Difficult Low Back Pain

Low back pain can be a frustrating condition to diagnose for both the doctor and the patient suffering this common human malady. Some low back pain sufferers only experience this misfortune occasionally but each episode may be debilitating precluding sitting or standing without pain. Sometimes these episodes are so severe that lying down is excruciating, which rules out getting a restful night of sleep. Unfortunately, each successive episode is often worse than the last.

Even for sufferers of low back pain that is extremely severe, it can be very difficult for doctors to diagnose the exact tissues from which the problem is originating. This is because many episodes of low back pain are multi-factorial meaning they are comprised of many concurrently occurring factors contributing to the pain syndrome, none of which are easy to diagnose by themselves because of the overwhelming and overlying presentation of symptoms.

One group of low back pain sufferers that can be particularly difficult to diagnose are those people who are unable to tolerate lumbar flexion. Lumbar flexion is the movement or body position that places the trunk of the body (belly and chest) closer to the thighs. Such a body position may be seen when bending forward while in the standing position (commonly referred to as the Adam’s position) or while seated. In both of these instances there is lumbar flexion involved.

In such cases the lumbar (low back) discs may be involved though diagnosis of their involvement may be difficult to prove leading to inconclusive diagnoses. Why should this be difficult to diagnose? Can’t a bulging or herniated disc be seen on MRI?

Yes, a bulging or herniated disc can be seen on MRI (usually) but what may not be so evident is the degeneration, injury to internal disc structures, and inflammation that may be taking place within the disc. These aggravating factors can be irritating pain receptors within the disc and causing excruciating pain while leaving the nerve roots untouched. In cases such as these, low back pain without leg pain can be the major presenting symptom. However, trigger points in the muscles which are reacting to the pain from internal disc structures may refer pain into the buttock and/or down the leg. Pain from muscular trigger points is commonly one sided.

How can the low back muscles contribute to low back pain? There are a number of ways.

Trigger points within the muscles can become generators of pain by themselves. Additionally, pain signals from the low back (such as that occurring from within the disc) may inhibit the deeper core muscles contributing to the loss of their ability to perform at optimum capacity and/or anticipate bodily movements. These deficiencies can lead to pain.

Many of the deeper core muscles provide stability that prevents uncontrolled movements. An increase in uncontrolled bodily movement caused by reduced stability due to decreased function in these compromised muscles augments further degeneration and loss of function in low back structures thereby increasing the potential for additional low back pain in the future.

Can’t imaging techniques such as x-rays, MRI, or CAT scan show where the pain is coming from in low back pain syndromes? Often these techniques are not helpful due to the amount of damage and degeneration contained in the area of lumbar discs including disc degeneration, disc bulging, or even ruptured discs which may be present but not cause pain. However, disc involvement can be inferred by the presenting nature of pain.

If pain is most evident upon rising in the morning or even if pain awakens a person from sleep it may be due to the disc swelling during sleep, which is a natural occurrence. Pain produced by exiting an automobile or rolling over in bed can be indicative of disc involvement because of the stress placed upon the disc by these maneuvers. Does the pain present while sitting or while rising from the seated position? These are all signs the disc is involved.

The bottom line is that your local Doctor of Chiropractic is well versed in diagnosing, identifying the irritated structures, and treating low back pain regardless of which tissues are causing you agony.

Conservative Chiropractic Care or Minimally Invasive Spinal Surgery?

Conservative chiropractic care has become well known for its ability to help people with low back pain, neck pain, and headaches. However, some people are suffering debilitating pain and they want an “instant cure” that will allow them to immediately return to a pain-free lifestyle. This is the situation where the lure of “minimally invasive” surgical intervention can become extremely strong. This is understandable because a person suffering debilitating pain is simply seeking a “cure all” that requires the absolute least disruption of tissue, pain, disability, and recovery time.  

But is minimally invasive spinal surgery truly as good as it sounds?

Unlike conservative chiropractic care which has a plethora of scientific studies showing its efficacy in treating a multitude of spinal pain syndromes, minimally invasive spinal surgery has a sparse and conflicting track record in the scientific literature. It must be understood that the term “minimal” is attractive to sufferers of debilitating pain because of the implied simple nature of the procedures expected to offer relief of symptoms.  However, this may not be the case because there is no definitive definition of minimally invasive spinal surgery. The lack of terminology definition can lead to ambiguous determination of risks as well as an over inflation of benefits in the minds of people suffering spinal pain.  

It is not that anyone is purposefully trying to obfuscate the facts regarding minimally invasive spinal surgery but the thought processes of the average health care consumer wants to believe that the term “minimal” must mean the procedures are somehow better, safer, or more effective than previously used protocols. This may not be the case when minimally invasive spinal surgery is being considered.

In order to be able to discuss the merits of minimally invasive spinal surgery (or the potential lack thereof) it must first be defined. Minimally invasive spinal surgery is designed to preserve as much of the natural spinal structures as possible thereby hoping to avoid excessive tissue damage, reduce surgical recovery time, and reduce surgical risks. The use of such techniques has exploded over the last twenty years with the development of vital technological advances and devices but the fact remains that there is very little scientific literature delineating the indications for using these types of techniques and whether they are any better than previously utilized techniques.  

Minimally invasive spinal surgery techniques all share the common theme of utilizing a small portal of entry into the human body thereby creating a narrow surgical corridor within which the surgeon can work. Basically, minimally invasive spinal surgery involves one of three surgical procedures: ablation, decompression, or fusion-stabilization.

Ablation involves the destruction of nerves carrying pain signals to the brain or the removal of scar tissue. Common methods of ablation include using radiofrequency, alcohol, laser, or freezing the suspected pain-causing tissues located in the spinal disc or facet joint.  Decompression techniques, on the other hand, attempt to relieve suspected pain-causing pressure on sensitive spinal nerves. Fusion involves the physical fusing of one bone to another in an attempt to stabilize the suspected pain-causing structures. Regardless of the type of surgical procedure being used in minimally invasive spinal surgery the question always arises as to whether the targeted tissue of the surgical procedure is truly the source of a patient’s pain.

All surgical procedures suffer the same primary challenge of being able to determine the exact anatomical structure within the spine which is producing pain. In reality, the inability to exactly pinpoint the pain producing spinal structures is a major stumbling block in treating these common maladies, especially in cases of nonspecific back pain. It is this inability to correctly identify pain producing spinal structures that gives conservative chiropractic care a distinct advantage as a treatment for spinal pain syndromes.

Conservative chiropractic care should always be thoroughly utilized before a spinal surgical procedure of any type is considered. Changes made to the human body via surgery are irreversible which is why procedures such as conservative chiropractic care that has been shown to be very effective for spinal pain syndromes should be utilized before any other techniques regardless of how “minimal” they are advertised to be.

Will You Choose Dangerous Drug Interactions or Natural Collaborative Care?

More and more research is establishing the danger of common drugs such as acetaminophen, which is the main ingredient in Tylenol. For example, Tylenol has been available on the American market since the early 1950s with Children’s Tylenol coming onto the market in 1955. The acetaminophen (which is also known as paracetamol) found in Tylenol is still being studied with adverse reactions continuing to be discovered.

One of those adverse reactions can be found in the findings reported in the Journal of the AMA – Pediatrics of a previously unknown association between acetaminophen consumption during pregnancy and ADHD. Acetaminophen consumption during pregnancy can lead to the child who was exposed to acetaminophen while in the womb developing attention-deficit/hyperactivity disorder.  Attention-deficit/hyperactivity disorder is commonly referred to as ADHD. The findings of this study are profound because acetaminophen is one of the most frequently used drugs for pain and fever during pregnancy.

There is only one desired effect a drug elicits in the human body but a plethora of other effects that may be undesirable and are commonly referred to as “side effects.” Some side effects are relatively innocuous but others can be very severe or even life threatening. Dangerous drug treatments are nothing new since all drugs are known to have side effects.

But will anyone pay attention to such studies and the warnings regarding potentially life altering side effects of consuming drugs? It is unlikely. The pharmaceutical industry spends an estimated $600 billion dollars on marketing every year. Anyone trying to tell folks that a trusted pharmaceutical such as Tylenol has problems associated with its use will have a difficult time convincing them after they have seen or read numerous advertisements touting the benefits of a given drug. However, there is a better way.

Chiropractic is a healthier, drugless way to improve your health and address some of the problems associated with pregnancy. Utilizing the preventive health care aspects of chiropractic for your family’s healthcare needs can help prevent many bad outcomes. Adopting an outlook on healthcare that encompasses chiropractic care is addressed by the Patient Protection and Affordable Care Act in that it encourages the formation of multidisciplinary practitioner teams.

Multidisciplinary practitioner teams formed under the Patient Protection and Affordable Care Act are referred to as Patient Centered Medical Homes (PCMH). A PCMH may be comprised solely of conventional biomedical practitioners such as medical doctors or it may also employ the services of Doctors of Chiropractic, psychologists, acupuncturists, naturopaths, massage therapists, and related health oriented practices such as yoga, meditation, and Reiki.    

The concept of organizing a PCMH is based upon the model of integrative health care focusing on preventive healthcare and treating the whole person. Such an organizational model demands an open mind on the part of the practitioners so they will freely refer to fellow practitioners thereby allowing a patient to fully enjoy the holistic approach to healthcare a PCMH offers.

An integrated approach such as the PCMH offers is bolstered by recently instituted electronic health records systems that must be in place by 2015 per federal dictate. Such electronic health records systems allow all practitioners in a PCMH to access patient records and share information.

 Collaborative efforts such as this example allow a varied assortment of practitioners to treat a wide variety of patient complaints including but not limited to: chronic low back pain, polymyalgia rheumatica, depression, and musculoskeletal pain. Integrative medicine allows practitioners of all disciplines to contribute to the successful resolution of health depleting conditions that cannot be treated as successfully by each disciple working independently.

The question is whether you will choose dangerous drug interactions or natural collaborative care. Knowing what you know now, what will you choose?

 

Vitamin D and You

Vitamin D is often neglected because it is surmised that the human body makes enough of this vitamin by simple exposure to the sun. However, it is being discovered that many people are seriously deficient in vitamin D levels. This is vitally important because recent studies are showing that vitamin D has the potential to improve your daily mood, control your blood sugar levels, and regulate your blood pressure.

 

While studies like these are great sources of information for all of us such information is particularly important for folks suffering from Type 2 diabetes. Diabetes affects approximately ten percent of the people in the United States but that number is expected to grow phenomenally to twenty-five percent by the year 2050. The effects of Vitamin D on daily moods are particularly important for women because approximately 25 percent of female diabetics suffer depression to some degree.

 

The same factors that may deprive diabetics of the ability to take in enough Vitamin D can affect anyone whether they are diabetic or not. These factors include a limited intake of foods containing Vitamin D, obesity (which causes more Vitamin D to be stored in fat thereby depriving it of its ability to circulate in the bloodstream), lack of exposure to the sun, inborn genetic factors, and inflammatory states within the body such as autoimmune diseases, diabetes, and cancer.

 

Remember, inflammatory states within the body may be subclinical and do not present obvious symptoms. Therefore, just because you do not have an autoimmune disease, diabetes, or cancer you should not automatically assume you do not have inflammatory processes operating within your body. On the contrary, because the typical American diet fosters the formation of inflammation within the body it can be assumed that most people living in the United States have an inflammatory state existing within their body thereby making them susceptible to not being able of taking in enough Vitamin D.

 

The good news is that Vitamin D supplementation can improve blood sugar control by increasing insulin secretion from the pancreas and increasing the ability of insulin receptor sites on cells to improve their insulin uptake capability.

 

Vitamin D helps in the absorption of calcium, an essential nutrient, which may aid in the reduction of the incidence of osteoporosis. It is often suggested that Vitamin D and 1200 mg of elemental calcium be taken daily in conjunction with a well balanced diet to assist in warding off osteoporosis.  But how much Vitamin D should you take every day? The Food and Nutrition Board of the Institute of Medicine recommends consuming 600 IU of Vitamin D daily for people 19 to 70 years of age while folks age 71 and older should consume 800 IU of Vitamin D daily.

 

However, studies showing that Vitamin D reduces inflammation and improves blood sugar control have used daily doses of 4,000 IU of Vitamin D daily over many months to achieve these results. Evidence based upon studies such as these have stimulated the emergence of using Vitamin D in the management of diabetes. It has been suggested that healthcare practitioners treating patients with diabetes and/or metabolic syndrome routinely monitor blood levels of Vitamin D.

 

If Vitamin D is found to be low, Vitamin D supplementation should be considered at least until blood levels of Vitamin D reach desirable levels. Daily doses of 4,000 IU of Vitamin D appear to be a sage and reasonable dosage to begin a supplementation regimen in an effort to reestablish desirable levels of Vitamin D in the blood stream if deficiencies are found.

Sitting, Flexibility, Mobility and Back Health

The reality of today’s world in the United States is that most people sit for the better part of their day. This is true whether an individual is driving in a car, sitting at a computer at work, sitting at a computer at home, or sitting in front of the television being a “couch potato.” It is bad to be  sitting this much because the human body is made to stand and move but not to sit, which is why sitting causes so much trouble for the human musculoskeletal system.

So what are you to do?

You can move to keep your body flexible and mobile. It’s not as hard or involved as you may think. You can easily fit flexibility and mobility training into your hectic day without much fuss or effort.

Most folks think of stretching to increase flexibility but to achieve usable flexibility you must perform more than simple static stretching of your muscles. Simple static stretching of muscles can improve the non-moving static flexibility but does not prepare your body for fast and efficient movements, which is why static stretching before physical exertion or participating in athletic endeavors is now being discouraged.

To better understand this concept it may be a good idea to actually define what flexibility is instead of simply relying on what your idea of flexibility consists of because your conceptualization of flexibility may be in error. We will also define the difference between flexibility and mobility for the same reasons.

Flexibility is the physiological maximum range of motion that can be achieved within a given movement of the body that is passive in nature and does not produce pain or severe discomfort. Flexibility exercises are done to restore normal tissue length as well as to help guard against the injury that may occur when a muscle is overused over the long term. Flexibility is not strength dependent.

Mobility on the other hand, is the ability to move a limb through the full range of a joint’s motion. It involves voluntary movement, conscious control of that limb, and strength to achieve full range of motion within that joint. Mobility is more important than flexibility because to achieve mobility you must be in active control of your movements whereas flexibility is a passive endeavor not requiring strength. As far as your body and your personal well being are concerned it is better to be inflexible with good mobility than it is to be flexible with poor mobility.

Because of long term flexibility and mobility problems caused by prolonged sitting as is commonly found in an office worker or traveling sales person sitting in their automobile for long periods of time it is advisable that you see your local doctor of chiropractic to be evaluated for the best flexibility and mobility exercises for you. After a thorough examination your chiropractor can devise a plan designed for you based upon static postural analysis, orthopedic and neurological testing, and functional movement assessments of how your body moves.

Treatment may consist of working the soft tissues of your body using deep-tissue laser (also known as cold laser or light therapy), lymph channel drainage, myofascial decompression techniques, and vibration or percussion treatment to help break down adhesion or scar tissue that may have formed from long standing problems. You doctor of chiropractic can also teach you to use soft tissue myofascial release techniques using a foam roll or other device so you can continue your care at home.

Dynamic flexibility warm-ups and dynamic mobility training can also be used at home and may have a greater effect than static flexibility exercises. Dynamic mobility training offers greater stability as you increase your range of motion which helps reduce the risk of injury from having too much range of motion and not enough stability in the joints.

Talk to your local Doctor of Chiropractic about your options before more serious conditions set in and become permanent.

Kentuckiana: The Chiropractic Children’s Center

When people hear the term “chiropractic” they usually think of manual manipulation as a treatment for back pain, neck pain, and/or headaches. While it is true chiropractic has become well known as a popular treatment for these common ailments it is actually a form of preventive healthcare with much broader applications.

This discrepancy in the perception of chiropractic and the reality of its role in modern healthcare can be illustrated by the Kentuckiana Children’s Center. The Kentuckiana Children’s Center treats special needs children with chiropractic as the foundational treatment modality. At Kentuckiana, chiropractic care is supplemented with care from many other healthcare disciplines. By placing all these healthcare disciplines under one roof and working toward the united goal of helping children these angels of mercy are able to help children burdened with what would have previously been described as being dim potential and allow them to have greatly improved lifetime outcomes.

By using chiropractic as the foundational treatment modality it allows physical therapy, speech therapy, nutritional therapy, and all the other allied healthcare disciplines available at Kentuckiana to be maximally effective. The combined effects of these therapies supply diverse sensory input resulting in better outcomes than would normally be expected from the application of any of these healthcare disciplines used by itself. This diverse sensory input appears to promote greater cognitive stimulation and therefore improved outcomes and results for the children under care at this unique facility.

Utilizing all of these different healthcare disciplines to promote greater cognitive stimulation in children allows the organized sensory input to augment cognitive function (the ability to think and reason), the immune system, and motor coordination. The improvement in physical functions the practitioners at Kentuckiana are able to attain for the children under care in this type of environment offers results not being achieved at other facilities.

The organization of sensory input to strengthen the cognitive function, immunity, and motor coordination is well documented in the scientific literature and in clinical observation. To stay abreast of the latest medical developments the doctors, staff, and board members at Kentuckiana regularly attend workshops, seminars, and other types of continuing education functions pertinent to the conditions they treat in the pediatric population at the facility. Additionally, the doctors perform research at Kentuckiana to submit for publication in scientific journals.

Some of the observable results found at Kentuckiana via the use of chiropractic as the foundational treatment modality include: improved speech, decreased severity of seizures, improved bowel function, improved sleep patterns, fewer tantrums, less seizures, calmer behavioral patterns, and the speedier attainment of goals when undergoing other therapies such as occupational therapy, speech therapy, and physical therapy. Overall, many of the parents note that their child is simply more pleasant to be around.

Additionally, the special needs children treated at Kentuckiana are a shining example of Doctors of Chiropractic being modulators of the nervous system thereby affecting all the various functions the nervous system controls. This takes Doctors of Chiropractic out of the realm of being simply doctors treating low back pain, neck pain, and headaches.

However, such care of special needs children demands funds to keep this effective therapy available. Kentuckiana accepts private-sector donations, insurance reimbursement, as well as conducting fundraisers, writing grants, and mailing requests for donations numerous times throughout the year. Some donors make specific donations of equipment or facility maintenance thereby allowing the continued operation of this special facility. However, the current economic climate and increasing competition from other non-profit organizations that compete for the same funds is creating funding difficulties for Kentuckiana. 

Zinc Deficiency, Age, and Cancer

Sometimes findings from medical studies seem to make so much sense it is difficult to understand why anyone had to spent good money on an expensive study to find the simple solution to confounding problems. Such is the case of the nutrient zinc as it pertains to inflammatory responses within the body and cancer formation. Zinc has been found to be helpful in repairing damage to DNA which is very important because DNA damage has been linked to an increased risk of developing cancer.

The information we are discussing can be found in an article published in The Journal of Nutritional Biochemistry. The study found that supplementing the diet with zinc helps to control inflammation which is associated with cancer formation, heart disease, autoimmune diseases, and diabetes. An important aspect of this study is that it points to the importance of increasing dietary zinc supplementation as people age.

Findings from this study used laboratory animals to make determinations regarding the effects of aging on the absorption of zinc and the effects of age-related zinc deficiencies. In other words, as these laboratory animals aged their ability to assimilate zinc into their body was reduced to the point of zinc being found in deficient quantities below the levels necessary to keep DNA damage and cancer in check. This inability to absorb zinc into the body occurred even when sufficient amounts of zinc were supplied in the diet. It was necessary to increase the dietary requirement of zinc tenfold before anti-inflammatory markers were restored to levels normally found in younger animals. 

So, how big of a problem is zinc deficiency in people? Well, studies show that approximately 40 percent of elderly Americans are deficient in zinc, and this could be problematic for them. Why would this situation be problematic?

The answer is simple.

Elderly people exhibit a combination of not consuming an adequate amount of zinc in their daily diet with an impaired ability to absorb the zinc they do consume. This is essentially a double whammy leading to a serious zinc deficiency problem. It is a double whammy because more cellular and genetic damage is taking place due to aging while there is less zinc available to repair that damaged genetic material.

In the elderly this is significant because the amount of genetic damage is increasing while their ability to repair that damage is decreasing. This situation can lead to an increased risk of cancer as well as other degenerative diseases including arthritis, Alzheimer’s disease, and heart disease. Zinc deficiency has been implicated in all of these deleterious processes.

Having sufficient amounts of zinc in your body can aid immune function, wound healing, eye health, and prevention of cancer in addition to the inflammatory diseases listed above. However, taking more than 40 milligrams of zinc per day can cause problems so avoid taking more than this amount.