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You might ask, what does this headline have to do with chiropractic?  It’s often said case management or patient care is much more than just what we do to our patients (such as in chiropractic, applying a spinal adjustment). The patient education portion of our care plan can frequently make or break a successful outcome in a case.  It is the goal of this Health Update to potentially save your life by empowering you with the knowledge needed when it’s time to purchase your next car.  This is about what specific automobile features contribute to crash survival - hence, saving lives!

Did you know the car you choose can improve the odds of crash survival by 400%? In the popular magazine Consumer Reports, they wrote, “Ultimately, safety is active and passive, balancing the ability to avoid an accident and to survive one.” Typically, the first thing we do as consumers when we consider safety in a particular car is to look at the crash-test results.  While this is important, we must first consider the size and weight so we compare crash-test results between cars in the same weight class since statistics show there are two times as many occupant deaths annually in small vs. large cars. Keeping size and weight in the foreground, when evaluating crash-test results, the front and rear end “crumple zone” of the car should be designed to absorb crash forces by buckling and bending in a serious collision. If you’ve ever watched race cars crash, you usually see car parts bend and break off as they bounce off the guard rail or other cars, sometimes to the point where all that is left is the cage surrounding the driver.  Amazingly, the race car driver often climbs out of the cage and walks away, seemingly unharmed.

The next important car feature to consider is a car with a structurally superior passenger compartment. Look for a high quality “restraint system” made up of 3 components: seat belts, airbags, and head restraints. These work together to keep us safe and in place during a crash while the outside of the car crumples, absorbing the energy of the crash.

So where do you look to get this information?  There are several resources available:

• The NHTSA (National Highway Traffic Safety Administration) tests front end impacts at 35 mph, and in 1997 added side impact tests at 38 mph. They also test for the rollover potential for SUVs and trucks and grade the results for each category from 1 to 5 stars representing the likelihood of suffering a life-threatening injury in a crash.
• Since 1995, the IIHS (Insurance Institute for Highway Safety) has used a method reviewed by Consumer Reports as being more realistic by crashing only half of the vehicle at similar speeds into fixed barriers, since most crashes are not direct, whole car strikes.
• Consumer Reports is a 3rd option. They integrate the data from both NHTSA and IIHS and gives us their “CR Safety Assessment,” and run 40 new cars each year through numerous individual tests.

Other important “accident avoiding” features often overlooked include: Tires - greatly impact braking and emergency handling so REPLACE them as needed; Braking-check for the distance required to stop the car at different speeds- the shorter, the better; Emergency Handling-data about accident avoidance and choosing a vehicle with electronic stability control (ESC), especially in SUVs is wise; Acceleration-the quicker a car can get to highway speeds, the better; Driver position and visibility-a good view of the surroundings, especially the “blind spots” is important.  We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you.

Fibromyalgia (FM) is a chronic condition affecting multiple body systems is not limited to any one aspect of health. Because of this, there is no ONE diet that works the same for all FM patients. Since most dietary guidelines that address FM are based on general healthy eating principles utilized for many conditions such as hypoglycemia, diabetes, food allergies, headaches, digestive disorders, and fatigue, let’s review some of the most popular and successful dietary approaches that have been reported regarding FM.

Basic Guidelines:

• Carbohydrates: AVOID all refined carbs (white flour products). Eat whole grain bread, oatmeal, granola, nuts. Avoid artificial sweeteners and limit sugar intake to a max. of 40g/2000 calories. Eat roughly 14 grams / 1000 calories consumed of soluble dietary fiber such as apples, oats, and legumes vs. insoluble fiber such as bran. Your total carb intake from all sources should be between 30-55% of your total calories.
• Fats: AVOID saturated fats (these clog up circulation, lead to inflammation and pain). That means <10% of total calories consumed, so limit or eliminate foods such as cheese, beef, milk, oils, ice cream, cakes, cookies, mayonnaise, margarine, chips and chicken skin. Eat mono- and poly-unsaturated fats and include regular amounts of omega 3-fats. Eat < 300mg/day of cholesterol; Try to avoid ALL trans fats such as cakes, cookies, crackers, pies, bread, margarine, fried potatoes, chips, shortening. Take omega 3 fatty acids like alpha-linolenic acid (ALA) as these help make other omega 3 fats like EPA and DHA, and are very helpful for the brain. ALA is found in flaxseed, linseed oil, or cod liver oil. Limit total fat intake to 20-35% of calories consumed.
• Protein: Go easy on red meat as they are high in saturated fat. Instead, eat more fish and vegetable protein (legumes and soybeans are great). When eating meat or poultry, remove all visible fat and skin before eating. Maintain protein at 20-40% of total caloric intake. AVOID: processed meats, especially salt-cured, smoked or nitrate-cured.
• Fruits & Vegetables: Whole fruits are superior to juices. Include blackberries, strawberries, raspberries, kiwis, peaches, mango, cantaloupe melon and apples. Some FM sufferers cannot tolerate citrus fruits but if you can, fruits like oranges and grapefruits are great. Vegetables are crucial. Good choices include carrots, squash, sweet potato, spinach, kale, collard greens, broccoli, cabbage, and Brussels sprouts. These foods reduce the risk of developing chronic diseases (diabetes, heart disease, stroke and cancers).
• Dairy Products: Choose reduced or fat-free varieties of cow or soy milk. This also applies to yogurt and cheese.
• Healthy drinks: Drink 8 glasses of water a day or diluted fruit juices, or herbal teas. Drinking water helps flush out toxins. Avoid coffee, tea, and alcohol as these increase fatigue, increase muscle pain and interfere with normal sleeping patterns. Limit or eliminate alcohol.
• Healthy Snacks: Chopped vegetables, unsalted nuts and/or seeds; AVOID ALL commercial snack foods (except salt-free air-popped popcorn) as these are high in trans fats & salt. Avoid chocolate and candy.
• Junk Food: Regular consumption of this is BAD for FM patients due to the high levels of fat, sodium, calories and general lack of nutrition.
• Artificial Sweeteners: AVOID them! Examples: aspartame, NutraSweet, & saccharine.
• MSG: (monosodium glutamate (MSG) and Sodium (Salt) can aggravate FM!
•  QUANTITY: Eat smaller light meals, especially in the evenings.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, 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.

            “Doc, I try to do my exercises but I have to hit the ground running in the morning….to get the kids ready for the school bus….I have morning meetings….I’m not a morning person….I’m pulled in 100 directions during the day….I forget about them until I’m in bed….I exercise on my job and that’s enough….”

            I’m sure we’ve all rationalized our inability to keep up with exercises, especially after our episode of low back pain (LBP) subsides. In fact, only about 4% of LBP patients continue doing their exercises after their pain subsides. That means 96% of us with chronic, recurring low back pain DO NOT exercise even though we know we should.  We feel bad, even guilty for not exercising.  So, what can we do to “trick” ourselves into being more compliant with our low back exercises?

            First, let’s accept the fact that most of us cannot consistently “fit in” exercise into our busy schedules.  With that said, the TIMING of when to do the exercise may be more important than even doing them at the same time every day. In other words, do a few exercises when you need them the most. For example, if you’re working at a computer for more than 1 hour, and you start to feel back pain from the prolonged sitting - especially if your work station set up is less than ideal - do one or two sitting exercises right at your work station, BEFORE your back pain gets any worse. If you wait too long, the exercises may not be of much benefit. Setting a timer next to your screen that beeps every hour is a good reminder to do one or two simple exercises and only takes a minute or two.  Many inexpensive digital watches can be set to beep on the hour/every hour or, you can set a “timer” to beep after 60 minutes as a “gentle” reminder.  Some cell phones also have a timer feature. Here are three sit down low back exercise options (try them all and decide which one(s) feel most productive/helpful):

• 1. “Crossed Knee Stretch”: Cross your legs; pull the crossed knee towards your opposite shoulder (feel the pull in your buttocks); arch your low back and at the same time, twist or rotate to the side of the crossed knee. Hold for 5-10 seconds and repeat up to 3 times. Repeat this on the opposite side.
• 2. “Sit Twists”: Reach across with your right hand and grasp your left leg at mid-thigh. Twist/rotate your back to the left and pull with your arm. Hold 5-10 seconds / repeat 3 times. Repeat this on the opposite side.
• 3. “Sit Floor Touches”: Bend over as if to touch the floor or tie a shoe. Hold 5-10 seconds.

            If you do the math, it would take a minute for #1 and #2, 30 seconds for #3 (total 2.5 min.).  If that’s too long, hold for 5 seconds.  If that’s too long, do 1 rep, not 3.  You get the idea…..MAKE IT WORK!  Modify the dose to fit your schedule or ability to stretch.  If you do this AT THE TIME you start to feel tight or sore, you can PREVENT a LBP episode!

            We realize you have a choice in where you choose your healthcare services.  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.

Few conditions leave their victims as miserable and agitated as headaches.  There are many causes of headaches including stress, odors, bright lights, noise, fatigue, certain foods, hormonal shifts, allergies, as well as genetic predisposition.  With all the possible causes of headaches, it’s not surprising many people seek help from many different approaches such as conventional medical therapies like pharmaceuticals and injections.  Others prefer a non-drug treatment approach such as chiropractic, massage therapy, acupuncture, and nutritional counseling.

Usually, there is not one specific cause of headaches so treatment can focus on various areas.  For example, muscles that attach to the base of the skull in the neck and upper back are often very short and tight, resulting in pressure or a squeezing effect on the surrounding nerves and blood vessels — resulting in headaches.  Chiropractic treatment includes methods aimed at reducing the tightness found in the joints and muscles. One of these approaches is called spinal manipulation or “adjustments” where the joints in the neck are moved to restore motion and reduce joint fixations. By relaxing the muscles and tension between the joints, the nerves in the neck are less pressured which, in turn, can reduce headaches.  The top three nerves that exit the upper neck travel into the head and are often the culprit behind the onset of headaches.  The second nerve from the top is the one responsible for causing radiating pain over the top of the skull which communicates with other nerves sometimes causing the pain behind the eye.

Another chiropractic approach in the management of headaches includes soft tissue therapy where trigger points found in tight muscles are addressed through various forms of massage and mobilization methods.  Manual traction of the head and neck can also be highly effective in reducing the tension found in headache sufferers.  Exercises are often taught to the headache patient with significant benefits reported.  Some of these, such as range of motion exercises with and without resistance (example: pushing your head into your hand during neck movements) and posture re-training (chin tucks - reducing the forward head position), help address the limited motion problems of the neck. Cervical (neck) traction performed by placing a rolled up towel placed behind the neck while lying on the back so that the head can hang off the side of the bed can also be very helpful.  Another neck traction approach is the use of a unit that hangs off a door where water is placed in a plastic bag calibrated for weight for 15 minutes at a maximum tolerated weight. This can be of great benefit as it can be performed at home at your convenience multiple times a day or, as needed.

Other treatment approaches that chiropractic utilizes include stress management (such as biofeedback, relaxation instructions, meditation, visualization and others), diet modifications (as certain foods can trigger headaches), nutritional supplementation (such as fish oil, Vit. D, feverfew and others), and sleep restoration.

If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and we look forward in serving you and your family presently and in the future

You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?”  This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications.  On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between.  Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging.  To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care.  The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.”  In the study, 93 patients were divided into three groups consisting of:

Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;

Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,

Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.

The average time from injury to first treatment was 12 months and an average of 19 treatments over a 4 month time frame was utilized.  The patients were graded on a 4-point scale that described their symptoms before and after treatment.

Grade A patients were pain free;

Grade B patients reported their pain as a “nuisance;”

Grade C patients had partial activity limitations due to pain; and

Grade D patients were disabled.

Here are the results:

Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.

Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.

Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.

This study is very important as it illustrates how effective chiropractic care is for patients who have sustained a motor vehicle crash with a resulting whiplash injury.  It’s important to note the type of patient presentation that responded best to care had neurological complaints and associated abnormal neck range of motion.  This differs from other non-chiropractic studies where it is reported that patients with neurological dysfunction responded poorly when compared to a group similar to the Group A patient here (neck/shoulder pain, reduced neck ROM, and with normal neurological function).  We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you through this potentially difficult process

Fibromyalgia (FM) is a condition that usually affects different organ systems in the body, causing a number of symptoms. Some of these include:

1)    The muscles (the musculoskeletal system): tender, achy, stiff, tight muscles, trigger or tender points all over the body;

2)    The nerves (the nervous system): headaches, light headedness, sleep disruption, depression, anxiety, numbness/tingling (overlaps with the cardiovascular system);

3)    The stomach and intestines (the gastrointestinal system): diarrhea, constipation, irritable bowel, leaky gut, heart burn, lack of appetite, abdominal cramping;

4)    Breathing (the respiratory system): hyperventilation, rapid / shallow breathing patterns;

5)    The heart (the cardiovascular system): racing heart rate - palpitations, feeling cold all the time, numbness/tingling (overlaps with the nervous system);

Because of the multiple systems involved, there are many challenges to managing Fibromyalgia.  Studies suggest a balance between several approaches works best.  Some of these approaches include biomedical treatments, organ-specific treatments, and cognitive interpersonal treatments.  Within these categories, the following can be broken down further:

1)    General - those treatments directed at the whole body such as anti-inflammatory measures.  These include (but are not limited to) medications (corticosteroids, NSAID’s - such as Advil, Aleve) and nutrients (ginger, turmeric, boswellia, Vitamin D, and others).  Other anti-inflammatory measures include diet, such as the Paleo Diet or “caveman diet.”  This diet eliminates grains or flour-based products from the diet.  That means no more breads, pastas, crackers, cookies - anything made with flour.  This approach emphasizes consuming fruits, vegetables, grass-fed lean meats and fish.  The main ingredients in grains that are of concern in the Paleo Diet are gluten and lectins

2)    Central - those treatments directed at the chemical factors in the brain that control mood, depression, anxiety and so on.  These include (but are not limited to) medications (tricyclic antidepressants, muscle relaxers like Cyclobenzaprine, SSRI, SNRI and Trmadol) and certain nutrients (neurotransmitter support such as 5-HTP - tryptophan, DHEA, phenylalanine, and others).

3)    Psychotherapy and active behavioral therapy - treatments that are supportive of nervous system such as cognitive behavior therapy, aerobic exercise, patient education, multidisciplinary therapy, hypnotherapy, biofeedback, and strength training.

4)    Passive physical intervention - chiropractic therapy, massage therapy and other forms of manual therapy, and acupuncture.

The goal of this article is to look at fibromyalgia from a holistic perspective so that those struggling with FM and similar conditions can better appreciate the concept of multidisciplinary treatment, of which chiropractic care plays a significant role.  Coordination of care and finding the “right” health care providers cannot be over-emphasized.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, 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

Low back pain (LBP) can have many causes such as genetics, acquired abuses, body type (especially obesity - body mass index or BMI >30), gender, as well as cultural aspects that predispose one to acquire low back trouble.  So, the question remains, “what can I do to reduce my risk for developing low back pain?”

The answer, like the cause is - you guessed it - multifactorial.  Since we can’t change our genetics, we’ll have to accept that one.  But, we can change our BMI by keeping our weight to a reasonable amount.  In an April 2010 study from Norway, 60,000 men and women provided BMI information and 20.9% of the men and 26.3% of the women indicated they had chronic low back pain. The authors found a direct relationship to a high BMI and an increased prevalence of LBP.  Similar results attributing obesity to LBP were also reported in a meta-analysis published in January 2010 in the American Journal of Epidemiology (2010; 171(2):135-154).

So, what is, “…a reasonable amount of weight?”  When using the BMI, a BMI of 18.5 to 25 is considered “normal,” while 25-30 is described as overweight and >30 represents obesity.  We should also mention anything LESS than 18.5 is considered underweight and that’s not good either as many nutritional needs of the body are compromised and too little weight can negatively affect bone health leading to osteoporosis and a myriad of other problematic health issues.

You may be wondering what a body mass index or BMI is, as its quite important and is quickly gaining respect in the medical world.  In fact, it has been suggested to include the BMI along with the other “vital signs” pairing it up with blood pressure (BP), pulse, breathing rate, height, weight, and temperature.  The BMI is a formula of height and weight and it’s a rough calculation of our total body fat, which is related to the risk of disease and death.  However, according to the National Heart, Lung and Blood Institute (NHLBI) it’s a little more complicated than that as people with greater muscle mass (such as a body builder) will have a higher BMI, suggesting they are overweight. At the other end of the spectrum, older individuals who have lost muscle mass may be still be overweight but their BMI will not reflect that.

The NHLBI reports 3 factors of importance when defining obesity and its many negative health effects, including the increased prevalence of LBP.  The 3 factors are: 1) The BMI; 2) The waist measurement; 3) The presence of other negative health factors including: high BP, high LDL-cholesterol, low HDL-cholesterol, high triglycerides, high blood sugar, a family history of heart disease, physical inactivity and smoking cigarettes.  If you have a waist size >35″ for woman, >40″ for men, AND 2 or more risk factors, simply put, you MUST lose weight!  Even a small weight loss of 10% (such as 30# if you’re 300#), will help lower your risk of developing diseases associated with obesity such as heart disease, high cholesterol related diseases, stroke, certain types of cancers and type 2 diabetes.

We also realize you have a choice in who you choose for your healthcare services.  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.

“When I try to thread a needle, button my shirt, or crochet, I can’t seem to feel my finger tips.  I’ve also noticed when unscrewing jars, my grip feels weak.  In fact, I almost dropped a cup of coffee the other day.  I wake up 3-4 times a night and I have to shake my hand and flick my fingers to wake them up.  Gripping the steering wheel is becoming a challenge and I have to change hands frequently while I drive. I’ve had this off and on for the last 5 years but this last year it seems to be getting worse.  I’m really getting concerned.  Can you help me?”

            If this history sounds familiar, you may be suffering from carpal tunnel syndrome or CTS.  It’s a very common disorder affecting millions each year.  Its also one of the biggest problems for certain types of industries such as meat packaging plants, textile manufacturers, and virtually any job that requires fast, repetitive movements commonly used on assembly lines in many lines of work. 

            CTS is the result of pinching of the Median Nerve as it travels from the neck into the arm, through muscles in the forearm and into the hand through the carpal tunnel.  Pressure on the nerve at any of these locations can create the symptoms of CTS. This tunnel is quite small in size and included inside the tunnel are 9 tendons, blood vessels, and the median nerve. When the muscles of the forearms and hands are overworked, they inflame and swell.  Because the carpal tunnel is normally so tight, the increased swelling inside the tunnel pushes and pinches the median nerve creating the classic pain, numbness, tingling, and sometimes burning sensations often described by people suffering with CTS. 

            Certain situations make people more vulnerable or prone to develop CTS.  CTS is more common in woman than men by 3 or 4:1.  This is partially because women’s bone structure is smaller and therefore their Carpal Tunnel is smaller too. 

            Women also experience fluid retention or build up during menstruation leading to symptoms like swollen fingers and swollen and painful breasts. Swelling in the already tight, confined space of the carpal tunnel will increase their susceptibility for developing CTS.  Another hormone related cause or contributing factor is the use of birth control pills (BCPs).  Since there are many different types of BCPs and each woman is unique and different, finding the BCP with the “right balance” of hormones where the swelling side effect is minimized is very important and should be discussed with the doctor who prescribed the BCPs. 

            Age (>50 years) is also a risk factor and with our aging work force, this is becoming a big issue.  Other conditions like hypothyroid, diabetes, certain types of arthritis, and hypertension / congestive heart failure where an increase in fluid retention occurs can also increase the chance of developing CTS.  Obviously, occupation type plays an important role as previously mentioned.  Many jobs today require the use of computers and we’re finding the position of the monitor, the keyboard and mouse, are very important. 

            Chiropractic management of CTS includes wrist, forearm/elbow, shoulder and neck adjustments, corrective exercises, the use of night splints, and an anti-inflammatory diet. Also, correcting the “ergonomic factors” or, job-related causes is of utmost importance.  This is why a chiropractor who treats all of these areas and has the specialized knowledge about CTS is the perfect choice of health care providers. If you, a friend or family member require care for CTS, we would be honored to render our services.