Just a quick note to let you know that our week is almost full. We have just a few appointments left this week, so call us at 303.300.0424 or use the Appointment link at the top to contact us.. If you’re in pain of feel like your back is out of alignment, don’t delay.
For those of who who read last week’s email on my wife’s skiing related knee injury, I just wanted to update the story. First of all thanks to all of you who sent good wishes for a speedy recovery. She did indeed completely rupture the ACL in her left knee. She also has two small fractures. Surgery is set for Feb 9th. She’s a tough lady and will be fine in the long run. She’s already started an aggressive pre-surgery rehab program.
Obviously, the goal of all health care providers, including chiropractic management of Carpal Tunnel Syndrome (CTS), is to AVOID surgical intervention, but this is not always possible. Last month, we looked at herbal approaches to reduce inflammation with the focused goal of preventing surgical need. But, as chiropractors, we also care for patients post CTS surgery, and one of our treatment approaches beyond manual therapies includes nutritional management (In addition to Active Release Techniques to address scar tissue in the forearm muscles).
As we all know, during the surgical process, tissue damage occurs due to incisions, removal of injured tissue, and other factors. Depending on the “success” of the surgical procedure, damage to the nerves causing numbness, weakness, and/or other nerve related symptoms can occur. Often, nerves will regenerate during the healing process but not always 100%. This may be due to factors such as the amount of tissue damaged during the surgery, the length of time CTS had been present pre-surgery, how well the patient follows post-surgical instructions, as well as the general health and overall condition of the patient. A healthy diet along with certain specific vitamins can play a positive role in tissue healing and nerve regeneration. Here are some examples:
There are many others we didn’t get to (such as B1, 3, 5; zinc, Bromelain, and Quercetin). Bottom line: Eat healthy, exercise, don’t smoke, and fortify your diet with these nutrients!
We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing the Active Release certified chiropractors at Denver Chiropractic Center for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.
Fibromyalgia (FM) is a condition with a polarized audience comprised of those who believe it’s real and those who don’t. This interesting political-like conflict is, in a large part, centered around the topic we discussed last month concerning the causes of FM. This month’s article will focus specifically on the immune system and its relationship to FM.
“EXTRA, EXTRA, READ ALL ABOUT IT! New research published on 12-17-12 in BMC Clinical Pathology describes cytokine abnormalities were found in FM patients when compared to healthy controls.” OK! But what does that mean?
Very simply, this study reports that immune dysfunction is part of the cause of FM. The most exciting part is that this study identified a BLOOD TEST (finally!) that, “…demonstrates value as a FM diagnostic tool.” Looking at this closer, the researchers used multiple methods to examine cytokine (proteins that help regulate our immune response) blood levels in FM patients. They found the FM group had, “…considerably lower cytokine concentration than the control group, which implies that cell-mediated immunity is impaired in fibromyalgia.” This study’s findings of an immune response abnormality strays from previous study findings which largely pointed to the central nervous system (CNS – brain & spinal cord) as the origin of the FM syndrome.
This makes some sense as the study of immunology (in this case, “neuroimmunology” – the combination of neurology and immunology) has only been around for about 10 years, and as such, may hold some important answers as more evidence is uncovered to further support this potential “paradigm shift” in considering the primary cause of FM. The authors offer further excitement as this focus could lead to a better understanding of the cause of other neurological conditions such as multiple sclerosis (MS)! They go on by describing how body temperature, behavior, sleep, and mood can all be negatively affected by “pro-inflammatory cytokines” (PIC) which are released by certain types of activated white blood cells during infection. PIC have been found in the CNS in patients with brain injury, during viral and bacterial infections, and in other neurodegenerative processes (like MS)!
To further support this advance in understanding, the National Institutes of Health (NIH) reported, “…Despite the brain’s status as an immune privileged site, an extensive bi-directional communication takes place between the nervous and the immune system in both health and disease.” They describe multiple signaling pathways that exist between the brain and the immune system that function normally throughout our lifetime. When immune, physiological, and psychological “stressors” occur, cytokines and other immune molecules stimulate interactions within the endocrine (our hormone) system, nervous system and immune system.
To prove this, brain cytokine levels go up following stress exposure and similarly go down when treatments are applied that alleviate stress. They list other conditions such as stroke, Parkinson’s, Alzheimer’s disease, MS, pain, and AIDS-associated dementia as being similarly affected as well. They also report that cytokines and other neuro-chemicals play a role in our neuro-development throughout our lifespan, help regulate brain development early in life and brain function throughout life, and how this all changes in the aging brain. There are also interactions of these immune chemicals that result in gender differences on brain function and behavior.
Needless to say, it will be very interesting to watch for additional developments along this line of research as it pertains to the FM patient and future treatment recommendations! Also, immune stimulation by chiropractic adjustments has been postulated as a benefit and this too may be better understood using this new research approach!
If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing Denver Chiropractic Center!
We are happy to announce that we have added Cigna to the long list of insurures with whom we are in-network. After years of patients sending letters asking that Cigna add us to the network, they listened. For those of you with Cigna policies, we will need to verfiy your coverage the next time you’re in the office. We are also now in-network with Great West.
Here are the other major insurers for whom we are in-network providers:
Anthem / Blue Cross
United Healthcare
Aetna
Federal Employee Benefits Program
Kaiser PPO
Mail Handlers Benefits Program
PHCS
Humana
MedPay for auto injuries and ALL auto insurance policies
Workers’ Compensation (Level 1 Accredited)
Why pay more for out-of-network providers? We do all the paperwork and file insurance claims on your behalf! We will continue to do all that we can to better serve our patients now and in the future in this changing health care world.
Weekly Health Update
Week of: Monday, August 19, 2013
“Healing is a matter of time,
but it is sometimes also a matter of opportunity.”
~ Hippocrates
Mental Attitude: Optimism and Stress.
A six-year study of 135 older adults (>60 years old) found that pessimistic people have a higher baseline level of stress and have a more difficult time handling stress than their more optimistic peers.
Health Psychology, May 2013
Health Alert: Decrease Your Heart Disease Risk. A 16-year study of nearly 27,000 male health care professionals found that those who skipped breakfast were 27% more likely to suffer from coronary heart disease.
Circulation, May 2013
Diet: Eat More Nuts To Decrease Risk Of Death From Cancer & Cardiovascular Disease.
Individuals who eat more than three servings of nuts a week had a 55% lower risk of death from cardiovascular disease and a 40% reduced risk of death from cancer. (But, of course, if you’re allergic like my son is, stay away from nuts.)
BMC Medicine, July 2013
Exercise: Moderate-Intensity Walking Timed Correctly May Help Protect Against Diabetes.
A moderate paced fifteen minute walk after each meal appears to help older individuals regulate their blood sugar levels and could reduce the risk of developing type 2 diabetes.
Diabetes Care, June 2013
Chiropractic: Chronic Pain in the Neck Relieved With Chiropractic. Patients with chronic neck pain showed significant improvements in pain levels following spinal manipulation and showed positive changes up to 12 weeks post-treatment.
Journal of Manipulative and Physiological Therapeutics, March 2007
Wellness/Prevention: Retire Later In Life To Lower Dementia Risk. A very large study of self-employed people living in France found that individuals who retired at a later age had a lower risk of developing dementia. The study appears to confirm other research that suggests lifelong mental activity and challenge may protect against several forms of dementia.
International Longevity Center-France, July 2013
Video link- How to foam-roll your hips.
Whiplash is a slang term for cervical acceleration, deceleration syndrome, or CAD. There are facts and myths surrounding the subject of whiplash. Let’s look at some of the facts.
The origin of CAD. The history of CAD dates back to a time prior to the invention of the car. The first case of severe neck pain arose from a train collision around the time of 1919 and was originally called “railroad spine.” The number of whiplash injuries sharply rose after the invention of cars due to rear-end crashes.
Whiplash synonyms. As stated previously, the term “cervical acceleration-deceleration disorder, or CAD, is a popular title as it explains the mechanism of injury, where in the classic rear-end collision, the neck is initially extended back as the car is propelled forward, leaving the head hanging in space. Once the tissues stretch enough in the front of the neck, the head and neck flex forward very rapidly, forcing the chin towards the chest. This over stretches the soft tissues in the back of the neck. Another term for whiplash is WAD or, Whiplash Associated Disorders. In 1995, the Quebec Task Force categorized injuries associated with whiplash by the type of tissues that were found to be injured. Here, WAD Type I represents patients with symptoms/pain but normal range of motion and no real objective findings like muscle spasm. Type II includes injuries to the soft tissues that limit neck motion with muscle spasm but no neurological loss (sensation or muscle strength). WAD Type III includes the Type II findings plus neurological loss, and type IV involves fractures of the cervical spine.
Head rest facts: Prior to the invention of head rests, whiplash injuries were much more common and more serious because the head was propelled in a “crack-the-whip” like fashion. However, headrests are frequently not adjusted correctly; they are either too low and/or too far away from the head. If the seat back is reclined, this further separates the head from the headrest. The proper position of the head rest should be near the center of gravity of the head, or about 9 cm (3.5”) below the top of the head, or at minimum, at the top of the ears. Equally important is that it should be as close as possible to the back of the head. When the distance reaches 4” away from the head, there is an increased risk of injury, especially if it’s also set too low. When the headrest is properly positioned, the chances of head injury are decreased by up to 35% during a rear-end collision.
Seat back angle. The degree of incline of the seat back can also contribute to injury of the cervical spine. As stated above, as the seat is reclined, the head to headrest distance increases, furthering the chance for injury. A second negative effect is called “ramping.” Here, the body slides up the seat back resulting in the head being positioned over the top of the head rest. Also, the degree of “spring” of the seatback contributes to the rebound of the torso during the CAD process.
Concussion: The notion that the head has to hit something to develop a concussion is not true. Also, the idea that a loss of consciousness is needed to develop a concussion is also false. Simply, the rapid forward/backward movement of the head is enough force for the brain (which is suspended by ligaments) to literally slam into the inner walls of the skull and can result in concussion. The symptoms associated with concussion are referred to as post-concussive syndrome or, mild traumatic brain injury.
We realize you have a choice in where you receive your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Neck pain is a very common problem. In fact, 2/3rds of the population will have neck pain at some point in life. It can arise from stress, lack of sleep, prolonged postures (such as reading or driving), sports injuries, whiplash injuries, arthritis, referred pain from upper back problems, or even from sinusitis! Rarely, it can be caused from dangerous problems including referred pain during a heart attack, carotid or vertebral artery injuries, or head or neck cancer, but these, as previously stated, are very uncommon. However, since you don’t know why your neck hurts, it’s very important to have your neck pain properly evaluated so the cause can be properly treated and not just covered up from the use of pain killers!
Barring the dangerous causes of neck pain listed above, treatment methods vary depending on whom you elect to consult. Classically, if you see your primary care physician, pharmaceutical care is usually the approach. Medications can be directed at reducing pain (Tylenol, or one of many prescription “pain killers”), at reducing inflammation and pain (Aspirin, Ibuprofen, Aleve, etc.), to reduce muscle spasms (like muscle relaxers) or, medications may be directed to reduce depression, anxiety, or the like. When a sinus infection affects the 2 deep sinuses (ethmoid and sphenoid sinuses which are located deep in the head), the referred pain is directed to the back of the head and neck. Here, an antibiotic may be needed and/or something specifically directed at allergies when present. In general, in cases that do not respond to usual chiropractic care, co-management with the primary care physician is a good option.
However, the good news is that chiropractic care usually works well, and the need for medication can be avoided since the side effects of medication can sometimes be worse than the benefits. Recently, The Bone and Joint Decade Task Force on Neck Pain published arguably the best review of research published between 2000 and 2010 regarding neck pain treatment approaches. They concluded that spinal manipulation and mobilization are highly effective for many causes of neck pain, especially when arising from the muscles and joints – the most common cause. Therefore it would seem logical to consult with a Chiropractor FIRST since manipulation and mobilization are so effective and safe. When we add neck exercises, the results are even better, according to some studies.
As chiropractors, we will often use different modalities including electric stimulation, ultrasound, hot and/or cold (which are usually given as a good home-applied remedy), and others. In particular, low level laser therapy (LLLT) has been shown, “…to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain” [Lancet, 2009; 374(9705)]. LLLT is a commonly used modality by chiropractors and when combined with spinal manipulation, the results can be even faster! We will also evaluate your posture, body mechanics, and consider “ergonomic” or work station problems and offer recommendations for improving your work environment. We also frequently utilize anti-inflammatory nutrients including vitamins, minerals, herbs, and more to avoid the negative side effects to the stomach, liver, and kidney negative that can result from using non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or Aleve. Make chiropractic along with Active Release Techniques (ART) your FIRST choice when neck pain strikes, NOT last resort!
We realize that you have a choice in where you receive your healthcare services. If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Last month, we started a great discussion on “what NOT to do” for low back pain (LBP). Let’s continue that focus this month!
5. STAY STILL: You’ve heard, “…don’t do that – you’ll get a bad back!” There is something to be said about being careful, but one can be too cautious as well. In order to determine how much activity vs. rest is appropriate, you have to gradually increase your activities by keeping track of how you feel both during and after an activity. If you do notice pain, it may be “safe” to continue depending on the type and intensity of the pain. In general, a sharp, knife-like pain is a warning sign that you should STOP what you’re doing, while an ache is not. Until you’re comfortable about which type of pain is “safe,” start out with the premise, “…if in doubt, stop.” If the recovery time is short (within minutes to hours), then no “harm” was done. If it takes days to recover, you overdid it. Think of a cut on your skin – if you pick at it too soon, it will re-bleed, but if you are careful, you can do a lot of things safely without “re-bleeding.” Talk to us about the proper way to bend, lift, pull, push, and perform any activity that you frequently have to do that often presents problems. There is usually a way to do that activity more safely!
6. SURGERY IS A “QUICK FIX”: Though in some cases this may inevitably be the end result for your back condition, most of the time, it is not needed. As a rule, don’t jump to a surgical option too soon. It’s tempting to view surgery as a “quick fix,” but non-surgical care at least for 4-6 weeks and maybe several months is usually the best approach. As the old saying goes, you can’t “un-do” a surgery, so wait. UNLESS there are certain warning signs such as: a) bowel or bladder weakness &/or, b) progressive neurological losses (worsening weakness in the leg). If there are no “surgical indicators” meaning, no instability, no radiating leg pain, and only low back pain that is non-specific and hard to isolate what is generating the pain, DO NOT have surgery as the chances of improvement following surgery drops off dramatically in this group. There are guidelines that we all should follow and they all support non-surgical care initially for 4-6 weeks. Chiropractic is one of the best options cited in these guidelines because it’s less costly, involves less time lost from work, and chiropractic carries the highest patient satisfaction.
7. DON’T STRETCH – IT’S HARMFUL: You may have heard or read that stretching can actually increase or worsen your time if you’re a runner, reduce your ability to lift heavy weight (if you’re a weight lifter), or cycle as fast. Though this seems obviously silly, there IS a growing body of evidence that has found this TO BE TRUE! HOWEVER, it appears (at least at present), that is applies primarily to static, long hold stretching and NOT to dynamic exercising like jumping jacks, toy-soldier like high kicks, or core stabilization. Moreover, no study YET has found a negative effect for non-athletic competitive activities or for low back pain specifically. A good general rule is, if you feel better after exercising, or in this case stretching, it’s probably better for you than not. Also, as stated last month, there is a “right vs. wrong” time to exercise and WAY to exercise. For example, when LBP occurs in flexion but reduces in extension, there is plenty of evidence published that performing exercises INTO the direction of pain relief is VERY helpful. So until you hear differently, KEEP ON STRETCHING, but follow our advice!
We realize you have a choice in where you receive your healthcare. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Mental Attitude: Sibling Fighting Linked To Mental Health Issues.
Fights between siblings (either verbal or physical) are so common they’re often dismissed as simply part of growing up. However, a new study finds that sibling aggression is associated with significantly worse mental health in children and adolescents. In some cases, the effects of sibling aggression on mental health were equal to those of peer aggression.
Pediatrics, July 2013
Health Alert: Third-hand Smoke a Danger!
Cigarette smoking has long been associated with risks to human health. Subsequent research has confirmed the dangers of second hand smoke. Now, scientists are noting the risk of environmental pollutants that persist even after the second hand smoke has cleared. These pollutants remain on the surfaces of buildings, furniture, floors, clothing, and other items exposed to smokers and are being referred to as third-hand smoke. Recent studies link DNA damage to third-hand smoke.
Mutagenesis, March 2013
Diet: Early Introduction of Solid Food Increases Type 1 Diabetes Risk.
Infants have an increased risk of developing type 1 diabetes later in life if they’re started on solid food before the age of four months.
JAMA Pediatrics, July 2013
Exercise: To Lose Fat, Don’t Eat Before Workout.
Exercising on an empty stomach may not be such a bad idea. Researchers found that cyclists who trained without eating beforehand burned significantly more fat than their counterparts who ate before training.
Journal of the American College of Sports Medicine, April 2010
Chiropractic: Chiropractic Adjustments Produce Immediate Changes on MRI.
Compared to acute low back pain patients who received either non-manipulative care or no treatment, MRIs of patients who received two weeks of spinal manipulation showed the most substantial improvement in spinal gapping in the facet joint (L4/5 and/or L5/S1). This supports the premise that adhesions (think internal “scar tissue” that restricts healthy joint motion) formed in these small spinal joints are released by spinal manipulation, thus restoring normal joint motion and ultimately reducing pain and improving the patient’s function.
Journal of Manipulative and Physiological Therapeutics, April 2013
Wellness/Prevention: Deadly Belly Fat.
According to Dr. Robert R. Henry, a leading endocrinologist and professor of medicine at the University of California at San Diego, belly fat is toxic to the body. Fat around the midsection secretes chemicals that spark a cascade of intricate interactions that can weaken your heart, damage your blood vessels, dampen your immunity, and inevitably, if you continue to gain weight, will shorten your life or will lessen your ability to enjoy it to the fullest.
Prevention, June 2013
Fibromyalgia (FM) is a very strange condition. Can you think of any other condition that creates so many symptoms and yet all the blood and imaging tests are negative? FM symptoms include chronic fatigue, muscle aches and pains, depression, sleep disturbance, memory affects, and more. The degree or severity of FM varies from mild to severe, leaving some totally disabled and distraught. So, the question of the month is, where does the pain come from?
Since the usual markers of injury are negative (that is, blood and other tests), we can tell you first that the pain is NOT coming from damaged tissue such as muscle, bone, organs, and the like. If it did, abnormal enzymes &/or inflammatory tests would result. Rather, the origin of pain appears to be arising from within the central nervous system. That is to say, there are portions of the brain and spinal cord where pain signals are received and when they reach a certain level or threshold, the sensation is felt. When the sensory input is below that level, it will not be felt. In fact, there are MANY MORE incoming sensory signals that are NOT felt compared to those that are. This “thermostat-like” function is vital so we DO NOT feel everything that arrives to the brain. This is why we don’t feel the clothes hanging from our backs or the shoes on our feet (unless the laces are tied too tight!). It’s been said that if we DID “sense” all the incoming signals we would, in a sense, “…short circuit.”
In the FM patient, this thermostat is “messed up.” It is set lower than what is considered normal, and as a result, patients do sense or feel more than they should. This “nervous system overload,” sometimes referred to as a “sensory storm,” occurs in the FM sufferer. A more fancy term called “central sensitization” can be searched and you will find a LOT to read about this interesting subject (check it out)!
So how does this hypersensitive situation start? Fibromyalgia is classified into two main categories – type I and type II. In type I, or primary FM, the cause is unknown. The cause could include one’s genetic make-up, but the bottom line is, we really don’t know. In type II or, secondary FM, some other known condition or situation can be identified such as irritable bowel syndrome, rheumatoid arthritis, after a trauma, or following an illness or infection. Some also feel the lack of sleep or sleep loss can cause FM. This is because it takes about four hours of sustained sleep to reach deep sleep, and because of frequent sleep interruptions, the person never reaches deep sleep. Over time, deprived of the relaxing deep sleep benefits, the body gradually tightens up, “re-setting the thermostat” and too much sensory information reaches the brain, resulting in overload, and a heightened pain level is perceived. Studies have shown that when sleep is restored, many FM patients gradually improve and function better. This focus on sleep restoration is important in the management strategies of FM treatment. We all know our tolerance to just about everything suffers when we are over-tired, similar to the toddler who cries at the drop of a dime when they need a nap.
Chiropractic adjustments, certain nutrients like melatonin, valerian root, and vitamin B complex can facilitate sleep restoration. Treatment for sleep apnea can also help patients with FM. As we’ve said before, FM is usually multi-factorial and including chiropractic in the FM treatment “team” is essential for a satisfying result!
If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!