Archive for April, 2011
Wellness Adjustments Reduce Back Pain
Tuesday, April 26th, 2011
There has been many studies showing the effectiveness of chiropractic manipulation (adjustments) in decreasing pain and disability levels in neck and low back pain. Most of these research projects only have the patient receive treatment for a few months and then discontinue it. For years, chiropractic physicians have noticed that patients who routinely return for preventitive adjustments (we call them wellness adjustments at our office) tend to have less back pain and flare-ups. Most chiropractors left preventitive care decisions up to the individual patient — we didn’t have any concrete proof on its effectiveness — just clinical experience.
In January 2011, the journal Spine published a landmark study that studied the effectiveness on preventitive adjustments on chronic low back pain patients after completing a month of active care treatment. The results surprised everyone. There were 3 groups in the study: (Group #1) Didn’t receive any chiropractic manipulation, (Group #2) Received chiropractic manipulation for one month and (Group #3) Received chiropractic manipulation for one month and then preventitive adjustments every 2 weeks for 10 months. Although Group #2 had lower pain and disability scores than Group #1 (who didn’t receive treatment), Group #3 had the lowest pain and disability scores at the end of the 10 months when compared to the other 2 groups. What this research means is although chiropractic manipulation is effective for treating chronic low back pain as part of a short-term treatment plan, patients who receive ongoing preventitive chiropractic manipulation (wellness visits) experience better long-term results and lower pain/disability levels than those without treatment or only 1 month of chiropractic treatment.
So the next time you are being discharged from active treatment in our office and we offer the option of preventitive wellness visits, you might want to think strongly about taking us up on the offer. Not only have we our clinical experience telling us that patients tend to do better, but now have research that backs us as well (no pun intended!).
How many repetitions does your back have left?
Tuesday, April 19th, 2011
I was recently listening to a webinar by Stuart McGill PhD, a researcher in Canada who has made it his life’s mission to solve the puzzle of low back pain. He was speaking about recent research that has shown that flexion-type exercises such as sit-ups, crunches or ab machines increase lumbar disc degeneration by overloading the delicate structures of the low back.
For the past year, we have eliminated the use of all flexion exercises in our rehab department and also have been encouraging patients not to do sit-ups and ab machines at the gym — especially if they already have low back pain. Sometimes it’s hard to convince patients that there is inherent risk with these exercises. After all, we all have been doing sit-ups since we were in PE class.
Dr. McGill used an example that I think will help patients better understand why flexion exercises increase risk for low back pain. If you wanted to make a break in a wire hanger, what would you do if you didn’t have wire cutters? You would repetitively bend the hanger at the spot that you wanted it to break. After a few dozen bends, you would have two pieces of wire hanger. Mission accomplished.
The lumbar spine (low back) has the same properties as that wire hanger. Every low back has a limited number of “bends” until something breaks. The number of “bends” each back has in its capacity is predetermined by genetics and other injuries that we may have experienced over the years. Since we all need to flex forward to accomplish certain movements and tasks, the best strategy to avoiding low back pain is to limit flexing to when we need to do it — not burning up thousands of repetitions through sit-ups.
So instead of using up your reserve through sit-ups (which are very ineffective ab exercises, by the way), investigate the use of bridging, planks, bird-dogs and other dynamic floor exercises which have been shown to prevent low back pain by stabilizing the spine — avoiding flexion. And as always, if you have questions on how to add this into your home exercise program, please let us know and we’ll be sure to set aside time to assist you!
Can a pair of shoes give you a better butt?
Tuesday, April 12th, 2011
We see them everywhere. Sketchers, Reebok and New Balance make them. The athletic shoes with the rounded soles that promise to help us burn more calories and build stronger butt muscles. Several celebrities are saying that they work for them. The shoes cost $60-120 depending on the brand. Are they worth the investment? Do they help people lose weight?
First of all, the research behind these companies claims that their shoes burn more calories and strengthen muscles is very limited and the studies were sponsored by the manufacturers, which makes us question their results. It’s interesting to also note that most people do not walk properly in these types of shoes (they avoid striking their heel on the ground), which minimizes the addition “muscle activation” that the ads claim will occur without stepping in the gym!
Second, many patients find that the rocker action of the shoe can either flare up an existing ankle, leg or low back problem or create one as they try to walk on the unstable surface. The reason that these shoes can increase injuries is because the rocker shape of the shoe forces your ankle to dorsiflex (the tilting of your foot back towards your body — like doing a calf stretch) more than a normal shoe. The majority of adults have a lack of dorsiflexion in their ankles due to old sprains, injuries and tight muscles. When they walk in this shoe, it forces them to move in a direction that they cannot easy do — creating stress on the achilles tendon and calf muscles.
To compensate for this lack of mobility, most people will start walking more on their forefoot or toes, throwing off the alignment of the legs, hips and low back. The end result is tendonitis in the ankle/calf, knee, hip or low back pain after wearing the shoes for several weeks. Because most people wear these shoes all the time, they don’t even realize that their shoes are the culprit, causing their pain.
My advice is to save your $100 for a good pair of running shoes that are fitted to your foot/arch and skip the hype/injuries associated with these fad shoes. Besides they look a little silly, don’t they?
Easy test for hip strength can predict knee pain risk
Tuesday, April 5th, 2011Knee and thigh pain are some of the most common complaints that we see in our pediatric and adult athletic patients, whether they run track, play softball or compete in triathalons. Many times, patients will come in with a stack of CD’s containing MRIs, x-rays and other testing done on their leg to no avail — they’re still in pain. Since nailing down the exact cause of knee and thigh pain can be tricky (especially if there is nothing showing up on imaging), chiropractic sports physicians and other rehab specialists started testing various hypothesis on how muscle imbalances in the hips and legs might contribute to knee pain.
Proper positioning during the SLST
One of these hypothesis is that weakness in the muscles that abduct the hip (keep the thigh from tilting towards the midline) creates additional pressure on the thigh and knee, creating additional wear and tear along the backside of the patella. To test the strength of these hip muscles, we have the patient stand on one leg and perform a small squat or dip, keeping the torso perpendicular with the ground. If the hip, knee and ankle all stay in one line during the test, the patient’s hip strength is good. If the knee moves towards the midline during the test, the patient’s hip strength is poor. This test is called the Single Leg Squat Test (SLST).
Athough this hypothesis has been working well for doctors in a clinical setting, researchers at the
Failing position during the SLST
Melbourne School of Engineering in Australia wanted to test the reliablity of the SLST for measuring hip strength as well as predicting risk for knee pain. In the February issue of the American Journal of Sports Medicine, their study was published and it confirmed that the SLST was a reliable tool and also can identify those at risk for knee pain. What’s even better about the SLST is that it doesn’t cost anything to perform and can be done by the sports doctor in 60 seconds — much easier than spending thousands of dollars on MRIs and CT scans.
It’s important to see a doctor who is familiar with sports injuries and also is up to date on the latest diagnostic and treatment methods to get you back to your sport as quickly as possible. Although family practice and immediate care physicians are great at detecting fractures and life threatening conditions, they may not be up to date on functional strength tests such as the SLST and possibly miss the true cause of your knee pain.
If you have knee pain or think that you might not pass the SLST, feel free to email me at drerin@ducatchiropractic.com and I would be glad to answer your questions. Remember the longer you compete on an injured or weak area, the longer it will take to get back to 100%!