Healthy Life Newsletter, October 2021
Suffering from Knee Pain? Your Chiropractor Is Your Best Choice
New research confirms what many doctors of chiropractic and their patients with patellofemoral pain syndrome (PFPS) – the most common cause of knee pain, characterized by cartilage damage under the kneecap due to overuse or injury – likely know already: spinal manipulation is more effective than local exercise therapy in reducing pain, improving function and other key outcome measures.
A randomized, controlled trial [Scafoglieri A, and colleagues; BMC Musculoskel Disord, 2021] assigned PFPS patients (ages 16 and older and experiencing anterior knee pain for at least three months) to a local exercise or spinal manual therapy group. For six weeks, patients received high-velocity, low-thrust manipulations of the thoracolumbar region, sacroiliac joint and/or hip (one session per week); or supervised training of the knee and hip muscles with mobilization of the patellofemoral joint (also one session per week). Patients in both groups also received instructions on home exercises that focused on mobilizing the thoracolumbar region.
Outcome measures included maximum, minimum and current pain; function; and maximum voluntary peak force (MVPF) of the quadriceps – all assessed at three points: before intervention, after six weeks of intervention and after six weeks of follow-up (week 12 of the study).
In terms of improvement, significant between-group differences for both pain and functionality were noted, favoring the spinal manual therapy group. Significant between-group differences were not noted relative to improvement in quadriceps MVPF.
Per the study authors: “This is the first study supporting evidence that spinal manual therapy is more effective than local exercise therapy in patients with PFPS in the medium term. Compared to local exercise therapy, six sessions of manipulative therapy of the spine resulted in minimal clinically important differences in pain and functionality after 6 weeks of intervention and at 6 weeks of follow-up.”
Eat the Pain Away
The foods you eat on a daily basis can impact your weight, your mood and your overall health on numerous levels. But what about pain? Can your diet lead to pain? Indeed it can, suggests research; and the culprit is a familiar one: the Western diet, characterized by high intake of red meat, processed meats, prepackaged foods, fried foods, high-fat dairy products, and processed foods low in nutrients and high in sugar.
Sound all too familiar? This dietary pattern has been shown to fuel the obesity and type 2 diabetes epidemics. Imagine being obese and/or suffering from diabetes – and then experiencing chronic pain? Not a pretty picture. But that’s just the picture many people face due to their diet, according to a recent study published in Nature Metabolism.
The findings are depressing, to say the least, but they should also be motivating. Here’s why: Researchers discovered that while the typical Western diet (which is high in inflammation-promoting omega-6 fatty acids) can lead to inflammatory and neuropathic pain, dietary modifications away from the Western diet toward one higher in omega-3 fatty acids (which are anti-inflammatory) can reduce or even reverse pain.
These findings are significant because as the researchers state, chronic pain is the leading cause of worldwide disability and is commonly associated with comorbidities such as obesity / diabetes. Something as simple as changing your diet (or continuing on the healthy dietary path you’re on) could make all the difference when it comes to avoiding chronic pain and living a healthier, happier life. Talk to your doctor for more information.
The Amazing Importance of Magnesium in Your Body
The following is exerpted from the link above. Check out the link for the full important story.
Magnesium is the fourth most abundant mineral in the human body. It is involved in over 300 enzymatic reactions and is a necessary component for energy metabolism, muscle function, blood pressure regulation, insulin metabolism, cardiovascular function, nerve transmission, neuromuscular contraction and more. Because of this widespread need, chronic magnesium deficiency can lead to general feelings of unwellness and contribute to the development of many different diseases.
The following symptoms and signs can be indications of magnesium deficiency, although any clinical signs of deficiency are usually totally absent (meaning magnesium deficiency may silently impact your health).
Neuromuscular: weakness, tremor, twitching (muscle fasciculation), difficulty swallowing (dysphagia), facial twitching as a reaction to facial nerve tapping (positive Chvostek’s sign), application of a pressure cuff to transiently block off the main artery in the arm resulting in spasm of muscles of the hand and forearm (positive Trousseau’s sign)
Cardiac: arrhythmias, changes in heart function that are detected on ECG
Central Nervous System: depression, agitation, psychosis, uncontrolled movements of the eye (nystagmus), seizures.
Conditions related to magnesium deficiency include asthma, migraine and other headaches, prenatal outcomes, osteoporosis, diabetes, depression and anxiety, restless leg syndrome, constipation, cancer, physical performance and strength, and much more.
Up to 60% of the US population is estimated to be deficient in magnesium. Deficient magnesium levels can be due to insufficient magnesium in the diet, as well as problems with kidney function, alcoholism, and the use of diuretics and proton pump inhibitors.
Note from Dr. Mha Atma: There are blood tests for magnesium deficiency but it’s safe and sensible for most folks to go ahead and take a magnesium supplement. Magnesium glycinate or citrate are the best, and the only side effect if you take a bit too much is loose bowels, an indication to reduce the dose. Magnesium also greatly facilitates the body’s utilization of vitamin D.
How to Avoid Sitting Too Much and Moving Too Little
By Paul Hooper, DC, MPH, MS
Partly due to rising health costs and the awareness that sitting for long periods has a negative effect on health, there is some significant motivation to get workers out of their chairs and on their feet. In addition to the stated health benefits, people tend to be more productive when they work on their feet.
Even the American Medical Association (AMA) recognizes that prolonged sitting is bad for you. The AMA recently adopted a new policy on sitting at work. It is now urging employers and others to make alternatives to sitting available to workers. AMA board member Dr. Patrice Harris said, “[giving] employees alternatives to sitting all day will help to create a healthier workforce.”
A Nation of Obese Sitters
So, is sitting a healthy thing to do? It would appear not! At least not for long periods of time. In spite of significant evidence, the plain fact is we have become a nation of sitters. We sit at work, sit on the way to and from work, sit while we eat, and sit during the evening while watching TV. Among some of the other negative aspects of prolonged sitting, there is a correlation between the amount of time spent seated and the development of obesity. It’s really no wonder we are becoming a nation of obese sitters.
In addition to its recent policy on sitting at work, the AMA just saw fit to make obesity a disease, rather than a lifestyle choice. Interesting call! On a personal note, I’ve considered myself to be far too short for my weight most of my life. However, I don’t consider that I have a disease; never have. Rather, I credit my own situation to more calories going in than going out. Labeling obesity as a “disease” sort of takes the personal-responsibility part out of the equation.
So, back to the sitting thing. There is ample evidence that sitting, whether at work or at home watching TV, has a negative effect. Studies show that prolonged sitting leads to an increase in childhood obesity, diabetes and even attention problems.
An interesting study was published a few years ago in the Archives of Internal Medicine. The study was conducted at Duke University and looked at the impact of obesity on worker’s compensation costs. Workers with a body mass index (BMI) greater than 40, filed twice as many worker’s compensation claims, had seven times higher medical costs, and lost 13 times more time from work when compared to non-obese workers.
Tools to Help Fight the “Sitting” Epidemic
In an attempt to curb the sitting epidemic, the American Heart Association (AHA) is promoting a new device. It’s actually a smartphone app, Hotseat. It is designed to do one thing: Get people out of their seats for a few minutes throughout the day.
I’m not in the habit of promoting products, but this one has me intrigued. A pilot study by the AHA found that 71 percent of the app users took more breaks from sitting during the workday. Additionally, nearly 87 percent of the workers said that using the app made them more aware of the time they spend sitting.
Those using Hotseat set up an individual break profile, one that they feel comfortable and capable of doing. They then set up the number of breaks they want to take and when they want to take them. Each break is approximately two minutes in length. Rather than a fixed schedule, the app syncs the breaks with the worker’s calendar. Nifty use of a smartphone. Fran Melmed, the creator of the Hotseat app, says it is designed to combat “sitting disease.”
One other thing that seems to help is the treadmill desk. I wrote about this in an earlier article, but it’s important to re-emphasize, because it does get people out of their chairs. The treadmill desk consists of a treadmill that is set up as a standing workstation.
Perhaps the most important thing you can do is move more. Don’t spend too long in any one position. Take the stairs rather than the elevator. Park far enough away from the store that you are forced to walk a bit. Take walks after lunch and dinner.
I’m always amused when a worker who has injured his/her back is given a temporary work assignment that involves seated work. The opportunity to sit at work is considered to be “light work.” In reality, it comes with its own price.
I’m personally pleased to see the interest in the negative effects of sitting. Prolonged sitting leads to a variety of health problems, from obesity to back pain to postural fatigue. It behooves all of us, doctors and patients alike, to move around more.
Alcohol Use Linked to Over 740,000 Cancer Cases Last Year, New Study Says
At least 4% of the world’s newly diagnosed cases of esophageal, mouth, larynx, colon, rectum, liver and breast cancers in 2020, or 741,300 people, can be attributed to drinking alcohol, according to a new study.
markhanna/Getty Images/RooM RF
The link between smoking and cancer is well-documented and widely known. But alcohol?
“Fewer than one in three Americans recognize alcohol as a cause of cancer,” says Harriet Rumgay, researcher at the International Agency for Research on Cancer, the specialized cancer agency of the World Health Organization. “That’s similar in other high-income countries, and it’s probably even lower in other parts of the world.”
A new study shows just how much of a risk drinking can be. At least 4% of the world’s newly diagnosed cases of esophageal, mouth, larynx, colon, rectum, liver and breast cancers in 2020, or 741,300 people, can be attributed to drinking alcohol, according to a study in the July 13 edition of Lancet Oncology. Men accounted for three-quarters of alcohol-related cancers. Of the 172,600 alcohol-related cancer cases diagnosed in women, the vast majority, or 98,300 cases, were breast cancer.
The more a person drinks, the greater the likelihood of biological damage.
To come up with their statistical estimate, researchers crunched three sets of data: estimated global alcohol consumption estimates, specific cancer risks from alcohol, and estimates of the global incidence of those cancers in 2020.
They found that the more alcohol people drink, the higher their risk of an alcohol-related cancer. Drinking at least two and as many as more than six drinks a day, defined as risky to heavy drinking, posed the greatest risk of a future cancer. Even moderate drinking, two or fewer drinks a day, accounted for an estimated 14%, or 103,000 cases, of alcohol-related cancers, according to the study.
Wrong Choice … Right Choice (About Spinal Epidurals)
By Ronald Feise, DC
Your family medical doctor has recommended a steroid injection for sciatica. Your MD tells you that you have disc herniation and degeneration, and that the steroid injection will help with the pain and inflammation. For the sake of example, you are in your mid-50s and are underweight.
How do you respond? What does the current research demonstrate? Let’s investigate the risks and benefits of steroid spinal injections, starting with the risks.
Steroid Injections: The Risks
A case-control study assessed the effects of lumbar epidural steroid injections on the risk of subsequent vertebral body fracture. This study was published in the Journal of Bone & Joint Surgery, a top-tier peer-reviewed journal for orthopedists.1 The research team consisted of five medical researchers and the principal investigator, an orthopedic spine surgeon.
Let’s take a look at the study’s patient population. This research team randomly selected 3,000 patients who had been exposed to steroid injection and a matched cohort of 3,000 patients who had not been exposed. There were no differences between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or oral steroid use. The researchers assessed the incidence of vertebral body fractures in each group.
right and wrong - Copyright – Stock Photo / Register MarkEach steroid injection increases the risk of fracture by 21 percent. This is the first scientifically rigorous effort to quantify the fracture risk associated with spinal steroid injections. But it is not the first study to explore this issue.
Another study examined postmenopausal women and demonstrated diminished bone density in the hip after a single lumbar steroid injection.2 Multiple research teams now caution against using these injections in women and underweight individuals.
Numerous other adverse events are associated with steroid injections. Although the vast majority are minor and transient in nature, serious complications, including nerve damage, paralysis, strokes and death, may also result.3
Infection is another possible risk that should not be ignored. Several years ago, an outbreak of fungal meningitis from tainted steroids killed 64 people and seriously sickened 751 others.
No Demonstrated Benefits
Scientists use double-blind, placebo-controlled, randomized clinical trials to examine the benefits of interventions because this research design can accurately measure effects. Combining the results of multiple trials in a meta-analysis adds a level of reliability to the conclusions of the individual studies.
Oliveira and his research team conducted systematic review and meta-analysis to investigate the efficacy of epidural corticosteroid injections compared with placebo injections in reducing leg pain (primary outcome) and disability in patients with sciatica.4 They included in their review 25 placebo-controlled, randomized clinical trials that provided data from a total of 2,470 sciatica patients.
The researchers found that while epidural steroid injections are more effective than placebo injections in reducing leg pain immediately after injection (e.g., the first two weeks), the effect fades rapidly. Epidural steroid injections were not better than placebo injections for leg pain at any point after two weeks. Additionally, epidural steroid injections were not effective in reducing back pain or improving disability at any point in time.
Multiple medical research teams performing independent systematic reviews agree with Oliveira, et al.5-6 They have concluded that there is no evidence to support the use of injections for the treatment of low back pain, spinal stenosis or sciatica. Although some patients will experience a few weeks of pain relief, the benefit does not last. Based on multiple randomized trials, steroid injections are not better long term than placebo injections with saline solution.
A Better Way: Chiropractic Care
In the case of spinal steroid injections, the risk of harm is considerable, serious and predictable, and the benefits are extremely limited (14 days). Therefore, patients with sciatica, low back pain or spinal stenosis should avoid this invasive treatment and instead receive chiropractic care.
Please note that the FDA has not approved injectable corticosteroids for use through spinal injection, but these products continue to be used off-label. Unfortunately, the FDA has not stated that corticosteroids are contraindicated, which would forbid their use for spinal conditions. However, based upon the data to date, the FDA should ban injectable steroids for spinal conditions.
References
Mandel S, Schilling J, Peterson E, et al. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg (U.S.), 2013;95:961-4.
Al-Shoha A, Rao DS, Schilling J, et al. Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women. Spine, 2012;37:E1567-71.
Abbasi A, Malhotra G, Malanga G, et al. Complications of interlaminar cervical epidural steroid injections: a review of the literature. Spine, 2007;32:2144-51.
Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for sciatica: an abridged Cochrane systematic review and meta-analysis. Spine, 2020;45:E1405-E1415.
Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med, 2015;163:373-81.
Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med, 2012;157:865-77.