Sitting and Your Neck Pain

More people than ever sit in front of a computer for a living these days, and if you're reading this it's likely that you're one of them. So before you get back to being productive for your boss, let's review some ways you can spare your neck in the process.

First, the basics: Your head weighs, on average, about 12 pounds. You have a fairly complicated series of joints and muscles holding that weight off your shoulders and giving you the freedom to look around. Like every other complicated system, the more moving parts to deal with, the more likelihood for something to go wrong. Some of the muscles that get tweaked and stretched when your head moves too far forward (the classic computer posture) are the deep flexor muscles. That would be these guys:

These muscles work in concert with others in the posterior part of your neck to give both stability and freedom of movement to the head. They also get beat up when we get our heads too far forward and keep them there all day, like you may very well be doing right now. Interesting fact--every inch forward your head moves takes three times more power to support the weight. Makes sense--if you hold a bowling ball close to your body it's easier to support than holding it out in front. And your head weighs about the same as a bowling ball. No disrespect.

Eventually, certain muscles get too tight which causes others to turn off ("reciprocal inhibition," again). This happens because muscles activated on one side of a joint cause the muscles on the other side of the same joint to become inhibited--when you flex your bicep, your tricep has to turn off so you can perform the movement. Your neck is no different, and when it happens for hours on end in only one direction neck pain is often the result. This is sometimes referred to as "upper crossed syndrome." It looks like this:

Upper crossed syndrome can lead to a wide variety of pain and instability problems, including shoulder pain, pain around the shoulder blades (especially at the upper, inside border), and, of course, neck pain. None of which is very fun. 

Incidentally, the shoulder pain I just referred to is more than just pain, it's lack of stability. The shoulder blades are essentially the reason your shoulders move the way they do, and the serratus anterior muscles you can see in that picture (the ones that get inhibited) are important when it comes to stabilizing your shoulder joint. If they get turned off and you go try throw a softball around or swing a racket of some kind you could be in for some shoulder issues. More on that in a future post.

An ounce of prevention, as they say, so let's look at the exercise I give every patient with neck pain who walks in the door here: The Brugger. This is done while sitting on the edge of your chair. Step one--tuck your chin straight back while keeping your eyes nice and level. This will create a really nice double chin that you can be proud of. Step two--try and keep your head in position while placing your palms in a a forward facing position with your arms slightly bent and back a little. You should feel a nice stretch where your chest connects to your shoulders.You'll be in this position at the end of the movement: Hold this position for three deep breaths and then go on about your business.

Sometimes the neck pain associated with the upper crossed syndrome is due to joint restrictions in your neck. Static postures held for hours on end can cause the joints to stop moving like they should, which can often lead to pain. Classically, the base of the neck (where your neck connects to your body) gets locked up, and when the muscles of the shoulders join the party to protect the compromised joint, the combination drives people to my office. The joint right at the base of the skull is another key location for dysfunction, and the combination of those locations can cause blistering headaches with a fairly predictable pattern, such as this:

Fortunately, those headaches respond quickly to manipulation of the affected joints, especially when combined with soft tissue work to release the trigger points in the muscles. I recently had a patient leave the office with tears of joy welling up in her eyes because her chronic headache had disappeared for the first time in about a year. 

So do your Bruggers, and take your eyes off the screen and focus on something on the other side of the room while you do them. This will help your back, neck, shoulders, and your eyes, too. Why don't you start now? And if the headaches have already begun, and this doesn't make them go away, come see me at Green Chiropractic. Tell 'em the blog sent you.

Some Thoughts on Back Surgery

Yesterday I had the opportunity to see a spine surgery up close and personal. The procedure is known as a spinal fusion, and is the final stop up the totem pole when it comes to treating lumbar instability. I am very grateful to the surgeon who let me in his OR--he was quite gracious the entire time, and introduced me to the OR staff as a new chiropractor in town who wants to see what goes on in a surgical setting in order to better serve my patients, which is true. All the OR staff seemed interested in the fact that I was invested enough to come and observe, and several asked me questions about what I do. Nobody acted like I had nine heads when the word "chiropractor" was used to describe me, either. A good sign.

I met this surgeon years ago, and he made the offer way back then to see a surgery if I ever wanted. I had to use Facebook to track him down, but when I finally got in touch with him he was still just as willing to let me in his world for an afternoon. We met at the hospital and he led me through the maze of behind the scenes hallways and rooms to the OR. Before that, I should mention, was a trip through the surgeon's suite, complete with drinks and buffet style food set up all for free. Free!

Just outside the OR was the "scrub in" area. We talked about his first day to ever go through the procedure, which is radically different now with all the germ killing disinfectants made for these situations. Then we went in. There, all laid out in a very organized way, were all the tools and accoutrements needed to fuse someone's lumbar spine together. It was an impressive display that took up two tables to hold it all. There was also a full time tool-getter handing off one thing and cleaning the blood and bone chips off the other.

The only word that describes the procedure itself is a word that I think is largely overused, and consequently a word I tend to avoid: surreal.

There was Christmas music, which was changed to classic rock being piped into the OR as the incision was made that revealed someone's spine. There were some rather gruesome sounds coming from the procedure itself--the muscles and soft tissue attached to the spine have to be moved out of the way to insert hardware, and there's no amount of onomatopoeia in my power to type out what that sounds like. There was also a great deal of hammering with a chisel to get the hardware inserted and aligned. Hearing Steve Miller playing Rock' N' Me while that hammering was going on may just stick in my mind forever.

To be sure the hardware was lined up in all the necessary angles and orientations, a fluoroscope was brought in. A fluoroscope is an x-ray unit that runs continuously to see things in motion. I should mention that the surgeon nailed it on the first try.

Just before closing I was invited to take a look at table side, so after even more sterilization procedures I got a look at everything from inches away. With Jefferson Airplane's White Rabbit in the background, I got an intimate view of the amazing anatomy underneath our skin: The lumbar spine that had failed this patient to the point where this entire process was necessary, the muscles around it and the sacrum below it. Although it appears that the lumbar spine is fairly close to the surface, it's actually buried farther down than you might think. This patient was petite, and her spine was about six inches deep.

The take home points for me were these:
1. The stability of the lumbar spine is important. Doing core work shouldn't be considered a fad, it should be considered a necessary component to having a healthy spine. Look for some core stability posts soon.
2. Spine surgery is hard work. The good doctor had to use some muscle several times during the procedure. He was also exceptionally focused. He has his share of back problems himself, and has even had a fusion, so he could definitely sympathize with the patient.
3.Classic rock is superior to seasonal holiday music for surgical interventions.

Desk Jockeys Continued...

In the last post we talked about tight hip flexors and how they turn your glutes (butt) off and some of the potential consequences of that scenario, none of which are good: knee pain, ankle pain, etc... And who wants that? About the same amount of people who want a weak, mushy butt.

Tight hip flexors can also lead to low back pain, too, and as you might imagine is something I find myself explaining with some regularity here at Green Chiropractic. First, let's review the anatomy:

As you can see, your hip flexors, when contracted, will lift your thigh toward your body. You'll also notice one particular group, the psoas, connects your spine to your femur. This is the reason many office workers/desk sitters/couch potatoes have low back pain. It's a matter of mechanics. When the psoas is too short the lumbar spine is pulled forward. This hyper extension puts undue stress on the facet ("fa-set") joints of the posterior lumbar spine. Once that happens pain is soon to follow.

Fortunately, treatment is fairly straight forward--spinal manipulation can open the joints up and give them some breathing room, and some simple stretches will, over time, lengthen the hip flexors that are causing all the trouble in the first place. And so as not to leave you hanging, here are some pics of those stretches:

 Pete demonstrates the basic stretch for the left hip--hard on your knees without the mat.

 Raise your arms up to sink further into the stretch.

 The standing version

 By twisting and bending away from the hip you're stretching you can get a little more out of the movement

Attention Desk Jockeys

I'm a fan of computers and all, but sitting all day is bad for your back, bad for your neck, and bad for your sense of well being, too. I know--I'm writing this while sitting, and if it weren't for the fact that I regularly show (and therefore do myself) people exercises to help recover from the excesses of sitting, I'd likely end up with back pain myself. That scenario is not a practice builder.

What's so bad about sitting? I'm glad you asked--first off, prolonged time in any position can shorten certain muscles and lengthen others beyond the norm. Sitting though, especially at a desk in front of a computer, can really wreak havoc on the low back and neck. Let's start from the bottom, at the hip flexors. That would be these guys:

 

That one muscle, the psoas ("so-as") is especially prone to shrinking to fit the shape it's called to be conformed to all day long. As a result, we get tight in the front of our hips. Right here:

When a muscle is shortened it is essentially flexed. You have built into your muscles a mechanism (called "reciprocal inhibition") that causes muscles on the opposite side of a joint to relax to enable the contracting muscle to contract unimpeded. As an example, when you flex your biceps, your triceps relax so your arm doesn't tear off or explode with all that raw power.

In the same way, when your hip flexors are contracted, and end up shortening after all day sit-a-thons, the muscles that are forced to relax are found beneath your back pockets and are known far and wide as your glutes. Also known as your butt muscles.

When your glutes get turned off because your hip flexors are contracted and shortened and therefore always a little too activated, problems in gait (the way you walk) can be the consequence. Because, you see, your glutes help extend your hip when you walk--in other words they help with the pushing off motion of taking a step. Go ahead, touch your own and extend your leg backwards to feel them activate.

When your glutes aren't doing their job, other muscles and tissues try to compensate, but there really is no other muscles that can do the job as well. This often leads to IT Band Syndrome when runners go from desk to the track with inhibited glutes. IT band syndrome results in pain on the outside of your thigh. You can see in the following picture that the IT band is in a key location to try and do something it shouldn't be doing when the glutes are fast asleep at the wheel.

The effects of sleepy glutes can eventually lead to knee pain and ankle pain as well--it just depends on how your system compensates for the faulty movement pattern.

Short hip flexors can also cause low back pain, which we'll explore in the coming days. I'll follow up with how sitting affects your neck, and then we'll get into some stretches and exercises that will help with both ends of you. You can usually manage these things yourself, which is good, but if you're in more that the usual pain it could be something that could use a more experienced eye, and if that's the case, come see us at Green Chiropractic. If you live in Houston, that is...

A Little More on Soft Tissue Treatment

In the form of a video--I'm trained in Graston, but now use a different (although similar) set of tools...
Check it out here.

Vitamin D--A Response to the Recent Recommendations

Vitamin D has been in the spotlight more and more in the last several years. "Now with vitamin D" has become one of the latest catch phrases for different products. Sometimes the justification is bone health, sometimes it's because vitamin D has been linked to reductions in breast cancer. The list goes on, and the research keeps mounting. Recently the Institute of Medicine (IOM) released a report detailing their recommendations on the amount of D one should be supplementing/consuming every day. Those recommendations were a baby step in the right direction, and although their suggested levels will probably keep you from getting rickets, they are woefully short of what the most current research has to say about the subject.

The IOM recommends 600 IU a day, with a safe upper limit of 4,000 IU a day. Just for a reference, I easily take 10,000 IU a day and have for over a year. Before that it was 6,000 for around a year, and before that it was 2,000 for several years. The reason I've changed the amount over the years is based on the fact that I measure my blood levels with some regularity, and I've moved from Florida, where I surfed in the Atlantic as much as I could (and we lived very close to the beach), to Rhode Island, where the sun never hit my skin for months. From there is was back to Texas to open Green Chiropractic, where I happen to spend the majority of my day indoors and out of the sun.

For a white boy like myself, ten to twenty minutes in that Florida/Texas sun in the middle of the day is enough for me to generate over 10,000 IUs. For my much darker skinned children (they're from Haiti), it takes at least double that amount of time. They take 2,000 IUs a day (in the form of a cinnamon flavored chewable that they really like). To round out the household, my wife takes between 5,000 and 10,000 daily. And I've gotta tell you, our record for avoiding the illness de jour around the flu season is nearly batting a thousand. One of our boys has been sick one day since we picked them up over a year and a half ago. He was fine the next day. The other boy lurches right through flu season with the unwashed hands of a 5 year old like he's bullet proof. How many four and five year olds avoid the funk that successfully?

I've been shooting to get my levels between 40-80 ng/ml of blood. When I was taking the 10,000 in Rhode Island my levels went down from my Florida levels, even though I nearly doubled the amount I was supplementing. I use the test from Grassrootshealth.net, in case you're interested. Getting your blood levels measured is really the best way to know how much you need.

The IOM is a quasi-government organization, so I'm actually shocked that they even moved in the right direction at all--they are now recommending maintaining blood levels at 20 ng/ml. That's still less than half of the recommended level coming from John Cannell, MD, who is one of the founders of the Vitamin D Council, an organization that does nothing but research the mighty D. I'll let him finish this post, so it won't  look like a crazy chiropractor ranting about the newest fad in nutrition (and one that I happen to sell, at that):

I, my family, most of my friends, hundreds of patients, and thousands of  readers of the Vitamin D Council newsletter, have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems.  My advice: especially for pregnant women, continue taking 5,000 IU/day until your (OH)D] is between 50 ng/ml and 80 ng/ml (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories).  Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia (2), a doubled risk for preeclampsia (3), a tripled risk for gestational diabetes (4), and a quadrupled risk for primary cesarean section (5). 

Yesterday, the FNB failed millions of pregnant women whose as yet unborn babies will pay the price.  Let us hope the FNB will comply with the spirit of "transparency" by quickly responding to our freedom of Information requests.

John Cannell, MD

The Vitamin D Council

1241 Johnson Avenue, #134

San Luis Obispo, CA 93401

(1) Cannell JJ.. On the aetiology of autism. Acta Paediatr. 2010 Aug;99(8):1128-30. Epub 2010 May 19.

(2)Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63(4):473-7.

(3) Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-22.

(4) Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3(11):e3753.

(5) Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5.

And They Came Bearing Gifts

Time for a Christmas post! Anyone who knows me knows that I am prone to talking about nutrition, and when that happens I'm especially likely to bring up the sub category of inflammation. In chiro school we were trained to understand the deleterious effects of chronic inflammation because one of the consequences of said inflammation is the sensitization of the pain system. I frequently demonstrate this to patients by bending back my index finger and telling them, "this doesn't hurt now, but see me in an hour. If my pain system were sensitized this might start to hurt in ten minutes. This causes situations where stimuli that is usually considered non-painful becomes painful; everything just starts to hurt." People get that, and besides, it's the truth.

Explaining the actual mechanisms of inflammation can get tricky--for one thing, most people just don't care that much about how it all works. Also, people don't have the time to invest that it takes to wrap one's mind around it. They just take some non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen and move on with life.

Like most things in life, though, taking a pill for what ails you isn't likely to be the wisest course of action in the long run. Long term usage of NSAIDs, for instance, can cause joint degeneration. And people often take ibuprofen daily for the aches and pains that they associate with walking on planet earth. Along with the NSAIDs are big pharma's select Cox2 inhibitors such as Vioxx (which was taken off the market) and celebrex, but those drugs have developed reputations for causing cardiac events (one of my favorite euphemisms). Besides, the Cox pathway is just one way the bad things you eat can get turned into pain. When one pathway is cut off, the other pathway gets more traffic. And so it goes.

There are times when we eat stuff we shouldn't. These times, for me at least, are often accompanied by generally high stress--such as during the holidays. Put bad eating and stress together and you've got a perfect storm of inflammation to deal with. And if you're like me, you don't want the eroded joints or heart attacks we just talked about. Fortunately, there are some natural alternatives readily available (some of which may be in your refrigerator right now). Here's a short list of the heavy hitters:

Cinnamon
Ginger
Tumeric (the stuff that makes curries and mustard that special color of yellow)
Rosemary
White Willow (what? You don't have White Willow in your fridge?)

Most any spice you can name will have properties that modulate inflammation--that is, blunt the impact of the bad aspects of inflammation while bolstering the good.

You may be wondering what any of this has to do with the title of this post or my allusion to Christmas. Well, here goes: Boswellia is a potent anti inflammatory that has been found to relieve joint pain, especially in the weight bearing joints of the knees. It also has been shown to be effective for treating asthma, and ulcerative colitis. The dried sap of the Commiphora species of trees has been shown to be a potent anti inflammatory as well. So has gold for that matter. Boswellia, by the way, is another name for frankincense, and that dried sap I just mentioned is what we call myrrh. Seems like the gifts left for the new king had layers of meaning beyond the symbolism usually attributed to those gifts.

And by the way, boswellia, along with many others from the list are found in some of the products we carry at Green Chiropractic. Have a great December.

Chiropractors: The General Practioner of the Spine

Allow me to explain. When you think of your primary care provider (PCP) you don't think of neurosurgery. What you know is that your PCP can handle most things you walk in with, and that they can recognize situations where a referral is necessary. I submit that chiropractors who follow the evidence based non surgical spine specialist model should be the person you go to first with spine pain/musculoskeletal complaints. We can diagnose most of the conditions that walk in, and we know when it's time to make the referral as well.

Chiropractors often work together with other doctors for the benefit of the patient. Common examples are pain management doctors for injections. Injections can often help the acute patient deal with their pain enough to handle the treatment prescribed by the chiropractor. In the the case of disc pain, for instance, flexion/distraction manipulation is considered one of the treatments of choice to decompress the bulging, painful disc, but sometimes the patient is in too much pain to even lie on the table, let alone handle the treatment. To which I say--steroids to the rescue.

Chiropractors are also well trained in differential diagnosis. Recognizing that your back pain is actually referred pain from your kidneys is something we should pick up on. To prove my differential diagnosis skills I can tell you that I've figured out the condition in two different episodes of House: Lyme disease, and myasthenia gravis. They were triumphant moments, and I'm still basking in the glory. But I think you get my point.

Low back pain and neck pain are often mechanical problems that need a mechanical solution. Chiropractic school is non stop, hands on, physical examination and manipulation training. Some of us go into the world of soft tissue treatments as well, which broadens our scope of practice to extremity pain of the non surgical nature. A torn tendon is out of my pay grade, but scar tissues that inhibit normal movement patterns are my turf.

One final area of expertise your chiropractor should have is a knowledge of nutrition and supplementation. This could possibly be the skill set of your chiropractor that can help you the most with your general welfare, spine pain or not. There are several diet related causes of low back pain that can also cause all sorts of other nasty conditions. Anyone who knows me knows not to get me started about diet and nutrition unless they really want to get me going. What can I say? I'm passionate.

If you're living with back pain, neck pain, or the headaches that often accompany neck pain, come see your favorite Houston chiropractor and get the help you need. I really enjoy my work--it's almost too fun to call this a job, and I look forward to meeting and serving you.

Soft Tissue and Chiropractic

Many chiropractors fall into the one trick pony model of adjusting only, and ignore the soft tissue component of people's dysfunction. Or the nutritional needs, exercises, ergonomics or other things, but the title of this post dictates that I get back to the soft tissue...

Here's the deal--there are really four main pain generators when it comes to back or neck pain: joint, muscle, nerve, and disc. They all have their signature pain description (although there is some overlap), and they often cause pain in combination. Muscle, for instance, almost always gets involved.

Chiropractors are known for joint manipulation (the adjustment), which is often the treatment of choice for back and neck pain. Patients tend to self-select for that particular treatment, too. But when the soft tissues are involved they should be addressed. The most oft overlooked soft tissue component is something you may have never heard of called fascia.

Fascia is the connective tissue that surrounds your muscles and allows your muscles and skin to slide over each other smoothly. Injuries to the soft tissue can produce adhesions in the fascia which will cause movement restrictions which can eventually lead one down the path of dysfunction. Another problem with the fascia is the fact that it's relatively  avascular, that is, it doesn't have much blood supply. Tissues without much blood supply don't heal as quickly. What that means is after an injury muscles heal, but fascia can be deformed and cause lasting problems.

Enter Instrument Assisted Soft Tissue Mobilization (IASTM). I'm not the only Houston chiropractor to use it, but you can probably count on one hand how many do, and this is a big city. IASTM involves using a special set of tools to identify the adhesions in the fascia and then break them down. The tools purposely cause an inflammatory reaction which can bring blood flow to an area that doesn't usually get much blood. It also helps break down scar tissue which causes movement restriction.

What is it good for? I'm glad you asked. Just today I've seen two shoulder complaints, both of which are bordering on being fairly chronic. I also have a chronic tennis elbow (lateral epicondylitis if you want to be technical) patient who is responding nicely, and another with the same condition who is now pain free. Ankle sprains respond well, too. And that's just the extremity stuff. Fascia is often involved with chronic neck pain as well.

I love treating back pain and neck pain. When I get ten seconds to tell people what I do, I stick to those two bread and butter conditions. But give me 45 seconds and I'll get through headaches and move straight into extremity conditions that are usually driven by soft tissue dysfunction.

A Quick Word About Fish Oil

Omega 3's are the new black, and for good reason. However, it seems the reason is often lost on both the public and the supplement manufacturers. Allow me to clarify. And I promise not to get too technical...

To put it as simply as I can: the types of fats you eat eventually become a part of the cell membranes of all your cells. Those fats are then used as raw materials for the cell when it needs to make things, especially mediators of inflammation. What that means is you really are what you eat, and you can eat excess inflammation. Excess inflammation will eventually cause your genes to express sensitivity to pain, and if left unchecked, they'll also express most of the diseases of the west.

Cancer, heart disease, diabetes, and Alzheimer's disease are all, at least in part, inflammatory conditions that have taken ten steps too many. What disease you as an individual end up getting is contingent on your particular genetic influences. If heart disease runs in your family, then excess inflammation is very likely to show up as heart disease in you. As a matter of fact, the blood test for C reactive protein has historically been used to test for likelihood for a cardiovascular accident. The reality though, is that it tests for a marker of systemic inflammation, and when people have high levels of that marker they are likely to have heart troubles AND/OR a bunch of the other pathologies we'd all like to avoid.

Omega 3 fatty acids, such as those found in fish oil, are used by your cells to make anti-inflammatory chemicals that cause tissue healing. This is good. The specific omega 3's in fish oil are EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, respectively). Flax oil, by the way, contains omega 3's, too, but not EPA or DHA, which are the fats that make it into your actual cell membranes. Flax seed oils go through a biochemical process that eventually yields EPA and DHA, but it takes on average about 11 times the flax to get the same amount of EPA/DHA into your cells as straight up fish oil. If you're a vegetarian, flax is the way to go, but if you're not, go straight for the fish.

Omega 6 fatty acids, on the other hand, produce inflammatory chemicals when plucked from the cell membrane and converted. You need some of those fats and they're not all evil or anything, but at the same time you need to limit intake. In a perfect world we would consume a fairly equal ratio of 6's and 3's. 4 to 1 is acceptable. The rub is that most of the foods we eat in America are chock full of omega 6's. Basically any grain product or food that ate a grain product like your grocery store beef are high omega 6. Same thing goes for vegetable oils.

The reason to take fish oil is to simply get some balance between the two. For this reason you should avoid products calling themselves EFA's, which stands for "essential fatty acids." They almost always have an equal ratio of 3's, 6's, and sometimes 9's (what you find in avocado oil). We eat too many 6's already, so you certainly don't need to take more.

Fruits and vegetables have a 3 favoring ratio, as do cold water oily fish like salmon and mackerel. Grass fed beef, which is getting easier to find these days (especially in Texas) has a good ratio, too. And it's not as expensive as you think. If you aren't ready to get that committed, then at least tilt the balance your way by avoiding grains and fried foods (at least foods fried in vegetable oil), and take some fish oil. Read my previous post about supplement quality, and know that we're here for your health at Green Chiropractic.

One more thing: if you have a group that would be interested in hearing more of this kind of thing, drop us a line at the web site. I'd love to make arrangements to spread the dietary love.

Back Pain Treatment Sans Crack

Low back pain is the number one reason for lost time at work, and it's getting worse since more jobs require marathon sitting sessions in front of computers like the one you're reading this post from right now. You should know that sitting puts more pressure on the lumbar discs than almost any other position (the worst is bending forward from a seated position and picking something up from the floor like a purse, for instance).

Statistically, the average back pain patient seeks help from a primary care physician. This typically leads to a round of anti-inflammatory drugs that may or may not help. Inflammation is huge when it comes to pain to be sure, but if the pain is being generated from a mechanical issue in the back such as a disc bulge, well, you need a mechanical solution. Enter Green Chiropractic.

There are plenty of reasons people avoid chiropractors, all of which will be addressed here in upcoming posts. Today, however, we'll focus on the fear of the crack that is often associated with spinal manipulation. I'll explain what the crack is, what it does, and why you should still come here if you're nervous about it.

Low back pain can be caused by many things, and is often the result of multiple factors coming into play. There can be a weakness in the protective muscles, along with a bulging lumbar disc. If the disc bulges far enough backwards it can compress the nerve roots coming off your spinal cord and lead to the classic numbness and tingling symptoms associated with sciatica down the leg or arm pain when you have a disc in your neck acting up.

Allow me to illustrate:

A scenario like the picture here can often be managed with spinal manipulation and exercise. The cracking style manipulation (often referred to as an adjustment by chiropractors) gaps the joints around the disc, and gives everything a little room to breathe, so to speak. The cracking sound is the release of gasses inside the joint that occurs when the joints gap, the same as when your knuckles crack. The resulting loss of pressure on the nerve root will decrease pain. However, there is an even cooler pain reducing mechanism that occurs--the nerves that transmit regular non-painful stimulus are fast conducting compared to the pain relaying nerves. But they enter the spinal cord through the same pipe. When the faster nerves are stimulated from the action of the joints gapping, the mechanical nerves overtake and dampen the signal of the pain-bringers. Sort of like when you hit your knee on something and then rub it to make it hurt less, but a lot better.

What I just described is one of the big reasons some people like to get adjusted on a regular basis. They feel "looser" and there is a general reduction in the aches and pains of life that we all get as we age. And that's cool with me.

However, not everyone is so hip to get their crack on, but they still need help with their back pain. Enter option two: Flexion/Distraction (F/D). I've always thought it should really be distraction/flexion, since that's the correct order of operations, but nobody asked me. F/D is essentially the use of a special table that uses mechanical traction  to open up the tissues around the disc. This has been proven to lower the pressure inside the disc which effectively creates a vacuum inside that can correct a disc bulge. See here for more info than most people would ever care to read. The opening around the nerve root has been measured to increase by 28% using this technique, and when it's just a millimeter of disc material pressing against a nerve root, 28% can be huge.

F/D is also helpful for people with bone spurs closing in on the nerve root, muscle tightness, and a number of other pain generators that can ruin your day. Determining the pain generator(s) is what we'll do on exam here, and usually doesn't require imaging or any other expensive procedures. But we'll save stuff for another post...

And as always, see our website for more info including where we are and what we do.

Supplement Quality--What's the Deal?

In the United States alone there are approximately 1,000 supplement manufacturers. These companies can be anything from a mom and pop operation putting raw materials into capsules in a garage to a multimillion dollar lab with high tech equipment comparable to some of the large pharmaceutical companies. And there's no government regulation of the supplement world. This often leads the consumer to question the purity and manufacturing process of what they see on the shelves, as they should. All supplements are definitely not created equal. But just because the government doesn't regulate the supplement industry (which is good, because they would probably make it worse) doesn't mean the industry doesn't have some internal regulation.

I now direct you to the Natural Products Association, a company that, among other things, has a "Good Manufacturing Process" seal of approval available to supplement companies that pay to have their labs audited. If the supplement company goes for it, and passes, they get to put the "GMP" stamp of approval on their products. I already mentioned that there are 1,000, give or take, supplement companies in the U.S. There are only 77 companies that have made it through the process and sport the GMP label.

And of the 77 that have made it that far, only one company can claim that they also, in fact, manufacture actual pharmaceuticals, and therefore have inspectors and auditors of various natures in their facilities on a very regular basis. And that supplement company is Anabolic Labs--the guys I deal with.  Not just because of their level of quality; their actual line of products is congruent with my thinking about what people need less of: inflammation. They're making it easy these days by putting 30 day packages together of the four supplements I think most people should take: vitamin D, magnesium, fish oil, and a multivitamin that contains no iron (more on that in a future post). The clinical results from a low inflammatory diet (more on that, too) and the addition of the aforementioned supplements can be impressive.

I'm not telling you not to take the stuff they sell at your corner vitamin/supplement store, I'm just telling you to be aware that there are quality control measures in place. There are some good companies that aren't participating (yet) such as Houston's own Biotic Labs. I just set up an account with those guys because they have some great products. But I sure would like it if they were on the list, too.

Flu Season Cometh

If you want to get a flu shot that's cool with me, but I would be remiss if I didn't give you the goods on Vitamin D studies that show that elevating your levels of this substance (it's really more of a steroid hormone than a vitamin) can be incredibly beneficial when it comes to avoiding the bug of the season. The bonus is that there are many other reasons to get those blood levels up besides not getting the flu. The other bonus is that there are almost zero reasons to not take it (the most common reasons to be aware of are hyperparathyroidism, and taking the medication hydrochlorothiazide).

Among the most well known researchers on the subject is a fella name J.J. Cannell MD. In a paper titled Use of Vitamin D in Clinical Practice he and another researcher, Bruce Hollis, PhD, break down the mighty vitamin's role in everything from cancer prevention to inflammatory bowl disease. Also listed among vitamin D's uses are a role in prevention of macular degeneration, osteoporosis, and even periodontal disease. The authors describe a year long study of incidence of colds/influenza after supplementing with 2,000 IU of vitamin D. There was a placebo group, and also a subgroup of participants that took 800 IU a day (which is twice the government's recommended dose, by the way). The results? The placebo group had the usual high incidence of influenza, especially in the winter. The 800 IU group was markedly lower, and nobody from the 2,000 IU group even caught a cold that winter. Or the spring. One in the summer, and none in the fall.

I can tell you from personal experience that I haven't had a cold or the flu in over four years--the same amount of time I've been supplementing. On my 40th birthday in July I didn't feel quite right, but I still had people over, still cooked dinner and still had a good time. And by the next morning I was feeling normal again. I suspect I had a touch of the flu, but it just never "took."

The authors of the paper also state that a potential therapeutic dose when someone feels the initial onset of the flu is 2,000 IU per pound of body weight for 7 consecutive days. I've taken 100,000 IU at a time when I feel the slightest hint of sickness (like on my birthday), and lived to tell about it, so there you go. Very little concern for taking too much.

So take vitamin D! Wintertime holidays bring us in close quarters with each other when our D levels are naturally lower from the lower level of sun exposure we get that time of year. Plus, it's likely that you will be eating more sugar which lowers immune resistance, too.

And if you're wondering where to get a high quality supplement, look us up at Green Chiropractic

www.greggreendc.com

"Evidence Based" Chiropractic?

The "Evidence Based" question (as in, what does that mean?) comes up with some degree of frequency, so I thought I would address it here. Part of my standard spiel about the profession is that there are a wide variety of styles, philosophies, and practice models when it comes to chiropractic. Sometimes you get a doc that walks around you in a counter-clockwise circle with a crystal in his hand telling you that he can cure all that ails you, and some of us stick to strictly musculo-skeletal diagnosis and treatment. And in case you didn't pick up on it, my passion lies within the latter camp. The exception comes in the area of nutrition advice, which is good for much more than just preventing back pain, neck pain, and headaches.

So what does that look like in day to day practice? Very often it looks like what you're used to seeing in a chiropractor's office. Spinal manipulation (the adjustment) is very often used as a treatment for back pain for instance. The real difference is the explanation for how it all works along with the fact that manipulation isn't the only tool in the toolbox here. Exercise and rehab are the bigger focus--which is good for the patient because they can learn to be independent from any health care provider to maintain their freedom from pain.

We don't spend time trying to get you to sign up for lifetime care. We try to get you well and rehabilitated as quickly as possible so you'll tell your friends about us. We also want you to come back if anything else goes wrong up the road, which we think you'll do if we treat you right the first time!

Chiropractic and Nutrition

It's hard these days to know who to believe when it comes to diet and nutrition advice. Some say low carb. Others counter with whole grain. And there's everything in between. The same goes with supplements. How do we even know what to take, let alone know what brands are reliable? Should we be taking supplements at all? And don't chiropractors just treat back and neck pain? Why would a chiropractor know about any of this stuff?

These questions and many more permeate the collective conscience of the community at large that are seeking to lose weight, get off of medications, and feel better. And I've got a little secret for you: a good chiropractor knows much more than you would think about these subjects. Chiropractors don't prescribe. As a result, we don't take a heck of a lot of pharmacology classes (one of the many reasons I tell my colleagues that we aren't qualified to enter the debate about vaccinations, but I digress), but we do take quite a bit of nutrition. One of the reasons for this is that the consequences of inflammation from a poor diet are often manifested in the form of low back pain. If I can't help people get to the root cause of their pain then I'm not really helping with anything other than symptomatic relief. For me, those classes were a great revelation. I ate it up, if you'll pardon the pun. And as a result, at 40 years of age I'm healthier than I ever was in my 20's. I had the bonus of being instructed by one of the most well known authorities on clinical nutrition, Dr. David Seaman. Don't tell him, but I recorded every lecture, and have listened to them all multiple times.

Chiropractic as a profession is moving toward an evidence based paradigm. And Dr. Seaman is leading the charge when it comes to nutrition. As a result, I have literally hundreds of papers to back up my nutrition recommendations to go along with the self-experimentation I've been up to for years now. These recommendations have helped people lose weight to be sure, but even more gratifying are the cases of ulcerative colitis, IBS, acid reflux, and joint and muscle pain that have resolved or gone into remission after starting my program. And I use the word "program" loosely, as it's more of a sustainable way of eating that I advocate than a "follow these three easy steps" kind of program.

If you're ready to make a change, give us a call at Green Chiropractic. 832-203-5884. You can learn more about what we do at our website: www.greggreendc.com