Why I Love This Mouse...

I heard an interesting statistic on the radio the other day.  It seems that within a few years, 47% of the jobs in this country will involve the use of a computer on some level.  From the perspective of the office, I've noted a gradual shift in the percentages of patients who suffer from lower back pain (LBP) and those who suffer neck and arm pain (NAP).  A slow but steady decline in the number of LBP complaints has been accompanied by a similar increase in the number of NAP patients.

During the history or initial discussion of a NAP problem, the subject of computer use typically comes up.  I don't have an exact number, but the
percentage of people with a NAP condition who list computer use as an irritant to their pain is very, very high.

While computer use itself may not be as strenuous as doing construction, it does lend itself to chronic static strain and repetitive use disorders, such as neck pain and carpal tunnel syndrome, respectively.  Both of these can be alleviated, or even eliminated, with proper workstation setup.

This diagram is a good general setup for your workstation.  We have copies at the office, if you would like one.  Now, back to the mouse...

Moving the mouse around typically involves using your dominant hand and arm to get the cursor to the spot you would like it to be.  Why this needs to involve your entire arm, shoulder, and neck is beyond me. Especially when this particular movement seems to be the source of a lot of NAP issues.  The mouse pictured is a far better choice because you only have to move your index and middle fingers a small amount to move the cursor instead of your entire arm.  No more reaching, no more "wax on/wax off" to get the cursor to where you need it.  These are available through any office supply store or online for around $30.  If you use a computer for any significant part of your day, it's worth every penny to minimize strain and repetitive use injury.

NAP problems usually resolve quite quickly if the source of pain is correctly identified and the right treatment is applied.  Call us today to see if we can help you start feeling better now!

Morning Stiffness...Feel Better TODAY!

Morning lower back stiffness is a common symptom people describe when they come to see us.  Usually, folks describe an ache and stiffness that prevents them from getting up from laying or sitting as fast as they might like.  Typically this discomfort lessens within a few minutes and eventually passes in a couple of hours. If this pain has occurred in response to a recent acute injury to the lower back or acute flare up of chronic pain, it is usually the last symptom to leave.

Why Does Morning Stiffness Happen?

Regardless of whether it's from arthritis or an acute injury, joint stiffness typically occurs because of the accumulation of inflammatory fluid within the joints during periods of relative immobility.  Joints are essentially a closed system that cannot tolerate this buildup of fluid.  When congested, the joint cannot move freely until this fluid has been eliminated by movement and/or gravity.  This is why movement, and specific stretching in particular, is so helpful.

My Morning Stiffness Story

I have shared the story of how I came to be a chiropractor with some of you, but for those who are unfamiliar, here it is: (and yes, it has something to do with morning stiffness).  As a teenager, I injured my lower back lifting weights.  When the injury occurred, I didn't really have any pain, but the next morning my back was so stiff, I couldn't get out of bed.  I went to see the chiropractor my father had been seeing.  I had X-rays which showed some alignment issues, but nothing more. Within a few weeks of treatment, I was feeling great, and this made such a profound impact on my life that I decided I wanted to do this for a living. A couple years later, I had another set of X-rays done because I was starting to experience morning stiffness more regularly than any 19 year old should.  I was shocked to hear that I had a degenerative disc and some early osteoarthritis in my lower back.

As you might suspect, morning stiffness has been an issue for me from time-to-time.  Mostly, this has been in the wake of a low back injury, but not always.  Over the past 18 years, I've noted some things that can help you alleviate that pain substantially within a short period of time.

1.  Your Mattress

Does your mattress have a crater in the middle the size of Death Valley?  Was your mattress made in the previous millennium?  If so, it might be time to visit my friends at Lynn's Bedroom City.  A mattress should be replaced every 8-10 years, sooner if it shows signs of excessive wear.  I don't have a specific recommendation for mattress types, I generally recommend a medium firmness with a pillow top, which you should rotate every month. I strongly recommend buying quality.  I have no personal experience with the memory foam or air mattress type bedding. The patients I know who have them are about 50/50: 50% love them, 50% do not.  The professionals at Lynn's Bedroom City will be able to help you make a choice that fits.

2.  Stretch

Upon retiring to bed every evening AND before getting out of bed in the morning, take 5-7 minutes to do basic flexibility exercises for your lower back.  These include the "single knee to chest" stretch, the "low back rotation" stretch, and the pelvic tilt exercise.  If you don't know these, please stop by the office for a copy of these simple stretches.  Not only will this greatly reduce, or possibly eliminate your pain, it will get you moving much faster.

3.  Keep Some Elginex/Biofreeze on the Nightstand

I do this when I've flared up my lower back and it really does get me out of bed and moving more quickly.  I apply it after I've done the stretches, wait for it to warm up, then I get up and go turn on the coffee.

But My Morning Stiffness is Chronic...

If you've had morning stiffness for some time, it's time to come in for a chiropractic checkup.  We may need to do some X-rays to see what's going on.  For a long-standing problem, I recommend a trace mineral supplement from Standard Process called Trace Minerals B12.  I have had people take 1-2 tablets per day to alleviate morning stiffness and for a good percentage of people, it seems to work great.  Trace minerals provide the micro-nutrients necessary to create strong collagen cross-linkages, which give the cartilage in your discs and joints the strength to withstand shearing (tearing) forces.  They're even more important in cases involving arthritis because of the ever present struggle between repair and (inflammation producing) degeneration.

Now, you've probably heard the recent commercials talking about Ankylosing Spondylitis, or AS, as a possible cause of chronic morning stiffness.  AS is an autoimmune disorder that affects 0.1-0.2% of the population, so while it is a possible cause, it is relatively rare. More commonly, plain old osteoarthritis is the culprit.  AS has distinctive features on X-ray and is easily confirmed by a simple blood test (HLA B-27).

Should I Exercise?

The simple answer is YES!  Movement is how joints and discs get their nutrition, so I highly recommend walking if you are physically capable.  Of course, if you haven't been exercising, you should always consult your physician first.  More often than not, exercise should reduce your problem, not exacerbate it.  If it does seem to make it worse, I suggest you give us a call.

Get an Adjustment

Chiropractic has always been on the forefront of preventative healthcare and health maintenance in its truest form.  “Eat well, think well, move well, be well” is our official motto at Integrated Chiropractic Rehab.  Regular wellness care is like flossing your spine.

People often forgo or drop out of care only to come back a few months later with a flare-up of their condition.  Typically, it takes a number of these episodes for the realization to sink in:  Maintenance care is a good idea...and now science is beginning to confirm what we have long known.

A study submitted to the medical journal Spine examined whether continued spinal manipulation (adjustments) was beneficial for people with chronic low back pain (LBP).  60 patients with chronic, nonspecific LBP lasting at least 6 months were randomly assigned to one of three groups.  The first group got 12 sham (fake) adjustments over one month, the second group received 12 actual adjustments over one month but no follow-up care, and the final group got 12 adjustments followed by maintenance manipulation every two weeks for nine months.  Those receiving the real adjustments (groups 2 and 3) had significantly lower pain and disability at the end of one month, but only the third group (the maintenance group) showed a continuation of these benefits at the 10 month mark.  Regular chiropractic adjustments can be the ticket to continued pain control and improved quality of life.  In almost every case, there is also a substantial financial savings when compared to treating multiple episodes.  Maintenance care takes less time and less money, so what’s stopping you?

Senna, M et al. Does maintained spinal manipulation for chronic non-specific low back pain result in better long term outcome?  Spine. Published ahead of acceptance  January 17, 2011.

Enjoy Your Independence Day!

Happy 4th of July!

The Staff and I wish you a

Safe and Healthy Independence Day!

In observance, the office will be closed Friday, July 4th.

Shoulder Pain: A Simple, Self-Evaluation Test

Warmer weather is finally here, and that means increased physical activity for most people.  We're barely clear of Winter and already I've had some folks with golf and/or landscaping injuries to their shoulders. Some are relatively acute, or new, others have been lingering for days, weeks, or even months.  Shoulder conditions can be quite debilitating, regardless of your daily activity level.  I thought I would share some background on the most common types of shoulder conditions we see in the office and what we typically do about them, but first, a little about the shoulder itself.

The shoulder is an amazing bit of engineering.  It allows the greatest range of motion of any joint in the body.  To be technically correct, the shoulder is actually comprised of three(3) joints and an "articulation":  The glenohumeral joint (GH) is the "ball and socket" component, the acromioclavicular joint (AC) is the union between the scapula (shoulder blade) and the clavicle (collar bone), the sternoclavicular joint (SC) is the connection between the collar bone and the sternum (breastbone), and the scapulothoracic "articulation", which describes the relationship between your shoulder blade and the rib cage on which it rests and moves.  All four must move in a synchronized manner for the shoulder to function properly.  Because it does allow such a wide range of motion, the shoulder is inherently unstable.  Overuse, poor posture, and strain are typical factors in the development of shoulder pain syndromes.

There are many muscles, tendons, and other soft tissues that can be irritated or injured.  Pain and limited motion are the reasons most people present for treatment.  The most common issues we see are rotator cuff injuries and bursitis.

THE ROTATOR CUFF

The rotator cuff is made of four tendons that attach to the ball portion of the upper arm bone (humerus).  The cuff is made up of the tendons of four muscles that originate from the scapula:

• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

We call these the "SITS" muscles.  The function of these muscles is to rotate the upper arm.  They can be strained by repetitive movements and/or frequent malposition of the arm from poor posture.  Golf and throwing sports (baseball, football, etc) have their fair share of players with rotator cuff injuries because of the tremendous amounts of force and repetitive movements.

Strain involves damage to the muscular portion of the rotator cuff, but the tendons are frequently damaged as well.  Sometimes, the tendons can be torn by force, or be worn by repetitive movement that causes it to rub against another structure.  On MRI, we sometimes hear of a rotator cuff tendon being "frayed."  Think of a rope being rubbed back and forth across a jagged rock, that's about what it looks like. In some instances, this tear must be surgically repaired.  However, a lot of the time, physical therapy including pain and inflammation control using electric stimulation and ultrasound, coupled with joint mobilization and therapeutic exercise can restore the function of the shoulder without surgery.

BURSITIS

The vast range of motion in the shoulder means that things are going to rub against one another.  Luckily, the body has developed a structure to deal with this sort of internal friction:  The BURSA.  A bursa is simply a fluid filled sack that allows one layer of muscle to slide smoothly over another, or a muscle to glide over a bone.  The most commonly affected bursa in the shoulder is the Subdeltoid Bursa, which is underneath the deltoid muscle, which makes up the contour of your shoulder.

Sometimes, this bursa will get pinched between the ball portion of the shoulder joint and the inside of the AC joint, or if there is significant and repetitive movement which utilizes the deltoid, it will become inflamed, or swollen.  Bursitis is a general term for when this structure gets inflamed. 

Bursitis also responds well to electric stimulation, ultrasound, mobilization and exercises.  Typically, bursitis goes away more quickly than rotator cuff syndromes, but sometimes these two occur together.

THE TEST

The following pictures illustrate a simple test that may help you determine if you've got a shoulder problem such as bursitis or rotator cuff injury:
                                                               Starting Position

                   

                                                                   Finishing Position

A positive test is when you cannot get to the end point without pain.  Most people with shoulder problems cannot get to this point, and usually stop moving the shoulder well before the end point.

WHAT DO I DO IF THE TEST HURT?

Let's be clear: this test is non-specific and doesn't differentiate between types of shoulder problems.  In the office, it's usually the first shoulder test I do to determine if something is going on within the shoulder itself or if it's radiating from the neck, upper back, or an internal organ such as the gallbladder (right) or heart (left). So, there are two possibilities:

1. Your shoulder hurts and the test hurt. If this describes your situation, then it is very likely that you have an internal shoulder issue.  It does not matter how much your shoulder hurts, if the test hurts, then it would be a good idea to give us a call and get it checked out.  There are other tests that can help us determine more accurately what is going on in the shoulder.

2. Your shoulder hurts but the test didn't make it hurt worse. In this situation, your shoulder may be hurting because of radiating pain from the neck, upper back, or an internal organ such as the heart or gallbladder. If you suspect the heart or gallbladder, you should contact your MD immediately or call 911 or go to the ER.  In the absence of pain from the heart or gallbladder, the neck and/or upper back is a possible source for your shoulder pain.  Again, we can do tests in our office that will help determine the source of your pain.

TREATMENT

Injury is almost always accompanied by pain and inflammation or swelling.  It may not be possible to feel or see the swelling yourself.  Our first line of treatment once the cause has been identified is to knock down the pain and inflammation using electric stimulation and ultrasound.  The electric stimulation decreases pain by interrupting the pain signal sent from the injured tissue to the brain.  It also helps reduce any muscle spasm that may be present.  Ultrasound uses high frequency sound waves that penetrate deeply to push the swelling out of the injured structure and into the surrounding circulation so that it may be cleaned up by the body. Acupuncture is another option for shoulder pain.  Joint mobilization is typically performed to reset the joint surfaces so the ball and socket can glide properly on one another.  We often do chiropractic manipulation to the neck and mid back (thoracic spine) because of the high degree of nervous and muscular interconnection between these areas of the spine and the shoulder.  In certain circumstances, we recommend natural anti-inflammatory and soft tissue repair supplements(Zymex II and Ligaplex II from Standard Process). Once the pain has reached a manageable level and range of motion allows, we start doing therapeutic exercises to increase flexibility (initially) and strength (later). Length of treatment typically depends on the severity of the condition and the compliance of the patient with the treatment schedule and home recommendations.

Whether your pain is from the shoulder or the neck or back, we have the skills and experience treating these issues and can help you get back on track to enjoy your summer!  Give us a call at 219-738-1925 today!

This was (almost) a great weight loss story...

I had high hopes when I read the story of a couple of identical twin MDs who went on polar opposite weight loss diets: One went low fat (no more than 2% of his daily intake!!) and the other went low carb.  Here's the link to the story as it appeared on Yahoo:

http://shine.yahoo.com/healthy-living/twin-brothers-act-guinea-pigs-sugar-v-fat-190600102.html

Ostensibly, you would think this was a great idea:  Identical twins eliminates the genetic issue, and they're MD's, so they should have approached this scientifically (please note I did watch the video clip but have not seen the documentary as of the date of this posting.)

If you read the story, please note two things:

• The low carb guy lost the most weight (9 pounds in a month)
• They never said if the low fat guy lost any weight at all

Furthermore, the story tells of the low carb guy going into ketosis, and a "nutrition expert" saying that ketosis is dangerous and can cause kidney failure.  Ketosis occurs when fat is metabolized, because the waste products of fat metabolism are water and chemicals called ketones.  Let me clarify things for you:

• Benign ketosis is required for fat loss (no ketosis = no fat loss)
• The ketosis caused by fat loss will not damage your kidneys
• Fat loss ketosis is not the same as diabetic ketoacidosis, which is damaging to the body

On even the most severely carb restricted diet, ketone levels are between 5 and 20 mg/dl, as opposed to levels of 200+mg/dl that occur in diabetic ketoacidosis.  A low carb diet is not going to damage your kidneys.  

Also, the story makes a point of saying that the low carb guy was constipated and tired.  Well, that is a short term situation that could have been managed or avoided if he consulted the works of his late colleague, Dr. Robert Atkins.  This is a normal occurrence for people who go on low-carb weight loss programs.  Typically, it's referred to as the Atkins Flu.  You can wait it out, or you can drink more water and add a little salt to your food to fight these symptoms and the "brain fog" that may also occur.  It hardly lasts more than a day or two in most circumstances. I can tell you that had Doctor followed the recommendations in "The New Atkins for a New You," which recommends foundation vegetables for fiber and high nutrient content, it is highly unlikely he would have experienced these symptoms.

At least this story admitted that the low carb diet produced the most weight loss, but it did so while subtly demonizing the method by pointing out some of its short term discomforts (fatigue, constipation).  Ask yourself this: Is a day or two of constipation and fatigue better than constant gnawing hunger (as described by the low fat guy)?  I bet the low fat guy lost little, if any weight.  I wonder if they'll mention it in the documentary.  I'll be sure to post!  Meanwhile, if you're interested in the TRUTH about fat/weight loss, click on this link to a fantastic book by Gary Taubes!

It's COLD...but we're OPEN!!

Extreme temperatures are making it dangerous for some to travel, in fact even some of us have been stranded or near-stranded because of it.  We are open today (January 27, 2014) and tomorrow (January 28, 2014) to serve you, but please do not take any unnecessary risks traveling in this weather!

Weight Loss Seminar Rescheduled!

Hello everyone! We trust you had a wonderful holiday season and are looking forward to an exciting and healthy 2014.

The Weight Loss seminar scheduled for this evening has been rescheduled to next Tuesday, January 14, 2014 at 6pm.  The office is open today, but the roads are treacherous and most people are still home because of the weather.  Hopefully next week will be better!

If you are unable to attend, email me at info@integratedchiro.net for a copy of the PowerPoint presentation!