Healthy Life Newsletter, November 2023
What Your Chiropractor Knows – That Your Medical Doctor Doesn’t
By Donald M. Petersen Jr., BS, HCD(hc), FICC(h)
An interesting study recently published in The Spine Journal examined what is important to patients as they seek care for their low back pain. The study included 419 patients who were surveyed, with each asked to rate (from 0 to 4) the importance of: “improvement in level of pain, improvement in ability to perform daily tasks, explanation of what is causing your problem, thorough physical examination, diagnostic testing, medication, physical therapy, surgery.” The investigators also surveyed 198 medical physicians, asking them to rate what they thought would be most important to their patients.
What Patients Want
In descending order, the top three most important items for patients are:
\1. Improvement in level of pain (3.48)
\2. Improvement in ability to perform daily tasks (3.31)
\3. Explanation of what is causing their problem (3.27)
And at the bottom of the list in terms of what patients consider important:
\7. Medication
\8. Surgery
A Disturbing Disparity
In comparing the ratings of the patient responses with those of the medical physicians, the investigators found statistically significant differences between the two. Specifically, physicians “underestimated the importance of an explanation of what is causing the problem” and overestimated the importance of diagnostic tests, medications and surgery.
What Chiropractors Know Better than Anyone
Knowing the cause and addressing it clearly matters to patients, much more than even a physical examination or diagnostic testing. This is why chiropractic continues to be appreciated and trusted by chiropractic patients.
The fact that back pain patients considered medications and surgery to be least important also points to their expectation and desire to see their condition cared for and resolved without the potential harm that many times accompanies drugs and surgery. This also underscores the importance of the chiropractic philosophy from the patient’s perspective.
What is likely a surprise for medical doctors is their patients’ lower regard for diagnostic testing. While this is certainly important from a pathology standpoint, it suggests many patients believe they know the problem(s) and that additional diagnostic tests do not play as prominent a role as MDs might expect.
At the end of the day, the majority of back pain patients want pain relief, improved function and a clear understanding of the cause of their back pain. They’re not interested in surgery or medication, and are likely suspect of their potential side effects. These patients want what chiropractic offers.
Reference
Smuck M, Barrette K, Martinez-Ith A, et al. What does the patient with back pain want? A comparison of patient preferences and physician assumptions. Spine J, 2022 Feb;22(2):207-213.
Steps for the Brain
Let’s talk about step count for a minute – after all, everyone else seems to be talking about it lately. More steps equal better health, pure and simple, reducing your risk of developing any number of diseases … or just dying “before your time.” The latest study has found an association between step count / intensity and dementia risk among adults ages 40-79. Let’s see what the research concluded.
In the study, researchers monitored nearly 80,000 adults who wore accelerometers to track activity (steps). A higher number of daily steps was associated with a lower risk of dementia by any cause; and a step count of just under 10,000 per day proved most effective in reducing the risk. In terms of step intensity and dementia risk reduction, the optimal pace (steps per minute) was 112 steps, on average, and was associated with greater risk reductions than walking for the same number of steps, but at a slower pace. Findings appear in JAMA Network Open.
You might not be a fan of the gym, but walking – all that takes is a comfortable pair of shoes and the willingness to open your front door and pick a direction. With all the research linking walking to better health, if you’re not walking every day, the question is: What are you waiting for?
Don’t Forget the Ginger
Ginger is commonly known for helping calm a restless stomach, among other benefits, but it also may play an important role in reducing inflammation in people suffering from autoimmune diseases, such as lupus and rheumatoid arthritis.
According to new research, ginger supplementation appears to influence a type of white blood cell called neutrophils, making them more resistant to “neutrophil extracellular trap (NET) formation.” Known as “NETosis,” this process promotes inflammation and may contribute to / worsen autoimmune diseases. In the study, healthy subjects who took a ginger supplement for one week boosted a specific chemical inside neutrophils, which inhibited NETosis. Study findings appear in the research journal JCI Insight.
Because autoimmune diseases are generally incurable – and the primary treatment strategy involves administration of medication, the possibility that a natural ginger supplement can provide value is exciting news. Your doctor can tell you more about natural symptom management for autoimmune diseases … and many other conditions too often managed by over-the-counter or prescription medication instead.
Why Kids Need Exercise
A considerable body of research supports the mental and physical health benefits of physical activity for young and old. The research base also suggests a clear connection between stress and poor health, particularly chronic stress that remains unresolved over time.
Fortunately, research also points to exercise as a great way to combat stress, and children – who are under increasingly damaging levels of stress these days – are no exception.
Researchers exposed children ages 10-13 to a stress-inducing scenario in a controlled experiment in which they were given inadequate time to prepare for a presentation. They repeated the experiment, but with no pressure to perform, and took saliva samples on both occasions to compare levels of cortisol – the so-called “stress hormone.” (The body produces cortisol in response to stress.)
Prior to the stress test, the researchers also tracked the children’s physical activity for one week via a wearable sensor that tracked their daily movement. Children who were more physically active (more than an hour per day) had lower cortisol levels than children who were less active. Study findings were published in the Journal of Science and Medicine in Sport.
There’s no negative to consistent physical activity, and with children increasingly participating in non-active pursuits (namely playing games or using social media on their phones, tablets and/or laptops), it’s high time for a reminder of the power of physical activity to help shape physical and mental health. It’s a win-win for your children’s healthy future.
5 Flights a Day
We’re not talking about airline flights or flights of craft beer; this article focuses on how walking up at least five flights of stairs every day can lower your heart disease risk. With all the talk about walking 10,000 steps per day, add walking up stairs to your list of must-do’s for a healthy heart.
Let’s see what new research says about the power of stair climbing.
Researchers evaluated stair climbing and its relationship to heart health among a population of more than 450,000 adults over a 12+-year period. Climbing more stairs on a daily basis reduced cardiovascular disease risk (coronary artery disease, ischemic stroke or acute complications), particularly among people with a low risk of disease. However, even among higher-risk individuals, stair climbing appeared to effectively offset the increased risk.
Compared with people who reported no stair climbing at baseline (the start of the study window), cardiovascular disease risks were lower for people climbing 1-5, 6-10, 11-15, 16-20, and 21 or more flights of stairs per day. The more flights of stairs climbed, the greater the risk reduction. Findings appear in the research journal Atherosclerosis. Overall, individuals who climbed at least five flights of stairs daily (approximately 50 steps) had a 20% risk reduction compared with non-stair climbers.
The good news is that not only is stair climbing a great way to diversify your physical activity, but it’s also as easy as walking to accomplish, at least in terms of accessibility. In fact, if you live in a multi-story home or work in a multi-story building, you can walk up five or more flights of stairs every day without any planning whatsoever. Wherever you go, find ways to take stairs if available, particularly if standing in an elevator (and not getting any exercise) is the alternative. Your heart will thank you for it.
Probiotics for BP?
Probiotics are essential for microbiome health. Not sure what a microbiome even is? Perhaps this explanation by the Harvard T.H. Chan School of Public Health will help clarify: “Picture a bustling city on a weekday morning, the sidewalks flooded with people rushing to get to work or to appointments.
Now imagine this at a microscopic level and you have an idea of what the microbiome looks like inside our bodies, consisting of trillions of microorganisms (also called microbiota or microbes) of thousands of different species. These include not only bacteria but fungi, parasites, and viruses. In a healthy person, these ‘bugs’ coexist peacefully, with the largest numbers found in the small and large intestines but also throughout the body.”
Now let’s talk about probiotics – live microorganisms like the ones referenced above. When people think about probiotics, they often think about yogurt first; Streptococcus thermophilus and Lactobacillus bulgaricus are common probiotic strains used to ferment milk as part of the yogurt-making process, but numerous other strains exist and can be found in other products and are available as supplements.
Probiotics are important for your microbiome, and they’re also important for regulating blood pressure, according to research. In fact, a new study suggests two additional strains can be added to the list of probiotics that positively influence blood pressure: Bifidobacterium lactis and Lactobacillus rhamnosus. Researchers conducting a mice study (which is common before proceeding to human studies) discovered that in hypertensive mice, blood pressure returned to normal levels after ingesting the two probiotic strains for 16 weeks.
Now here’s why we mentioned probiotics and the microbiome first: The researchers also investigated the potential connection between blood pressure, as modified by probiotic supplementation, and the GI microbiome. The found one: “[Our] findings indicate that the probiotic efficacies in alleviating hypertension are linked to specific gut microbes and metabolic pathways.” In other words, probiotics help facilitate a healthy microbiome … and a healthy microbiome may help facilitate normal blood pressure. Talk to your doctor for more information about the health benefits of probiotics and whether adding a probiotic supplement to your nutritional regimen is right for you.
For Pelvic Pain During or After Pregnancy, Think Chiropractic First
By Ronald Feise, DC
The prevalence of pregnancy-related low back pain and disability is significant. According to a review of the literature, the mean prevalence of pregnancy-related low back pain is about half of all pregnancies.1-2 Most women report a return to pre-pregnancy levels of low back pain within six months of delivery, but some go on to experience chronic low back pain. Research reports a postpartum prevalence of 37 percent at one year and 18 percent at six years.3
Four types of pregnancy-related low back pain are recognized: posterior pelvic pain, lumbar pain, mixed pain and radiculopathy. Among these, posterior pelvic pain is unique, as it is associated only with pregnancy and represents about one-third of all pregnancy-related low back pain.4
There are two main approaches to the management of chronic pelvic pain – pharmacological or non-pharmacological. Let’s take a look at the effectiveness and safety of each approach.
The Pharmacological Approach
Horne, et al., conducted a randomized, double-blind, placebo-controlled trial to measure the efficacy and safety of gabapentin in women with chronic pelvic pain.5 More than 300 participants were randomly assigned to receive gabapentin or a placebo for 16 weeks.
MarkTreatment with gabapentin compared with placebo did not result in lower pain scores in women with chronic pelvic pain, and it was associated with higher rates of side effects than placebo.
Although acetaminophen and NSAIDs offer a modest amount of pain relief, they have a poor safety profile. Maternal acetaminophen use during pregnancy is associated with a higher risk for attention-deficit disorder and autism spectrum disorder in children.6 Additionally, two meta-analyses found an association between the use of acetaminophen during pregnancy and asthma in children.7-8
Increased risks of miscarriage and malformations are associated with NSAID use in early pregnancy.9 Exposure to NSAIDs after 30 weeks’ gestation is associated with an increased risk of premature closure of the fetal ductus.10 Li, et al., demonstrated that NSAID use around conception was associated with an increased risk of miscarriage with a dose-response relationship.11
The Non-Pharmacological Approach
An effective non-pharmacological approach to pelvic pain includes an individualized treatment program consisting of: 1) adequate patient education and reassurance, 2) individualized exercises, and 3) spinal manipulation.
Exercises: An individualized exercise program that includes stabilizing exercises and aerobic exercise is part of an effective treatment strategy for pregnant patients with back or pelvic pain. In a randomized, controlled trial, researchers found that stabilizing exercises had a significantly better statistical and clinical effect than the controls on pain, functional status and health-related quality of life measured after 20 weeks of intervention and one year postpartum.12 A Cochrane systematic review confirmed these findings.13
Aerobic exercise contributes to the overall treatment plan for patients with spinal pain, because it is associated with improvements in mood state and overall feeling of well-being, strengthening the supporting spinal musculature, improving neuromotor control and coordination, and increasing nutrition for the disc. Thus, current research supports an exercise program of strengthening exercises and aerobic exercise.
Spinal Manipulation: Researchers have found that spinal manipulation can provide safe and effective relief of back and pelvic pain in pregnant women. A randomized clinical trial examined the effects of a chiropractic multimodal approach (including stabilization exercises) compared to standard obstetric care. The research team was composed of medical doctors and chiropractors, and the findings were published in the American Journal of Obstetrics & Gynecology.
“Effect size” is a measure of treatment benefit. The larger the effect size, the better the result. The chiropractic approach demonstrated clinically important reductions in pain compared with standard obstetric care.
Moreover, multiple systematic reviews support the conclusion that chiropractic treatment is a safe and effective intervention for reducing pain intensity and frequency in pregnant women with back and pelvic pain.15-16
Science Supports Conservative Care
Chiropractic care is the premier non-pharmacological choice for patients with chronic pelvic pain. As a patient, you can help communicate the safety and effectiveness of chiropractic to your medical doctor / OB-GYN and insurance company with this research. And of course, if you’re pregnant and experiencing pelvic or other pain, schedule an appointment with your doctor of chiropractic.
Chiropractic and the tech neck epidemic
The following is excerpted from f4cp.org . Go to the link to read the full article.
Tech neck, also commonly called ‘text neck syndrome,’ is not just caused by texting. It is a condition that exemplifies the price our bodies are paying due to the upsurge of technology use as a whole and is swiftly being considered a 21st century health issue. The unnatural positioning of the body while using phones, tablets, computers and other devices is creating undue stress on the involved joints and soft tissues of the body such as joint capsules, muscles, ligaments, tendons and nerves.
Basic symptoms may include but not be limited to: headaches, pain, stiffness, neck spasms, back pain, numbness, tingling or even weakness in one or both arms. Tech neck may also cause sharp, sudden pain in the neck when users look down at their phone or other devices.
Tech neck correlates with a very specific abnormal posture that is hallmarked by anterior weight-bearing of the head. Anterior weight-bearing means that the head is unnaturally hanging forward, away from the body and away from the supportive column of the spine. This can create immense pressure on the joints and soft tissues of the spine and lead to straightening or even reverse the normal curve of the neck which predisposes people to joint damage in the neck and spine, a dowager hump, other health complications and future deformities.
The head is like a 10-12 pound bowling ball that sits atop the strong pillar of the spine. In an ideal posture, the head is positioned over the pillar of the spine and is held even with the shoulders. This natural position would only exert pressure that would simply equal the weight of one’s head. As the head incrementally comes forward (away from the support pillar) from looking at devices, the pounds of pressure created increases detrimentally and correlates with the angle of the neck and head. The joints of the spine and soft tissues of the head, neck and back can be subjected to an additional 27-60+ pounds of pressure with technology use. When you think about this happening for many hours each day, every day, it ultimately alters posture and leads to degeneration, deformity and symptoms (not necessarily in that order).
In general, people are overusing devices every single day to text, stream, surf the web, answer emails, etc. and it is altering normal posture. After consistently looking downward with the head hanging forward throughout the bulk of the day (while using devices) the problems compound. </p>
Children and youth, starting with the use of devices so young, are especially at risk for problems earlier in life, even before being fully grown. Having forethought about what postures can affect future health is pertinent for technology users of every age. Young people in particular could be setting themselves up for a variety of imminent health issues and even a shortened life.
Tech Neck in Children and Youth
The excess stress from these abnormal postures is alarming and can involve the musculoskeletal system, eyes, heart, lungs, head and mental health. In the past, children would go outside to play and interact with other people. Kids of the 21st century are more sedentary and spend more time alone in their rooms staring at their phones. They may have more ‘friends’ on social media, but they are lacking face to face meaningful relationships and the physical activity required for optimal childhood growth and development.
For those of us that adopted technology use later in life, and in moderation, it may not seem like such an issue. However, for children and adolescents, the use of tech is ingrained in daily life and most spend a median of 5-7 hours a day on their smartphones and handheld devices. This comes with an extensive positioning of their heads and necks flexed forward to text and watch their screens. </p>
In a recent study of 207 children and adolescents with nonspecific neck pain, 180 were diagnosed with musculoskeletal findings and muscle spasm. Of the 180, 100% reported flawed flexion of their back and neck while studying and/or using devices. Also, 21% had eye symptoms and 82% of the parents of participants reported a change in the social and psychological behavior of their children.
Doctors of chiropractic (DCs) have a long-standing history of whole body health and prevention. As musculoskeletal experts, DCs can examine and evaluate children’s spines and postures, adjust affected joints and recommend changes and exercises for spinal alignment.
DCs can also advise on ergonomic positioning when using devices and help guide parents through the process of creating limited screen time for their kids to promote physical and social activity to benefit healthy well-rounded development.