Interferential Current Therapy for Musculoskeletal Pain

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

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

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?

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

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

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

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?

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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?

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.

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

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.

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

-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

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

-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

-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

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

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

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

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

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.

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

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

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