Whiplash – Can We Predict Long-Term Problems?

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors who also use Active Release Techniques, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

The many types of headaches: chiropractic can help

Headaches come in MANY different sizes, shapes, and colors. In fact, if you search “headache classification,” you will find the IHS (International Headache Society) 152 page manual (PDF) lists MANY different types of headaches! Last month, we discussed migraine headaches. This month, we’ll talk about the other headache types. So WHY is this important? Very simply, if we know the type of headache you have, we will be able to provide you with the proper treatment. Headaches are classified into two main groups: “primary” and “secondary” headaches. The “Primary” headache list includes: 1) Migraine; 2) Tension-type; 3) Cluster; 4) “Other primary headaches,” of which eight are listed. One might think that with this simple breakdown of the different types of headaches it should be easy to diagnose a type of headache. Unfortunately, that’s NOT true! In fact, a 2004 study published that 80% of people with a recent history of either self or doctor diagnosed sinus headache had NO signs of sinus infection and actually met the criteria for migraine headaches! So, the more we can learn about the different types of headaches, the more likely that we will arrive at an accurate diagnosis.

Tension-Type Headaches: This is the most common type affecting between 30-78% of the general population. It is usually described as a constant ache or pressure either around the head, in the temples, or the back of the head and/or neck. There is typically NO nausea/vomiting, and tension-type headaches rarely stop you from performing normal activities. These headaches usually respond well to chiropractic adjustments and to over-the-counter medications like Advil, aspirin, Aleve, and/or Tylenol, though we’d prefer you first reach for an anti-inflammatory herb like ginger, turmeric, bioflavonoid, and the like as these have less stomach, liver, and/or kidney related side-effects. These headaches are typically caused by contraction of the neck and scalp muscles, which can be result of stress, trauma, lack of sleep, eyestrain, and more.

Cluster Headaches: These are less common, typically affect men more than women, and occur in groups or cycles. These are VERY DISABLING and usually arise suddenly and create severe, debilitating pain usually on only one side of the head. Other characteristics include: a watery eye, sinus congestion, or runny nose on the same side of the face as the headache. An “attack” often includes restlessness and difficulty finding a pain-reducing, comfortable position. There is no known cause of cluster headaches, though a genetic or hereditary link has been proposed. The good news is that chiropractic adjustments can reduce the intensity, frequency, and duration of cluster headaches!

Sinus Headaches: Sinusitis (inflamed sinuses) can be due to allergies or an infection that results in a headache. This may or may not include a fever, but the main distinguishing feature here is pain over the infected sinus. There are four sets of sinuses. Many people know about the frontal (above the eyes on the forehead) and maxillary (under the eyes in our cheeks) but the two sinuses deep in head (ethmoid and sphenoid sinuses) are much less known or talked about. These two deep sinuses refer pain to the back of the head, and when infected, it feels like the back of the head could explode. Lying flat is too painful so sitting up is necessary. Chiropractic adjustments applied to the sinuses, upper neck, and lymphatic drainage techniques work GREAT in these cases!

We will continue next month with the remaining types of headaches!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for headaches, we would be honored to render our services.

Can Chiropractic Help the Post-Surgical Patient?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!

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Chiropractic Promotes Normal Ranges of Motion

“It is hypothesized that because spinal manipulative therapy (adjusting) brings a joint to a normal range of motion, routine manipulation of asymptomatic patients may retard the progression of joint degeneration, neuronal changes, changes in muscular strength, and recruitment patterns, which may result in improved function, decreased episodes of injuries, and improved sense of well-being.”
Journal of Chiropractic Humanities, December 2011

Chiropractic and Active Release: Ulnar Nerve Compression.

A 41-year-old woman with ulnar tunnel compression complained of poor grip strength and numbness in her right forearm and middle fingers. She was treated with chiropractic care including manipulative therapy, Active Release Techniques, and elastic therapeutic taping. Home exercises and improvements to her workstation ergonomics were also implemented. After her first treatment, immediate improvements were noted regarding weakness and numbness. The patient’s symptoms resolved completely after 11 treatments.
Journal of Chiropractic Medicine, June 2013

Broccoli again? This Week’s 1-Page Health News

We hope you have a great Thanksgiving this year! We are here today and tomorrow, with Dr. Hyman’s schedule completely full. Dr. Stripling has availability if you need us.

Should you happen to hurt yourself really badly after tomorrow (be careful!), either contact us through our website- it goes directly to Dr. Hyman- or call the office to get the on-call doctor’s cell phone # from the voicemail.

We’ll be back in the office for a full week next week.

Mental Attitude: Einstein’s Brain.
The left and right hemispheres of Albert Einstein’s brain were unusually well connected to one another, which may have contributed to his brilliance. This study is the first to detail Einstein’s corpus callosum, the brain’s largest bundle of fibers that connects the two cerebral hemispheres and facilitates interhemispheric communication.
Brain, October 2013

Diet: More Reasons to Eat Broccoli and Cauliflower!
Sulforaphane (found in cruciferous vegetables including broccoli, cabbage, cauliflower, kale, and collards) may help reduce the risk of respiratory inflammation that leads to chronic diseases such as asthma and chronic obstructive pulmonary disease. In a study setting, researchers found that those who consumed 200 grams of broccoli had nearly three times as many antioxidant enzymes in their upper airway cells compared to baseline measurements. These protective antioxidant enzymes help fight against common environmental pollutants.
Clinical Immunology, March 2009

Exercise: Better Math, English, and Science Grades!
Research on British school children has found a link between academic performance and daily exercise. English, math, and science scores went up as the number of minutes per day of exercise increased with the greatest gains in female science scores. With boys and girls only exercising 18-29 minutes per day on average, how much could grades improve if physical education hours were increased instead of cut back to save money?
British Journal of Sports Medicine, October 2013

Chiropractic: Decrease Childhood Asthma.
A past study found that 3.5% of children raised under chiropractic care developed asthma, whereas 5% of children raised under medical care developed asthma. The authors of the paper concluded that the immune systems of children receiving chiropractic care may be better able to handle allergens which cause asthmatic conditions.
Journal of Chiropractic Research, May 1989

Wellness/Prevention: Kids Need Regular Bedtimes.
A study of 10,000 children in the United Kingdom found that children with inconsistent bedtimes are more likely to suffer from behavioral and emotional problems than their peers who go to sleep at the same time every night. The good news is that the effects are reversible once children settle into a regular bedtime.
Pediatrics, October 2013

Chiropractic care: Lack of Spinal Motion and the Nervous System.

The negative effects of immobilization (lack of proper motion) in the spine begin as soon as four hours after injury! The direct effects of deconditioning on the nervous system include decreased proprioception (ultimately affecting balance and joint coordination) and a decrease in central neuromotor control of movement and posture. Chiropractic adjustments to restore mobility and alignment of the spine help keep the nervous system functioning properly.
Journal of Manipulative and Physiological Therapeutics, 1992

Brought to you by the Denver chiropractors at Dr. Glenn Hyman’s Denver Chiropractic Center

The United States Government Supports Chiropractic Care.

“The Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. It recommended spinal manipulation (chiropractic) as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.”
U.S. Department of Health and Human Services, December 1994

“Orthopedics Today” says chiropractic is an excellent choice

“Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.”
Orthopedics Today, February 2003

This Week’s 1-Page Health News from the chiropractors at Denver Chiropractic Center

Diet: Beans!
People who eat beans have healthier diets overall, lower body weight, and a reduced risk for obesity. A study found bean-consumers between the ages of 12-19 weighed 7 lbs (~3 kg) less and had nearly an inch (~2.5 cm) smaller waist circumference than their non-bean consuming peers. Those who ate beans frequently had a 22% reduced risk of being obese. (So take that all you anti-legume hard-core paleo people.)
The Experimental Biology Conference, 2006

Exercise: More Reasons.
Exercise increases the diffusion capacity of the lungs, which enhances the exchange of oxygen from your lungs to your blood.
Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: The Benefits of Adjustments.
Besides pain relief, what are the benefits of getting adjusted? 1. Adjustments restore joint motion, both symmetry and range of motion. 2. Adjustments normalize the biomechanics and load distribution of the spine, bone, joints, and disks. 3. Adjustments pump out metabolic waste products from soft tissue cells. 4. Adjustments improve nutrition to disks and cartilage. 5. Adjustments relax tight muscles. 6. Adjustments accelerate healing as movement increases the metabolic rate, and increases collagen and protein production.
Malik Slosberg, D.C.

Wellness/Prevention: Mushrooms & Cancer Risk?
Eating fresh mushrooms (greater than or equal to 10 grams per day) and dried mushrooms (greater than or equal to four grams per day) may decrease your cancer risk by 64% and 47%, respectively. The most commonly consumed mushroom in this study was the white button mushroom (one small white button mushroom weighs 10 grams). An additional protective effect was seen when mushrooms and green tea were both consumed on a daily basis.
International Journal of Cancer, 2009