. In a 2015 study, researchers provided Lactobacillus rhamnosus GG (a probiotic) to infants at six months of age and then followed them for the next 13 years. At age 13, six of the children in a placebo group had been diagnosed with either ADHD or Asperger syndrome while none of the kids in the probiotic group had been affected by either condition. The researchers concluded that probiotic use early in life may reduce the risk of neuropsychiatric disorder development later in childhood.

The Many Functions of Your Nervous System

Every movement, smell, taste, touch, sound, thought, and dream has its origin in the nervous system.

Every function of your body, both voluntarily and involuntarily is controlled, at least in part, by your nervous system.

To better understand how the nervous system works, it is necessary to discuss what makes up the nervous system.

The Nervous system is made up of two primary systems: the central nervous systemlabeled-nervous-system-diagram-nervous-system-diagram-labeled-central-nervous-system-diagram and the peripheral nervous system.

The central nervous system (CNS) is made of the brain and spinal cord, while the peripheral nervous system (PNS) is comprised of nerves such as those in our arms, legs, and torso that deliver information back to the CNS for processing.

Many of the functions of the PNS are voluntary—that is, we can control actions like reaching for plate, swinging a golf club, or swimming.

Other actions are involuntary like the beating of the heart, breathing rates during exercise, digesting food, regulating our blood sugar, metabolism, and so on.

Many of the automatic involuntary functions are controlled by a subcategory of the PNS called the autonomic nervous system (ANS) which has two components: the sympathetic and parasympathetic nervous systems.

There is always activity in the sympathetic nervous system operating at a basal level called “sympathetic tone” and its activity increases at times of stress (producing a “fight-or-flight” response).

The parasympathetic nervous system basically does the opposite of the sympathetic nervous system.

When the heart rate increases (sympathetic response), the parasympathetic nervous system slows it down. Just as the “fight-or-flight” response relates to the sympathetic NS, a “rest and digest” function describes the parasympathetic NS.

Hence, the autonomic nervous system (ANS) is made up of nerves that innervate cardiac muscle, smooth muscle, and glandular tissue.

From a functional perspective, think of the nervous system as a highway with information being transmitted to and from different locations in the body.

The roads or pathways bring information to the CNS (brain/spinal cord) and are called sensory nerves (afferent).

Consider what happens when you touch a hot stove…

In this example, your hand is quickly pulled away from the stove. To accomplish this, there are nerve fibers that connect or bridge between the afferent (sensory) and efferent (motor) nerves called interneurons.

To break this down even further, under a microscope, the space or junction between two neurons/nerves is called a synapse, which is a very narrow gap where chemicals called neurotransmitters allow an impulse to pass through the gap so an impulse can travel onto another “road” (nerve) to bring information to and from the CNS. Therefore, each synapse is like a ferry boat (chemicals) carrying a car (the impulse) across the gap to the next road in route to the brain and/or spinal cord. This gets further complicated as there are many different chemicals (“ferry boats”) called neurotransmitters that result in different types of responses. These responses are broadly classified into either those that excite or inhibit and result in an action that is incredibly fast, which is often needed to avoid injury or death. The example of touching the stove clearly describes the quick reaction that results from the combined chemical and electrical signaling that takes place. If these chemicals get out of balance, different reactions can occur and many of the medications used in treating depression, bipolar disorder, schizophrenia and other psychological conditions exert their effects directly on these neurotransmitters (such as serotonin).

So as you can see, the nervous system is very complex and yet, very balanced allowing us to function and perform in an automatic, coordinated way, so that most of the time, we don’t have to think about what we are doing to a point of exhaustion.

Many things can negatively affect the functions of the nervous system such as trauma/injury, lack of sleep, stress, chemical abuse (alcohol, cocaine, heroin, etc.), and diet.

Chiropractic focuses much attention on balancing these functions through manipulation of the spine, which has both local and more distant effects through “somatovisceral” and “somatic” responses, thus affecting both voluntary and involuntary functions.

Management of sleep, stress, diet, exercise, and other aspects of life are important in maintaining a healthy lifestyle and quality of life.

Much of this information was obtained from the following URL (check it out!): http://en.wikipedia.org/wiki/Nervous_system#Nervous_system_in_humans. This site includes many pictures of the CNS and PNS as well as a description of all the components that make up the nervous system.

Can Chiropractic Prevent Some Types of Arthritis?

This question is asked frequently by patients visiting chiropractors.article-009-arthritis

To answer this question, let’s first talk about, “what is arthritis?”

The word “arthritis” is derived from “arth-” meaning “joint” and “-itis” meaning “inflammation.”

Hence, arthritis is basically swelling in the joint.

Many types of arthritis have been identified—in fact, over 100!

Some types of arthritis are primary (not caused by anything that can be identified), while others are secondary to a disease or other condition.

The nine most common primary forms of arthritis are: osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, juvenile idiopathic arthritis, Still’s disease, and ankylosing spondylitis.

The most common type that virtually affects everyone sooner or later is osteoarthritis. This is basically the wearing out of the joint, which usually seen in the older person but can be found at any age after trauma or injury occurred or after an infection in the joint.

The next most common is rheumatoid arthritis, which is an autoimmune disease where the person’s antibodies attack the joint (and possibly other tissues as well). This can occur at a young, middle, or older age whenever the body is triggered to produce the joint attacking antibodies. Crystals deposited in joints can injury the cartilage surface of which the most common is gout—often attacking the base joint of the big toe, and pseudogout.

SO NOW THE QUESTION…
CAN CHIROPRACTIC PREVENT
SOME FORMS OF ARTHRITIS?

The answer is yes…. sometimes. For example, when a spinal joint is fixated, stuck, or subluxated, the normal biomechanics of the spine are altered because of the faulty movement between the vertebrae.

Restoring movement can restore proper function so excess forces are not exerted on the adjacent levels.

A good example of this is when 2 or 3 vertebrae are fused together (surgical or congenital), the levels above and below the fusion have to work harder for the spine to move and function and tend to become osteoarthritic sooner than the other non-fused levels.

From a more broad approach, lifestyle changes including exercise, weight management, the use of a brace or splint, and certain medications and dietary supplements can be helpful as well.

Exercise, in particular, can have significant benefits to the joint surface in both pain relief and slowing down or even stopping the degenerative process (osteoarthritis).

Diet emphasizing an anti-inflammatory approach includes the paleodiet or caveman diet where grains/glutens are avoided and lean meats, fruits, and vegetables are emphasized (see http://www.paleodiet.com/ and http://www.deflame.com/).

The Cause & Solution for Ear Infections

Ear infections are an epidemic in our society. 90% of children will experience ear infections before they are school age. Most children experience two to three episodes per year. There is an estimated 10 million new cases per year. Despite extensive medical intervention, children’s ear infection rates continue to soar. An estimated $3.4 billion is spent every year for medications and surgeries. A study published in Canadian Family Physician stated that 97.7% of American children diagnosed with ear infections were given antibiotics but there was only a “definite need for antibiotics in only 5-10% of those cases!”Happy Babies (4)

Rate of ear infections soaring and medical science has failed to find an answer. The reason why they have failed is because the cause of ear infections is not micro-organisms. The real cause is an abnormally lowered immune response in the inner ear.

There is a solution to the problem. The real solution lies in locating the cause of the lowered immune response in the ear. A leading German authority, Dr. Gutmann, found 800 of 1000 (80%) infants checked during the first month of life had Blocked Atlantal Nerve Syndrome directly related to birth trauma. Blocked Atlantal Nerve Syndrome interferes with the nerve impulses in the upper neck area, lowers immune resistance and leave the child vulnerable to ear, nose and throat infections.

The cause of Blocked Atlantal Nerve Syndrome is the modern day birth process. The stress that is placed on the infant’s neck during the normal birthing process causes trauma to the upper cervical spine.

How do you fix Blocked Atlantal Nerve Syndrome? Only a trained Chiropractor qualified to remove the interference with a specific adjustment to the Atlantal Nerve. A chiropractic evaluation is of “decisive importance” and Chiropractic care can often bring about amazingly successful results.

“Birth Trauma at my age?”

A Patient asked me a typical question the other day. “What caused my neck problem?” He was shocked to discover that the reasons why many individuals suffer from neurological problems and health challenges as adults are from subluxations that were caused during the birth process. Signs and symptoms typically don’t show up until later in life, yet rob the individual of their health, vitality and wellness. Dr. Godfrey Gutman, medical researcher, discovered that more than 80% of the infants that he examined shortly after birth were suffering from injuries to the cervical spine (the neck), causing all types of health problems.

“If a child is subluxated at birth, that child’s perception of the world is distorted and their ability to respond to the world is compromised. This has severe implications throughout the life of that child! We are dealing with the single most devastating event in most individuals’ lives, it’s really that important. Every child should be checked for subluxations as soon as possible after birth.” Dr. Christopher Kent.

Dr. Towbin, of the Harvard Medical School’s pathology department, found that “the birth process, even under optimal conditions is potentially a traumatic, crippling event. Spinal cord annewbornd brain stem injuries occur often during the process of birth but frequently escape diagnosis.” As a chiropractor, we would much rather examine and adjust every newborn than to have to deal with a lifetime of health problems. We would rather adjust the newborn than wait 26 years and learn that the young person developed gall bladder disease in the areas where the nerve tissue was injured and compromised since birth.

At the Rockefeller Institute, Dr. Arpad DeNagy determined that interference to the nervous system, due to spinal stress, resulted in serious damage within a short period of time. He recommends that stabilizing biomechanical care should begin as soon after birth as possible. Furthermore, he indicated that this spinal stress tragedy may take sixty years to develop fully! “The entire birth process, from conception and pregnancy to delivery and post-delivery, can lay the foundation for later mental and physical disease. We now know that the trauma surrounding the birth process is engraved as imprints in the developing nervous system of the fetus and newborn.” Arthur Janov, Ph.D.

Has Your Birth Process Caused You An Early Demise?

A Boston University pathologist demonstrated that there is severe spinal damage to the infant as a result of the “usual” birth process. “The real cause of our demise is not diseases, but the spinal stress that happens at birth. This robs us of our innate potential for a very long, very healthy, and very happy life.” “The child will have less than optimal physical, mental, and social well-being. The birth damaged child carries the seeds of premature death with him at all times.” Studies at Columbia University have shown that the average child loses seventy percent of his biological potential by the age of seventeen. Traumatic birth syndrome, whether it results in immediate symptoms or diminishes your human potential over the course of yourbaby lifetime must be dealt with immediately.