Evidence-based chiropractors explain the disconnect between symptoms and imaging findings.
Recently, Daimon K et al. (2018) published a landmark study for EVERY evidence-based chiropractor. It highlights the notion that degenerative changes are merely age-related and do not necessarily correlate with symptoms. This study assimilates two decades of sequential imaging to prove that there little association between degeneration and clinical symptoms:
“results of our statistical analysis and the different rates of disc degeneration versus clinical symptoms reported here and elsewhere, the degenerative findings on cervical MRI do not appear to be generally associated with the development of clinical symptoms.” (1)
Structural findings take months or years to progress. Acute symptoms usually occur within moments to days after a trauma, or change in activity, movement, hobby, or habit. Structural abnormalities can complicate tissue failure, but are not directly correlated with symptoms. It is essential that we focus on what is correctable and what is not. There is no treatment to eliminate the degenerative changes in the spine; however evidence-based chiropractic care can effectively and efficiently resolve symptoms.
Arthritic and degenerative changes are a fact of life. It is important not to focus on what shows up on imaging but rather focus on what we can do with the cards that were dealt.
“the rate of degenerative progression at one intervertebral disc level on MRI over the 20-year period was 95.3%, whereas the rate of the development of clinical symptoms was 66.9%. Statistical analysis of the relationship between the progression of the 5 degenerative findings in the cervical spine and the occurrence of clinical symptoms only detected a significant association between foraminal stenosis and upper limb pain.”
When a patient presents with a one-week onset of neck pain; is it from their stenosis? NO! The cervical narrowing has been there for years. Is it a complicating factor? YES. We treat the patient’s symptoms by focusing on the functional reasons the pain started. Once the pain is gone, the stenosis will still be there. Our office educates the patient to not blame their arthritis for every malady affecting their life. We focus on their habits, hobbies, and postures to eliminate the stressors on their body that are exacerbating their spinal condition. This same paradigm works for disc pathology, or chronic meniscus injuries, or SLAP lesions, or…(name your chronic structural lesion)
“A study of clinical symptoms and cervical MRI findings by Siivola et al. showed that neck and shoulder pain in young adults was not associated with disc degeneration, an annular tear, or disc protrusion on MRI.”(2)
When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!
Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you’ll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.
When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain.
Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is
caused from lack of blood flow to the leg(s) as opposed to nerve flow.
At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot.
In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.
We’ve all heard time and time again that we should sit up straight and practice good posture; possibly because our mothers constantly reminded us to look more poised and proper. But posture impacts more than just our looks. Poor posture, over time, can lead to many health problems. Here are four painful conditions that may result from poor posture.
1. Neck Pain –Neck and shoulder soreness is very common among those with poor posture. Poor workstation ergonomics and excessive mobile device usage are common culprits. Learn more about neck pain how you can avoid this problem here.
2. Lower Back Pain – It’s one of the most common reasons people miss work in the US. Poor posture places extra strain on the muscles and ligaments causing aching or pain that progresses gradually over time.
3. Headache – Believe it or not, your chronic headaches could be the result of poor posture and the added stress on your neck. Learn all about this condition and how to prevent it in this helpful video.
4. Carpal Tunnel Syndrome – Studies show that neck pain (often caused by poor posture) can irritate the nerves in your arms, leading to a painful wrist condition called Carpal Tunnel Syndrome. Poor workstation posture can also cause Carpal Tunnel Syndrome. If you’re required to sit at a desk and use a computer for long periods of time, be sure to use proper workstation ergonomics.
Unfortunately, many people don’t realize or take note of their posture until a painful injury occurs. As chiropractors, we strive to educate our patients about how to avoid spinal damage while maintaining an active, healthy lifestyle. Sedentary lifestyles also cause postural issues over time, leading to some of the same conditions. So, stand up straight, keep moving, and if you find yourself burdened by an injury, give us a call at 772-286-5277.
With Permission via ChiroUP
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Headaches are a very common problem that can have multiple causes ranging from stress to trauma. To make matters worse, there are MANY different types of headaches. One such type is the “cervicogenic headache” (others include migraines, cluster headaches, etc.).
The main distinction between the symptoms associated with cervicogenic headaches and those associated with migraine headaches are a lack of nausea, vomiting, aura (a pre-headache warning that a headache is about to strike), light and noise sensitivity, increased tearing with red eyes, one-sided head, neck, shoulder, and/or arm pain, and dizziness. The items listed above are primarily found in migraine headache sufferers. The following is a list of clinical characteristics common in those struggling with cervicogenic headaches:
Infrequently, the cervicogenic headache sufferer can present with migraines at the same time and have both presentations making it more challenging to diagnose.
The cause of cervicogenic headaches can be obvious such as trauma (sports injury, whiplash, slip and fall), or not so obvious, like poor posture. A forward head posture can increase the relative weight applied to the back of the neck and upper back as much as 2x-4x normal. Last month, we discussed the intimate relationship between the upper two cervical vertebra (C1 & C2) and an anatomical connection to the covering of the spinal cord (the dura) as giving rise to cervicogenic headaches. In summary, the upper three nerves innervate the head and any pressure on those upper nerves can result in a cervicogenic headache. Doctors of chiropractic are trained to examine, identify, and treat these types of potentially debilitating headaches.
This is an excerpt from an email from Chiro-Trust founder, Dr Ben Altadonna. It pretty much sums up why I do what I do and why my office strides to provide the best possible service possible on EVERY visit. Great read:
"Yesterday really triggered me—probably because nothing frustrates me more than bad business practices… and nothing gives me more joy than experiencing businesses that get it right.
I also take a lot of pride in ChiroTrust and how we do business.
I know first-hand how much work it takes to add and maintain value to the lives of customers (my members, your patients).
I realize how hard it is to attract good customers, what it really takes to keep them, and how easy it is to lose them.
In business and in life, context is everything.
You and me are at the mercy of context.
My day yesterday is a perfect example.
But it really began with a tire store in Danville we'll call “TIRE SHOP #1”…
Two years ago, I had some work done on my Sprinter Van and as a result, “TIRE SHOP #1” accidentally damaged one of the Alcoa Aluminum Wheels.
It was a very forgivable experience. Accidents happen.
But what was not forgivable is how they failed to quickly resolve the problem. I had to take it up with Alcoa and “TIRE SHOP #1” corporate, something I hated but had to do. Typically, when I factor in my time, it’s cheaper to take the loss, write the check, or forget about things all together.
As a result of that experience, I decided not to do business with “TIRE SHOP #1” any longer.
Fast forward a year….
Again, I needed some work for the Sprinter and made an appointment with “TIRE SHOP #2”, the only other downtown Danville tire place. It happens to be owned by a guy who left “TIRE SHOP #1” months before my episode there.
He and I agreed that “TIRE SHOP #1” Danville isn’t what it used to be.
So I made an appointment for the following day at 8 am.
When I showed up, the reception area was busy. Actually the entire place was already roll’n. Remember, I scheduled an appointment a day prior.
We had an agreement. I showed up. I honored my word.
Well, maybe because the owner and I had a pleasant conversation the day before, he felt comfortable asking (telling) me to come in the next day. Maybe it was because he thought he already had me as a customer. That way, he could write up and service the new walk-ins that also entered at 8 am.
I smiled and walked out never to return.
We had an agreement.
(And likely because I already had a bad taste in my mouth with TIRE SHOP #1—context is everything.)
Another year later (yesterday)…
I drove my rig to a business in Fairfield, California to have a cigarette lighter-type receptacle wired to my “house batteries” and installed in the inside back of my rig. That way, I can charge my portable “Kodiak” lithium ion batter with my solar panels while I drive. (RV-VanLife talk)
I arrived at 8:45 and could tell that Chris, the guy that has taken great care of me in the past, was stressed. I think whomever initially scheduled me shouldn’t have told me that I could wait while they do the one-hour job.
He also stated that he need more time because he hadn’t had his coffee yet.
His problem was not my problem. I drove close to an hour for my morning appointment and didn’t like how I was treated.
So I calmly left and said to myself, “It’s a small custom job. I don’t need it. I want it. But not this bad. Since I’m close to Napa, I’ll go there and have a nice time.”
I also emailed Chris and explained why I left. He responded but since he didn’t accept responsibility, I didn’t accept his request for me to drive back. His email made no sense. I made the appointment with Justine, they knew the work and had the parts, and I was told that it would take an hour to install. (If only he had said, “Ben, sorry man, we’ll get to it right away. We will honor your appointment and get the work done while you wait. It’s not your fault, it was mine. I’m sorry man!”)
Instead, I drove 20 minutes to Napa and decided to make yesterday my monthly get-away day where I relax, think, and work alone and camp in my Sprinter Van on the mountain at “Napa Wilderness Park”. It's a cool place.
As I drove downtown, I heard and smelled something odd. I pulled over into a shopping center parking lot and noticed that my rear tire (inner rear tire, it’s a “dually”) was flat.
I got on my phone to map out where the tire shops are and to my surprise, there was a Les Schwab Tire Center literally 100-200 feet away in the same shopping center.
When I entered the huge reception area and show room, I noticed that nobody was there. Just me.
I waited and waited. Of course, due to my recent experiences, I was starting to get a little frustrated. Just then, a young kid (about 20 to 25 years old) got behind the counter.
I thought to myself, “This kid is young. Do I really want him advising me on what’s best for my close to 10,000 pound extended Sprinter Van?”
He took a look at my flat, said he could fix it and asked for my keys.
I hesitated, gave him the keys, and walked around the back as I watched him maneuver my rig through the parking lot and into one of the work bays.
I told him that I’d like to speak to whomever will be working on the van.
Of course, it was the youngest looking person on the clock. No joke, this guy looked like he weighed 135 pounds, tops. Good looking kid. Looks more suited for the men’s department at Nordstrom’s. (He’s standing to my left in the pic below.)
I asked him questions about where he planned on jacking up the rig and requested that he’d be easy on the rim. (All while feverishly posting questions in the online Sprinter Van form about jacking up Sprinter Vans without damaging them.)
In my head, I also said to myself…
“Maybe I should have had the rig towed to Mercedes Benz Commercial Dealership for the repair.”
“I should take pictures and/or video just incase they mess things up.”
“I should have had gotten an estimate first. I’m at their mercy. They got me.”
The kid working on my rig asked for advice and help from his co-workers. Roughly 45 minutes later, they lowered my rig and had done a good job.
As a team, they fixed Harvey (that's what I call my Sprinter Van).
Then Sean, who seemed to be the most seasoned and looked the oldest (maybe 25), backed Harvey out of the work bay, handed me the keys, smiled at me warmly and said…
“There is no charge… We just hope that if you ever need tires, you’ll think of us.”
I was blown away.
I was equally blown away how that gesture made me feel.
That is why I INSISTED that I pay for the work.
I’m not one of those guys who looks for or even prefer “free”. I always strive to stay ahead of fair exchange. I actually prefer to give more than I get out of people and out of life.
I walked into their office, expressed my gratitude, and desired to pay.
They declined and insisted that there was no charge.
So to thank them, I went next door, bought some beverages and snacks and return with my thank-you gift.
I also asked to speak to all of them at once…
To explain who I am and what I do…
To share why what they did is so important…
To thank each and every one of them…
I’m embarrassed to say that I even got a little emotional—no tears but definitely affected.
I’m in the business of trying to get Chiropractors to understand that “ads” don’t build practices. It’s about product, positioning, relevance, reputation, experience, and relationship building and maintenance. Everything ChiroTrust does to and for each member.
Context: MY past experiences, my morning debacle, the stories I was telling myself while having my rig repaired by guys who looked like they still belonged in high school… This ALL contrasted in a big way with how they handled my rig and those final words: no charge.
LET’S TAKE A LOOK AT THIS GESTURE AND HOW IT WILL IMPACT LES SCHWAB TIRE CENTER OF NAPA, CALIFORNIA AND QUITE POSSIBLY ALL THEIR CENTERS NATIONWIDE...
#1. – I am spending an hour of my time writing this.
#2. – I plan on including this email in my Yelp review for everyone in Napa searching for a tire place to see… maybe for years to come.
#3. – I will let Les Schwab corporate/National office know about my experience and offer to fly to and speak at their national convention (if they have one) on my dime.
And they will be my new source of tires and tire-related services for my four vehicles. "
Please visit Chiro-Trust.org for more information.
Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.
The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed by “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!
Reprinted via Chirotrust
Our Condition of the Month is Sacroiliac Joint Dysfunction. Keep reading to learn more about this condition:
Sacroiliac Joint Dysfunction:
Your sacroiliac joint is the mechanical link on each side of your hip that connects your legs to the rest of your body. The joint has a limited but very important degree of mobility. Symptoms develop when one or both of the joints loses normal motion. When a joint becomes "restricted", a self-perpetuating cycle of discomfort follows. Restriction causes the muscles to become overworked, leading to tightness, compression, inflammation, pain and more restriction.
Sacroiliac problems can happen as a result of repetitive strenuous activity or trauma- like a fall onto the buttocks. Other causes of sacroiliac joint problems include, poor posture, having one leg slightly longer than another, having an altered gait, having flat feet or scoliosis, or having pain somewhere else in your legs. Pregnancy is a common trigger for sacroiliac joint problems due to weight gain, gait changes and postural stress.
Sacroiliac joint problems often begin as a focal discomfort in your back just below the belt line, slightly to one side of center. Your pain can travel into your buttock or thigh. Symptoms are often worse by standing on the affected side. The pain may become more apparent when you change positions- like exiting a chair, car or bed, or during long car rides. The pain is often relieved by lying down.
To assist with your recovery, you should avoid any activity that provokes pain, like standing on the affected leg or prolonged sitting.
If you are experiencing any of these symptoms, be sure to call us for an evaluation.
Did you know that 80% of adults experience low back pain at some point in their lifetimes? It’s the leading cause of missed workdays and job-related disability. Although it’s incredibly common and potentially debilitating, the good news is that most cases of low back pain originate from mechanical causes, which means they aren’t caused by a disease and can be prevented with healthy habits. If you want to keep your back healthy, take these six tips into consideration.
1. Don’t Slouch. Poor posture puts a great deal of strain on your back. Be mindful of your posture whether you’re sitting in an office chair at work, driving, or texting on your cell phone. If you’re unsure of what proper posture looks like, watch this video that covers proper sitting posture.
2. Don’t Be A Couch Potato. People with sedentary lifestyles tend to have more occurrences of back pain. Sitting for prolonged periods of time contributes to many different ailments, including low back pain; so challenge yourself to move your body more often throughout the day.
3. Don’t Smoke. Studies show that smoking increases your chance of having low back pain. If you want to quit, SmokeFree.gov can help.
4. Don’t Sleep On Your Stomach. This position places excessive stress on your spinal joints and muscles. A better option is to sleep on your back with a pillow under your knees or on your side with a pillow between your knees. This keeps the spine elongated and neutral. View our sleep posture tutorial video here.
5. Don’t Ignore Your Core. Weak abdominal muscles can contribute to low back pain. If your core is weak, then your back muscles have to work harder to support your movements. This extra work often contributes to strain and injury. We commonly prescribe the Dead Bug, Bird Dog, and Side Bridge exercises to help build core strength. If you have back pain, be sure to check with us before starting.
6. Don’t Avoid Going To The Doctor. Treating your back pain symptoms with ice and/or heat is a good self-care option for the short-term, but any back pain that persists longer than two weeks should be examined by a professional. A visit with your chiropractor can help determine the underlying cause and develop the most effective treatment plan to get you back to feeling yourself again.
Re-Printed via Permission of ChiroUp
Cliff Atwell, B.S., D.C.