Health Update: Whiplash
Whiplash – What Can I Do to Help Myself?
Whiplash or whiplash associated disorders (WAD) is a commonly used term for an acceleration-deceleration force applied to the neck often occurring in car crashes but may arise from a slip and fall, a diving accident, or other traumatic injury. The net result is an injury to muscles, ligaments, joints, and/or nerves in the cervical spine or neck region and possibly a concussion.
This month’s article is intended to spotlight self-help strategies that YOU can do to help manage this afflicting condition. We HIGHLY recommend downloading “Whiplash Injury Recovery: A self-management guide” as it covers very important information in the 24 page PDF: (go to: http://bit.ly/WHIPLASHGUIDE ). It is authored by Professor Gwendolen Jull, the director of The Cervical Spine and Whiplash Research Unit, Division of Physiotherapy, at The University of Queensland. In her “message from the author,” she writes the following:
“This booklet aims to assist persons who have had a whiplash injury on the road to recovery. It provides information about whiplash-associated disorders, an explanation of whiplash, and exercise program which has been proven to assist in reducing neck pain and advice on how to manage your neck to prevent unnecessary strain and to assist recovery. The booklet is a self-help resource to aid recovery and to supplement any care being provided by a health care practitioner.”
In the table of contents, you will see whiplash defined, recovery information, and “helping yourself” topics followed by posture correction, proper sitting positions, lifting, carrying, and work instructions, as well as how to go about household activities. This 24-page guide concludes with exercise instructions followed by formal exercises, how often you should do them, and things to remember.
Here are some highlights: 1) Most people recover from a whiplash injury at different rates; 2) Recovery ranges from days to months and occasionally one to two years – the majority recover fully; 3) Research supports trying to continue with your normal daily activities – modify as needed and gradually return to normal work, recreation, and social activities; 4) Be adaptive – make modifications to avoid flair-ups; 5) Some activities hurt, but that doesn’t automatically mean further injury. If you recover quickly, make modifications as necessary but continue the activity; 6) You are your BEST resource in the recovery process (stay motivated to fully recover); 7) Stay active. Try to do as many of your normal activities as possible and gradually increase the intensity, frequency, and duration until normal function is returned; 8) Try to keep working – work with your employer and co-workers so you can stay on the job; 9) Don’t skip simple pleasures – enjoy time with family and friends, participate in social outings, begin or rediscover a new hobby; 10) Work with healthcare providers (like your doctor of chiropractic) to gradually introduce and increase exercises to regain motion, strengthen weak muscles, and improve function; 11) Be aware of your posture; 12) Modify activities to reduce strain during work and recreation; 13) Be more active / less sedentary to PREVENT neck pain; 14) Take breaks and change body positions throughout the workday; 15) Arrange your workstation/desk (monitor position, keyboard / mouse and chair “set-up”) to be more ergonomic; 16) Think about how you are sitting; 17) Act as usual, be active, be aware (posture, taking breaks, etc.); 18) DO YOUR EXERCISES (modify according to comfort); 19) Follow the instructions during exercise training (avoid sharp/knife-like pain); and 20) Communicate with your healthcare provider when questions arise!
Health Update: Low Back Pain
Is Sitting BAD for My Back?
A major manufacturer of workstations reports that 86% of work computer users have to sit all day, and when they do rise from sitting, more than half (56%) use food as the excuse to get up and move. In addition to sitting at work, for meals, and commuting to/from work, 36% sit another one to two hours watching TV, 10% sit one to two hours for gaming, 25% sit one to two hours for reading/lounging, and 29% use their home computer for one to two hours. In summary, the average American sits for thirteen hours a day and sleep for eight hours. That's a total of 21 hours a day off their feet!
The manufacturer's survey also notes 93% of work computer users don’t know what “Sitting Disease” is but 74% believe that sitting too much can lead to an early death. “Sitting Disease” represents the ill-effects of an overly sedentary lifestyle and includes conditions like “metabolic syndrome” (obesity and diabetes), which is rapidly becoming more prevalent, especially in the young – even in adolescence and teenagers! Recently, the American Medical Association (AMA) adopted a policy encouraging employers, employees, and others to sit less citing the many risks associated with sitting including (but not limited to): diabetes, cancer, obesity, and cardiovascular disease. Standing is SO MUCH BETTER as it burns more calories than sitting, tones muscles, improves posture, increases blood flow, reduces blood sugar, and improves metabolism. Standing is frequently overlooked as “an exercise” and it’s both simple and easy to do!
So, what about the low back and sitting? You guessed it – sitting is hard on the back! The pressure inside of our disks, those “shock absorbers” that lie between each vertebra in our spine (22 disks in total) is higher when we sit compared with simply standing or lying down. It's estimated that when we lay down, the pressure on our disks is the lowest at 25mm. When lying on one side, it increases to 75mm, standing increases disk pressure to 100mm, and bending over from standing pushes disk pressure to 220mm. When we sit with good posture, our disk pressure may reach 140mm but that can increase to 190mm with poor posture. To help relieve the pressure on our disks, experts recommend: 1) Getting up periodically and standing; 2) Sitting back in your chair and avoiding slouched positions; 3) Placing a lumbar roll (about the size of your forearm) behind the low back and chair/car seat; and 4) Changing your position frequently when sitting.
Because certain low back conditions “favor” one position over another, these “rules” may need modification. For example, most herniated disk patients prefer low back extension while bending over or slouching hurts. In those with lumbar sprain/strains, bending forwards usually feels good and extension hurts. Modifying your position to the one that is most comfortable is perhaps the best advice.
Health Update: Headaches / Neck Pain
The Great Challenge: Chiropractic Adjustments vs. Acupuncture vs. NSAIDs!
Wouldn’t it be nice if we could assess three common types of treatment for neck and back pain to determine which is the most effective? Here is a look at three studies that compared three popular forms of care for chronic spinal pain to determine the short-term and more importantly, the LONG-TERM benefits of chiropractic manipulation, acupuncture, and non-steroid anti-inflammatory drugs (NSAIDs, like Advil).
The FIRST published study included a pilot group of 77 patients complaining of chronic spinal pain (neck, mid-back, or low-back pain). These patients were separated into one of the three treatment groups and received either NSAIDs, acupuncture, or chiropractic manipulation. Patients received care for four weeks with outcome measures (questionnaires) used to assess changes in pain and disability. After a 30-day time frame, only patients who received chiropractic manipulation (CM) reached a level of statistically significant improvement, supporting CM to offer the best SHORT-TERM BENEFITS for those with chronic back/neck pain.
The SECOND study included 115 patients, again randomized, to receive either one of the same three treatments, but this time the outcome data was gathered two, five, and nine weeks after the start of treatment. Again, those who received chiropractic manipulation (CM) experienced the best overall improvement at nine weeks.
The THIRD study involved follow-up from the same patient group from the SECOND study two years later. Once again, participants completed outcome assessments that measure pain and disability. This time, the results showed that only patients in the chiropractic manipulation group maintained long-term improvements in pain and disability.
There have been other studies looking at the efficacy and benefits of SMT (spinal manipulative therapy) both in comparison with other forms of care (as presented here) as well as with different conditions or diagnoses. Perhaps the most exciting results were published in 2008 by the International Bone and Joint Decade 2000-2010 Task Force on Neck Pain. They divided patients into four groups (Group 1: Neck pain with little to no interference with activities of daily living – ADLs; Group 2: Neck pain that limits ADLs; Group 3: Neck pain with radiculopathy or radiating arm pain from a pinched nerve; Group 4: Neck pain with serious pathology such as cancer, fracture, infection, and/or systemic disease.) The researchers concluded that chiropractic care was highly recommended especially in Grades 1 and 2 (which includes the majority of neck pain sufferers). Interestingly, many multidisciplinary physician groups now incorporate chiropractic care as part of their “team” approach, which also offer pain management in the form of medications, injections, PT, and when necessary, surgery. They have seen the value of spinal manipulation for neck pain and often seek out chiropractic because it’s safe, beneficial, and cost effective!
Health Update: Fibromyalgia
The “TOP 10” FACTS of Fibromyalgia!
What are the ten most important attributes of fibromyalgia (FM)? Let’s take a look!
- FM definition: It’s characterized by widespread muscular pain and tenderness (in all four of the body’s quadrants) that’s NOT caused by inflammation or joint damage.
- FM can be primary or secondary: Secondary FM is caused by something else (often after trauma) in association with another disorder like rheumatoid arthritis (RA), irritable bowel syndrome (IBS), lupus, chronic fatigue syndrome, and more. Primary FM has no known association with another condition.
- FM is OFTEN chronic: Because FM is diagnosed by EXCLUDING other conditions, it’s often left undiagnosed for years! To further complicate this, when a person has a diagnosed condition such as Lyme disease, RA, etc., those conditions get all the attention and FM is left undiagnosed. In fact, the National Fibromyalgia Association reports that it takes about an average of five years to get an accurate diagnosis of FM!
- Sleep & Chronic Fatigue: A reported 90% of FM patients suffer from severe fatigue or a sleep disorder. Non-restorative sleep contributes significantly to fatigue and poor cognitive function, and is a hallmark of FM making it an important problem to address in treatment.
- FM Symptoms are many: Headache, IBS, memory problems, TMD (jaw pain), pelvic pain, noise-light-temperature sensitivities, restless leg syndrome (RLS), depression, and anxiety are ALL associated issues with FM (more reasons for a delayed diagnosis and treatment challenges)!
- FM includes both physical and psychological aspects: One study of 307 FM patients followed over an eleven-year time frame found that 33% had severe physical and psychological problems, another 1/3 had mild issues with both, and the last third had only mild physical symptoms.
- FM is HIGHLY VARIABLE: With the widespread pain, variable disability rates, variable physical and psychological aspects (see #6 above), and symptom/condition variability (see #5 above), a treatment approach to manage FM must be individualized! There is no “recipe” for managing FM!
- FM Tests: There are none! Diagnosing FM relies on the patient’s history of widespread pain and associated disabilities more than the physical exam, blood tests, and x-rays which are used to help “rule-out” other disorders.
- FM Treatment: The “best” management strategies for FM include a multi-disciplinary “team” of providers including primary care (medications), chiropractic (manual therapy, nutrition, exercise training), clinical psychology (depression/anxiety management), and other forms of treatment such as massage therapy, acupuncture, and meditation / relaxation therapy. Programs that are individualized work the best! The patient MUST BE an active participant who is willing to do the work!
- “Stats” about FM: First of all, it’s common! It affects women more than men, and about 2-4% of the population overall. What is left out of the stats is the intensity of symptoms, how well each patient responds to the different management strategies, and the patient’s coping skills with this chronic, sometimes totally disabling condition (see #6 above). Other “facts” about FM include: increased “substance P” (a chemical that increases nerve sensitivity), decreased blood flow to the thalamus (brain), hormone imbalances, low levels of serotonin and tryptophan, and abnormal cytokine function….and more!