Chiropractic Clinics in Maryland and Virginia

Chiropractic Manipulative therapy and low level laser

2011-04-19T06:27:00.001-07:00

Chiropractic Manipulative Therapy and Low-Level Laser Therapy in the Management of Cervical Facet Dysfunction: A Randomized Controlled Study

Received 7 May 2010; received in revised form 31 January 2011; accepted 10 February 2011.

Abstract

Purpose

The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.

Methods

Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.

Results

No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.

Conclusion

All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.

Team Lloyd Irvin & Recovery Doc Team Up!

2011-02-26T07:32:00.000-08:00

Physio ball for back pain relief

2011-02-14T14:20:00.000-08:00

The cause of back pain and the potential treatments for back injury are diverse. Back pain can be the result of a range of conditions that affect muscles, tendons, ligaments, discs, nerves, other soft tissues or joints. Most back pain does not have one simple cause, but may be due to a range of factors, such as poor posture, repetitive activity or trauma. A staple piece of equipment for rehabilitating a back injury is the physio ball.

No matter what the particular cause of back injury, it is well documented that the resulting low back pain inhibits the deep abdominal muscles whose job it is to support the spine. A vicious downward spiral is created where injury causes back pain, which causes the muscles that support the spine to weaken which in turn leaves that back more vulnerable to further injury. It is possible to break free from this cycle and specific lower abdominal stabilization training is a key component to winning the battle. This is where the physio ball comes in, it can also be referred to as an exercise ball, gym ball, stability ball or therapy ball. It is effective in rehabilitation of the back because it helps strengthen and develop the core body muscles that help to stabilize the spine.

It has been shown that the muscle activity required to perform a simple curl-up exercise is almost doubled when using a physio ball compared to the same exercise on a stable surface. Using equipment like the physio ball to perform abdominal exercises changes both the level of muscle activity and the way the muscles work together to stabilize the spine and whole body, this effect is exactly that which is required to counteract the negative effects that back pain has on the muscles.

The physio ball does not simply provide a method to restore the spinal stability that is lost in an episode of back pain. The range of exercises that can be performed when using it allows for expansive program progression, making it suitable for use in very early remedial exercises to end stage functional rehabilitation. It is also possible to perform a range of mobility exercises to promote increased range of motion about the spine as well as improve stability.

The use of a physio ball is an excellent conservative back exercise treatment option for back pain sufferers. It is a readily available, inexpensive and versatile piece of equipment that can be used under the supervision of a health professional and/or as part of an independent management plan for back pain. Not only will its use help to resolve the presenting complaint, it will also help prevent further episodes of low back pain when used as part of a rehabilitation program.

Reference: Exercises on a "swiss ball" for chronic low back pain. Stankovic, A, Lazovic, M and Kocic, M. 2008, Proceedings of the 7th Mediterranean congress of physical an rehabilitation medicine, pp. 58-60.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

Recovery and Sports

2011-02-11T06:55:00.001-08:00

Most of you that follow my blog know that I am passionate about recovery and feel that it's the secret to increased performance in elite level athletics. I recently found Restwise when a professional athlete I know suggested them to me. When I did some research and called the company I could not believe they were on the same page as I was in terms of implementing aspects of recovery.

"Restwise takes the science of recovery out of the lab and puts it into your hands. Answer a brief series of research-based questions on the Restwise website every day and the resulting Recovery Score will, for the first time ever, quantify your body's state of recovery. "

I will be teaming up with Restwise to sponsor a group of varied athletes in different sports, called "Team-Recovery Doc." I will be combining Restwise data and apply them to my five pillars of recovery in addition to all of the modalities at my disposal....

Dartfish Motion Analysis

Class IV Lasers

Diagnostic Muskuloskelteal Ultrasound

RecoveyDoc Movement Assements evaluation

Nutrition.......................etc etc.

We are going to change the way RECOVERY is done.

Check back soon to see who the newest members will be!!!!!

Chiropractic care is the key to optimum perfomance

2011-02-07T07:31:00.001-08:00

Green Bay Packers quarterback Aaron Rodgers and fitness pioneer Jack Lalanne are huge advocates for chiropractic care. Actually, Aaron Rodgers' father is a chiropractor in Chico, California and Jack Lalanne was a Doctor of Chiropractic himself.

Aaron Rodgers is not the only NFL player or athlete who believes in the benefit of chiropractic care. New Orleans Saints 2006 first round pick, Reggie Bush, has been receiving regular chiropractic care since playing football in high school and his collegiate years. "I look at Chiropractic care as important to keeping me healthy and at the top of my game." 2010 Hall Of Fame inductee Jerry Rice, who is a spokesperson for the Foundation for Chiropractic Progress, a non-profit organization dedicated to educating the public of the many benefits associated with chiropractic care. "I did a lot of things to stay in the game, but regular visits to my chiropractor made all of the difference", Jerry Rice says. Some of the elite athletes, Lance Armstrong, Tiger Woods, Emmitt Smith, Tom Brady, and Michael Jordan just to name a few, have all benefited from chiropractic care to help them to stay on top of their game. All 32 teams in the NFL have either one or several chiropractors on staff. The need for chiropractic care in the NFL has been driven by the players' desire for optimum performance, and not just for treating injuries.

The good news is that you don't have to be a professional athlete to receive chiropractic care, but you do have to want to make an investment in your health and want to create a healthier lifestyle. It doesn't matter if you have extreme pain or no pain at all, chiropractic allows you to live life to the fullest.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

Spinal Manipulation Therapy for Acute Low Back Pain

2011-02-04T07:37:00.000-08:00

The October 2010 issue of The Spine Journal includes a new review of the scientific evidence supporting spinal manipulative therapy (SMT) for low back pain (LBP). The results were quite favorable and reflect a growing body of evidence supporting SMT over medications and other conservative options. SMT research demonstrates “equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.” The authors conclude by recommending that other health care providers consider SMT as a viable option if self care or education fails to provide pain relief.

METHODS: Literature was identified by searching MEDLINE using indexed and free text terms. Studies were included if they were randomized controlled trials (RCTs) published in English, and SMT was administered to a group of patients with LBP of less than 3 months. RCTs included in two previous SRs were also screened, as were reference lists of included studies. Combined search results were screened for relevance by two reviewers. Data related to methods, risk of bias, harms, and results were abstracted independently by two reviewers.

RESULTS: The MEDLINE search returned 699 studies, of which six were included; an additional eight studies were identified from two previous SRs. There were 2,027 participants in the 14 included RCTs, which combined SMT with education (n=5), mobilization (MOB) (n=4), exercise (n=3), modalities (n=3), or medication (n=2). The groups that received SMT were most commonly compared with those receiving physical modalities (n=7), education (n=6), medication (n=5), exercise (n=5), MOB (n=3), or sham SMT (n=2). Most studies (n=6) administered 5 to 10 sessions of SMT over 2 to 4 weeks for acute LBP. Outcomes measured included pain (n=10), function (n=10), health-care utilization (n=6), and global effect (n=5). Studies had a follow-up of less than 1 month (n=7), 3 months (n=1), 6 months (n=3), 1 year (n=2), or 2 years (n=1). When compared with various control groups, results for improvement in pain in the SMT groups were superior in three RCTs and equivalent in three RCTs in the short term, equivalent in four RCTs in the intermediate term, and equivalent in two RCTs in the long term. For improvement in function, results from the SMT groups were superior in one RCT and equivalent in four RCTs in the short term, superior in one RCT and equivalent in one RCT in the intermediate term, and equivalent in one RCT and inferior in one RCT in the long term. No harms related to SMT were reported in these RCTs.

CONCLUSIONS: Several RCTs have been conducted to assess the efficacy of SMT for acute LBP using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.

Reference: Dagenais, S; Gay, RE; Tricco, AC; Freeman, MD; Mayer, JM (2010). "NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain.". The spine journal. 10 (10): 918–40.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

4 "Snow Day" Treadmill Tricks

2011-02-02T14:12:00.000-08:00

4 "Snow Day" Treadmill Tricks

The 'mill is a fine tool for staying fit when the mercury drops. But it's important to have a plan of action when you hit the machine. Not only will it make the time pass more quickly, but you'll get a greater fitness boost than you would if you did the same type of run every time you went inside. Here are four TM workouts to do on the days you'd rather not risk black ice—or blue toes.

How to avoid packing on pounds this off-season.

The "Fast 15"

Do this workout when you're pressed for time. Jog for three minutes. Then increase the speed to a faster pace and hold it for two minutes (it's okay if you're huffing and puffing a bit by the end). Walk for 30 seconds. Repeat the sequence. Next, extend the run portion to three minutes. Walk for 30 seconds. Repeat. Cool down with a short walk.

The Pace Booster

Warm up for six minutes by alternating 30 seconds jogging with 30 seconds walking. Then increase your speed slightly and run for 30 seconds. Walk for 30 seconds. Continue this 30/30 ratio. Increase your speed slightly with each successive run segment. Do as many cycles as you comfortably can.

Treadmill workouts that keep you focused—and fit.

The Distance Run

Increase your speed until you're running comfortably. Run for two minutes, then walk for one minute. Repeat this 2:1 ratio three times. Bump up the ratio: Run for three minutes, then walk for one minute. Repeat three times. End the workout by running two 2:1 segments, followed by two 1:1 segments.

Winter got you down? How to outrun the blues during the season of plunging temps and zero motivation.

The Hill Climb

Gradually increase your speed until you're at easy-run pace. Run for three minutes. Raise the incline to 2 percent for one minute, then to 4 for one minute. Lower the incline and rest for one minute. Raise to 4 percent and run for two minutes. Alternate running two minutes at an incline/jogging one minute on the flat for as long as you can.

Run stronger, longer, and faster with the latest science.

Dr. Joshua Brooks
Chiropractic - Physiotherapy, Fairfax, Va

Chiropractic Maintenance Care for Chronic Lower Back Pain

2011-02-02T13:25:00.000-08:00

A new single blinded placebo controlled study conducted by the faculty of medicine at Mansoura University, conclusively demonstrates that chiropractic maintenance care provides significant benefits for those with chronic low back pain.

BACKGROUND: Spinal adjustments is a common treatment option for low back pain (LBP). Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance adjustments in chronic non-specific LBP has never been studied.

In this study, 60 patients with chronic, nonspecific LBP lasting at leas 6 months were randomized into 3 groups:

1. One third of them received 12 treatments of sham adjustments over a one-month.
2. One third of them received 12 treatments of adjustments during a one-month period, with no follow-up care during the next nine months.
3. One third of them received 12 Chiropractic adjustments during the first month, followed by “maintenance” adjustments every two weeks, for the next nine months.

To determine any difference among these 3 care groups, researchers measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline, and at 1-month, 4-months, 7-months, and at 10-months.

RESULTS: Patients in groups (groups 2 & 3) experienced significantly lower pain and disability scores than the sham group at the end of the first 1-month period.

At the 10-month follow-up, only the maintenance group maintained improvements in pain and disability, while the group that only received 1-months care had reverted to their pretreatment pain and disability levels.

CONCLUSIONS: This is the first medically managed trial that clearly demonstrates that maintenance chiropractic care provides significant benefits to those who suffer from chronic low back pain.

SOURCE: "Does Maintained Spinal Manipulation Therapy for Chronic Non-specific Low Back Pain Result in Better Long Term Outcome?" Spine (Phila Pa 1976). 2011 Jan 17.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic

One more reason to take breaks from sitting: a smaller waistline

2011-01-26T14:02:00.000-08:00

Always wanted a smaller waist? Scientists have discovered that the answer could be something as simple as taking frequent small breaks from sitting.

A U.S. National Health and Nutrition Examination Survey published in the European Society of Cardiology’s European Heart Journal revealed that participants who took more small breaks from sitting had smaller waistlines than those who did not. This was true even for those who were spent up to 21.2 hours a day sedentary. For the 25% of participants who took the most breaks from sitting, the survey found that waistlines were on average 1.61 inches or 4.1 centimeters smaller than the 25% of participants who took the fewest breaks. The survey, led by University of Queensland researcher followed 4,757 people, all aged 20 and older. The survey lasted for seven days, during which participants wore an accelerometer on their right hips when they were awake. These accelerometers measured the intensity of the participants’ physical activity. Low levels of intensity were equated with sedentary periods.

Having a small waistline indicates less abdominal fat, which in turn is an indicator for better heart health. Larger waists, on the other hand, are linked to cardiovascular disease and high blood pressure as well as higher risk for type 2 diabetes. Another study published in the journal, Obesity, links increases in waistlines to increased chance of premature death.

Participants who took more frequent breaks from sitting also had lower levels of C-reactive protein (CRP). CRPs are produced by the liver. Production is correlated with the level of inflammation in the body. The study also found that taking breaks had a significant effect on lowering HDL-cholesterol, particularly in non-Hispanic whites. Conversely, those who were had higher sedentary times tended to have larger waists, higher HDL-cholesterol, CRPs, triglycerides and insulin.

The benefits of frequent breaks from sitting is linked to muscle activity in the legs and back. When sitting or reclining, these large muscles are largely inactive. However when standing, these muscles are forced to continually contract in order to maintain posture. This increased activity helps to clear plasma triglycerides, which is a risk factor for cardiovascular disease.

Still not convinced? By taking frequent breaks and doing some stretches while sitting at work will also save you from frequent neck and back pain.

Source: http://www.msnbc.msn.com/id/41028986/ns/health-diet_and_nutrition/

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Interferential Current Therapy for Musculoskeletal Pain

2010-12-23T06:30:00.000-08:00

Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysisfrom Physical Therapy current issue by Fuentes, J. P., Armijo Olivo, S., Magee, D. J., Gross, D. P.

Background
Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is widely used, the available information regarding its clinical efficacy is debatable.

Purpose
The aim of this systematic review and meta-analysis was to analyze the available information regarding the efficacy of IFC in the management of musculoskeletal pain.

Data Sources
Randomized controlled trials were obtained through a computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010.

Data Extraction
Two independent reviewers screened the abstracts found in the databases. Methodological quality was assessed using a compilation of items included in different scales related to rehabilitation research. The mean difference, with 95% confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was performed.

Data Synthesis
A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3 articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were considered to be of moderate methodological quality, and 3 studies were considered to be of poor methodological quality. Fourteen studies were included in the meta-analysis.

Conclusion
Interferential current as a supplement to another intervention seems to be more effective for reducing pain than a control treatment at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions. Interferential current alone was not significantly better than placebo or other therapy at discharge or follow-up. Results must be considered with caution due to the low number of studies that used IFC alone. In addition, the heterogeneity across studies and methodological limitations prevent conclusive statements regarding analgesic efficacy.

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

2010-09-01T11:30:00.000-07:00

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Manual therapy and exercise for neck pain: a systematic review

2010-09-01T11:25:00.000-07:00

Manual therapy and exercise for neck pain: a systematic review.

Miller J, Gross A, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggestsgreater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Dr. Paul S. Tetro
Takoma Park/Silver Spring, MD

Is Asymptomatic Lumbar Spine Pathology Predictive of Future Low Back Pain?

2010-08-31T07:15:00.000-07:00

This study investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in a group of 67 asymptomatic individuals with no history of back pain. In 1989, 21 subjects (31%) had an identifiable abnormality of a disc or of the spinal canal.

A questionnaire concerning the development and duration of low-back pain over a 7 year period was sent to the 67 asymptomatic individuals from the 1989 study. A total of 50 subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for 31 of these subjects.

Of the 50 subjects who returned the questionnaire, 29 (58%) had no back pain. Low-back pain developed in 21 subjects during the 7 year study period. The 1989 scans of these subjects demonstrated normal findings in twelve, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four of them had had normal findings on the original scans, two had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans.

The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.

Source: http://thepainsource.com/archives/399

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Save Your Knees

2010-08-19T11:37:00.000-07:00

Land on your toes, save your knees
August 10, 2010

Aggie player Paige Mintun goes for a layup and will be landing on those toes. (Wayne Tilcock/Davis Enterprise photo)
Anterior cruciate ligament injuries are a common and debilitating problem, especially for female athletes. A new study from UC Davis shows that changes in training can reduce shear forces on knee joints and could help cut the risk of developing ACL tears. The research was published online Aug. 3 in the Journal of Biomechanics.

"We focused on an easy intervention, and we were amazed that we could reduce shear load in 100 percent of the volunteers," said David Hawkins, professor of neurobiology, physiology and behavior at UC Davis. Hawkins conducted the study at the UC Davis Human Performance Laboratory with graduate student Casey Myers.

The anterior cruciate ligament lies in the middle of the knee and provides stability to the joint. Most ACL injuries do not involve a collision between players or a noticeably bad landing, said Sandy Simpson, UC Davis women's basketball coach.

"It almost always happens coming down from a rebound, catching a pass or on a jump-stop lay-up," Simpson said. "It doesn't have to be a big jump."

Hawkins and Myers worked with 14 female basketball players from UC Davis and local high schools. They fitted them with instruments and used digital cameras to measure their movements and muscle activity, and calculated the forces acting on their knee joints as they practiced a jump-stop movement, similar to a basketball drill.

First, they recorded the athletes making their normal movement. Then they instructed them in a modified technique: Jumping higher to land more steeply; landing on their toes; and bending their knees more deeply before taking off again.

After learning the new technique, all 14 volunteers were able to reduce the force passed up to the knee joint through the leg bone (the tibial shear force) by an average of 56 percent. At the same time, the athletes in the study actually jumped an inch higher than before, without losing speed.

Hawkins recommends warm-ups that exercise the knee and focusing on landing on the toes and balls of the feet. The study does not definitively prove that these techniques will reduce ACL injuries, Hawkins said: that would require a full clinical trial and follow-up. But the anecdotal evidence suggests that high tibial shear forces are associated with blown knees.

Hawkins and Myers shared their findings with Simpson and other UC Davis women’s basketball and soccer coaches, as well as with local youth soccer coaches.

Simpson said that the team had tried implementing some changes during last year's preseason, but had found it difficult to continue the focus once the full regular season began. In live play, athletes quickly slip back to learned habits and "muscle memory" takes over, he noted. More intensive off-court training and practice would be needed to change those habits, he said.

"We will be talking about this again this season," Simpson said. Implementing the techniques in youth leagues, while children are still learning how to move, might have the most impact, he said.

About UC Davis
For more than 100 years, UC Davis has engaged in teaching, research and public service that matter to California and transform the world. Located close to the state capital, UC Davis has 32,000 students, an annual research budget that exceeds $600 million, a comprehensive health system and 13 specialized research centers. The university offers interdisciplinary graduate study and more than 100 undergraduate majors in four colleges — Agricultural and Environmental Sciences, Biological Sciences, Engineering, and Letters and Science. It also houses six professional schools — Education, Law, Management, Medicine, Veterinary Medicine and the Betty Irene Moore School of Nursing.

Media contact(s):
•David Hawkins, Neurobiology, Physiology and Behavior, (530) 752-2748, dahawkins@ucdavis.edu
•Mike Robles, Intercollegiate Athletics, (530) 752-3680, merobles@ucdavis.edu
•Andy Fell, UC Davis News Service, (530) 752-4533, ahfell@ucdavis.edu

Dr. Joshua Brooks
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

Efficacy of spinal manipulation for chronic cervicogenic headaches

2010-08-18T06:45:00.000-07:00

Headaches are among the common complaints in patients presenting for professional care. Patients with headaches often seek chiropractic care because they find spinal manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine is often the origin of the headache as the nerves in the upper neck pass through the thick, overly taught neck muscles in route to the scalp/head. When the muscles of the neck are in spasm, the nerves get irritated or squeezed by the overly tight muscles resulting in headache pain.

A research study published in October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as spinal manipulation therapy (SMT) offers a perfect remedy for patients who doesn't want to utilize medications in the treatment of headaches. Combine SMT with dietary management, lifestyle modifications, stress management, and vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural approach to the management of chronic headaches can be accomplished.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

2010-08-07T10:06:00.000-07:00

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

What Triggers Headaches?

2010-07-30T12:39:00.000-07:00

Whether you’re a headache sufferer or not, you probably know someone who is. Many simply reach for a pain reliever and try to put their headache behind them. Headaches may be common, but they’re not normal! In my chiropractic office in Greenbelt, MD our patients benefit from safe, natural chiropractic care.

Common Headache Triggers

Stress – Hectic lives, work schedules and insufficient sleep are common culprits

Sleep – Either too much or too little can trigger headaches in some people. Try to keep a regular sleep schedule.

Diet – Certain foods, such as chocolate, red wine, MSG, aged cheeses, caffeine and processed foods can bring one on.

Smells – Strong odors, such as nail polish, smoke, paint, perfume, and cleaning products can cause headaches in certain people.

Injury – Headaches are a primary symptom of whiplash and whiplash associated disorder (WAD).

Eyestrain – If you stare at a computer monitor all day or squint because you need glasses, you might experience frequent headaches.

Subluxation/Joint Fixation – If you have hunched shoulders, a restricted cervical curve, restricted movement in your neck or hear grinding sounds, it may be the underlying cause of your headaches.

Chiropractic care has shown impressive results in helping those who get frequent headaches.

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Effectiveness of manual therapy for chronic tension-type headache

2010-07-27T08:45:00.000-07:00

Chronic tension-type headache has a considerable impact on daily functioning and work participation, it is also a risk factor for overuse of analgesic medication. Only about 20% of the chronic tension-type headache patients seek medical care for their headache. This low consultation rate may be explained by insufficient information on the effectiveness of treatments or by previous negative health care experiences.

The pathogenesis of chronic tension-type headache remains unclear, however, in recent research a correlation between chronic tension-type headache and impairment of the cranio-cervical musculoskeletal function (forward head position, trigger points trapezius muscle, neck mobility) has been demonstrated. In combination with results obtained in previous studies the present data support the hypothesis that improvement of the cranio-cervical musculoskeletal function by a manual therapy intervention (postural correction, mobilization of cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in chronic tension-type headache.

The purpose of this study in Cephalgia was to evaluate the effectiveness of manual therapy in participants with chronic tension-type headache, the authors of this study conducted a multicenter, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with chronic tension-type headache were randomly assigned to manual therapy or to usual care by the general practitioner. Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.

After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the manual therapy group. Disability and cervical function showed significant differences in favour of the manual therapy group at 8 weeks but were not significantly different at 26 weeks. Manual therapy is more effective than usual general practitioner care in the short and longer term in reducing symptoms of chronic tension-type headache.

Reference: Castien RF, van der Windt DA, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial. Cephalalgia. 2010 Jul 20.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Electric Muscle Stimulation and Rehab

2010-07-21T12:29:00.000-07:00

Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes: A Systematic Reviewfrom Journal of Orthopaedic & Sports Physical Therapy - JOSPT Site-Wide RSS
Kyung-Min Kim, Ted Croy, Jay Hertel, Susan Saliba

STUDY DESIGN: Systematic literature review.

OBJECTIVE: To perform a systematic review of randomized controlled trials assessing the effects of neuromuscular electrical stimulation (NMES) on quadriceps strength, functional performance, and self-reported function after anterior cruciate ligament reconstruction.

BACKGROUND: Conflicting evidence exists regarding the effectiveness of NMES following anterior cruciate ligament reconstruction.

METHODS: Searches were performed for randomized controlled trials using electronic databases from 1966 through October 2008. Methodological quality was assessed using the Physiotherapy Evidence Database Scale. Between-group effect sizes and 95% confidence intervals (CIs) were calculated.

RESULTS: Eight randomized controlled trials were included. The average Physiotherapy Evidence Database Scale score was 4 out of possible maximum 10. The effect sizes for quadriceps strength measures (isometric or isokinetic torque) from 7 studies ranged from –0.74 to 3.81 at approximately 6 weeks postoperatively; 6 of 11 comparisons were statistically significant, with strength benefits favoring NMES treatment. The effect sizes for functional performance measures from 1 study ranged from 0.07 to 0.64 at 6 weeks postoperatively; none of 3 comparisons were statistically significant, and the effect sizes for self-reported function measures from 1 study were 0.66 and 0.72 at 12 to 16 weeks postoperatively; both comparisons were statistically significant, with benefits favoring NMES treatment.

CONCLUSION: NMES combined with exercise may be more effective in improving quadriceps strength than exercise alone, whereas its effect on functional performance and patient-oriented outcomes is inconclusive. Inconsistencies were noted in the NMES parameters and application of NMES. LEVEL OF EVIDENCE: Therapy, level 1a–.

Dr. Joshua Brooks
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

Ginger may reduce pain associated with muscle injury after exercising

2010-07-19T08:37:00.000-07:00

For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise. Muscle pain generally is one of the most common types of pain and eccentric exercise-induced muscle pain specifically is a common type of injury related to sports and/or recreational activities.

While ginger had been shown to exert anti-inflammatory effects in rodents, its effect on experimentally-induced human muscle pain was largely unexplored. It was also believed that heating ginger, as occurs with cooking, might increase its pain-relieving effects. Two studies are directed to examine the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain. The researchers recruited 74 volunteers, 34 and 40 respectively, randomly assigned them to consume capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow flexors with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise.

Results showed that supplementation with both raw and heat-treated ginger attenuated muscle pain intensity 24 hours after eccentric exercise. Exercise-induced pain was reduced by 25 percent after daily supplements of raw ginger, and by 23 percent after supplementation with the heat-treated form. The study suggests that ginger may have anti-inflammatory and analgesic properties similar to that of Non-Steroidal Anti-Inflammatory drugs (NSAID’s).

Reference: Black CD, Herring MP, Hurley DJ, O'Connor PJ. Ginger (Zingiber officinale) Reduces Muscle Pain Caused by Eccentric Exercise. J Pain. 2010 Apr 23; DOI: 10.1016/j.jpain.2009.12.013

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

2010-07-19T07:42:00.001-07:00

Gait Biomechanics, Spatial and Temporal Characteristics, and the Energy Cost of Walking in Older Adults With Impaired Mobilityfrom Physical Therapy current issue by Wert, D. M., Brach, J., Perera, S., VanSwearingen, J. M.

Background
Abnormalities of gait and changes in posture during walking are more common in older adults than in young adults and may contribute to an increase in the energy expended for walking.

Objective
The objective of this study was to examine the contributions of abnormalities of gait biomechanics (hip extension, trunk flexion, and foot-floor angle at heel-strike) and gait characteristics (step width, stance time, and cadence) to the energy cost of walking in older adults with impaired mobility.

Design
A cross-sectional design was used.

Methods
Gait speed, step width, stance time, and cadence were derived during walking on an instrumented walkway. Trunk flexion, hip extension, and foot-floor angle at heel contact were assessed during overground walking. The energy cost of walking was determined from oxygen consumption data collected during treadmill walking. All measurements were collected at the participants' usual, self-selected walking speed.

Results
Fifty community-dwelling older adults with slow and variable gait participated. Hip extension, trunk flexion, and step width were factors related to the energy cost of walking. Hip extension, step width, and cadence were the only gait measures beyond age and gait speed that provided additional contributions to the variance of the energy cost, with mean R2 changes of .22, .12, and .07, respectively.

Limitations
Other factors not investigated in this study (interactions among variables, psychosocial factors, muscle strength [force-generating capacity], range of motion, body composition, and resting metabolic rate) may further explain the greater energy cost of walking in older adults with slow and variable gait.

Conclusions
Closer inspection of hip extension, step width, and cadence during physical therapy gait assessments may assist physical therapists in recognizing factors that contribute to the greater energy cost of walking in older adults.

Dr. Joshua Brooks,
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations

2010-07-09T10:40:00.000-07:00

This recent study shows that wearing a lumbar spine orthosis (a type of back brace) can negatively effect the lumbar spine muscles. Although the effects were deemed not detrimental after 3 weeks, virtually every chiropractor or other type of spine physician will agree that strong muscles in the lower back provide the best stabilization. As a chiropractor, I regularly work with patients to strengthen their spines, not just provide symptomatic relief of pain.
-LC

Background
The effects of lumbosacral orthoses (LSOs) on neuromuscular control of the trunk are not known. There is a concern that wearing LSOs for a long period may adversely alter muscle control, making individuals more susceptible to injury if they discontinue wearing the LSOs. The purpose of this study was to document neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO.

Methods
Fourteen subjects wore LSOs 3 hrs a day for 3 weeks. Trunk muscle activity prior to and following a quick force release (trunk perturbation) was measured with EMG in 3 sessions on days 0, 7, and 21. A longitudinal, repeated-measures, factorial design was used. Muscle reflex response to trunk perturbations, spine compression force, as well as effective trunk stiffness and damping were dependent variables. The LSO, direction of perturbation, and testing session were the independent variables.

Results
The LSO significantly (P < 0.001) increased the effective trunk stiffness by 160 Nm/rad (27%) across all directions and testing sessions. The number of antagonist muscles that responded with an onset activity was significantly reduced after 7 days of wearing the LSO, but this difference disappeared on day 21 and is likely not clinically relevant. The average number of agonist muscles switching off following the quick force release was significantly greater with the LSO, compared to without the LSO (P = 0.003).

Conclusions
The LSO increased trunk stiffness and resulted in a greater number of agonist muscles shutting-off in response to a quick force release. However, these effects did not result in detrimental changes to the neuromuscular function of trunk muscles after 3 weeks of wearing a LSO 3 hours a day by healthy subjects.

-Dr. Louis S. Crivelli II
Chriropractor
Greenbelt, MD

Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome

2010-07-06T12:36:00.000-07:00

The purpose of this study was to determine and compare the efficacy of kinesio-tape and physical therapy modalities in patients with shoulder impingement syndrome. 55 total patients were selected for the study, 30 were treated with kinesio-tape three times by intervals of 3 days, and 25 were on a daily program of local modalities for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping group were statistically significantly lower at the first week examination as compared with the physical therapy group. However, there was no significant difference in the same parameters between two groups at the second week. Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

Reference: Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheumatol. 2010 Apr 30.

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Back Pain Alexandria, VA

2010-06-25T11:02:00.000-07:00

Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic, i.e., not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

What Causes Back Pain?
The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements-for example, picking up a pencil from the floor-can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Back injuries are a part of everyday life, and the spine is quite good at dealing with these often "pulled" muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes some pain last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.

Will Back Pain Go Away on Its Own?
Until recently, researchers believed that back pain will "heal" on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily but will most likely return. The study demonstrated that in more than 33% of the people who experience low-back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.1

Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own.2 Those studies demonstrate that low-back pain continues to affect people for long periods after it first begins.

What Can I Do to Prevent Long-Term Back Pain?
If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.3 The relief they feel after a month of treatment is often greater than after seeing a family physician.4

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5

How Can I Prevent Back Pain?

Don't lift by bending over. Instead, bend your hips and knees and then squat to pick up the object. Keep your back straight, and hold the object close to your body.
Don't twist your body while lifting.
Push, rather than pull, when you must move heavy objects.
If you must sit for long periods, take frequent breaks and stretch.
Wear flat shoes or shoes with low heels.
Exercise regularly. An inactive lifestyle contributes to lower-back pain.
What Should I Tell My Doctor of Chiropractic?
Before any treatment session, tell your doctor of chiropractic if you experience any of the following:

Pain goes down your leg below your knee.
Your leg, foot, groin, or rectal area feels numb.
You have fever, nausea, vomiting, stomach ache, weakness, or sweating.
You lose bowel control.
Your pain is caused by an injury.
Your pain is so intense you can't move around.
Your pain doesn't seem to be getting better quickly.

--------------------------------------------------------------------------------

References
1.Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May;26(4):213-9.
2.Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.
3.Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.
4.Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.
5.Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003;23(2):14-15.

Dr. Joshua M. Brooks
Alexandria VA, 22304

Diagnose headaches with cervical flexion-rotation test

2010-06-21T14:16:00.000-07:00

Headache is one of the most common presenting complaint of chiropractic patients. A recent study compared the findings and identified the diagnostic accuracy of the cervical flexion-rotation test (FRT) between subjects with probable cervicogenic headache (CGH), migraine without aura (Migraine), and multiple headache forms (MHF).

Sixty subjects were evaluated: 20 with CGH, 20 with Migraine, and 20 with MHF. The average range of unilateral rotation to the most restricted side was 25 degrees, 42 degrees and 35 degrees for groups CGH, Migraine and MHF, respectively. Range of rotation was significantly reduced in the CGH group when compared to groups Migraine and MHF. The study found that “An experienced examiner using FRT was able to make the correct diagnosis 85% of the time (P<0.001)…”

This recent research continues to confirm the importance of a simple flexion rotation test (FRT) in the differential diagnoses of headaches. Many headache cases are often similar in terms of presenting symptom and the FRT has demonstrated in multiple research studies to be highly sensitive to identifying cervicogenic headache from migraine and multiple headache forms.

Reference: Hall TM, Briffa K, Hopper D, Robinson K. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. J Headache Pain. 2010 May 28.

Dr. David P. Chen
Chiropractor in Laurel Maryland
Laurel Regional Chiropractic

Shoulder Injuries Attributed to Resistance Training: A Brief Review

2010-06-20T05:51:00.000-07:00

Kolber, MJ, Beekhuizen, KS, Cheng, M-SS, and Hellman, MA. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res 24(6): 1696-1704, 2010-The popularity of resistance training (RT) is evident by the more than 45 million Americans who engage in strength training regularly. Although the health and fitness benefits ascribed to RT are generally agreed upon, participation is not without risk. Acute and chronic injuries attributed to RT have been cited in the epidemiological literature among both competitive and recreational participants. The shoulder complex in particular has been alluded to as one of the most prevalent regions of injury. The purpose of this manuscript is to present an overview of documented shoulder injuries among the RT population and where possible discern mechanisms of injury and risk factors. A literature search was conducted in the PUBMED, CINAHL, SPORTDiscus, and OVID databases to identify relevant articles for inclusion using combinations of key words: resistance training, shoulder, bodybuilding, weightlifting, shoulder injury, and shoulder disorder. The results of the review indicated that up to 36% of documented RT-related injuries and disorders occur at the shoulder complex. Trends that increased the likelihood of injury were identified and inclusive of intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique. A majority of the available research was retrospective in nature, consisting of surveys and descriptive epidemiological reports. A paucity of research was available to identify predictive variables leading to injury, suggesting the need for future prospective-based investigations. (C) 2010 National Strength and Conditioning Association

Questions on pain relievers.

2010-06-14T07:15:00.001-07:00

Several years ago, I worked with a chiropractor who used to tell patients not to take any pain medication. I disagreed with that approach, as I felt multiple strategies are often needed, especially for severe pain. Then he was in a car accident. He found chiropractic care extremely helpful. He also expressed considerable more appreciation for "the little brown M&M's", and he found it necessary to take them every four hours. He became much less dogmatic in telling people how to deal with pain. I feel it's important to not judge people who rely on medication to help with their pain. I also try to use whatever techniques that are available to relieve pain so that medication is ultimately unnecessary.

I get asked about pain medicine a lot. As a chiropractor, I'm not licensed to prescribe medications. I don't make recommendations for starting or stopping any medicine, including over the counter medications. I am not opposed to medicine, and recognize their neccessity in the healthcare of many people. I also feel if you can get by without it, you're often better off. When I'm asked, I'll defer to the patient's primary care doctor. I do need to ask patients questions about medications, especially pain medicines, as it gives me information on what's happening to the patient. It's fairly common for people to come to me because pain medication is not working for them. People often get in the habit of taking pain medicine on a daily basis without asking their doctor. Most over the counter pain medicines recommend that it not be taken for more than ten days without consulting a doctor, some patients I've seen have been taking them daily for years.

A recent Danish study looked at over a million individuals. It found the likelihood of heart attack or stroke increased 29% in patients who took ibuprofen. It was not just people who took medicines for long times. People who took high dosages, even for as short a time as only two weeks, saw an increase in heart problems and stroke. Naproxen was not found to have the same heart related side effects as ibuprofen. This was the first major study that saw this increase in cardiovascular problems in patients who had no prior record of cardiovascular problems. Heart problems were also seen with the less commonly used prescription medicines diclofenac and rofecoxib. As I've said, it's good to talk to your primary doctor if you have questions on changing a medicine. While this study saw benefits with naproxen in terms of heart disease, there are other side effects that may be more relevant to your health.

I was hesitant to blog about this because pain medication is a complex topic. As I said at the start, I'm not inherently against medicine. I don't want people who have to take pain medicine feel bad for taking it. I don't want people who'd be better off taking it to avoid or stop taking it. More studies will come out, likely making this an even more complicated subject. The techniques used in chiropractic are several orders of magnitude safer than pain medications. It's very common for us (the doctors at ABC Clinics) to see painful conditions that we can resolve with chiropractic care and physical therapy. If you have questions how we can help, please call or email.

Rosa Rehab Receives 2010 Best of Temple Hills Award

2010-06-11T09:59:00.000-07:00

Press Release
FOR IMMEDIATE RELEASE
Rosa Rehab Receives 2010 Best of Temple Hills Award
U.S. Commerce Association’s Award Plaque Honors the Achievement
NEW YORK, NY, June 4, 2010 -- Rosa Rehab has been selected for the 2010 Best of Temple Hills Award in the Chiropractors category by the U.S. Commerce Association (USCA).
The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.
Various sources of information were gathered and analyzed to choose the winners in each category. The 2010 USCA Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.
About U.S. Commerce Association (USCA)
U.S. Commerce Association (USCA) is a New York City based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.
The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.
SOURCE: U.S. Commerce Association

CONTACT:
U.S. Commerce Association
Email: PublicRelations@us-ca.org
URL: http://www.us-ca.org
###

Evidence Supports the Use of Therapeutic Ultrasound for Joint Osteoarthritis

2010-06-10T10:19:00.000-07:00

A Cochrane systematic review (January 2010) and another recent clinical trial (May 2010) both provided support for therapeutic ultrasound (US) in the management of patients with osteoarthritis (OA).

The objective of the Cochrane systematic review was to compare therapeutic US with sham or no specific intervention in terms of effects on pain and function safety outcomes in patients with knee or hip OA. The authors concluded that, "In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee."

The clinical study examined the short- and long-term efficacy in patients with primary hip OA with regard to pain, functional status, and quality of life (QoL). Forty-five patients with primary hip OA were enrolled into the study. The authors concluded that, "addition of therapeutic ultrasound to the traditional physical therapy showed a longitudinal positive effect on pain, functional status, and physical QoL in patients with hip osteoarthritis. The use of therapeutic ultrasound in the treatment of hip osteoarthritis should be encouraged."

References: Köybaşi M, Borman P, Kocaoğlu S, Ceceli E. The effect of additional therapeutic ultrasound in patients with primary hip osteoarthritis: a randomized placebo-controlled study. Clin Rheumatol. 2010 May 26.

Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003132.

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

CHIROPRACTIC AGAIN SHOWN TO BE MORE COST-EFFECTIVE

2010-06-09T11:51:00.000-07:00

Chiropractic Again Shown to Be More Cost-Effective
New Study Compares Chiropractic to Medical Care in "Real-World" Setting
By Editorial StaffOne of the reasons many companies are hesitant to include coverage for services such as chiropractic is the claim that inadequate scientific data verify the effectiveness of these forms of care.
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A new study published in the Archives of Internal Medicine,1 combined with the results of a survey conducted by the Kaiser Family Foundation,2 may finally put an end to the question of how chiropractic affects the cost of health care, and whether it is more effective than traditional medical procedures for the treatment of back pain.
"Prior to this, no study had ever linked chiropractic benefits to lower utilization levels in a real-world employee setting," commented Douglas Metz, DC, a co-investigator on the Archives paper. "Our study shows that systematic access to managed chiropractic care may prove to be not only clinically beneficial, but can reduce key cost factors that drive up employer health costs in traditional care settings."3
The Archives study was sponsored by American Specialty Health Plans (ASHP) - an organization that offers coverage for alternative health care providers such as chiropractors, acupuncturists and massage therapists, which is added to traditional insurance policies - and was conducted by Health Benchmarks, an independent health services research organization. Health Benchmarks reviewed four years of claims data on back pain from two groups: one group of 700,000 health plan members with chiropractic care coverage, and a second group of 1 million members who were in the same health plan as the first group, but who had no chiropractic coverage. Aside from chiropractic care, patients in both groups had access to the same physician network; the same rules on referral to specialty care, diagnostic tests, and hospital and surgery approval; and the same exclusions and limitations.
The analysis found wide discrepancies in health care costs for patients with and without chiropractic coverage:
The overall per-member, per-year health care cost of members with chiropractic coverage was $1,463 - $208 less than the cost of members without chiropractic coverage. This amounted to a 12 percent reduction in annual costs incurred by the health plan for members with chiropractic coverage.
The per-member, per-year health care cost of chiropractic patients with neuromusculoskeletal conditions was 13 percent lower compared to the same group of patients without coverage of chiropractic care. Similar reductions were seen in annual per-capita hospital costs and ambulatory services.
The greatest differences were seen when the authors reviewed cases of treatment related specifically to back pain. The average cost per back pain episode for patients with chiropractic coverage was 28 percent lower than for back pain patients without chiropractic coverage.
Back pain patients with coverage of chiropractic had a 41 percent reduction in hospitalizations for back pain, a 37 percent reduction in MRI scans, a 23 percent reduction in the use of X-rays, and a 32 percent reduction in the incidence of back surgery, compared to back pain patients who did not have chiropractic insurance coverage.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Chiropractic had the highest perceived benefit for back pain

2010-06-04T11:31:00.000-07:00

A study published in the Journal of the American Board of Family Medicine reports on interviews with 31,044 individuals who used complementary and alternative medicine (CAM) for low back pain (LBP). The results are as follows:

The top 6 CAM therapies for LBP, starting with the most-used approaches are: chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.

Chiropractic use (76% of respondents) was larger than all the other 5 therapies combined.

Of those who used CAM modalities for back pain, 27% used it because conventional medicine did not help, 53% used it in conjunction with medical care, and 24% used it because their medical provider recommended it.

Chiropractic users scored the highest on their satisfaction and clinical benefits out of all 6 approaches. This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that spinal manupulative therapy (SMT) provided the greatest pain relief scoring higher than nerve blocks, opioid analgesics, muscle relaxants, acupuncture, or NSAIDs.

Reference: Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med. 2010;23(3):354–362.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Chiropractic, Health Care Reform and Discrimination?

2010-06-04T09:39:00.000-07:00

I wanted to take a break from posting interesting new study abstracts in order to address an issue that many people may not be aware of. As we all know by now, out congress recently passed some sweeping changes to the health care system in this country. Part of this legislation (the Patient Protection and Affordable Care Act (PPACA)) contained an "anti-discrimination" clause (Section 2706). This clause assures that chiropractors, optometrists, podiatrists, and other physicians without an "M.D. or D.O." after their names, are treated fairly and equally within the new health care system.
Blatant discrimination against other types of physicians has been a policy of the American Medical Association for many years, as evidenced by the landmark legal verdict of Wilk vs. AMA in 1971. We chiropractors were very pleased to see Section 2706 included in the bill that was passed. We thought that perhaps the days of animosity between professions was finally at an end and we can ALL work together for the good of our patients.

Recently the AMA drafted a resolution that states:

"RESOLVED, That our American Medical Association immediately condemn and work to repeal new Public Health Service Act Section 2706, so-called provider “Non-Discrimination in Health Care,” as enacted in PPACA, through active direct and grassroots lobbying of and formal AMA written communications and/or comment letters to the Secretary of Health and Human Services and Congressional leaders and the chairs and ranking members of the House Ways and Means and Energy and Commerce and Senate Finance Committees (Directive to Take Action"

It seems that just when we thought we were entering a new era of cooperation and trust, we are again reduced to fighting "turf wars" over such issues as patient access, titles, and coverage by insurance.

If you are currently seeing a chiropractor, podiatrist, optometrist, or any other licensed physician that Section 2706 may effect, PLEASE contact your senator or congressman (or woman) and tell them to preserve Section 2706 in the current legislation.

I'll leave you with a quote from Dr. Benjamin Rush, co-signer of the Declaration of Independence and one of our founding fathers:

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic."

Dr. Louis S. Crivelli II
Chiropractic Physician
Greenbelt, MD

Weight Training-Related Injuries Increasing.

2010-05-31T18:22:00.000-07:00

A recent study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital has found that the number of injuries from weight training has unsurprsingly increased as the activity has become more popular. Almost a million weight training-related injuries were treated in U.S. hospital emergency departments between 1990 and 2007, increasing nearly 50 percent during the 18-year study period.

About two thirds of the recorded injuries were from weights dropping onto a person.

Males (82 percent) and youths aged 13 to 24 years (47 percent) sustained the largest proportion of weight training-related injuries. Injuries to the upper (25 percent) and lower trunk (20 percent) were the most common followed by injuries to the hand (19 percent). The most frequent injury diagnoses were sprains and strains (46 percent) followed by soft tissue injuries (18 percent).

While youths (ages 13-24) had the highest number of injuries, the largest increase in the incidence of injuries occurred among those aged 45 years and older. People aged 55 and older were more likely than their younger counterparts to be injured while using weight-training machines, and to sustain injuries from overexertion and lifting or pulling. On the other hand, youths 12 years and younger were more likely to be injured while using free weights. This age group had a higher proportion of cuts and fractures, and were more likely to sustain injuries as a result of having a weight drop or fall on them than those aged 13 years and older.

"Before beginning a weight training program, it is important that people of all ages consult with a health professional, such as a doctor or athletic trainer, to create a safe training program based on their age and capabilities," said study author Dawn Comstock, PhD, principal investigator in the Center for Injury Research and Policy at Nationwide Children's Hospital. "Getting proper instruction on how to use weight lifting equipment and the proper technique for lifts, as well as providing trained supervision for youths engaging in weight training, will also reduce the risk of injury."

The study also found that while males had the highest number of injuries, there was a larger increase in the incidence of injury among female participants.

"Weight training may still be a male dominated activity," said Dr. Comstock, also a faculty member of The Ohio State University College of Medicine. "However, the increase in incidence among female participants is likely the result of more women weight training as it becomes a more accepted fitness activity for women."

While this study focused on injuries, largely to assess and prevent them, there are decided benefits to weight-lifting. It is an effective means to decrease the incidence of osteoporosis, it has been suggested to help with increasing basal metabolism (your body's ability to burn fat),
it reduces the likelihood and severity of falls in the elderly , improves walking in the elderly, and increases strength and cardivascular health. Exercise plays a key role in our mental health too, as a good way of alleviating stress.

As a chiropractor who's seen a lot of sports injuries, my goal is to assess the nature of the injury, treat it as quickly and effectively as possible, and return the patient to his or her desired activity as soon as safe and reasonable to do so.

I've had the opportunity to treat people with a wide variety of injuries from the gamut of physical activities, from free weights to kettlebells, from fencing to mixed martial arts, from ballet to tapdancing, from yoga and tai chi to competitive boomerang. Removing people's pain and getting them back to the activities they love is absolutely the most gratifying part of my job.

The effects of spinal manipulation on shoulder pain

2010-05-27T11:13:00.000-07:00

This is an interestig study on the immediate effects of thoracic spine and rib manipulation in patients with primary complaints of shoulder pain. 21 subjects with shoulder pain were qualified for the inclusion. Following the physical examination, all subjects received high-velocity thrust manipulative therapy to the upper thoracic spine and/or ribs. The type and number of manipulative techniques performed during the treatment session were based on the presence or absence of specific thoracic and/or rib impairments. Post-treatment effects demonstrated a 51% reduction in shoulder pain and a corresponding increase in shoulder range of motion (30 to 38 degrees). The results from this study suggest that thoracic and rib manipulative therapy is associated with improved shoulder pain and motion in patients with shoulder pain. These interventions support the concept of a regional interdependence between the thoracic spine, upper ribs, and shoulder.

Reference: Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230-6.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

A can of soda raises your blood pressure two points.

2010-05-25T03:32:00.000-07:00

The average American drinks 2.3 sugar or high fructose corn syrup sweetened drinks per day. Recent research looked at the effects of this on blood pressure. On average, forgoing one sweetened drink was associated with a two point drop in the systolic blood pressure. No effect on blood pressure was noted from caffeine or diet drinks. It should be noted that research on diet drinks suggest that they may be associated with obesity, so switching to artificial sweeteners is not recommended. Additional news on the sugar front regards a comparison of high fructose corn syrup (HCFS) and sugar. Rats fed HFCS were significantly more obese than those fed table sugar, including developing unhealthy belly fat and having bad triglyceride profiles. This is more shocking as the amount of HFCS used was less than half that used in soda. While table sugar is still not good for you, HFCS may be much worse. As HFCS are found in an amazing variety of our food products (40% of all sweeteners used), it's important to read labels and limit the amount until its safety can be determined. Despite it's heavy usage, this is the first long-term study of the effects of high-fructose corn syrup consumption on obesity in lab animals. A similar study has not been done in humans. Further research is seriously needed.

Consumer Reports: Chiropractic is top rated treatment for back pain

2010-05-24T11:55:00.000-07:00

-Consumer Reports has recognized that patients are much more satisfied with chiropractic care as the top practitioner when compared to their primary care physician, specialist physician, and physical therapist

April 7 -- In light of a new survey showing that chiropractic spinal manipulation is the top-rated treatment for people suffering with back pain, patients should consider a consultation with a doctor of chiropractic, says the American Chiropractic Association.

The Consumer Reports Health Rating Center released the survey results of more than 14,000 Americans on April 6.

The survey rated doctors of chiropractic as the top practitioner, with survey respondents noting that they were more likely to be "highly satisfied" with the care received from their doctor of chiropractic (59 percent) than their primary care physician (34 percent).

"For the treatment of back pain, few options are better than chiropractic," says ACA President Glenn Manceaux, DC. "As shown in this latest survey, chiropractic spinal manipulation is an evidence-based and effective treatment for low-back pain and other musculoskeletal injuries. Coupled with the high-levels of patient satisfaction, patients should turn to chiropractic as their first choice."

To compare which treatments helped most, Consumer Reports asked its subscribers to rate a comprehensive list of potential remedies along with their satisfaction with the health-care professionals they visited. Most survey respondents had tried five or six different treatments on average, and many found that their back pain interfered with their daily activities, including sleep and their sex life.

Doctors of chiropractic provide drug-free, non-invasive treatment options for many types of pain and inflammation. For example, chronic back pain, neck pain, joint pain and headaches can often be reduced with the appropriate combination of chiropractic manipulation, rehabilitative exercises and lifestyle counseling - all of which are offered by doctors of chiropractic in a patient's personalized treatment plan.

A significant amount of evidence has shown that the use of chiropractic care for certain conditions can be more effective than traditional medical care, with many patients feeling improvement shortly after their first chiropractic visit.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Exercise to Reduce Pain

2010-05-21T13:04:00.001-07:00

Aerobic Exercise Alters Analgesia and Neurotrophin-3 Synthesis in an Animal Model of Chronic Widespread Painfrom Physical Therapy current issue by Sharma, N. K., Ryals, J. M., Gajewski, B. J., Wright, D. E.

Background
Present literature and clinical practice provide strong support for the use of aerobic exercise in reducing pain and improving function for individuals with chronic musculoskeletal pain syndromes. However, the molecular basis for the positive actions of exercise remains poorly understood. Recent studies suggest that neurotrophin-3 (NT-3) may act in an analgesic fashion in various pain states.

Objective
The purpose of the present study was to examine the effects of moderate-intensity aerobic exercise on pain-like behavior and NT-3 in an animal model of widespread pain.

Design
This was a repeated-measures, observational cross-sectional study.

Methods
Forty female mice were injected with either normal (pH 7.2; n=20) or acidic (pH 4.0; n=20) saline in the gastrocnemius muscle to induce widespread hyperalgesia and exercised for 3 weeks. Cutaneous (von Frey monofilament) and muscular (forceps compression) mechanical sensitivity were assessed. Neurotrophin-3 was quantified in 2 hind-limb skeletal muscles for both messenger RNA (mRNA) and protein levels after exercise training. Data were analyzed with 2-factor analysis of variance for repeated measures (group x time).

Results
Moderate-intensity aerobic exercise reduced cutaneous and deep tissue hyperalgesia induced by acidic saline and stimulated NT-3 synthesis in skeletal muscle. The increase in NT-3 was more pronounced at the protein level compared with mRNA expression. In addition, the increase in NT-3 protein was significant in the gastrocnemius muscle but not in the soleus muscle, suggesting that exercise can preferentially target NT-3 synthesis in specific muscle types.

Limitations
Results are limited to animal models and cannot be generalized to chronic pain syndromes in humans.

Conclusions
This is the first study demonstrating the effect of exercise on deep tissue mechanical hyperalgesia in a rodent model of pain and providing a possible molecular basis for exercise training in reducing muscular pain.

Dr. Joshua Brooks
Chiropractor Fairfax VA 22031
Chiropractor Alexandria VA 22304

Iatrogenic Disability and Narcotics Addiction After Lumbar Fusion in a Worker's Compensation Claimant

2010-05-21T11:32:00.000-07:00

-This tragic case study is a prime example of some of the dangers that accompany back surgery and routine follow up with narcotic medication. Chiropractic is a drug less, non-surgical healing art that has been shown over decades to help those injured at work and those involved in motor vehicle collisions. All of the worker's compensation and whiplash patients that are seen in my chiropractic clinic in Takoma Park/Silver Spring, MD are closely monitored by top medical doctors if they are taking any form of medication.
-PT

Spine: 20 May 2010 - Volume 35 - Issue 12 - pp E549-E552

Parks, Philip D. MD, MPH, MOccH; Pransky, Glenn S. MD, MOccH; Kales, Stefanos N. MD, MPH

Objective. Describe a case of chronic occupational low back pain with various treatments of questionable efficacy, leading to prolonged disability, iatrogenic narcotic addiction, and opioid-induced hyperalgesia.

Summary of Background Data. Concerns about narcotics and other questionable treatments for chronic low back pain are increasing, especially in those with work-related conditions.

Methods. Medical record review.

Results. The patient had significant, persistent low back symptoms, but good function at work and home. He underwent lumbar fusion to address persistent pain, and subsequently developed failed back surgery syndrome. He was prescribed increasing amounts of opioid analgesics and was recommended for an intrathecal morphine pump, without evaluation of the safety or efficacy of his current regimen. Subsequently, he was hospitalized for opioid detoxification and substance abuse treatment.

Conclusion. Patients with chronic low back pain are at risk for receiving ineffective and potentially harmful treatment. A focus on restoring function instead of complete pain relief may lead to better outcomes in these patients.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Changes in Head and Neck Posture Using an Office Chair With and Without Lumbar Roll Support

2010-05-21T11:12:00.000-07:00

-This is a nice study that illustrates once again how interconnected different areas of the spine are. Following a whiplash injury, many patients must return to their offices and immediately begin a full schedule. The authors' conclusions support the notion that by supporting the lumbar spine, favorable changes can be made in the cervical spine. In my chiropractic clinic in Greenbelt, MD we stress the spine, and ultimately the body as a whole.
-LC

Spine: 20 May 2010 - Volume 35 - Issue 12 - pp E542-E548

Horton, Stuart J. MPhty, DipMDT; Johnson, Gillian M. PhD; Skinner, Margot A. PhD

Objective. To investigate change in sagittal alignment of head and neck posture in response to adjustments of an office chair with and without a lumbar roll in situ.

Summary of Background Data. Forward head posture has been identified as a risk factor for neck pain, and there is evidence to show that ergonomic correction in sitting may reduce the incidence of pain. The effect placement of a lumbar roll has on cervical spine posture has not been previously investigated experimentally but rather, is assumed to have a positive influence on head and neck posture.

Methods. Thirty healthy male participants (18-30 years) were photographed while registered in the natural head resting position in each of 4 sitting positions with and without a lumbar roll in situ. Two positions incorporated adjustments to the back rest and 1 to the seat pan of the office chair. The craniovertebral (CV) angle, as a determinant of head and neck posture was measured from the set of digitized photographs obtained for each participant. Comparisons between the CV angle in all postural registrations were made using a mixed model analysis adjusted for multiple comparisons.

Results. Of the positions examined, significant differences in the mean CV angles were found with the backrest of the chair at 100° and at 110° (P < id="SPELLING_ERROR_6" class="blsp-spelling-error">situ and the backrest position at 110°, there was a significant increase in the mean CV compared with the angle without the lumbar roll in situ (2.32°, 95% confidence interval:
1.31-3.33; P < 0.001).

Conclusion. The degree of angulation of the backrest support of an office chair plus the addition of lumbar roll support are the 2 most important factors to be taken into account when considering seating factors likely to favorably change head and neck postural alignment, at least in asymptomatic subjects.

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

The Effects of Precompetition Massage on the Kinematic Parameters of 20-m Sprint Performance

2010-05-21T08:39:00.000-07:00

The Effects of Precompetition Massage on the Kinematic Parameters of 20-m Sprint Performance

The effects of precompetition massage on the kinematic parameters of 20-m sprint performance. J Strength Cond Res 24(5): 1179-1183, 2010-The purpose of this study was to investigate what effect precompetition massage has on short-term sprint performance. Twenty male collegiate games players, with a minimum training/playing background of 3 sessions per week, were assigned to a randomized, counter-balanced, repeated-measures designed experiment used to analyze 20-m sprints performance. Three discrete warm-up modalities, consisting of precompetition massage, a traditional warm-up, and a precompetition massage combined with a traditional warm-up were used. Massage consisted of fast, superficial techniques designed to stimulate the main muscle groups associated with sprint running. Twenty-meter sprint performance and core temperature were assessed post warm-up interventions. Kinematic differences between sprints were assessed through a 2-dimensional computerized motion analysis system (alpha level p <= 0.05). Results indicated that sprint times in the warm-up and massage combined with warm-up conditions were significantly faster than massage alone. Also, step rate and mean knee velocity were found to be significantly greater in the warm-up and massage combined with warm-up modalities when compared to massage alone. No significant differences were demonstrated in any measures when the warm-up and massage and warm-up combined conditions were compared. Massage as a preperformance preparation strategy seems to decrease 20-m sprint performance when compared to a traditional warm-up, although its combination with a normal active warm-up seems to have no greater benefit then active warm-up alone. Therefore, massage use prior to competition is questionable because it appears to have no effective role in improving sprint performance. (C) 2010 National Strength and Conditioning Association

5249 Duke Street Suite 100

Alexandria, VA 22304

703-750-1177

HYPERCHOLESTEROLEMIA, HYPERTRIGLYCERIDEMIA - Nuts, Total Cholesterol, LDL Cholesterol, HDL Cholesterol, Triglycerides

2010-05-21T08:33:00.000-07:00

Nut Consumption May Improve Blood Lipid Profiles
Keywords:	HYPERCHOLESTEROLEMIA, HYPERTRIGLYCERIDEMIA - Nuts, Total Cholesterol, LDL Cholesterol, HDL Cholesterol, Triglycerides
Reference:	"Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials," Sabate J, Ros E, et al, Arch Intern Med, 2010; 170(9): 821-7. (Address: Department of Nutrition, Loma Linda University, Nichol Hall Room 1102, Loma Linda, CA 92350, USA. E-mail: jsabate@llu.edu ).
Summary:	In a pooled analysis of 25 nut consumption studies involving 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications, results indicate that nut consumption may improve lipid profiles in a dose-dependent manner. A mean daily consumption of 67 g of nuts was associated with a 5.1% mean reduction in total cholesterol concentration, a 7.4% mean reduction in low-density lipoprotein cholesterol concentration (LDL-C), and a 5.6% mean reduction in ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C). Additionally, subjects with blood triglyceride levels of at least 150 mg/dL showed a 10.2% mean decrease in blood triglyceride levels. Lastly, the lipid-lowering effects of nut consumption was found to be strongest in subjects with high baseline LDL-C and subjects with low BMI (body mass index). Thus, the authors of this study conclude, "Nut consumption improves blood lipid levels in a dose-related mann er, particularly among subjects with higher LDL-C or with lower BMI."

4269 Branch ave

Temple Hills, MD 20748

301 316-2111

Recent reseach suggests drugs provide limited benefit against diabetes and heart disease

2010-05-20T14:46:00.000-07:00

Below are links to four recent articles suggesting that the pathway to a lower risk of diabetes and heart disease does not lie in medications. Changes in lifestyle are proving to be a more effective strategy. The best part is, even for those that are diagnosed as being at risk for diabetes or heart disease, it is never too late to benefit from a more active lifestyle.

U.S. News & World Report March 15, 2010

New England Journal of Medicine March 18, 2010 [Epub ahead of print] Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus

New England Journal of Medicine March 18, 2010 [Epub ahead of print] Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events

New England Journal of Medicine March 18, 2010 [Epub ahead of print] Effect of Nateglinide on the Incidence of Diabetes and Cardiovascular Events

New England Journal of Medicine March 18, 2010 [Epub ahead of print] Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus

Dr. Brian Lancaster

Chiropractor, Frederick, MD

Exercise at work to prevent low back pain

2010-05-20T12:10:00.000-07:00

More jobs now require prolonged sitting which has been associated with loss of the lumbar lordosis, intervertebral disc (IVD) compression, and height loss, possibly increasing the risk of lower back pain. There are numerous studies suggest that exercise can play an important role in preventing occupational and non-occupational low back pain. An innovative approach was published in the April issue of The Spine Journal that used an office chair exercise that is performed while seated. The exercise provides a brief decompression of the lumbar spine by moving forward on the chair seat, placing the hands on the seat of the chair, pressing downward with the arms to take pressure off the lumbar spine, and arching the back and shoulders backward at the same time. This decompression maneuver held for 5 seconds followed by 3 seconds of reloading (sitting normally) and was repeated 4 times. Sequential MRI demonstrated a marked increase in vertical height of the lumbar spine using this decompression strategy. The authors concluded that “Seated upright MRI and stadiometry, as performed in this study, appear to be feasible methods for detecting compressive and decompressive spinal changes associated with normal sitting and, alternately, seated unloading exercises. Larger studies are encouraged to determine normative values of our study measurements and to determine if morphological changes induced by seated unloading predict treatment response and/or reductions in the incidence of sitting-related LBP.”

There are numerous quality evidence that post-treatment exercise programs can prevent recurrences of back pain. There have been many studies published this past decade that support the value of exercise in primary, secondary as well as tertiary prevention of low back pain. These studies have been conducted with multiple age groups and multiple settings including sports venues and the workplace.

Source:
http://www.chiroaccess.com/Articles/Exercise-and-the-Prevention-of-Low-Back-Pain.aspx?id=0000162

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

TRIGGER POINTS

2010-05-20T09:35:00.000-07:00

TRIGGER POINTS

These muscle knots are “exquisitely tender points” that produce pain, either in the direct muscle area, or sometimes referred to another spot. As well as being extremely interesting when pressed, they are a very common phenomenon among athletes.

Should anyone worry about them? Well, yes, because exquisite pain is not their only characteristic. An active trigger point can also cause:

- loss of range of movement of soft tissue
- a change in muscle function, including weakness, loss of co-ordination and
decreased work tolerance
- subsequent changes in joint mechanics and overall movement patterns
- neural tension signs (reduced mobility of the nervous system)

And it’s worth noting that not all trigger points manifest pain – those that don’t are known as “latent” trigger points – but they nevertheless cause the same range of problems.

It is best to see a chiropractor trained in trigger point therapy for problems related to these nasty spots. All the doctors of ABC CLINICS are specifically trained to seek and destroy these points of pain.

Dr. John Rosa
Rosa Chiropractic and Physical Therapy Center
Rockville/Gaithersburg, MD

Headaches are effectively treated by addressing neck issues.

2010-05-17T05:55:00.000-07:00

It is very common when talking to patients for them to separate out neck pain and headaches as two unrelated problems. Before I became a chiropractor, my thinking was that a headache represented some imbalance in the brain. Since the brain has no pain receptors itself, we understood that something outside the brain is the most likely cause. Common causes are muscle spasm or joint problems. When I first started ten years ago, my patients and myself were often both surprised when I treated their necks and their headaches vanished. A recent study found that spinal surgery was effective in relieving headaches in a great number of patients. While surgery has improved, it is unfortunately not the least risky approach to dealing with headaches. A 2007 study on these procedures noted a 1 out of a 1000 risk of death. An earlier meta-analysis identified spinal manipulation as an effective intervention for headaches, comparable in some studies to the relief from pain medication. The risk of death from chiropractic based on most up to date research is considered to be less than 1 in 5 million, this risk is much less than the risk from pain medication.
I would like to point our that I do not talk about the risks to dissuade people from seeking conventional help for headaches, as I firmly believe that all options should be available. I think it's wonderful that the people in the surgical study lost their headaches. In the interest of "first do no harm", chiropractic is a safe option that is often not tried. My colleagues and myself find nothing is quite so fun as taking someone's headache away.

Chronic Whiplash Pain Caused by Spinal Facet Injury

2010-05-14T12:08:00.000-07:00

In an article published in late 2007 in the Journal of the American Academy of Orthopedic Surgeons revealed that a significant number of people suffering acute neck pain following a motor vehicle collision develop chronic pain that last for years. The most common source of the chronic pain is damage to the spinal facet joints, followed by disc pain. The authors reviewed the medical literature and published data concerning chronic whiplash pain. The review reveals that 15% to 40% of patients with acute neck pain following a motor vehicle collision develop chronic pain, and that 5% to 7% become permanently partially or totally disabled. The most common source of chronic whiplash neck pain: the facet joint (49% to 54%).

In the treatment of chronic neck pain, exercise is recommended as helpful to strengthening the weak muscle groups but exercise alone is rarely curative. Many studies have shown that spinal manipulation is one of the most effective treatments for whiplash injury. Early manipulation to the cervical spine will restore motion, decrease pain, and increase the speed of recovery. The early manipulation will also decrease the buildup of scar tissue and future chronic pain syndromes.

As you may know, Tiger Woods announced on his blog on Wednesday that an MRI determined he has inflammation in the facet joint of his neck which causes pain in the area along with headaches and difficulty rotating the head. Even though he denied that his neck injury is related to the Nov. 27 car accident, but it is possible that Tiger may not have been aware of the damage immediately. As the damage sometimes doesn't manifest itself until a physical activity that puts strain on the neck - things like lifting boxes or hitting golf balls in Tiger’s case.

Reference: Schofferman J, Bogduk N, and Slosar P. Chronic whiplash and whiplash-associated disorders: An evidence-based approach. J Am Acad Orthop Surg. 2007 Oct;15(10):596-606.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Knee Osteoarthritis

2010-05-14T07:36:00.000-07:00

Moving to Maintain Function in Knee Osteoarthritis:

Evidence From the Osteoarthritis Initiative from Archives of Physical Medicine and Rehabilitation by Dorothy D. Dunlop, Pamela Semanik, Jing Song, Leena Sharma, Michael Nevitt, Rebecca Jackson, Jerry Mysiw, Rowland W. Chang, Osteoarthritis Initiative Investigators

Abstract: Dunlop DD, Semanik P, Song J, Sharma L, Nevitt M, Mysiw J, Chang RW, for the Osteoarthritis Initiative Investigators. Moving to maintain function in knee osteoarthritis: evidence from the Osteoarthritis Initiative.

Objectives: To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA).Design: Prospective cohort study of knee OA development and progression with 1-year follow-up.

Setting: Community.Participants: Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45–79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up.Interventions: Not applicable.Main Outcome Measure: A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile.

Results: Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes.

Conclusions: These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.

Chiropractor Fairfax VA 22031

2010-05-07T12:35:00.000-07:00

Here is another article to read when considering the current health care debate:

Health, life insurers hold $1.88 billion in fast-food stocks: AJPH article

Harvard researchers say insurers put profits over health

EMBARGOED until:
April 15, 2010, 5 p.m. Eastern time

Contact:
Arun Mohan, M.D., M.B.A.
J. Wesley Boyd, M.D., Ph.D.
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Just weeks after the passage of a health bill that will dramatically increase the number of Americans covered by private health insurers, Harvard researchers have detailed the extent to which life and health insurance companies are major investors in the fast-food industry.

Although fast food can be consumed responsibly, research has shown that fast-food consumption is linked to obesity and cardiovascular disease, two leading causes of death, and contributes to the poor health of children. The evidence is so compelling that as part of the new law more than 200,000 fast-food and other chain restaurants will be required to include calorie counts on their menus, including their drive-through menus.

A new article on insurance company holdings, published online in today's [Thursday, April 15] American Journal of Public Health, shows that U.S., Canadian and European-based insurance firms hold at least $1.88 billion of investments in fast-food companies.

"These data raise questions about the opening of vast new markets for private insurers at public expense, as is poised to happen throughout the United States as a result of the recent health care overhaul," says lead author Dr. Arun Mohan.

Among the largest owners of fast-food stock are U.S.-based Prudential Financial, Northwestern Mutual and Massachusetts Mutual Life Insurance Company, and European-based ING.

U.S.-based Northwestern Mutual and Massachusetts Mutual Life Insurance Company both offer life insurance as well as disability and long-term care insurance. Northwestern Mutual owns $422.2 million of fast-food stock, with $318.1 million of McDonald's. Mass Mutual owns $366.5 million of fast-food stock, including $267.2 in McDonald's.

Holland-based ING, an investment firm that also offers life and disability insurance, has total fast-food holdings of $406.1 million, including $12.3 million in Jack in the Box, $311 million in McDonald's, and $82.1 million in Yum! Brands (owner of Pizza Hut, KFC and Taco Bell) stock.

New Jersey-based Prudential Financial Inc. sells life insurance and long-term disability coverage. With total fast-food holdings of $355.5 million, Prudential Financial owns $197.2 of stock in McDonald's and also has significant stakes in Burger King, Jack-in-the-Box, and Yum! Brands.

The researchers also itemize the fast-food holdings of London-based Prudential Plc, U.K.-based Standard Life, U.S.-based New York Life, Scotland-based Guardian Life, Canada-based Manulife and Canada-based Sun Life. (See table; all data current as of June 11, 2009.)

"Our data illustrate the extent to which the insurance industry seeks to turn a profit above all else," says Dr. Wesley Boyd, senior author of the study. "Safeguarding people's health and well-being take a back seat to making money."

Mohan, Boyd and their co-authors, Drs. Danny McCormick, Steffie Woolhandler and David Himmelstein, all at the Cambridge Health Alliance and Harvard Medical School, culled their data from Icarus, a proprietary database of industrial, banking and insurance companies. Icarus draws upon Securities and Exchange Commission filings and news reports from providers like Dow Jones and Reuters. In addition, the authors obtained market capitalization data from Yahoo! Finance.

The authors write, "The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility."

Several of these same researchers, all of whom are affiliated with Physicians for a National Health Program, have previously published data about the extent to which the insurance industry is invested in tobacco. They say that because private, for-profit insurers have repeatedly put their own financial gain over the public's health, readers in the United States, Canada and Europe should be wary about insurance firms' participation in care.

Insurance industry holdings in fast-food companies (in millions of U.S. dollars) as of June 11, 2009.

Insurance Company	Jack in the Box	McDonald's	Burger King	Yum! Brands	Wendy's/ Arby's Group	Total
Prudential plc				80.5		80.5
Prudential Financial	34.1	197.2	43.7	80.5		355.5
Mass Mutual	23.1	267.2	58.8	17.4		366.5
New York Life	2.4					2.4
Northwestern Mutual	40.9	318.1		63.2		422.2
Sun Life				26.8		26.8
Standard Life		63.0				63.0
ING	12.3	311.7		82.1		406.1
Manulife		89.1		53.7	3.3	146.1
Guardian Life	7.2				9.5	16.7
MetLife					2.2	2.2
Total	120.0	1,183.3	165.5	404.2	15.0	1,888.0

"Life and Health Insurance Industry Investments in Fast Food," Arun V. Mohan, M.D., M.B.A.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; and J. Wesley Boyd, M.D., Ph.D. American Journal of Public Health, April 15, 2010.

Dr Brian Lancaster

Valley Chiropractic in Frederick, MD

Rehab Study for Low Back Pain

2010-05-07T10:41:00.000-07:00

Rehabilitation of a Patient with Functional Instability Associated with Failed Back Surgery,
The Journal of the American Chiropractic Association, Dec 2004 by Adams, Vincent
123456Next ..Abstract

Objective: A report of a case of a low-tech non-dynamometric functional exercise program in the rehabilitation of a functionally unstable lower back, associated with failed back surgery.

Clinical Features: A 41-year-old female presented to a chiropractic office with severe lower-back pain, with radiation down the left leg to the calf. Seven months prior, she had an L5-S1 discectomy. Two months after the surgery, her pain in the lower back and leg returned. An MRI 6 months after the surgery showed no evidence of a recurrent disc herniation, but revealed a small image enhancement along the, posterior annulus adjacent to the right S1 nerve root, consistent with post-operative change. Plain film radiography was unremarkable.
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Intervention and Outcome: The home-based therapeutic techniques used in this case were based on the patient's weaknesses demonstrated on a functional evaluation. This evaluation consisted of 4 functional tests, including the repetitive squat, Sorenson static back endurance, repetitive sit-up, and the repetitive arch-up tests. The exercises were performed over a 6-week period, and resulted in a decrease in both pain and functional disability based on visual analog scale, pain diagrams, and the Oswestry low-back pain questionnaire.

Conclusion: A home-based exercise program proved very effective in decreasing this patient's functional disability level, but was ineffective in reducing pain levels. Further investigation of chiropractic management of such cases is warranted.

Key Words or Phrases: functional instability, rehabilitation, failed back surgery

Dr. Joshua Brooks
Chiropractor Fairfax, VA

Chiropractic management of fibromyalgia syndrome: a systematic review of the literature.

2010-05-07T09:52:00.000-07:00

This study concludes that chiropractic can be an effective treatment for fibromyalgia. In my chiropractic office in Takoma Park/Silver Spring, MD I see a fair amount of patients with fibromyalgia developing as the result of whiplash associated disorders.
-Dr. Tetro

Schneider M, Vernon H, Ko G, Lawson G, Perera J.

OBJECTIVE: Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic. The purpose of this study was to perform a comprehensive review of the literature for the most commonly used treatment procedures in chiropractic for FMS and to provide evidence ratings for these procedures. The emphasis of this literature review was on conservative and nonpharmaceutical therapies.
METHODS: The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. Online comprehensive literature searches were performed of the following databases: Cochrane Database of Systematic Reviews; National Guidelines Clearinghouse; Cochrane Central Register of Controlled Trials; Manual, Alternative, and Natural Therapy Index System; Index to Chiropractic Literature, Cumulative Index to Nursing and Allied Health Literature; Allied and Complementary Medicine; and PubMed up to June 2006.
RESULTS: Our search yielded the following results: 8 systematic reviews, 3 meta-analyses, 5 published guidelines, and 1 consensus document. Our direct search of the databases for additional randomized trials did not find any chiropractic randomized clinical trials that were not already included in one or more of the systematic reviews/guidelines. The review of the Manual, Alternative, and Natural Therapy Index System and Index to Chiropractic Literature databases yielded an additional 38 articles regarding various nonpharmacologic therapies such as chiropractic, acupuncture, nutritional/herbal supplements, massage, etc. Review of these articles resulted in the following recommendations regarding nonpharmaceutical treatments of FMS. Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification.
CONCLUSIONS: Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Study recommends conservative management of lumbar disc herniation before surgical discectomy

2010-05-07T09:25:00.000-07:00

A recent article appeared in the Spine Journal examines the cost of previous conservative care for patients that ultimately elect to have spinal surgery. The study consisted of 30,709 patients. The average cost of conservative care in the 90 days period before surgery was $3,445 each. Magnetic resonance imaging and other diagnostic procedures represented a little over half of the total pre-surgery costs. Of the treatment costs, 16% were for injections, 5.7% physical therapy, and 1.2% chiropractic care. Despite the fact that these expenses were for failed back conservative care, the authors recognize the overall benefits of conservative care and recognize that many patients are able to avoid surgery. They conclude that “Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate”.

Previous studies have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, “Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.” Another study of patients with disc herniation reported, “…with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.”

Sources:
Daffner SD, Hymanson HJ, Wang JC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010 Mar 31.

http://www.chiroaccess.com/Articles/Studies-Recommend-Conservative-Care-for-Low-Back-Pain-before-Surgery.aspx?id=0000148

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

2010-05-07T07:11:00.000-07:00

-This very interesting Sweedish study illustrates that the effects of whiplash can sometimes occur in body areas or systems that seem uncommon to most patients. In my chiropractic clinic in Greenbelt, MD, we focus on the body as a whole, not just the symptoms. As a specialist in whiplash related disorders, I strive to help patients overcome all aspects of this growing epidemic.
-Dr. C

Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD).

Kalezic N, Noborisaka Y, Nakata M, Crenshaw AG, Karlsson S, Lyskov E, Eriksson PO.

Centre for Musculoskeletal Research, University of Gavle, Sweden; Sports Medicine Unit, Umea University, Sweden.

OBJECTIVE: The present study aimed to elucidate possible physiological mechanisms behind impaired endurance during chewing as previously reported in WAD. We tested the hypothesis of a stronger autonomic reaction in WAD than in healthy subjects in response to dynamic loading of the jaw-neck motor system.

DESIGN: Cardiovascular reactivity, muscle fatigue indicies of EMG, and perceptions of fatigue, exhaustion and pain were assessed during standardised chewing. Twenty-one WAD subjects and a gender/age matched control group participated. Baseline recordings were followed by two sessions of alternating unilateral chewing of a bolus of gum with each session followed by a rest period.

RESULTS: More than half of the WAD subjects terminated the test prematurely due to exhaustion and pain. In line with our hypothesis the chewing evoked an increased autonomic response in WAD exhibited as a higher increase in heart rate as compared to controls. Furthermore, we saw consistently higher values of arterial blood pressure for WAD than for controls across all stages of the experiment. Masseter EMG did not indicate muscle fatigue nor were there group differences in amplitude and mean power frequency. Pain in the WAD group increased during the first session and remained increased, whereas no pain was reported for the controls.

CONCLUSION: More intense response to chewing in WAD might indicate pronounced vulnerability to dynamic loading of the jaw-neck motor system with increased autonomic reactivity to the test. Premature termination and autonomic involvement without EMG signs of muscle fatigue may indicate central mechanisms behind insufficient endurance during chewing.

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Foot Orthotics and Chiropractic care in Temple Hills, MD

2010-05-07T07:04:00.000-07:00

For decades, Foot Levelers has enthusiastically

supported and promoted chiropractic research.

Twenty-two years ago in our Success Express

magazine, we announced the commitment of a

quarter of a million dollars to fund the Greenawalt

Chair for Research at Northwestern College of

Chiropractic (now Northwestern Health Sciences

University).1 By that time Foot Levelers was

already an established financial backer of the

Foundation for Chiropractic Education and

Research (FCER), and we encouraged the readers

of our magazine—as well as other chiropractic

suppliers—to join us in giving to the profession’s

“primary source of financial support for chiropractic

research and postdoctoral research training of

doctors of chiropractic.”2-4

In the late 1990s, Foot Levelers teamed up with

New York Chiropractic College to establish “the

nation’s first gait research center in a chiropractic

setting” at NYCC’s Seneca Falls campus.5

Heeding Dr. Reed Phillips’ call to “be supportive

of chiropractic research in any way possible,”6

the partnership between Foot Levelers and NYCC

“sparked research that may reveal how the body’s

gait can disrupt chiropractic adjustments, which

could lead to the identification of ways an

adjustment can best be preserved, such as

through the use of orthotics.”7

This research booklet

is proof that “Foot Levelers’ products are a

beneficial adjunct to chiropractic care.”8 Here is

peer-reviewed research by some of the finest

academicians in the chiropractic profession,

including work done at NYCC’s Biomechanics/

Gait Research Laboratory in Seneca Falls.

The future of chiropractic research is limited only

by the support it receives from those who form

the chiropractic community of professionals,

staff, and suppliers. Foot Levelers pledges to

continue sponsoring and promoting chiropractic

research, and to share the benefits of that

research with our Partners In Progress.

References

1. [No author]. Chair for research announced. Success Express 1985; 9(2):59.

2. Rossman E. FCER’s role in chiropractic research. Success Express 1985;

9(3):57-61.

3. [No author]. Are your suppliers supporting chiropractic research? Success

Express 1985; 9(4):55-59.

4. [No author]. Chiropractic research…key to the future. Success Express

1988;12(1):45-47.

5. [No author]. NYCC and Foot Levelers team up to establish gait research

program. Success Express 1998; 18(3):28.

6. Phillips RB. A lesson in history: the need for research. Success Express

1988; 12(1):25-29.

7. [No author]. Foot Levelers gait research program is helping advance field

of chiropractic. Success Express 2000; 20(2):11.

8. [No author]. ACC conference highlights orthotics research. Success

Express 2004; 24(3):5.

Aekta Erry, D.C.

Chiroprator, Temple Hills, MD

Chiropractic management of patients post-disc arthroplasty: eight case reports

2010-05-07T06:32:00.000-07:00

Background: When conservative therapies for low back pain (LBP) are not effective, elective surgery may be proposed to these patients. Over the last 20 years, a new technology, disc replacement, has become increasingly popular because it is believed to maintain or restore the integrity of spinal movement and minimize the side-effects compared to fusion. Although disc replacement may relieve a patient from pain and related disability, soreness and stiffness of the lumbopelvic region seem to be common aftermaths of the surgery. This prospective case series was undertaken to identify and describe potential adverse events of lumbar spinal manipulation, a common therapy for low back pain, in a group of patients with symptoms after disc prostheses.Cases presentationEight patients who underwent lumbar spine total disc replacement were referred by an orthopaedic surgeon for chiropractic treatments.

These patients had 1 or 2 total lumbar disc replacements and were considered stable according to the surgical protocol but presented persistent, post-surgical, non-specific LBP or pelvic pain. They were treated with lumbar spine side posture manipulations only and received 8 to 10 chiropractic treatments based on the clinical evolution and the chiropractor's judgment. Outcome measures included benign, self-limiting, and serious adverse events after low back spinal manipulative therapy. The Oswestry Disability Index, a pain scale and the fear avoidance belief questionnaire were administered to respectively assess disability, pain and fear avoidance belief about work and physical activity. This prospective case series comprised 8 patients who all had at least 1 total disc replacement at the L4/L5 or L5/S1 level and described persistent post-surgical LBP interfering with their daily activities. Commonly-reported side-effects of a benign nature included increased pain and/or stiffness of short duration in nearly half of the chiropractic treatment period. No major or irreversible complication was noted. Conclusions: During the short treatment period, no major complication was encountered by the patients. Moreover, the benign side-effects reported after lumbar spine manipulation were similar in nature and duration to those frequently experienced by the general population.

Chiropractic management of patients post-disc arthroplasty: eight case reports

Julie O'Shaughnessy¹ , Marc Drolet² , Jean-François Roy³ and Martin Descarreaux¹

¹Département de chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada

²Private practice, Québec City, Canada

³Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise, Québec, Québec, Canada

Rosa Rehab

4269 Branch ave

Temple Hills Maryland

History of a Neck Injury in a Motor Vehicle Collision and Future Neck Pain

2010-04-29T07:27:00.000-07:00

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in an auto collision are more likely to experience future neck pain. A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year. We found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index (adjusted HRR = 2.14; 95% CI 1.12–4.10). The study suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

Reference: Nolet PS, Côté P, Cassidy JD, Carroll LJ. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. Eur Spine J. 2010 Mar 7.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Chiropractic in the Treatment and Prevention of Sports Injuries

2010-04-22T07:47:00.000-07:00

The study aims to investigate whether chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. The authors used two groups of male semi elite Australian Rules football athletes, matched them in several ways and randomly placed them in one of two arms of the study. All received the usual and customary management and medical care. Half also received chiropractic care which consisted of both soft tissue and high velocity spinal manipulation. The treatment plan was: 1 treatment per week for 6 weeks, 1 treatment per 2 weeks for 3 months, 1 treatment per month for the remainder of the season (3 months). The research evaluated several outcomes. When chiropractic care was added to conventional management, there was a significant reduction in lower limb strain injuries, time missed as a result of knee injuries, lower back pain, and there was improvement in health status. “In addition, although not statistically significant, there was a trend towards prevention of hamstring and primary non-contact knee injuries and there were no reported adverse outcomes from the intervention.”

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Medicare Patients Strongly Support Chiropractic

2010-04-20T17:41:00.000-07:00

Medicare Patients Give Chiropractic High Marks
Results from demonstration project suggest feasibility of expanding chiropractic services in the Medicare program.
By Peter W. Crownfield, Executive Editor

The long-awaited final report on the Centers for Medicare & Medicaid Services (CMS) chiropractic demonstration project, conducted from April 2005 through March 2007, is good news for chiropractic, with 87 percent of patients surveyed giving their doctor of chiropractic a score of 8 or higher when asked to rate their satisfaction with care (1-10 scale), and 56 percent rating their chiropractor a perfect 10.

Moreover, in all but one of the demonstration sites (metropolitan Chicago), health care costs did not increase significantly with the addition of chiropractic services.

The demonstration project, "Demonstration of Coverage for Chiropractic Services Under Medicare," was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The project evaluated the effects of expanding coverage of chiropractic services in four different regions of the country: Maine, New Mexico, 26 counties in northern Illinois and one county (Scott) in Iowa, and 17 counties in rural Virginia. Approximately 40 percent of eligible DCs in the four regions participated in the project at some point or another.

Key findings from the summary report, relative to patient experiences with chiropractic care and analysis of chiropractic-specific Medicare costs during the project, include the following. To review the report in its entirety, visit www.acatoday.org/pdf/demo_report.pdf.

"Medicare beneficiaries reported good relief of symptoms and high degrees of satisfaction with the chiropractic care they received."

"The most frequent reasons given for seeking care from chiropractors were favorable earlier experiences (59 percent) and insufficient relief of symptoms by prior treatments of other health professionals (39 percent)."

"Clinical problems involved the back in 78 percent, neck in 50 percent, hip in 38 percent, and shoulder in 32 percent. Pain was the most frequent symptom, followed by difficulty walking. ... Sixty percent of [survey] respondents indicated that they received 'complete' or 'a lot of' relief of symptoms from their chiropractic treatments."

"Chiropractic care was felt to be easily accessible, and nearly 95 percent of respondents indicated that they had to wait no more than one week for appointments. Similarly high proportions reported that chiropractors listened carefully and spent sufficient time with them."

"Among users of expanded chiropractic services, visits increased by 60 percent overall and related Medicare expenditures increased by $34.8 million. ... Essentially, all of the increased costs occurred in urban non-HPSA [Health Professional Shortage Areas] and in Illinois, and especially in Chicago and its suburbs."

"Illinois accounted for 80 percent of the total increase in costs and also had the highest per-person increases in costs of $485 per person compared with increases of $136 per person in Virginia and $35 per person in Maine, and decreases in the other two states." [Per-person costs decreased by $178 in Iowa and $59 in New Mexico.]

"The types of prior treatments received from other health care professionals differed strikingly from those received by chiropractors, including pain pills in 58 percent, pain injections in 30 percent, both pain pills and injections in 22 percent, and surgery in 12 percent. ... The high reported use of pain medications and surgery in treatments received from other types of health care professionals suggests the potential for achieving cost offsets [by using chiropractic care]."
The stated purpose of the demonstration project was "for evaluating the feasibility and advisability of covering chiropractic services under the Medicare program (in addition to the coverage provided for services consisting of treatment by means of manual manipulation to the spine to correct a subluxation described in section 1861(r)(5) of the Social Security Act." Chiropractic was defined as "care for neuromusculoskeletal conditions typical among eligible beneficiaries and diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which such treatment is provided." Chiropractic care needed to conform with CMS's policy for reimbursement of chiropractic services, meaning treatment was for active conditions with reasonable expectation of improvement or resolution. Maintenance and prevention services were excluded per the CMS policy.

For additional background information on the Demonstration of Coverage for Chiropractic Services Under Medicare project, read "Details of CMS Demonstration Project Revealed" in the April 9, 2005 issue.

Chiropractor, Fairfax VA 22031

Spinal manipulation is more effective for chronic low back pain

2010-04-15T06:13:00.000-07:00

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week.

Outcome measures were the Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6), assessed at baseline, discharge, and at 3, 6, and 12months. 205 patients completed the study. At discharge, the results showed that spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups; pain recurrences and drug intake were also reduced compared to back school or individual physiotherapy.

Reference: Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, Macchi C. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil 2010; 24: 26-36.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic

Treatment for Osteoporosis

2010-04-14T12:29:00.000-07:00

Article from ACAtoday...

Osteoporosis: Not Just An Elderly Disease

It used to be that osteoporosis was considered a disease that affected only the elderly. We particularly associated osteoporosis with older women whose backs were slightly hunched over or those who could no longer stand up straight. Today, the truth is that an estimated 20 million American women suffer from osteoporosis, and 80 percent of them don't even know it.

Osteoporosis is a chronic, progressive condition that steals bone from the body, leading to fractures of the hip, spine and wrist. Older people can suffer disability and even death from osteoporosis-related fractures. Alarmingly, one in two women and one in eight men will suffer from an osteoporosis-related fracture in his or her lifetime.

Many people confuse osteoporosis with arthritis, and wait for swollen joints and discomfort before being tested. Even though osteoporosis is painless until a bone fracture occurs, it is important to find out how healthy your bones are now and if need be, adjust your lifestyle to avoid this brittle bone disease. The American Chiropractic Association recommends the following tips to maintain healthy bones:
Start a regular exercise program. Walking, skipping rope, jogging, playing racquet sports, swimming and aerobics are all helpful in reducing the risk of osteoporosis. Exercising for 20 minutes, three times a week, is helpful.

Although weight lifting exercises are generally recommended, the National Osteoporosis Foundation says those suffering from osteoporosis should consult their health care practitioner before beginning a weight lifting program because excessive strain on the bones could result.

Those with severe osteoporosis and who have suffered from fractures may find Tai Chi, a form of martial arts, to be a beneficial strength training exercise system.

People suffering from osteoporosis should be careful when bending and lifting heavy objects, including grandchildren. Bend from the knees, not the waist, when lifting, and try to avoid hunching while sitting or standing.

Be sure to include calcium in your daily diet. The National Institutes of Health's recommendations are 1,000 mg/day for post-menopausal women taking estrogen; 1,500 mg/day for postmenopausal women not taking estrogen, and 1,500 mg/day for men and women over 65 years of age.

If you are looking for a calcium supplement, try one that's highly absorbable, such as microcrystalline hydroxyapatite concentrate (MCHC), or one of the malates, fumarates, succinates, glutarates, or citrates. But don't overdo it. Taking more than the recommended amount of calcium may cause kidney stones.

Consider taking additional nutritional supplements, such as vitamin D, C, magnesium, zinc and silica after consulting with your doctor of chiropractic.

Eat a healthy, balanced diet, including fresh vegetables, fruit, nuts and seeds. Try broccoli, kale, collard greens, cabbage and turnip greens. Experiment with tofu, salmon, sardines and grains. Low-fat milk and/or yogurt are good sources of calcium. (A glass of low-fat milk and a cup of yogurt add 600 mg of calcium to your daily diet.)

Drink 8 eight-ounce glasses of water a day (herb teas, juices and coffee are not a substitute for water.) Avoid caffeine, carbonated sodas, alcohol, baked goods and junk food.

Watch your animal protein intake.
Chiropractic Care Can Help...
Talk to your doctor of chiropractic about ways to improve the health of your bones. Doctors of chiropractic are licensed and trained to treat patients of all ages and can help people suffering from osteoporosis lead healthier lives.

Chiropractor, Fairfax VA 22031

Study shows little evidence of benefit for spinal fusion surgery

2010-04-08T07:39:00.000-07:00

More Medicare patients are having complex back surgery even when there’s often an easier, less risky and less costly fix, according to a study in the Journal of the American Medical Association. The rate of complex fusion surgery for spinal stenosis, which causes lower back pain, increased 15-fold from 2002 to 2007, according to the study.
The study and an accompanying editorial suggest that aggressive marketing by implant makers, and greater physician compensation for high-tech procedures, may be influencing treatment. Meanwhile, taxpayers bear the expense, and patients face increased risks.

There are non-surgical approaches and treatments for spinal stenosis or degenerative disc disease. The symptoms can be treated with exercise, weight loss, chiropractic, and physical therapy. A study in the BMC Musculoskeletal Disorders concluded that distraction manipulation (DM) and neural mobilization (NM) are viable alternative to surgery for patients with lumbar spinal stenosis (LSS), and compares favorably with other non-surgical approaches that have been studied. The study further suggest that “As the efficacy of surgery does not appear to decrease if it is delayed in favor of a non-surgical trial, most patients with LSS should be treated non-surgically for a period of time before considering operation. DM and NM may be one non-surgical option that can be offered to patients.”

References:
Murphy, DR, Hurwitz, EL. Gregory, AA, Clary, R. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study. BMC Musculoskelet Disord. 2006; 7: 16.

Deyo, RA, Mirza, SK, Martin, BI, Kreuter, W, Goodman, DC, Jarvik, JG. Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults. JAMA. 2010;303(13):1259-1265.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Chiropractic usage by intercollegiate athletes

2010-04-03T06:33:00.000-07:00

It's estimated that more than one-third of the American public uses the services of doctors of chiropractic and other complementary and alternative medicine (CAM) providers each year. Among those who take full advantage of CAM's benefits are professional athletes; in fact, many pro sports teams now have chiropractors and other CAM providers as part of their medical or training staff. A new study shows that chiropractic and other types of CAM are extremely popular among athletes on the college level as well.

In this study, researchers gave a survey to more than 300 college athletes attending a Division I school in Hawaii. The survey asked the athletes about their use of different types of CAM in the previous year, along with their use of traditional medical care. Fifty-six percent of the athletes reported using some type of CAM within the past 12 months, with more women using CAM than men. Chiropractic was the second most popular form of CAM, just behind massage; 29 percent of the athletes said they had used chiropractic at least once in the past year.

While considerable evidence suggests chiropractic can improve the performance of elite athletes, there's just as much evidence which shows chiropractic care is effective for a variety of everyday problems, too. Back pain, neck pain and migraine headaches are just a few of the many conditions that can be treated by a well-trained doctor of chiropractic.

Source: Nichols AW, Harrigan R. Complementary and alternative medicine usage by intercollegiate athletes. Clinical Journal of Sport Medicine May 2006;16(3):232-7.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Neuromuscular Training for Sports Injury Prevention: A Systematic Review

2010-03-25T06:46:00.000-07:00

A March 2010 systematic review conducted in Germany underscores the value of neuromuscular training in preventing sports injuries. The aim of this systematic review was to assess the effectiveness of proprioceptive/neuromuscular training in preventing sports injuries by using the best available evidence.

7 methodologically well-conducted studies were considered for this review. Pooled analysis revealed that multi-intervention training was effective in reducing the risk of lower limb injuries, acute knee injuries, and ankle sprain injuries. Balance training alone resulted in a significant risk reduction of ankle sprain injuries and a nonsignificant risk reduction for injuries overall. Exercise interventions were more effective in athletes with a history of sports injury than in those without.

They concluded that “On the basis of the results of seven high-quality studies, this review showed evidence for the effectiveness of proprioceptive/ neuromuscular training in reducing the incidence of certain types of sports injuries among adolescent and young adult athletes during pivoting sports.”

Source: Hubscher M, Zech A, Pfeifer K, Hansel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Medicine and Science in Sports and Exercise 2010 (Mar);42(3):413–421.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
www.laurelregionalchiropractic.com

Study Shows Chiropractic Helps Headaches

2010-03-19T08:20:00.000-07:00

A study published in the February 2010 issue of The Spine Journal provided additional evidence demonstrating the effectiveness of chiropractic for cervicogenic headaches.

In this study, 80 patients with chronic cervicogenic headaches were divided into three groups. Two of the groups received various forms of chiropractic adjustments, which the study authors called Spinal Manipulative Therapy (SMT), and one group received just a light massage so as to be able to compare the results. Results were calculated using standard pain scales. Data from the subjects was collected every 4 weeks for a 24 week period.

The researchers found that the groups that received chiropractic treatment showed significantly greater improvement in pain scores as compared to the group that got just light massage. Those receiving the chiropractic care were more likely to have a 50-percent improvement in their pain. The two groups of patients who received chiropractic care were only given either 8 or 16 chiropractic sessions. The study did see a slightly better response for the group receiving more adjustments, but due to the study parameters, no data was available beyond 16 visits.

In conclusion it states, “Our pilot study adds to an emerging picture of spinal manipulative therapy dose for the treatment of headache. It showed that a plateau in intervention effect might be found in the range of eight to 16 treatment sessions, although a dose effect at these treatment levels cannot be ruled out. The study also adds to the support of spinal manipulative therapy in moderate doses as a viable option for the treatment of chronic cervicogenic headaches.”

Source: Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose Response and Efficacy of Spinal Manipulation for Chronic Cervicogenic Headache: A Pilot Randomized Controlled Trial. Spine J. 2010(Feb);10(2):117-128.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Stevia- good alternative for diabetics

2010-03-13T06:26:00.000-08:00

For those who have been led to believe that various artificial sweeteners are perfectly safe and healthy are probably skeptical when a product comes out that is touted as a safe and natural way to sweeten a food or beverage without any calories, sugar, or unhealthy side effects.

But that seems to indeed be the case for Stevia, a plant with leaves that are ground up and consumed for just that purpose. Leaves from the Stevia plant have been found to be 100 times sweeter than sugar without all the negatives for those that need to cut back on sugar.

Although Stevia is approved as a food additive in many other countries, it is currently only approved in the U.S. as a dietary supplement. But leave it to the FDA to miss the boat when it comes to this potentially beneficial additive. In a market where sucralose and aspartame rule, with potentially harmful consequences, it does not appear that Stevia will be approved by itself as a food additive. Instead, a form of Stevia called Truvia has been approved.

The jury is still out on the true safety of Truvia. Instead of using the entire plant, Truvia is a sweetener based on two components of Stevia. For now, my suggestion is to cut out the artificial product that may or may not prove to be safe, and stick with the plant. It can be easily found in most health food stores as a dietary supplement. Just don't expect to see it in a local restaurant anytime soon.

Brian Lancaster, D.C.

Valley Chiropractic

Frederick, MD

Worst Habits That Hurt Your Back

2010-03-12T11:42:00.000-08:00

Back pain sends more patients to doctors than any condition other than the common cold. There are many possible causes of back pain, which means there are also many noninvasive solutions. It turns out that some seemingly insignificant everyday habits can take a big toll on your back over time. Here are some of the mistakes that may be causing your aches:

You're chained to your desk
Did you know that sitting puts 40 percent more pressure on your spine than standing? On a jam-packed day, regular stretching breaks may not seem like a wise way to spend your time. But skipping these habits may cause your back to suffer. That's because back muscles will weaken if you don't use them; inactive joints lose lubrication and age more quickly.
You have a long commute
Just like at your desk, hunching over a steering wheel can tighten chest muscles and cause your shoulders to round.
You've been ditching the gym
Get moving to alleviate aches and pains and fix back pain faster. New research shows that 40 percent of people become less active after back pain strikes—a strategy that's likely to delay healing or even make their condition worse.
You're Addicted to Crunches
Sit-ups and crunches may actually cause more back pain than they prevent. We hear all the time how a strong core protects your back, which is true. But crunches don't work the abdominal muscles that stabilize your back. In fact, they can contribute to pain by causing core imbalance.
You're not the healthiest eater
Finnish research found that people who suffered from back pain were more likely to have clogged arteries to the spine than healthy control subjects. Healthy circulation brings nutrients to the spine and removes waste. If this doesn't happen, inflammation can result, and inflammatory chemicals in the back can trigger nerves to send pain signals to the brain.
You carry your entire life in your purse
A stuffed-to-the-gills handbag may cause back damage that's comparable to a sports injury! When you tote a heavy bag, your shoulders become imbalanced. Your body elevates the shoulder carrying the bag, which throws your spine off-kilter. Doing this every day can cause back muscles to ache over time.
Your mattress is from another decade
A study at Oklahoma State University found that most people who switched to new bedding after five years slept significantly better and had less back pain.
Your bike isn't adjusted quite right
Do you routinely get a sore back after even a leisurely bike ride? You may need to adjust your equipment. Anywhere from 30 percent to 70 percent of bike riders experience some form of back pain. You don't need to give up on this great form of exercise, but you should make sure your bike is properly fitted for you.
You have a thing for high heels
Or even flip-flops. Both lead to foot instability, which can in turn affect your back. High heels force you to arch your back, making your spinal muscles work harder. Backless shoes like sandals cause your feet to move from side to side, which distributes your body weight unevenly and can cause pain.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Concussion in Sports New study

2010-03-08T13:23:00.000-08:00

Natural History of Concussion in Sport: Markers of Severity and Implications for Management

by Makdissi, M., Darby, D., Maruff, P., Ugoni, A., Brukner, P., McCrory, P. R.
Background
Evidence-based clinical data are required for safe return to play after concussion in sport.

Purpose
The objective of this study was to describe the natural history of concussion in sport and identify clinical features associated with more severe concussive injury, using return-to-sport decisions as a surrogate measure of injury severity.

Study Design
Cohort study (prognosis); Level of evidence, 3.

Methods
Male elite senior, elite junior, and community-based Australian Rules football players had preseason baseline cognitive testing (Digit Symbol Substitution Test, Trail-Making Test–Part B, and CogSport computerized test battery). Players were recruited into the study after a concussive injury sustained while playing football. Concussed players were tested serially until all clinical features of their injury had resolved.

Results
Of 1015 players, 88 concussions were observed in 78 players. Concussion-associated symptoms lasted an average of 48.6 hours (95% confidence interval, 39.5–57.7 hours) with delayed return to sport correlated with ≥4 symptoms, headache lasting ≥60 hours, or self-reported "fatigue/fogginess." Cognitive deficits using the Digit Symbol Substitution Test and Trail-Making Test–part B recovered concomitantly with symptoms, but computerized test results recovered 2 to 3 days later and remained impaired in 35% of concussed players after symptom resolution.

Conclusion
Delayed return to sport was associated with initially greater symptom load, prolonged headache, or subjective concentration deficits. Cognitive testing recovery varied, taking 2 to 3 days longer for computerized tests, suggesting greater sensitivity to impairment. Therefore, symptom assessment alone may be predictive of but may underestimate time to complete recovery, which may be better estimated with computerized cognitive testing

Temple Hills, MD

Study shows that Cold Laser Therapy helps Chronic Neck Pain Sufferers

2010-03-02T15:11:00.000-08:00

A new Australian study appeared in the journal Lancet shows that using cold laser therapy to treat chronic neck pain can be very effective.

Low-level laser therapy, also known as LLLT involves using a laser's light to stimulate tissue repair and ease pain. Lead researcher Roberta Chow of the Brain and Mind Research Institute at Australia's University of Sydney carried out an overview of 16 randomized trials that put this increasingly popular procedure to the test. 820patients were enrolled in the trials and divided into two groups: one that received either the therapy or other one that received a dummy treatment.

In five trials, the researchers found that patients given LLLT were around four times more likely to have reduced pain compared with a placebo. In the 11 other trials, for which there was a detailed analysis of pain symptoms, LLLT patients reported reductions of chronic pain by around 20 points on a scale of 100 points. The pain reduction continued for up to 22 weeks.

LLLT compares favorably with other drugs and remedies for effectiveness and its side-effects are mild, says the study. The researchers further suggested that low level laser therapy be used in combination with an exercise program for neck pain as well.

Original article: Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.” Lancet. 2009 Dec 5;374(9705):1897-908.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Repetitive Stress Injury & Chiropractic Care for Musicians

2010-02-20T09:14:00.000-08:00

Musicians are similar to athletes in that they put their efforts in perfecting their skills through endless practice. These sessions entail long hours of pushing the arm and hand muscles to exhaustion. Some may dismiss this as simply fatigue and with a few hours of rest will solve the problem. However, if the pain is persistent and you experience a stabbing pain in the forearm accompanied clumsiness and numbness of hand, then it is possible that you have a repetitive stress injury (RSI) due to prolonged training without sufficient breaks to properly rest the muscles. The National Institute of Occupational Safety and Health said that roughly 50% of the work force suffers from different forms of RSI. Musicians comprise a part of this statistic as they overuse their muscles in unidirectional movement patterns such as a guitarist. Other musicians commonly affected by such condition are flute and string players, and keyboardists. This condition is a horror story for any musician as this may dictate the end of their professional career.

Slight discomfort while playing an instrument may seem trivial at first, but for musicians this should not be neglected. Tell-tale signs should be considered with utmost concern because if RSI is treated in its early stage, your muscle will definitely heal faster. Always remember that in order to keep your music playing, a dose of chiropractic care is all you need.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Bike Fit using Video Motion Analysis Dartfish

2010-02-17T16:38:00.000-08:00

WEDNESDAY, FEBRUARY 17, 2010

Bike Fit using Video Motion Analysis Dartfish

Many injuries that occur as a result of ridding a bike can be traced back to poor bike positioning.

The first step to correcting a problem or gaining some watts on the bike is with a proper bike fit. There are many schools of thought and methods but I feel that SICI ( Serotta International Cycling Institute) has the best methods, training staff and the ability to know its reproducible. Using Video to analyze motion has been around for years the first exposure I had was working with Dr. Robert Roe a chiropractor that had worked at the Olympic training center in Colorado in the early 90 using a much more cumbersome and primitive form of analysis. At that time we were using it to evaluate work loads on patients. Now I have been using Dart fish to analyze bio-mechanics of all types of athletes. At SICI we trained using there fitting principles and High Def cameras to evaluate motion down to the smallest detail. It is a more dynamic fitting process that can breakdown movement to a much higher degree. When you add power and HR data things get even more interesting. The amount of information and precision is really remarkable. I have added a video of a fit I did in Northern Virginia of a Pro cyclist that is having a few problems even after several Bike fits by other professionals.

This is an example of a marker that was placed on his right leg that is short when compared to the left and is not tracking properly. The patient feels like his right leg is wobbly and dives in medialy on the power stoke. He notes hitting the top tube. I will also let you know that after the exam I also found very specific weak core strength that needed to be address. Using this software and combining that my physical exam finding I am able to find a new starting point to make small adjustments until the correct fit is obtained.

Temple Hills, MD

Effects of resistance training and chiropractic treatment in women with fibromyalgia

2010-02-12T13:50:00.000-08:00

A recent study has found that resistance training is more helpful for women with fibromyalgia if it is combined with chiropractic treatment.

The randomized controlled study aimed to evaluate resistance training and resistance training combined with chiropractic treatment on the impact and functionality of fibromyalgia in women. 21 women with fibromyalgia, who had an average age of 48 years, took part in the study. They were randomly assigned to either resistance training or resistance training combined with chiropractic treatment, with 10 women in the first group and 11 in the second. Both groups completed 16 weeks of resistance training consisting of 10 exercises performed two times per week. The group assigned to receive both resistance training and chiropractic treatment also received chiropractic treatment two times per week.

The results showed that both groups increased upper and lower body strength and there were similar improvements in fibromyalgia impact in both groups as well as the strength domains of the functionality assessment. However, only the group receiving resistance training combined with chiropractic treatment significantly improved in the pre- to post-functional domains of flexibility, balance and coordination, and endurance.

One factor in the beneficial effects of the chiropractic treatment may have been that many chiropractors perform some myofascial release as part of their treatments. Myofascial pain is a common problem with fibromyalgia and it can cause exercise to be more painful and less effective.

Original article by: Panton LB, Figueroa A, Kingsley JD, Hornbuckle L, Wilson J, John NS, Abood D, Mathis R, Vantassel J, McMillan V. Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia. J Altern Complement Med. 2009 Mar;15(3):321-8.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Effects of Strength Training for Women

2010-02-07T11:33:00.000-08:00

For women, strength training works muscles and mind

01/28/2010

Older women who do one to two hours of strength training per week may stave off cognitive impairments associated with aging, according to a study published this week in the Archives of Internal Medicine.

For the study, researchers from the University of British Columbia in Vancouver and colleagues assigned 155 women ages 65 to 75 to a once-weekly or twice-weekly resistance training workout program or a twice-weekly balance and tone training exercise regimen. They found that after one year, women in the resistance-training groups improved their performance on cognitive tests by 10.9% to 12.6%, while women in the balance and tone group saw a 0.5% decline.

According to researchers, the results show that resistance training may not only improve muscular function in older women but also enhance cognitive functions, including selective attention, decision making and conflict resolution. They conclude that the findings have important clinical implications because there is currently no effective pharmaceutical treatment for cognitive impairment and resistance training is not a widespread practice among elderly individuals (Liu-Ambrose et al., Archives of Internal Medicine, 1/25 [subscription required]; Rabin, New York Times, 1/25 [registration required]; Gever, MedPage Today, 1/26).

Chiropractor Fairfax VA 22031

The Benefits of Stretching

2010-02-05T14:18:00.000-08:00

The muscles tighten as a person ages which can lead to a decrease in range of joint movements. That is why as the person grows older, bending or flexing becomes more limited. This is why stretching regularly, as part of a routine is very important. Simple stretches can be done everyday and can be easily incorporated in your daily activities. It does not require much of your time. So how can stretching help with your overall health?

Regular stretching exercises can lengthen the muscles and the tendons which can help in increasing the range of your movement. Stretching can prevent injury to joints, tendons, and muscles. When the muscles and tendons are well-flexed, they are considered in good working order. The muscles of the body will be able to take more exhausting and rigorous movements with less probability of being injured. If the muscles are given their regular exercises and stretching, it is less likely that they will contract. This will definitely relieve you of any muscle pain or problems.

A research article appeared in the October 2009 issue of the American Journal of Physiology-Heart and Circulatory Physiology suggests that flexibility, as defined by how far you can reach while sitting down, may be linked to the stiffness of your arteries. It’s known that arterial stiffness often precedes life-threatening cardiovascular disease. Researchers don’t know why flexibility might be linked to arteries. One theory is that people who are more flexible do stretching exercises that help slow down stiffening of the arteries. So give your tight muscles a good stretch as it could help your heart!

At Laurel Regional Chiropractic, we not only help our patients learn the proper stretching techniques but we also tailor stretches and exercises to each individual patient in regards to what they do all day.

Dr. David Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Short-Term Effects of Cervical Kinesio Taping on Pain and Cervical Range of Motion in Patients With Acute Whiplash Injury: A Randomized Clinical Trial

2010-01-29T21:41:00.000-08:00

The purpose of this study was to compare the short-term effects of a Kinesio Taping application to the cervical spine versus placebo tape application on both neck pain and cervical range of motion in patients with acute whiplash-associated disorders (WADs).

Forty-one patients (21 females) were randomly assigned to 1 of 2 groups: the experimental group received Kinesio Taping to the cervical spine (applied with tension) and the placebo group received a sham Kinesio Taping application (applied without tension). Both neck pain and cervical range-of-motion data were collected at baseline, immediately after the Kinesio Tape application, and at a 24-hour follow-up by an assessor blinded to the treatment allocation of the patients.

The results indicated that patients receiving Kinesio Taping experienced a greater decrease in pain immediately postapplication and at the 24-hour follow-up. Patients in the experimental group obtained a greater improvement in range of motion than those in the control group.

Original article published in J Orthop Sports Phys Ther. 2009;39(7):515-521

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic
http://www.laurelregionalchiropractic.com/

Chronic pain can add the effect of 20 to 30 years of age.

2010-01-25T08:40:00.000-08:00

A study in the Journal of the American Geriatric Society reports that middle aged people with pain develop limits to their ability to function normally associated with people 20 to 30 years older.

The four physical abilities examined were: walking or jogging; stair climbing; ability to perform tasks with the shoulders and arms; and activities of daily living (bathing, dressing, eating etc).

24% of participants had significant pain (often troubled by pain that was moderate or severe most of the time) and across all four physical abilities looked at, participants with pain had much higher rates of functional limitations than subjects without pain. In the mobility function, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile and 91% were able to walk several blocks without difficulty. In the subjects with pain, only 9% could jog a mile and only 50% were able to walk several blocks.

The lead author of the study, Dr. Kenneth Covinsky of the Division of Geriatrics at University of California, San Francisco: “We found that the abilities of those aged 50 to 59 with pain were far more comparable to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile and 55% were able to walk several blocks, making pain sufferers appear 20 to 30 years older than non-pain sufferers,” surmised Covinsky. “After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations.”

It's not unusual for me in my Silver Spring office to see patients who've been ignoring pain for long periods of time. Sometimes years, sometimes decades. While there are few things as satisfying as removing a decade-old pain, it's always striking how long people will tolerate pain. People often convince themselves that it's normal. Sometimes a past doctor who wasn't effective at removing the pain will convince them it's normal. While I of course can't help everyone, if I can't help you I'll do my best to figure out who can. Pain that effects your quality of life is not normal. You deserve to not have pain. The people in your life will be happier to see the pain free version of yourself. You'll make the lives of those closest to you easier. While it's admirable to be able to function under duress, this paper study suggests that long time pain will eventually wear you down and limit your life. If you've questions on any type of pain, on any treatment feel free to call or email one of us.

ABSTRACT
OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.

DESIGN: Cross-sectional study.

SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.

PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS.

MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).

RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20–3.69, for mobility; AOR=2.84, 95% CI=2.48–3.26, for stair climbing; AOR=3.96, 95% CI=3.43–4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71–5.06, for ADL function).

CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

Treatment for Sciatica in Fairfax, VA

2010-01-24T20:13:00.000-08:00

Featured article from the ACA...

Sciatica

Sciatica describes persistent pain felt along the sciatic nerve, which runs from the lower back, down through the buttock, and into the lower leg. The sciatic nerve is the longest and widest nerve in the body, running from the lower back through the buttocks and down the back of each leg. It controls the muscles of the lower leg and provides sensation to the thighs, legs, and the soles of the feet.

Although sciatica is a relatively common form of low-back and leg pain, the true meaning of the term is often misunderstood. Sciatica is actually a set of symptoms—not a diagnosis for what is irritating the nerve root and causing the pain.

Sciatica occurs most frequently in people between the ages of 30 and 50 years old. Most often, it tends to develop as a result of general wear and tear on the structures of the lower spine, not as a result of injury.

What are the symptoms of sciatica?
The most common symptom associated with sciatica is pain that radiates along the path of the sciatic nerve, from the lower back and down one leg; however, symptoms can vary widely depending on where the sciatic nerve is affected. Some may experience a mild tingling, a dull ache, or even a burning sensation, typically on one side of the body.

Some patients also report:
• A pins-and-needles sensation, most often in the toes or foot
• Numbness or muscle weakness in the affected leg or foot

Pain from sciatica often begins slowly, gradually intensifying over time. In addition, the pain can worsen after prolonged sitting, sneezing, coughing, bending, or other sudden movements.

How is sciatica diagnosed?
Your doctor of chiropractic will begin by taking a complete patient history. You’ll be asked to describe your pain and to explain when the pain began, and what activities lessen or intensify the pain. Forming a diagnosis will also require a physical and neurological exam, in which the doctor will pay special attention to your spine and legs. You may be asked to perform some basic activities that will test your sensory and muscle strength, as well as your reflexes. For example, you may be asked to lie on an examination table and lift your legs straight in the air, one at a time.

In some cases, your doctor of chiropractic may recommend diagnostic imaging, such as x-ray, MRI, or CT scan. Diagnostic imaging may be used to rule out a more serious condition, such as a tumor or infection, and can be used when patients with severe symptoms fail to respond to six to eight weeks of conservative treatment.

What are my treatment options?
For most people, sciatica responds very well to conservative care, including chiropractic. Keeping in mind that sciatica is a symptom and not a stand-alone medical condition, treatment plans will often vary depending on the underlying cause of the problem.

Chiropractic offers a non-invasive (non-surgical), drug-free treatment option. The goal of chiropractic care is to restore spinal movement, thereby improving function while decreasing pain and inflammation. Depending on the cause of the sciatica, a chiropractic treatment plan may cover several different treatment methods, including but not limited to spinal adjustments, ice/heat therapy, ultrasound, TENS, and rehabilitative exercises.

An Ounce of Prevention Is Worth a Pound of Cure
While it’s not always possible to prevent sciatica, consider these suggestions to help protect your back and improve your spinal health.

• Maintain a healthy diet and weight
• Exercise regularly
• Maintain proper posture
• Avoid prolonged inactivity or bed rest
• If you smoke, seek help to quit
•Use good body mechanics when lifting

Chiropractor Fairfax, VA 22031

Athletes Enhance Physical Performance With Chiropractic Care

2010-01-21T07:26:00.000-08:00

What do Barry Bonds, Tiger Woods, Andy Roddick, and Lance Armstrong have in common? They are incredibly accomplished athletes that have used chiropractic care as a key ingredient to their success.

The fact is that more professional athletes are under chiropractic care than ever before. Even more revealing is the increased use of regular chiropractic care for the entire professional teams. In fact, Chiropractic Economics reported that over 95% of teams in the NFL use chiropractors as a regular part of player care.

Some professional athletes pay personal chiropractors to give treatment before, during, or after a game. Barry Bonds, one of the best all time baseball players, has a personal chiropractor who travels to games. Barry Bonds has incorporated chiropractic into his lifestyle. He reportedly said, “I think it should be mandatory to see a chiropractor and massage therapist.”

Professional athletes get three main benefits with chiropractic care: to prevent injury, manage injury, and to enhance physical performance.

A research study conducted by Drs. Anthony Lauro and Brian Mouch, published in the Journal of Chiropractic research and Clinical Investigation in 1991, indicated chiropractic care might improve athletic performance by as much as 16.7% over a two week period. The report also concluded that subluxation-free athletes react faster, coordinate better, execute fine movements with improved accuracy and precision, amounting to an overall better athlete. Another study in the Journal of Vertebral Subluxation Research in 1997 revealed that chiropractic care increases an athlete’s capillary count. This means increased blood flow and more oxygen to the body.

It is strongly recommended that both professional and amateur athletes look into chiropractic and to see how it can help them perform to their potential.

Dr. David P. Chen
Chiropractor at Laurel Regional Chiropractic
Laurel, Maryland

Vitamin D Deficiency (Part 2)

2010-01-19T18:00:00.000-08:00

In part one of the vitamin D discussion, I reviewed how highly prevalent a vitamin D deficiency is, even in southern areas in the country with warmer climates. I mentioned that the current recommended dosage appears to be significantly lower that evidence suggests would be a necessary minimum dosage, and concluded that the best way to determine the necessary dosage is to be tested.

Currently, the two lab tests are 1,25(OH)D, and 25(OH)D. The later, which is also referred to as 25-hydroxyvitamin D, appears to indicate a true deficiency with more accuracy. The range of normal levels in the test is 20-56 ng/ml. However, even the low end of the normal range is probably too low. A more appropriate normal range appears to be at the high end, closer to the 56 ng/ml.

So what happens when you are low? First of all, join the club. So many of us, myself included, have tested deficient. The obvious solution is to get more sun exposure when possible. However, in some climates that is easier said than done. This is where oral supplementation comes in. Two possible supplements exist. One is cholecalciferol, otherwise known as D3, and ergocalciferol, known as D2. Research indicates that D3 is the better option, since the body is able to use it more effectively. Once supplementation begins, lab results should be monitored closed, every 4-6 months at first, until the optimal dosage becomes clear.

The good news is that this is a problem that, when properly identified and managed, is fairly easy to treat and control. A little vitamin D can go a long way to helping you live a longer, healthier life.

Brian Lancaster, D.C.

Valley Chiropractic in Frederick, MD

Complementary and alternative medicine use among US Navy and Marine Corps personnel

2010-01-15T08:50:00.000-08:00

Throughout the years in Greenbelt, MD I have seen many military and government service personnel. Recently, chiropractic care has been fully integrated into the United States Armed Services and the Veterans Health Care Administration. I say it's about time that our best and bravest get the care they so much deserve.
-LC

Background

Recently, numerous studies have revealed an increase in complementary and alternative medicine (CAM) use in US civilian populations. In contrast, few studies have examined CAM use within military populations, which have ready access to conventional medicine. Currently, the prevalence and impact of CAM use in US military populations remains unknown.

Methods

To investigate CAM use in US Navy and Marine Corps personnel, the authors surveyed a stratified random sample of 5,000 active duty and Reserve/National Guard members between December 2000 and July 2002. Chi-square tests and multivariable logistic regression were used to assess univariate associations and adjusted odds of CAM use in this population.

Results and discussion

Of 3,683 service members contacted, 1,446 (39.3%) returned a questionnaire and 1,305 gave complete demographic and survey data suitable for study. Among respondents, more than 37% reported using at least one CAM therapy during the past year. Herbal therapies were among the most commonly reported (15.9%). Most respondents (69.8%) reported their health as being very good or excellent. Modeling revealed that CAM use was most common among personnel who were women, white, and officers. Higher levels of recent physical pain and lower levels of satisfaction with conventional medical care were significantly associated with increased odds of reporting CAM use.

Conclusion

These data suggest that CAM use is prevalent in the US military and consistent with patterns in other US civilian populations. Because there is much to be learned about CAM use along with allopathic therapy, US military medical professionals should record CAM therapies when collecting medical history data.

-Dr. Louis S. Crivelli II

Chiropractor

Greenbelt, MD

Good art decreases pain. Bad art, not so much.

2010-01-15T07:39:00.000-08:00

A recent study from Con sciousness and Cognition found that people looking at art they considered beautiful allowed them to distract themselves from a painful stimuli. They used a laser (not to be confused with the pain-relieving cold laser therapy available at most of our offices) and then directly measured brain waves activated when pain is occurring as well as the subjects opinion on the pain. Neutral or ugly art neither increased or decreased pain on average. Favorites as beautiful were "Starry Night" by Vincent Van Gogh and Botticellis "Birth of Venus", Picasso's work was often chosen as ugly. Interestingly, a few labelled Edward Munch's "The Scream" as beautiful, and noticed pain lessened while looking at it. As doctors focused on relieving pain, we are focused on any reasonable means of reducing pain, and there's certainly no harm in enjoying the art. In addition to encouraging people with pain to use art as a way of feeling better, it has other applications too. Men who are asked their opinion of china patterns, fabric swatches or paint samples could offer concrete evidence that they have absolutely no aesthetic preference. I would personally find this less painful than traditional alternatives. Art critics who claim an uncoventional art is beautiful could have their brain waves measured to see if they're telling the truth, or just being pretentious. If you've got a question on therapy for pain; conventional, unconventional or completely outside the box, feel free to ask any of our doctors.

Effects of Biofreeze and chiropractic adjustments on acute low back pain: a pilot study.

2010-01-14T07:02:00.000-08:00

Objective
The specific aims of the study were to study the effectiveness of Biofreeze combined with chiropractic adjustments on acute low back pain (LBP) compared with chiropractic care only. The hypothesis was that Biofreeze enhances the effect of chiropractic adjustments on acute LBP.

Methods
The data were collected at the baseline, 2 weeks after treatment, and 4 weeks after treatment for final analyses. Diversified manual adjustments were provided by licensed chiropractors twice a week for 4 weeks to both control and experimental groups. Biofreeze was applied to the lower back area 3 times a day for 4 weeks in the experimental group. For at-home care, subjects were instructed to apply Biofreeze 3 times a day as follows: Using a 5-g sample pack, subjects were instructed to apply Biofreeze to the low back once in the morning and 2 times in the afternoon. For evening application, subjects were instructed to apply once in the late afternoon, once in the evening, and once at bedtime. Outcome assessments included visual analog scale, Roland Morris Disability Questionnaire, heart rate variability for stress, and electromyography for low back muscle activity.

Results
A total of 36 subjects were recruited in the study (25 male). The average age was 34 years. Significant pain reduction was found after each week of treatment in the experimental group (P < .05). The Roland Morris Disability Questionnaire did not show significant changes in both groups. There were no significant differences for pain reduction in the control group. Heart rate variability analysis showed no significant change (P > .05) in the experimental group after 4 weeks of Biofreeze and chiropractic adjustments. There were no statistically significant changes in the electromyography readings between the 2 groups.

Conclusion
Biofreeze combined with chiropractic adjustment showed significant reduction in LBP. Biofreeze cooling gel gives rise to the cooling sensation without lower skin temperature because of the unique characteristic of menthol, which is one of the main ingredients. It is clear that the cooling effect of Biofreeze is different from the application of cold. It is possible that menthol stimulates the peripheral sensory receptors to inhibit pain through the gate control mechanisms.

Original article by: Zhang J, Enix D, Snyder B, Giggey K, Tepe R. J Chiropr Med. 2008 Jun;7(2):59-65.

Dr. David P. Chen
Chiropractor at Laurel Regional Chiropractic
Laurel, Maryland

Vitamin D deficiency (Part 1)

2010-01-13T09:16:00.000-08:00

As we learn more about the growing problem of Vitamin D deficiency, we are finding that the current recommendations for intake are insufficient. Currently 400 IU of Vitamin D is recommended in order to prevent pathology resulting from a deficiency. However, many studies are finding that a daily intake of over 10 times that amount is needed to affect other, seemingly unrelated diseases, such as breast cancer, colon cancer, osteoporosis, diabetes, and hypertension.

The difficulty with making recommendations in the past is that it can vary widely since the body can produce Vitamin D from sunlight. This has led many to assume that his or her individual exposure is adequate. Research is showing otherwise*. An alarmingly large number of patients are showing deficiency in labwork.

I say this as a person that has tested deficient recently. Like everyone else, I suffer from the belief that eating, sleeping, and exercising adequately should suffice. The results show that I was wrong.

Based off preliminary findings, it is safe to assume that many people need a daily intake in excess of 4,000 IU of Vitamin D. The only way to truly know what the correct intake needed is to be tested.

Stay tuned for more information on laboratory tests, and how to proceed when a deficiency is noted.

* http://ods.od.nih.gov/factsheets/vitamind.asp

Dr. Brian Lancaster

Valley Chiropractic in Frederick, MD

Alpha-Lipoic Acid and Gamma Linolenic Acid Supplementation plus Physical Rehab Improves Neuropathic Symptoms in Patients with Radicular Neuropathy More Effectively Than Rehab Alone

2010-01-12T06:07:00.000-08:00

Keywords:BACK PAIN, RADICULAR NEUROPATHY, CHRONIC PAIN, NEUROPATHIC PAIN, NERVE ROOT COMPRESSION, INTERVERTEBRAL DISC INJURY - Alpha-Lipoic Acid, Gamma Linolenic Acid, Physical Rehabilitation

Reference:“The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life,” Ranieri M, Sciuscio M, et al, Int J Immunopathol Pharmacol, 2009; 22(3 Suppl): 45-50. (Address: Physical Medicine and Rehabilitation Unit, Neurological and Psychiatric Sciences Department, Aldo Moro University, Bari 70124, Italy. E-mail: ranieri@neurol.uniba.it ).

Summary:In a study involving 203 patients with back pain including compressive radiculopathy syndrome from disc-nerve root conflict, supplementation with alpha-lipoic acid (600 mg/d) and gamma-linolenic acid (360 mg), along with participating in a physical rehabilitation program for a period of 6 weeks was found to be more effective than patients who were treated with the physical rehabilitation program alone. Specifically, those who received the ALA + GLA were found to have significantly greater improvements in paresthesias, stabbing and burning pain, Oswestry Low Back Pain Disability Questionnaire, Aberdeen Low Back Pain Scale, and improvements in quality of life, assessed via the SF-36, Revised Leeds Disability Questionnaire, and the Roland and Morris disability questionnaire. The authors conclude, “Oral treatment with alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA) for six weeks in synergy with rehabilitation therapy improved neuropathic symptoms and deficits in pa tients with radicular neuropathy.”

Vitamin D Deficiency May Contribute to Musculoskeletal Pain

2010-01-08T13:35:00.000-08:00

Almost on a daily basis at my office in Germantown, MD, I see patients who commonly present with idiopathic musculoskeletal pain, or in plain english, physical pain of an unknown origin. Despite the high incidence and potential consequences of such pain, precise diagnosis and effective treatment are not always easily attained.

Additionally, extremely low levels of vitamin D, known as hypovitaminosis D, may be a cause of nonspecific musculoskeletal pain that goes undetected, leading to more severe consequences, such as softening of the bones, which occurs in osteomalacia.

In a study designed to evaluate the prevalence of hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain, researchers screened 150 consecutive patients (ages 10-65) who presented to a primary care clinic between February 2000 and June 2002 with complaints of idiopathic musculoskeletal pain. Patients had no known health condition that would decrease production or absorption of vitamin D, and none had fibromyalgia, temporomandibular disorder or complex regional pain syndrome that could account for their musculoskeletal pain.

Rates of vitamin D deficiency were "unexpectedly high," according to the authors, "particularly in this population of nonelderly, nonhousebound, primary care outpatients." Overall, 28% of patients had severely deficient vitamin D levels; 55% of those individuals were younger than age 55. These deficiencies were similar for men and women, and season was not a significant variable in determining vitamin D levels.

Conclusion: "All patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D," state the authors. "Because osteomalacia is a known cause of persistent, nonspecific non-musculoskeletal pain, screening all outpatients with such pain for hypovitaminosis D should be standard practice in clinical care."

Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clinic Proceedings 2003;78:1463-70.

Dr. Michael Cramer

Cramer Chiropractic & Rehabilitation

Germantown, MD

4 WAYS TO SHED BELLY FAT

2010-01-07T12:16:00.000-08:00

1. Exercise- You can't exercise to spot reduce, but it will help you shed excess pounds -- and often, the fat your body sheds first comes from your belly. Abdominal crunches can help tone muscles to make your stomach look flatter, but to truly get rid of fat, you have to burn it off through aerobic activity.

2. Be a mindful eater- Researchers are currently investigating whether really paying attention to what you eat can help redistribute body fat from your waist to your hips. Plenty of studies, though, have shown that mindful eating can help with weight loss efforts.

3. Get adequate amounts of sleep- Too little sleep (less than six hours) or too much (more than eight hours) results in an excess production of the stress hormone cortisol. This hormone promotes the storage of fat in the belly.

4. Reduce stress- Penciling in 15 minutes a day for relaxation can also lower your cortisol levels, helping you shed belly fat. Deep breathing, a stroll outdoors under the blossoming trees, or a bubble bath can help you leave the world behind.

Dr. John Rosa
Chiropractor
Rockville, MD

2010-01-06T22:17:00.000-08:00

A Comparison Between Chiropractic Management and Pain Clinic Management for Chronic Low-back Pain in a National Health Service Outpatient Clinic

OBJECTIVE: To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain (CLBP) when managed in a hospital by either a regional pain clinic or a chiropractor. DESIGN: The study was a pragmatic, randomized, controlled trial.

SETTING: The trial was performed at a National Health Service (NHS) hospital outpatient clinic (pain clinic) in the United Kingdom.

SUBJECTS AND INTERVENTIONS: Patients with CLBP (i.e., symptom duration of >12 weeks) referred to a regional pain clinic (outpatient hospital clinic) were assessed and randomized to either chiropractic or pain-clinic management for a period of 8 weeks. The study was pragmatic, allowing for normal treatment protocols to be used. Treatment was administered in an NHS hospital setting.

OUTCOME MEASURES: The Roland-Morris Disability Questionnaire (RMDQ) and Numerical Rating Scale were used to assess changes in perceived disability and pain. Mean values at weeks 0, 2, 4, 6, and 8 were calculated. The mean differences between week 0 and week 8 were compared across the two treatment groups using Student's t-tests. Ninety-five percent (95%) confidence intervals (CIs) for the differences between groups were calculated.

RESULTS: Randomization placed 12 patients in the pain clinic and 18 in the chiropractic group, of which 11 and 16, respectively, completed the trial. At 8 weeks, the mean improvement in RMDQ was 5.5 points greater for the chiropractic group (decrease in disability by 5.9) than for the pain-clinic group (0.36) (95% CI 2.0 points to 9.0 points; p = 0.004). Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group (p = 0.023).

CONCLUSIONS: This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a subpopulation of patients with chronic low-back pain.

Original article published by: Wilkey A, Gregory M, Byfield D, McCarthy PW. J Altern Complement Med. Jun 2008; 14(5): 465-473.

Dr. David P. Chen
Chiropractor at Laurel Regional Chiropractic
Laurel, Maryland

Barefoot running may be better

2010-01-06T18:53:00.000-08:00

Years ago, a friend from karate showed me a magazine ad for a shoe designed to be worn for karate. "But we're all barefoot! Everyone runs, jumps, breaks boards and (outside of when we kick trees) no one's needed them in the history of the art before. Grandmaster's been stomping around for 50 some years barefoot, and he doesn't need any shoes. Why would someone need them now?" My answer is that it wasn't driven by anyone's need for shoes, but by someone's desire to sell shoes. Recent research bears me out. It has been suggested that for running, conventional "neutral" running shoes may cause some of the knee/leg/ankle/hip problems that some runners see. This article in the American Academy of Physical Medicine and Rehabilitation suggests that barefoot runners may have less torque, suggesting less damage, to critical areas in the ankle, knee and hip. The article recommended that future design be closer to barefoot than current conventional running shoe design. In my practice, my goal for patients who exercise is always to find a way for them to keep exercising the way they wish to. I'm grateful that advancing research keeps giving insight into how to make this possible.

Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment

2010-01-06T09:49:00.000-08:00

This wonderful study demonstrates that the immune system can be positively effected with an adjustment. Empirical evidence has suggested this for years, but it's nice to see some objective studies starting to back it up. In Takoma Park, MD I make sure to tell my patients to get adjusted when they feel a cold "coming on".

-PT

Background

Increasing evidence supports somato-visceral effects of manual therapies. We have previously demonstrated that a single spinal manipulative treatment (SMT) accompanied by audible release has an inhibitory effect on the production of proinflammatory cytokines in asymptomatic subjects. The purpose of this study is to report on SMT-related changes in the production of the immunoregulatory cytokine interleukin 2 (IL-2) and to investigate whether such changes might differ with respect to the treatment approach related to the presence or absence of an audible release (joint cavitation).

Methods

Of 76 asymptomatic subjects, 29 received SMT with cavitation (SMT-C), 23 were treated with SMT without cavitation (SMT-NC) and 24 comprised the venipuncture control (VC) group. The SMT-C and SMT-NC subjects received a single, similar force high velocity low amplitude manipulation, in the upper thoracic spine. However, in SMT-NC subjects, positioning and line of drive were not conducive to cavitation. Blood and serum samples were obtained before and then at 20 and 120 min post-intervention. The production of IL-2 in peripheral blood mononuclear cell cultures was induced by activation for 48 hr with Staphylococcal protein A (SPA) and, in parallel preparations, with the combination of phorbol ester (TPA) and calcium ionophore. The levels of IL-2 in culture supernatants and serum were assessed by specific immunoassays.

Results

Compared with VC and their respective baselines, SPA-induced secretion of IL-2 increased significantly in cultures established from both SMT-C and SMT-NC subjects at 20 min post-intervention. At 2 hr post-treatment, significant elevation of IL-2 synthesis was still apparent in preparations from SMT-treated groups though it became somewhat attenuated in SMT-NC subjects. Conversely, IL-2 synthesis induced by TPA and calcium ionophore was unaltered by either type of SMT and was comparable to that in VC group at all time points. No significant alterations in serum-associated IL-2 levels were observed in any of the study groups.

Conclusion

The present study demonstrates that, the in vitro T lymphocyte response to a conventional mitogen (SPA), as measured by IL-2 synthesis, can become enhanced following SMT. Furthermore, within a period of time following the manipulative intervention, this effect may be independent of joint cavitation. Thus the results of this study suggest that, under certain physiological conditions, SMT might influence IL-2-regulated biological responses.

-Dr. Paul Tetro

Chiropractor

Takoma Park, MD

Professional Athletes Utilize Chiropractic Care

2010-01-05T10:04:00.000-08:00

NFL Game Day Morning recently included on the show how Jacksonville Jaguar running back Maurice Jones-Drew utilizes chiropractic care to help him heal and perform better. Although the coverage was great, this is nothing new when it comes to professional athletes incorporating chiropractic.

In the recent past, chiropractic care has been utilized by many professional athletes, including Muhammad Ali, Nolan Ryan, Kareem Abdul-Jabbar, Carl Lewis, Barry Bonds, Emmitt Smith, and Joe Montana. Jerry Rice once stated that "chiropractic care has been instrumental in my life, both on and off the field. . ."

As someone that races mountain bikes on a non-professional level, even I have been quite grateful to have immediate chiropractic care after a race. The jarring during a long ride or race can often cause my upper neck to tighten, leading to a headache. Having someone help correct the damage I know I am inflicting on myself with the sport I enjoy is certainly helpful!

But the question is why everyone, regardless of sport activity level, doesn't utilize chiropractic care. I'm not just referring to reducing symptoms, but providing a boost in performance. We may not all get to play for the Jacksonville Jaguars, but we all have people that depend on us.

Brian Lancaster, D.C.
Valley Chiropractic
Frederick, MD

Kinesio Tape in Alexandria VA

2010-01-05T09:15:00.000-08:00

What is Kinesio Tape?

For over 25 years, Kinesio has provided comfort and stability to our loyal users. Kinesio Tape offers patients a more gentle approach to rehabilitation than those provided by conventional athletic tape. On the heels of our unprecedented publicity and positive feedback from the 2008 Olympic Games in Beijing, we here at Kinesio would like to invite you to experience what athletes and medical practitioners around the world are calling the rehabilitative and enhancement tool. I have worked with Kinesio tape for over 10 Years and am a certified Kinesio taping practitioner.

Kinesio Tape is a Latex free, non-medicated, thin, porous cotton fabric with a medical grade acrylic adhesive. The tape is comprised of elastic qualities which are designed for a 30-40% longitudinal only stretch when applied. Our bodies were designed to move and the Kinesio Taping Technique promotes movement and motion. With Kinesio Tape, we are not only limited to supporting and stabilizing musculature, but allowed to provide rehabilitation while encouraging movement!

How it Works:

The technique relies heavily on insertions and origins of muscles. The built-in stretch of the tape can help stabilize injured muscles, support fatigued, weakened and/or strained muscles, and can also help facilitate a stretch for those muscles in spasm.

In addition to muscle support, Kinesio Tape can lift the skin to increase the space between the skin and muscle. This reduced localized pressure in the affected area helps promote circulation, lymphatic drainage, and lessen the irritation on the subcutaneous neural pain receptors. As an end result, the Kinesio Taping Technique reduces pain and inflammation.

Since the introduction of Kinesio Tape in the United States, medical practitioners such as PTs, ATCs, OTs, DCs, MTs and MDs have recognized and embraced this effective, safe and best of all, easy-to-use modality. The method and tape allow the individual to receive the therapeutic benefits 24 hours a day with both comfort and ease because it can be worn for several days per application. Currently, Kinesio Tape is being used in hospitals, clinics, high schools, colleges, professional sports teams, and even at the Olympic level

Alexandria, VA

Arthritis Treatment

2010-01-04T15:28:00.000-08:00

Another great article from ACA today...

Don't Take Arthritis Lying Down

Years ago, doctors hardly ever told rheumatoid arthritis patients to "go take a hike" or "go for a swim." Arthritis was considered an inherent part of the aging process and a signal to a patient that it's time to slow down. But not so anymore. Recent research and clinical findings show that there is much more to life for arthritis patients than the traditional recommendation of bed rest and drug therapy.

What Is Rheumatoid Arthritis?
The word "arthritis" means "joint inflammation" and is often used in reference to rheumatic diseases. Rheumatic diseases include more than 100 conditions, including gout, fibromyalgia, osteoarthritis, psoriatic arthritis, and many more. Rheumatoid arthritis is also a rheumatic diseases, affecting about 1 percent of the U.S. population (about 2.1 million people.)1 Although rheumatoid arthritis often begins in middle age and is more frequent in the older generation, it can also start at a young age.

Rheumatoid arthritis causes pain, swelling, stiffness, and loss of function in the joints. Several features distinguish it from other kinds of arthritis:
-Tender, warm, and swollen joints.
-Fatigue, sometimes fever, and a general sense of not feeling well.
-Pain and stiffness lasts for more than 30 minutes after a long rest.
-The condition is symmetrical. If one hand is affected, the other one is, too.
-The wrist and finger joints closest to the hand are most frequently affected. Neck, shoulder, elbow, hip, knee, ankle, and feet joints can also be affected.
-The disease can last for years and can affect other parts of the body, not only the joints.2
-Rheumatoid arthritis is highly individual. Some people suffer from mild arthritis that lasts from a few months to a few years and then goes away. Mild or moderate arthritis have periods of worsening symptoms (flares) and periods of remissions, when the patient feels better. People with severe arthritis feel pain most of the time. The pain lasts for many years and can cause serious joint damage and disability.

Should Arthritis Patients Exercise?
Exercise is critical in successful arthritis management. It helps maintain healthy and strong muscles, joint mobility, flexibility, endurance, and helps control weight. Rest, on the other hand, helps to decrease active joint inflammation, pain, and fatigue. For best results, arthritis patients need a good balance between the two: more rest during the active phase of arthritis, and more exercise during remission.2 During acute systematic flares or local joint flares, patients should put joints gently through their full range of motion once a day, with periods of rest. To see how much rest is best during flares, patients should talk to their health care providers.3

The following exercises are most frequently recommended for patients with arthritis:*

Type of Exercise Benefits Frequency of Exercise
Range-of-motion exercises, e.g. stretching and dance Help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day.
Strengthening exercises, e.g. weight lifting Help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe.

Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming Help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe.

Range-of-motion exercises, e.g. stretching and dance Help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day. Strengthening exercises, e.g. weight lifting Help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe. Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming Help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe.

* Adapted from Questions and Answers about Arthritis and Exercise.3

If patients experience
Unusual or persistent fatigue,
Increased weakness,
Decreased range of motion,
Increased joint swelling, or
Pain that lasts more than one hour after exercising,
they need to talk to their health care provider.3 Doctors of chiropractic will help arthritis patients develop or adjust their exercise programs to achieve maximum health benefits with minimal discomfort and will identify the activities that are off limits for this particular arthritis patient.

Nutrition for the Rheumatoid Arthritis Patient
Arthritis medications help suppress the immune system and slow the progression of the disease. But for those who prefer an alternative approach, nutrition may provide complementary support. Some evidence shows that nutrition can play a role in controlling the inflammation, and possibly also in slowing the progression of rheumatoid arthritis.

Some foods and nutritional supplements can be helpful in managing arthritis:
Fatty-acid supplements: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma linolenic acid (GLA). Several studies point to the effectiveness of these fatty acid supplements in reducing joint pain and swelling, and lessening reliance on corticosteroids.4,5

Deep-sea fish, such as salmon, tuna, herring, and halibut, are sources of EPA and DHA. GLA is found in very few food sources, such as black currants and borage seed.

Turmeric, a spice that's used to make curry dishes, may also be helpful. A 95 percent curcuminoid extract has been shown to significantly inhibit the inflammatory cascade and provide relief of joint inflammation and pain.

Ginger extract has been shown to be beneficial in terms of inflammation.

Nettle leaf extract may inhibit some inflammatory pathways.

A vegetarian or low-allergen diet can help with the management of rheumatoid arthritis as well.

The benefits and risks of most of these agents are being researched. Before taking any dietary supplement, especially if you are using medication to control your condition, consult with your health care provider.

What Can Your Doctor of Chiropractic Do?
If you suffer from rheumatoid arthritis, your doctor of chiropractic can help you plan an individualized exercise program that will:
Help you restore the lost range of motion to your joints.
Improve your flexibility and endurance.
Increase your muscle tone and strength.
Doctors of chiropractic can also give you nutrition and supplementation advice that can be helpful in controlling and reducing joint inflammation.

Chiropractor Fairfax, VA 22031

Prediction of Treatment Outcome in Patients with Low Back Pain Treated by Chiropractors - does the psychological profile matter?

2010-01-04T14:18:00.000-08:00

It is generally thought that a patient's psychological status can serve as a boost or a hindrance to their recovery. In this interesting Swedish study, the investigators found no link between psychological status and the outcome of their chiropractic care. In Greenbelt, MD we find that by boosting patient morale, we achieve better, longer lasting results.

Background

It is clinically important to be able to select patients suitable for treatment and to be able to predict with some certainty the outcome for patients treated for low back pain (LBP). It is not known to what degree outcome among chiropractic patients is affected by psychological factors. Objectives: To investigate if some demographic, psychological, and clinical variables can predict outcome with chiropractic care in patients with LBP.

Method

A prospective multi-center practice-based study was carried out, in which demographic, clinical and psychological information was collected at base-line. Outcome was established at the 4th visit and after three months. The predictive value was studied for all base-line variables, individually and in a multivariable analysis.

Results

In all, 55 of 99 invited chiropractors collected information on 731 patients. At the 4th visit data were available on 626 patients and on 464 patients after 3 months. Fee subsidization (OR 3.2; 95% CI 1.9-5.5), total duration of pain in the past year (OR 1.5; 95% CI 1.0-2.2), and general health (OR 1.2; 95% CI 1.1-1.4) remained in the final model as predictors of treatment outcome at the 4th visit. The sensitivity was low (12%), whereas the specificity was high (97%). At the three months follow-up, duration of pain in the past year (OR 2.1; 95% CI 1.4-3.1), and pain in other parts of the spine in the past year (OR1.6; 1.1-2.5) were independently associated with outcome. However, both the sensitivity and specificity were relatively low (60% and 50%). The addition of the psychological variables did not improve the models and none of the psychological variables remained significant in the final analyses. There was a positive gradient in relation to the number of positive predictor variables and outcome, both at the 4th visit and after 3 months.

Conclusion

Psychological factors were not found to be relevant in the prediction of treatment outcome in Swedish chiropractic patients with LBP.

-Dr. Louis S. Crivelli II

Chiropractor

Greenbelt, MD

Has organic labeling worked?

2009-12-31T08:50:00.000-08:00

With organic food production shifting from a "mom & pop" operation to industrial production, it is no wonder that lines are getting blurred on what organic means. Before the 90s, organic food consumption was widely considered to be a niche market. Those days are over. Organic food consumption has been growing quickly since the 90s, and the food industry has noticed and adapted.

Most everyone is aware of the USDA label that is appearing on organic food products these days. According to the USDA, an organic farmer uses renewable resources and better manages food and water consumption for the product. USDA standards were put into place in October, 2002, known as the National Organic Program. It details various aspects of production, processing, and delivery of products. It is currently certified through 56 accrediting agencies.

Many people called for strict regulation in the 90s when it became apparent that claims of a product being organic were being overstated. However, USDA labeling has been met with a large number of challenges. Enforcement of standards has been poor at best. Very few 3rd party inspectors exist, certainly not enough to adequately perform the job needed, and many of those inspectors have been audited and poorly reviewed (*). Even worse, small farmers that were truly organic before the certification process met with financial difficulty obtaining certification.

So do we give up and eat convention food that is usually a little cheaper? A lot of local farmers are still producing organic food, but are not obtaining the USDA certification. The best solution seems to be to get to know some local suppliers and ask questions. What chemicals do they use? Is it genetically modified? Has it been artificially ripened or irradiated? These are the questions that you had to ask before the labeling, and as it turns out, they are the questions that still need to be asked.

* http://www.alternet.org/environment/94146/is_your_organic_food_really_organic /

Dr. Brian Lancaster

Chiropractor

Valley Chiropractic in Frederick, MD

Exercising Into 2010

2009-12-31T08:47:00.000-08:00

Exercising is one of the most important activities you can do for your health. However, just as your diet, variety is the key. It’s important to vary your exercise routine in order to get the absolute best results.

Your muscles simply get used to the same activity and they require a level of muscle confusion if they are to continue to improve and grow stronger.

Four Principles of Exercise

Your body is an efficient machine, and if you do the same type of exercise day after day, you’ll become quite good at it. However, when exercise becomes easy to complete, it’s a sign you need to work a little harder and give your body a new challenge.

So when you’re planning your exercise routine, make sure it incorporates the following types of exercise:

1. Aerobic: Jogging, using an elliptical machine, and walking fast are all examples of aerobic exercise. As you get your heart pumping, the amount of oxygen in your blood improves, and endorphins, which act as natural painkillers, increase. Meanwhile, aerobic exercise activates your immune system, helps your heart pump blood more efficiently, and increases your stamina over time.

2. Interval (Anaerobic) Training: Research is showing that the BEST way to condition your heart and burn fat is NOT to jog or walk steadily for an hour. Instead, it’s to alternate short bursts of high-intensity exercise with gentle recovery periods. This type of exercise, known as interval training or burst type training, can dramatically improve your cardiovascular fitness and fat-burning capabilities.

Another major benefit of this approach is that it radically decreases the amount of time you spend exercising, while giving you even more benefits. For example, intermittent sprinting produces high levels of chemical compounds called catecholamines, which allow more fat to be burned from under your skin within the exercising muscles. The resulting increase in fat oxidation increases weight loss. So, short bursts of activity done at a very high intensity can help you reach your optimal weight and level of fitness, in a shorter amount of time.

3. Strength Training: Rounding out your exercise program with a 1-set strength training routine will ensure that you're really optimizing the possible health benefits of a regular exercise program.

You need enough repetitions to exhaust your muscles. The weight should be heavy enough that this can be done in fewer than 12 repetitions, yet light enough to do a minimum of four repetitions. It is also important NOT to exercise the same muscle groups every day. They need at least two days of rest to recover, repair and rebuild.

4. Core Exercises: Your body has 29 core muscles located mostly in your back, abdomen and pelvis. This group of muscles provides the foundation for movement throughout your entire body, and strengthening them can help protect and support your back, make your spine and body less prone to injury and help you gain greater balance and stability.

Exercise programs like pilates and yoga are great for strengthening your core muscles. Focusing on your breath and mindfulness along with increasing your flexibility is an important element of total fitness.

So do it and do it right by exercising your way into 2010

Dr. John Rosa
Chiropractor
Rockville, MD

Chiropractic Care May Reduce Surgeries, X-rays. Back Pain Treatment Less Costly With Chiropractic Care.

2009-12-30T12:26:00.000-08:00

Chiropractic care cuts health care costs, a new study shows. The study comes from American Specialty Health Plans Inc. of San Diego. The company provides employers with health insurance coverage for complementary medicine, including chiropractic care and acupuncture.
The company compared four years of back pain claims from two groups: 700,000 health plan members with chiropractic care coverage and 1 million members with the same health plan without chiropractic care coverage. It's the largest study yet of how chiropractic care affects the cost of health care.

Costs Down, Patient Satisfaction Up With Chiropractic Care
Compared with doctor-only health plans, the study found that:

Chiropractic care cut the cost of treating back pain by 28%.
Chiropractic care reduced hospitalizations among back pain patients by 41%.
Chiropractic care reduced back surgeries by 32%.
Chiropractic care reduced the cost of medical imaging, such as X-rays or MRIs, by 37%.

The report appears in the Oct. 11 issue of Archives of Internal Medicine.

Patients often say they are satisfied with the chiropractic care they receive, says Scott Boden, MD, director of the Emory Orthopedic and Spine Center in Atlanta. "A disease like back pain can have a lot of variability in the ways medical professionals approach patient care," Boden says. "The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care. Many -- if not most -- primary care providers have little training in how to manage musculoskeletal disorders. That leads to some of the costs. If you were to match a chiropractic network against trained physicians instead of general medical practitioners, you might get different results."

Chiropractic Care Entering Mainstream

This may be the first study to offer concrete evidence that chiropractic care saves money. But businesses already are getting the message, says George DeVries, president and CEO of American Specialty Health. "Since 1987, we have thousands if not tens of thousands of employer groups that offer chiropractic coverage as a supplemental insurance rider," DeVries tells WebMD. "These range from mom-and-pop groceries to top-10 businesses. The reason they continue to offer these plans is patient satisfaction and low cost." Boden says his institution is opening a new facility that will offer patients integrated medical care that will include chiropractic care. "We have everything under one roof. The finishing piece is going to be a complementary medicine center that will include chiropractic, massage, acupuncture, and probably nutrition," he says. "The bottom line is that conservative management of back care is effectively performed by doctors of chiropractic," he says. "In cases where medical intervention is needed, chiropractors are schooled to make the appropriate referrals. It is a cost-effective option for back pain."

Original article written by Daniel J. DeNoon. WebMD Health News. Oct. 12, 2004.

Dr. David P. Chen

Chiropractor

Laurel, Maryland

Treatment for Neck Pain, Fairfax VA

2009-12-29T16:41:00.000-08:00

A great article from ACAtoday...

Neck Pain: Conservative Care of Cervical Pain, Injury

Your neck, also called the cervical spine, begins at the base of the skull and contains seven small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury.

The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have a variety of causes.

Here are some of the most typical causes of neck pain:

Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting “rebound” in the opposite direction is known as whiplash. The sudden “whipping” motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.

Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Over time, a disc may bulge or herniate, causing tingling, numbness, and pain that runs into the arm.

Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.

Chiropractic Care of Neck Pain
During your visit, your doctor of chiropractic will perform exams to locate the source of your pain and will ask you questions about your current symptoms and remedies you may have already tried. For example:

When did the pain start?
What have you done for your neck pain?
Does the pain radiate or travel to other parts of your body?
Does anything reduce the pain or make it worse?
Your doctor of chiropractic will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting movement that causes pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.

In some instances, your chiropractor might order tests to help diagnose your condition. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show bulging discs and herniations. If nerve damage is suspected, your doctor may order a special test called electromyography (an EMG) to measure how quickly your nerves respond.

Chiropractors are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist. He or she may also ask for permission to inform your family physician of the care you are receiving to ensure that your chiropractic care and medical care are properly coordinated.

Neck Adjustments
A neck adjustment (also known as a cervical manipulation) is a precise procedure applied to the joints of the neck, usually by hand. A neck adjustment works to improve the mobility of the spine and to restore range of motion; it can also increase movement of the adjoining muscles. Patients typically notice an improved ability to turn and tilt the head, and a reduction of pain, soreness, and stiffness.

Of course, your chiropractor will develop a program of care that may combine more than one type of treatment, depending on your personal needs. In addition to manipulation, the treatment plan may include mobilization, massage or rehabilitative exercises, or something else.

Research Supporting Chiropractic Care
One of the most recent reviews of scientific literature found evidence that patients with chronic neck pain enrolled in clinical trials reported significant improvement following chiropractic spinal manipulation.

As part of the literature review, published in the March/April 2007 issue of the Journal of
Manipulative and Physiological Therapeutics, the researchers reviewed nine previously published trials and found “high-quality evidence” that patients with chronic neck pain showed significant pain-level improvements following spinal manipulation. No trial group was reported as having remained unchanged, and all groups showed positive changes up to 12 weeks post-treatment.

Chiropractor Fairfax VA, 22031

Chiropractic for Headaches in Temple Hills, MD

2009-12-29T14:51:00.000-08:00

Chiropractic Manipulation: A New Study Regarding Headaches

Written by Vegas_Chiropractor on Dec-27-09 10:08pm

From: DrMichaelReissBlog.com

Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

Aekta Erry, D.C.

Chiropractor, Temple Hills, MD

Disinfectant linked to resistant bacteria

2009-12-28T09:03:00.000-08:00

A commonly used disinfectant (the one used in products like Lysol) was linked by a recent study published in the journal Microbiology to increases in a strain of bacteria (pseudomonas aeroginosa) that became resistant to common antibiotics. The bacteria is known to cause serious infections in hospitals. There has been questions for decades about the overuse of antibiotics in medicine as well as in agriculture. While I believe antibiotics are a boon to humanity, their overuse has greatly decreased their power in combatting disease. More recently, the pervasive use of antibacterials in soaps and other household products has also been questioned. This study on the CDC website discusses the issue, as well as potential immune disorders that their prevalence may cause. The Microbiology study is new as it examines cleaning a common cleaner and sees how it may effect our homes and hospitals.

Laugh Your Pain Away

2009-12-23T10:05:00.000-08:00

Laughter has a real beneficial effect on your physical health, according to research. In the study, subjects were observed as they watched both serious movies and comedies. During the comedies, their arteries dilated and their blood pressure dropped, suggesting that laughter can in fact be a powerful medicine indeed.

The study looked at 20 healthy participants with an average age of 33. The results showed for the first time that laughter is linked to healthy function of blood vessels. It appears to cause the endothelium, which is the tissue that forms the inner lining of blood vessels, to dilate or expand in order to increase blood flow.

The study also showed that the opposite effect occurred when the subjects watched suspenseful films, suggesting a link between mental stress and the narrowing of blood vessels.

The University of Maryland researchers believe laughing causes your body to release beneficial chemicals called endorphins, natural “pain killers” that contribute to your sense of well-being and may counteract the effects of stress hormones and cause blood vessels to dilate.

Previous research has even found that just anticipating laughter can increase your endorphin levels, whereas laughing may help boost your immune system and reduce inflammation in your body, which is linked to a variety of diseases.

So laugh your pain away this holiday season weather its your nutty brother or crazy uncle that makes it happen let out the laughter it is sure to help in ways you never thought possible.

Dr. John Rosa
Rosa Chiropractic and Physical Therapy Center
Rockville, MD
Abcclinics.com

A study of side airbag effectiveness in reducing chest injury in car to car side impacts using a FE model

2009-12-23T07:47:00.000-08:00

Hayashi S, Yasuki T, Yamamae Y, Takahira Y: A study of side airbag effectiveness in reducing chest injury in car to car side impacts using a FE model. International IRCOBI Research
Conference on the Biomechanics of Impact, Madrid, Spain, September 20-22, 2006, 397-400.

The effect of side airbag in reducing chest injury in car-to-car side impacts was studied using a human FE model (THUMS). A simulation was conducted assuming that a car was struck
by another car at 50 km/h impact speed. Injuries were predicted for both front and rear seat occupants, and compared between cases with and without side airbags. Rib fractures were
observed in the inferior thorax regardless of seating position without side air bags. With side air bags, on the other hand, the number of rib fractures was reduced because of smaller local deformation.

Yet another study showing that side airbags reduce injuries. In my office in Greenbelt, MD we see a fair amount of patients that have been in side impact collisions. Unfortunately, not all of the vehicles involved contain side airbags. It's certainly good to see more and more vehicles with side airbags STANDARD.

-Dr. Louis S. Crivelli II

Chiropractor

Greenbelt, MD