Welcome to 2020 and the new decade
Welcome to 2020!
But is it really a new decade? Well what we can say is we are now out of the teens!
With the New Year upon us, here are some steps you can take to improve the health of your spine and your overall well-being.
· Aim to get daily exercise, preferably close to nature. Many of the benefits of regular exercise can be experienced with just 30 minutes of physical activity a day. Not only will you decrease your risk of illnesses like heart disease and diabetes, you may also be more likely to experience a reduction in back pain and other aches and pains. Try walking on the beach or in the bush or using public transport especially if you walk to the bus or train! I did it in 2019!
· Breathe. Mindfulness, meditation, going on walks, and taking breaks throughout the day can all aid in stress reduction. Lowering your stress may also help your immune system be more resilient and decrease chronic pain flare-ups.
· Laugh often and easily. Laughter helps to relieve mental stress; and fires off a cascade of physiological reactions that benefit your health. Studies show that laughing can stimulate the heart, muscles, and lungs— not to mention the flurry of endorphins that are released.
· Eat things recently alive and mostly plants, especially your greens... and reds and yellows... in fact as many colours as possible. Cruciferous vegetables like broccoli and kale, which are rich in calcium, may help to decrease the risk of osteoarthritis. Spinach, lentils, and beans are high in magnesium, a mineral shown to benefit some people with back pain. Drink water instead of soft drinks.
· Whatever you do, don’t smoke… (or drink too much or do drugs. Drugs are bad OK). Smoking increases your risk of just about everything including spinal pain and arthritis. Quitting smoking has also been tied to an improvement in spinal pain. As a bonus, research shows that smokers who attempt to quit in January are more successful because of the extra motivation the New Year provides.
· Don’t forget your chiropractic care. New research shows people who see chiropractors use less drugs such as opioids which don’t cure back pain anyway. No surprises there!
Have a great year!
Musculoskeletal conditions may increase the risk of chronic disease
This meta-analysis found that musculoskeletal conditions may increase the risk of chronic disease. In particular, osteoarthritis appears to increase the risk of developing cardiovascular disease. Prevention and early treatment of musculoskeletal conditions and targeting associated chronic disease risk factors in people with long standing musculoskeletal conditions may play a role in preventing other chronic diseases. However, a greater understanding about why musculoskeletal conditions may increase the risk of chronic disease is needed.
Chiropractic maintenance care may be preventive for low back pain?
The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial
Andreas Eklund , Irene Jensen, Malin Lohela-Karlsson, Jan Hagberg, Charlotte Leboeuf-Yde, Alice Kongsted, Lennart Bodin, Iben Axén
Published: September 12, 2018
Conclusion
MC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203029
Mid-thoracic spinal manipulation appears to have a transient effect on the passive range of motion of the lower extremities
The immediate and 1-week effects of mid-thoracic thrust manipulation on lower extremity passive range of motion.
Authors:
Derrick Sueki, PT, PhD, DPT, GCPT, Shaun Almaria, PT, DPT, Michael Bender, PT, DPT, and Brian McConnell, PT, DPT
Affiliations:
Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA; Peak Sports Medicine and Rehabilitation, Phoenix, AZ, USA; Performax Elite, Burbank, CA, USA; dHealthcare Partners, Torrance, CA, USA
"The purpose of this study was to determine whether MTM (thoracic spinal manipulation) would result in a clinically significant change in lower extremity range of motion as measured by the passive straight leg raise (PSLR) test and whether changes would still be present after a 1-week time period. The results of this study did demonstrate that MTM produced an immediate significant and detectable change in PSLR in the subjects who received the manipulative intervention. Subjects who received the sham manipulation did not experience a detectable change in PSLR values. These changes appear transient in nature as after 1 week, no significant change was present.
...The findings of this study appear to reinforce previous studies and suggest that spinal
manipulation has transient effects that extend beyond localized and adjacent tissue responses.
The results of this study reinforce findings suggesting that as an intervention, spinal manipulation can have generalized effects that extend beyond local and adjacent regions to more remote regions of the body. While the physiological mechanisms underlying these effects are still being explored, these results challenge the common perception that the effects of spinal manipulation are due to alterations in biomechanical factors such as improved joint mobility or reduced muscle activity.
...These (and many other results) coupled with De Oliveira et al. (2013), who found that lumbar manipulation increased remote alterations in pain processing, are indicative of a generalized effect to spinal manipulation that may be attributable to changes in neurophysiological processing".
https://www.tandfonline.com/doi/abs/10.1080/09593985.2018.1492056?journalCode=iptp20
Mindfulness mediates the physiological markers of stress
In a meta-analysis and systematic review, studied outcomes included cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression.
Forty-five studies were include d. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.
Source :http://dx.doi.org/10.1016/j.jpsychires.2017.08.004
New evidence that for adolescents with chronic low back pain, spinal manipulation combined with exercise is more effective than exercise alone
Evans et al have just published a paper in the highly respected journal PAIN which concluded "For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months".
According to the abstract; "Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks".
Looking at the details, it is interesting to observe that at 26 weeks the proportions reporting being 100% improved are 5.9% (ET alone) and 20.0% (SMT + ET) a difference of 14.1 (95% CI: 4.1 to 24.1). Put another way, that is 3.4 times greater proportion reporting being 100% improved if they received SMT as well as exercise...
New white paper on non-pharmacological management of pain
Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: the Consortium Pain Task Force White Paper
To quote the abstract of this important paper:
"Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC.
There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies.
Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability".
Study funded by Australian Spinal Research Foundation Reveals Multi-sensory Impacts Of Sub-clinical Neck Pain
As research mounts up, it is becoming increasingly clear that neck pain has impacts far beyond pain and stiffness. A recent piece of research, partially funded by the Australian Spinal Research Foundation, has become the first to reveal that people with subclinical neck pain have slower visual and multisensory response times, and the differences caused by subclinical neck pain don’t improve on their own.
This post was first published here
An Osteopathic Approach to Diagnosis and Treatment
Osteopathic medical students and faculty benefit from a uniquely practical text that organizes osteopathic concepts and step-by-step techniques into a single comprehensive volume. This new edition includes new, all-important updates on somatic and visceral problems, writing the osteopathic manipulative prescription, and case histories to reflect changes in the national licensing examination. The book’s integrated method for diagnosis and treatment embraces basic osteopathic history and philosophy, osteopathic palpation and manipulation, and specific manipulative treatments and concepts. Abundant photographs demonstrate step-by-step techniques. Meticulous illustrations depict underlying anatomy.
https://www.amazon.com/Osteopathic-Approach-Diagnosis-Treatment/dp/0781742935
Review by: David Aston (Malmö, Sweden)- This review is from: An Osteopathic Approach to Diagnosis and Treatment (Hardcover)
"This is a book good book with both theory and techniques from the American perspective of osteopathy which means it covers the fields of musculoskeletal and cranial field. The book could have contained more theory, especially regarding case studies. The strong part of the book is the wide area of different techniques within osteopathic manual medicine field it covers. It is a good book well recommended for all manual therapists".
David Aston: Registered Physical Therapist
Family Therapy and Chiropractic
In early March my wife Deisy & myself made a presentation at the World Congress of the International Family Therapy Association (IFTA) in Bangkok Thailand
Title: Working With An Integrative Systemic Approach to Health: The WHOLE Is Greater Than The Sum Of Its Parts
Short Description: This presentation explores the application of collaborative care between two complementary health professions, family therapy and chiropractic which acknowledges the complex inter-relationship of mind and body within a systemic scaffold.
Abstract: This presentation explores the application of collaborative care between two complementary health professions, family therapy and chiropractic which acknowledges the complex inter-relationship of mind and body within a systemic scaffold. One of the key aspects of optimum health and well-being is that it is integrative, both in the manner in which it is viewed and in the manner in which it is managed. This includes health practitioners working collaboratively with individuals and families while acknowledging the interplay of mind and body. Health care systems are grounded in ideals of availability and responsiveness to the diverse needs of individuals, families and communities. However, sometimes dissonance arises, particularly in the Western world, with a tendency to view health and well-being in a mechanistic rather than in a holistic way, leading to a wide range of problems manifesting in inappropriate service provision and resultant poor outcomes for individuals and families. In exploring this dynamic, we examine two complementary health professions; family therapy and chiropractic. Family therapy focuses on the individual/system relationship viewing problems through a systemic lens given issues in the individual being impacted by their 'system', thus engaging the whole system as a functioning unit. Similarly, chiropractic focuses on the interrelationship between structure (body) and function (mind) and how that relationship affects the preservation and restoration of health and well-being. Using the example of these two complementary health professions, the aim of this presentation is to reflect how the two components of mind and body together constitute 'wholeness' in addressing health issues and applying systemic practice in a relevant, appropriate and whole-listic manner. Clinical systemic concepts will be explored, including the application of relevant working models.
http://www.ifta-congress.org/2018/docs/2018_IFTA_Program_Book.pdf
National Rural Health Alliance Scientific Symposium
On the 11th April 2018 I was honoured to be the first chiropractor ever to make a podium presentation to the 6th Rural and Remote Health Scientific Symposium "Outback in Front": 20 Years of Rural and Remote Health Research in Canberra Australia.
My presentation was ‘Going Up-North’: chiropractic undergraduate clinical immersion placements in country Western Australia
http://www.ruralhealth.org.au/6rrhss/sites/default/files/inline-files/Program09Apr2018_3.pdf
There are apparently no drugs that work for back pain... and disabling back pain is partly iatrogenic (caused by practitioners)
Disabling low-back pain is partly iatrogenic according to Professor Buchbinder from Monash University in an article in Australian Doctor. Iatrogenic means: "due to the activity of a physician or therapy. For example, an iatrogenic illness is an illness that is caused by a medication or physician"."In a series of Lancet papers reviewing the global burden of low-back pain, researchers led by Australian rheumatologist Professor Rachelle Buchbinder of Monash University say medical mismanagement is rife and reiterate that medications are not effective for treating spinal pain".
Recommendations are to stay active and stay positive.
Chiropractors and nutrition
I recently co-authored a paper on chiropractors use of nutrition advice in clinical practice in Australia. The results are encouraging in that firstly most chiropractors report receiving education on nutrition, and secondly discussing the importance of good nutrition with their patients.
Citation:
BMJ paper on manual care of infants
Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. [Published in the journal BMJ Open]
Author affiliations:
- Barts and The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
- Faculty of Health, Universtiy of Applied Sciences, Western Switzerland, Fribourg, Switzerland
- National Council for Osteopathic Research, London, UK
Results: "Nineteen studies were selected for full review: seven randomised controlled trials, seven case series, three cohort studies, one service evaluation study and one qualitative study. We found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time (favourable: −1.27 hours per day (95%CI −2.19 to –0.36)), sleep (inconclusive), parent–child relations (inconclusive) and global improvement (no effect). The risk of reported adverse events was low: seven non-serious events per 1000 infants exposed to manual therapy (n=1308) and 110 per 1000 in those not exposed".
Points to consider
A cost burden analysis found that the annual cost to the UK National Health Service of infant crying and sleeping problems in the first 12 weeks of life was £65 million. There are associations between unsettled infant behaviour and high maternal depression scores, and the natural crying peak at 6 weeks coincides with the peak age for severe infant injury or death as a result of child abuse.
Safety
Those infants who received manual care had an 88% reduced risk of having an adverse event compared with those who did not (adverse events defined as "worsening of signs & symptoms" or "seeking other care").
Citation
Carnes D, Plunkett A, Ellwood J, Miles C., Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses
My previous posts
3rd June 2017
My new book chapters
I have been fortunate to have been invited to collaborate as a co-author with some of the leading authors in the chiropractic world in two new books just released in the last few months!
Check them out here;
The Praeger Handbook of Chiropractic Health Care
Evidence-Based Practices
by Cheryl Hawk, DC, PhD, CHES, Editor
Foreword by John Weeks
Chiropractic is the second largest physician-level U.S. health profession, providing care to at least 20 million patients annually. Even so, members of the general public and other health care providers are often unaware of the scientific evidence proving the benefits of chiropractic health care.
Careers in Chiropractic Health Care
Exploring a Growing Field
by Cheryl Hawk, DC, PhD, CHES, Editor
Foreword by John Weeks
The U.S. Bureau of Labor Statistics projects that chiropractor employment will increase by 17 percent in the period from 2014 to 2024—more than double the projected growth average (7 percent) for all U.S. jobs.
4th March 2017
Could back pain could be an early warning sign of premature death?
For years we have been told that back pain is insignificant and self-limiting. Usually this opinion did not come from chiropractors who have long recognised that back pain is often recurrent, debilitating and associated with poor quality of life, especially if it becomes chronic or persistent.
So the message now is; "ignore your bad back at your own risk!" Back pain is a common problem and it can have grave consequences. New research suggests that sufferers are actually 13 percent more likely to die early from any cause, and this follows findings that painkillers are ineffective in treating it. The researchers from the University of Sydney assessed the link between death rates and spinal pain in 4,390 twins over the age of 70 and found there is a clear link between back pain and mortality although we don’t know yet why this is so. Back pain is ranked as the highest contributor to disability in the world and may affect four in five people at some point in their lifetime. Studies have shown paracetamol or ibuprofen is ineffective against back pain, and more powerful opioid painkillers are both ineffective and highly dangerous.
18th Feb 2017
Things that work for back pain… and those that don’t
The mainstream medical media recently included spinal manipulation on a list of things that work for back pain. Chiropractors have always maintained that our non-pharmacological, non-surgical approach makes logical sense and should be tried in conjunction with active care such as lifestyle modification to include physical activity as a first option for both acute and chronic spinal pain.
What works:
Exercise; Tai chi; Yoga; Mindfulness-based stress reduction and other psychological therapies, Spinal manipulation and massage, Acupuncture.
What doesn’t work: Passive physical therapies (interferential therapy, short-wave diathermy, traction, ultrasound, lumbar supports, taping, electrical muscle stimulations), Opioids, Paracetamol, Benzodiazepines, Systemic corticosteroids, Tricyclic and SSRI antidepressants, (Insufficient evidence for gabapentin/pregabalin).
4th Feb 2017
NSAIDS no better than a sugar pill for back pain
A new study published in the highly respected journal Annals of the Rheumatic Diseases, has concluded "Compared with placebo, non-steroidal anti-inflammatory drugs (NSAIDs) do not provide a clinically important effect on spinal pain".
Researchers found six patients had to be treated with anti-inflammatory drugs for one patient to achieve a clinically important benefit in the short-term and the drugs come with side effects. Their safety analysis revealed NSAIDs increased the risk of gastrointestinal side effects by 2.5 times, compared to placebo.
This study follows on ‘the back’ of previous findings by the same expert team in the George Institute in Sydney which found that Paracetamol is also no better than placebo for back pain. These studies are really interesting because they appear to bring into question the current clinical practice guidelines that suggest these over the counter (OTC) medications as first line treatments for back pain.
So where does that leave people who have back pain and want relief? Well the best advice appears to be; 1) stay active 2) avoid bed rest 3) remember that avoiding the pain may not help, in other words even if it hurts to move it’s probably not causing harm, and 4) consider getting spinal manual care.
While the guidelines do already recommend that spinal manipulation be considered for pain relief and functional restoration if pain persists, it looks as though the guidelines should now be reconsidered in light of this new evidence to suggest spinal manipulation as the first option.
Other reference: Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014.
WA Health Department Spinal Pain Model of Care
Media
31st Jan 2017
Relieving spinal pain might also help mental and emotional well-being
I recently published a paper with some colleagues that reported the results of a controlled study looking at responses to chiropractic care among residents of a therapeutic community who had spinal pain. The results were interesting because we found that people who obtained relief from their spinal pain did better in the mental and emotional domains as well.
There is a lot of discussion around at the moment about the effects of chronic pain on a persons' overall sense of well-being. While it is something that chiropractors often notice anecdotally, ie; when people get relief from back pain, they often feel better mentally and emotionally as well, it was interesting for us to measure the extent of these effects in this group of people.
This study was also important in the context of realizing why people end up in a Therapeutic Community at all. Most people go there as a result of alcohol problems and illegal drugs, but a significant proportion are there as a result of getting hooked on prescription drugs sometimes prescribed initially for relief of spinal pain. While they are in the community they are obviously not allowed to use the strong types of drugs like opiates that got them there in the first place, so being able to get drug-free pain relief from chiropractic care is something these people really value.
If you want a full copy of the paper for your own use please contact me.