Intersegmental Traction

Happy summer! Hoping everyone has a nice 4th of July, enjoy the fireworks and the HOT weather!

This month I want to talk about “Intersegmental Traction” or sometimes we here in the office call it “the rollers.” We have a whole section in our office dedicated to this service.  It is an evidence-based therapeutic treatment, for inducing “passive motion” into the spine. “Passive motion” means when someone or something moves your body for you.

How does it work?

Feel those little bony bumps on your back? Those are spinal bones or vertebrae. In between those verbebrae are discs, you cannot feel the discs with your fingers. “Discs” are basically pillows between your bones. They provide shock absorption and motion throughout your whole back. These discs do NOT have a blood supply. They are designed to move, and therefore get their nutrients through motion. If your back is “tight and stiff” it’s usually because your bones and discs are not moving. The purpose of Intersegmental traction, is to put motion into joints that are not moving on their own. This allows the circulating spinal fluids to lubricate the discs, so that they do not “thin out” from lack of motion or lack of nutrients.

So, what’s the experience like in OUR office?

We take you to our therapy room, and have you lay on your back on a bench table in a private setting. You are fully dressed. We turn on the Intersegmental traction beneath you, and the rollers move up and down your spine. The rollers travel from your hips all the way up to just below your neck. There are different levels of intensity, we communicate with you and find your tolerance level first, then show you how to control it on the machine, and how to turn it off if needed. Then we let you relax and enjoy for 10 minutes, the standard amount of time to make a difference but also not leave you feeling too sore. The rollers feel like “waves” beneath your spine. I’ve never had a patient tell me it “hurts.” When 10 minutes are up, the machine turns itself off and you can simply get yourself up and head to the front desk.

Contraindications to use Intersegmental Traction:

Open wounds. Pregnancy. Fractures that are currently healing. Severe osteoporosis. Ligamentous instability. Infection of the discs or spinal cord.

Indications to use Intersegmental Traction:

Reduced pain. Reduced swelling. Provides motion into places that are not moving on their own. Helps restore normal circulation of spinal fluids and nutrients to the discs. Prevention of disc “thinning” or degeneration. Preservation of the disc height that you already have.

Intersegmental traction is a great way to re-enforce a chiropractic adjustment, because it helps maintain the motion that was just put into your spine by your chiropractor. Movement is medicine, and this service is a very beneficial addition to your treatment during the healing process.

It’s just one of many treatments that we can incorporate on your road to recovery here with us, at Performance Health Center.  For more information on Intersegmental Traction, or any of the therapies offer, please contact me at drel@performancehealthcenter.com

 

 

 

When the Best Treatment is NO Treatment

By Dr. Leslie El-Turkmani

I am so excited to be here at Performance Health Center! I’ve met so many nice people, and have already seen some amazing things.  Last week for example……I saw a patient with severe symptoms, crying in pain during the consultation, and could barely get through the physical exam. I knew something more serious was happening.  I told her to come back tomorrow with the MRI of her spine she had taken 1 year ago. The next day she came back, her MRI revealed a “Chiari Malformation.” A congenital condition where the bottom of the brain pushes down the spinal canal at the base of the skull. I knew she needed a neurological consultation right away.

I called our “go to” neurosurgeon, Dr. Krishna Nirmel and got her a priority appointment in 4 days. She should have seen a neurosurgeon at the time of diagnosis, as this condition should be monitored for life. Unfortunately, I had to refuse to treat her. Manipulation could be a contraindication to care. The good news is I may have saved her life or more serious complications from happening by referring her.

At Performance Health Center, we do a detailed consultation, and a thorough physical, orthopedic and  neurological examination on every patient we see. From the examination and my professional training from New York Chiropractic College, I was confident in my diagnosis. Sometimes the greatest treatment you make is to not treat. And you have to know the difference, and when.

“Arnold-Chiari malformation” (CM-1) is caused by the “cerebellum” dropping down the “foramen magnum.” Named after German pathologists, Hans Chiari and Julius Arnold. The cerebellum, Latin for “little brain” is responsible for balance and motor control. The foramen magnum, Latin for “the great opening” is located at the base of the skull, about the size of a quarter with an oval shape. It allows passage of the brain stem and major arteries from brain to body, and vice versa. This herniation of the cerebellum down the foramen magnum is measured in millimeters. It can continue to drop further down over the years. This can lead to poor circulation due to unwanted pressure, and this pressure on the cerebellum can lead to issues with balance, dizziness, headaches, nausea, blurred vision, neck pain, and even atrophy of the structures.

The exact cause of CM-1 is unknown. It is a “malformation” because the individual is usually born with it. It can be symptomatic with signs like what my patient had, or asymptomatic for the individual’s entire life, depending on severity. It is fairly common, every 1:1000 births. It is more common in females. It is best diagnosed by MRI.

Take home message to my patients…pain is not a lifestyle! Nobody likes going to the doctor, but at least when you go see the chiropractor, you’re getting looked at nose to toes, inside and out to find the root of the problem

For more information, or to make an appointment call 508-655-9008.  If you have any questions please email me at DrEl@PerformanceHealthCenter.com

 

 

Spring Time = Tick Time

April is a great time to get outdoors and enjoy this great weather.  This Blog is directed for those of you who like to run, walk or cycle the trails.  I thought this would be a good time to post a Blog on how best to Prevent Lyme disease.  I am amazed at the number of patients that I have encountered who either currently have or that have previously had Lyme disease.  This is something you really do not want to ever get.  If caught early- it can be treated easily, but if not diagnosed right away you may end up with “late stage Lyme Disease” which is very difficult to treat.  I believe your best course of action is in Prevention.  Most of the following information here was written by the CDC (Center of Disease Control and Prevention).  Before gardening, camping, hiking, or just playing outdoors, make preventing tick bites part of your plans.

Lyme disease is spread by the bite of an infected tick. In the United States, an estimated 300,000 infections occur each year. If you camp, hike, work, or play in wooded or grassy places, you could be bitten by an infected tick.

People living in or visiting New England, the mid-Atlantic states, and the upper Midwest are at greatest risk. But you and your family can prevent tick bites and reduce your risk of Lyme disease.

PROTECT YOURSELF FROM TICK BITES

Know where to expect ticks. Blacklegged ticks (the ticks that cause Lyme disease) live in moist and humid environments, particularly in and near wooded or grassy areas. You may get a tick on you during outdoor activities around your home or when walking through leaves and bushes. To avoid ticks, walk in the center of trails and avoid walking through tall bushes or other vegetation.

Use a repellent with DEET (on skin or clothing) or permethrin (on clothing and gear). Repellents containing 20% or more DEET (N, N-diethyl-m-toluamide) can be applied to the skin and can protect up to several hours. Always follow product instructions! Parents should apply repellents to their children. Do not get repellent on children’s hands or in their eyes or mouth. Products that contain permethrin can be used to treat boots, clothing, and camping gear. Treated items can stay protected through several washings.  Shower shortly after coming inside.

Perform Daily Tick Checks

Check your body for ticks after being outdoors, even in your own yard. Search your entire body for ticks when you return from an area that may have ticks. Use a hand-held or full-length mirror to view all parts of your body and remove any tick you find.  Take special care to check these parts of your body and your child’s body for ticks:

  • Under the arms
  • In and around the ears
  • Inside the belly button
  • Back of the knees
  • In and around all head and body hair
  • Between the legs
  • Around the waist

Check your clothing and pets for ticks because they may carry ticks into the house. Check clothes and pets carefully and remove any ticks that are found. Place clothes into a dryer on high heat to kill ticks.

REMOVE ATTACHED TICKS QUICKLY AND CORRECTLY

Remove an attached tick with fine-tipped tweezers as soon as you notice it. If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small; however, other diseases may be transmitted more quickly.

Over the next few weeks, watch for signs or symptoms of Lyme disease such as rash or fever. See a healthcare provider if you have signs or symptoms.

BE ALERT FOR FEVER OR RASH

Even if you don’t remember being bitten by a tick, an unexpected summer fever or odd rash may be the first signs of Lyme disease, particularly if you’ve been in tick habitat. See your healthcare provider if you have symptoms.

PREVENT TICKS ON ANIMALS

Prevent family pets from bringing ticks into the home by limiting their access to tick-infested areas and by using veterinarian-prescribed tick collars or spot-on treatment.

CREATE TICK-SAFE ZONES IN YOUR YARD

It’s pretty simple. Keep patios, play areas, and playground equipment away from shrubs, bushes, and other vegetation. Regularly remove leaves, clear tall grasses and brush around your home, and place wood chips or gravel between lawns and wooded areas to keep ticks away from recreational areas (and away from you).

  • Use a chemical control agent. Effective tick control chemicals are available for homeowners to use, or a professional pest control expert can apply them.
  • Discourage deer. Deer are the main food source of adult ticks. Keep deer away from your home by removing plants that attract deer and by constructing barriers (like a fence) to discourage deer from entering your yard and bringing ticks with them. ​

I definitely want you to continue to lead the active healthy lifestyle that you want, and enjoying the outdoors is a great way to do so, just please be aware of the potential hazards of tick-borne illnesses, and please follow these guidelines to help prevent you or anyone you love from Lyme Disease or any other potential tick-borne illness.

If you have any questions about this Blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com or by phone at: (508) 655-9008.

What is the Difference Between 50 degrees in the fall and 50 degrees in the spring?

Question: What is the difference between 50 degrees in the fall and 50 degrees in the spring?

Answer: In the spring 50 degrees feels warm!

This last weekend was the first “nice” weekend of spring!  When I went out to get the morning paper the birds were singing and overnight flowers had bloomed in my garden, including crocus, bluets and periwinkle.  After breakfast I went for my first mountain bike ride of the season.  There were many other bikers and trail runners out.  I rode by a baseball game- must have been opening day!  As I passed a playground it was full of parents with little kids playing on the swings and slides.  Heading home the landscapers were doing spring clean-ups and spreading mulch.

I love this time of year! For many after a sedentary winter the weather gets warmer and we into activity.  Spring sports are starting for our youth athletes, we itch to get our gardens back in shape, we tune up our bikes and spring into action.

Many of us spring into action too fast and furiously and pay the price in pain. Monday mornings after weekends like this our phone rings off the hook with people who hurt themselves.  We get the traumatic injuries, but more commonly it is caused by overuse.  “Spring cleaning” the garden, playing catch with our kids for hours,  running a little more than their bodies are ready for, or hitting the gym too hard trying to get into bathing suite shape.   Whatever the cause of that flair-up, it is almost always caused by doing too much too fast.  One of the 1st questions I ask in a treatment room is, “did you stretch first”?  The answer is universally no.

I hope you are not one of those Monday morning phone calls looking for emergency pain relief.  If you are know that we are here and ready to help you.  We have a long stretch of nice weather heading our way leading into summer which I want you to enjoy.  No one want to be sidelined from an injury that you could have prevented.

Please remember to pace yourself.  Stretch before and after activity.  If you get injured, before calling the office start with home care.  This leads to the age old debate of whether to ice or heat.   I’m a big fan of ice.  You can’t have pain without inflammation and ice is the best, safest and most localized anti-inflammatory.  The only time I recommend heat is if you wake up the next morning and you feel sore like you haven’t used muscles in a while.  If there is pain at a joint or along your spine then ice is probably the best therapy.  The best way to ice in the first 24 hours after injury is 15 minutes on, wait 15 minutes then repeat.  After 24 hours you should  ice for 20 minutes than wait an hour before repeating.   Whether you ice or heat it should be moist otherwise you can freeze or burn the skin.  I like to dampen a paper towel then squeeze all the water out. This is damp enough for the ice or heat to penetrate, but doesn’t make a wet mess.

Spring is also a great time to do a spring tune-up to your spine.  Your spine is made up of 24 vertebrae and has over 120 joints. It is the chassis for your torso and also houses and protects your spinal cord.  My job as a chiropractor is to make sure these joints are moving correctly and to make sure the muscles that move the spine and support your posture are balanced and functioning properly.  At Performance Health Center we take care of your spine and all the joints of your body.  Before you spring into spring activities, now is a great time for a body tune-up.

To see if your body is ready for the spring, or to get that spinal-tune-up that maybe overdue, please call the office at 508-655-9008.  If you have any questions please email me at drbradweiss@performancehealthcenter.com

 

10 Reasons to Use a Humidifier

As a Doctor of Chiropractic, I see a lot of sick and injured people every day, and it is my job to help these patients get better.  Yes… Chiropractic can also help with colds and flu- studies show that getting regular chiropractic adjustments helps boost the immune system which in turn can help prevent getting the common cold or even the flu.  I wanted to write this month’s blog on how using a humidifier this winter can also help you prevent getting the cold or flu.

We are just now entering the coldest months of the year, and a time where people are more likely to get sick.  The old theory was that we spend more time in the winter indoors and more time inside in close proximity closer to other people, but more recent research has shown that it is the big drop in humidity that leaves us more susceptible to colds and the flu.  Winter air is dry air. Humidifiers put moisture back into the air, which can create a lot of benefits for you and your family.

A 2013 study, for example, showed that increasing humidity levels to 43% or above significantly reduced the ability of airborne viruses to cause flu infections. In fact, in a low humidity environment, 70-77 % of viruses could transmit the disease through coughs, but when humidity was increased to 43% or more, that number dropped to only 14%.

An earlier 2009 study showed similar results, with humidity limiting the transmission of the influenza virus.

Using a humidifier may help you avoid getting sick this winter, and it can offer other benefits for you, and your family and it may even benefit your house.

10 Benefits of Using a Humidifier

  1. Reduce risk of infections. Viruses and bacteria can’t travel as well in moist air. A humidifier could mean the difference between getting the flu this winter and remaining healthy.
  2. Softer, more vibrant skin. Cold, dry air saps moisture from your skin, which causes all kinds of problems, including dryness, dullness, flaking, and accelerated aging. A humidifier can help prevent all these damaging effects, and help you maintain that glowing, vibrant look for all your holiday parties and get-togethers.
  3. Comfortable sinuses. You know that dry, tight feeling you get in your nose in the winter? Even if you don’t have a cold (it’s worse when you do), winter air can dry out your sinuses, lowering your resistance to bacteria and viruses. Sleep with a humidifier and wake up with a more comfortable nose—and throat!
  4. Faster healing times. Say you do end up with a cold, a sinus infection, or the flu. A humidifier will shorten your suffering. Keeping your nasal passages and your throat moist will help you heal faster, and will reduce symptoms like coughing and sneezing.
  5. Healthier houseplants. Plants help pull toxins out of the air. But they can suffer in dry, winter air. Have you noticed that the soil is dryer than usual? Are the leaves looking droopy and sick? A humidifier can help keep your houseplants healthy—which helps keep you healthy, too!
  6. Protected wood furnishings. Dry air can damage wood furniture, as well as moldings and doors, causing them to split and crack. A humidifier can help preserve the integrity of the wood, maintaining your pieces for years to come.
  7. No growling morning voice. Do you often sound like a bear in the mornings? That’s dry air getting to your vocal cords. Sound more like your normal self when you sleep overnight with a humidifier in your bedroom!
  8. Reduced heating bill. Did you know that moist air feels warmer than dry air? It’s true. If you add some moisture to the air, it will feel warmer, which can help you save on your heating bills this winter.
  9. Fewer electric shocks. No one likes a static electricity shock—especially not the cat! But you may have noticed that in the winter, it’s harder to avoid it. That’s the dry air again. Use a humidifier and leave the lightning outside.
  10. Improved sleep. If you or a partner snores, a humidifier may help. We tend to snore more if our sinuses and throats are dry. A moist environment also tends to feel warmer and more comfortable, which can encourage a good night’s sleep.

Some Precautions

While humidifiers are great for you for a number of reasons, they do need to be cleaned regularly. Otherwise, they can become a source of bacteria and mold, which you don’t want floating around your home.

Here are some tips to help:

  • Use distilled or demineralized water. This can save you a lot of work. Regular tap water has minerals that create buildup in your machine and promote bacterial growth. Distilled and demineralized water contain fewer minerals and will save you from having to clean as often.
  • Clean once a week. If you make this a regular part of your routine, you’ll be able to get it done quickly and will keep your home healthy. Put if off and you’ll face a harder job and risk bacteria and mold buildup.
  • Change filters regularly. If your humidifier has a filter, follow the manufacturer’s directions for changing it.
  • Too much humidity can be just as problematic as not enough. Use a “hygrometer” (you can find one at home improvement and electronic stores) to measure the humidity in your home. Ideal, as shown by the study, is about 40-50 percent.

We are here to help you feel and function better so you can do all the things you like to do.  If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com

Stay Safe During Hot Weather Exercise

If you are a regular reader of these blogs you know that I definitely advocate exercising on a regular basis, but when the summer months turn really hot and humid, you need to be careful to avoid heat related illnesses like heat stroke or heat exhaustion.

Whether you’re running, playing tennis, working in your yard or garden, or going for a power walk, please be careful when the temperature rises. Even in your home, you should take measures to ensure the home is nice and cool. You might want to check out Allen Kelly & Company, Inc. if you need an air conditioning facility.

Exercising in hot weather puts extra stress on your body. If you don’t take care when exercising in the heat, you risk serious illness. Both the exercise itself and the air temperature and humidity can increase your core body temperature.

To help cool itself, your body sends more blood to circulate through your skin. This leaves less blood for your muscles, which in turn increases your heart rate. If the humidity also is high, your body faces added stress because sweat doesn’t readily evaporate from your skin. That pushes your body temperature even higher.

Under normal conditions, your skin, blood vessels and perspiration level adjust to the heat. But these natural cooling systems may fail if you’re exposed to high temperatures and humidity for too long, you sweat heavily, and you don’t drink enough fluids.

The result may be a heat-related illness. Heat-related illnesses occur along a spectrum, starting out mild but worsening if left untreated. Heat illnesses include:

  • Heat cramps.Heat cramps, sometimes called exercise-associated muscle cramps, are painful muscle contractions that can occur with exercise. Affected muscles may feel firm to the touch. You may feel muscle pain or spasms. Your body temperature may be normal.
  • Heat syncope and exercise-associated collapseHeat syncope is a feeling of lightheadedness or fainting caused by high temperatures, often occurring after standing for a long period of time or standing quickly after sitting for a long period of time. Exercise-associated collapse is feeling lightheaded or fainting immediately after exercising, and it can occur especially if you immediately stop running and stand still after a race or a long run.
  • Heat exhaustion.With heat exhaustion, your body temperature rises as high as 104° F, and you may experience nausea, vomiting, weakness, headache, fainting, sweating and cold, clammy skin. If left untreated, heat exhaustion can lead to heatstroke.
  • Heatstroke is a life-threatening emergency condition that occurs when your body temperature is greater than 104° F. Your skin may be dry from lack of sweat, or it may be moist.

You may develop confusion, irritability, headache, heart rhythm problems, dizziness, fainting, nausea, vomiting, visual problems and fatigue. You need immediate medical attention to prevent brain damage, organ failure or even death.

During hot-weather exercise, watch for signs and symptoms of heat-related illness. If you ignore these symptoms, your condition can worsen, resulting in a medical emergency.

WARNING SIGNS:

  • Muscle cramps
  • Nausea or vomiting
  • Weakness
  • Fatigue
  • Headache
  • Excessive sweating
  • Dizziness or lightheadedness
  • Confusion
  • Irritability
  • Low blood pressure
  • Increased heart rate
  • Visual problems

If you develop any of these symptoms, you must lower your body temperature and get hydrated right away. Stop exercising immediately and get out of the heat. If possible, have someone stay with you who can help monitor your condition.

Measuring core body temperature with a rectal thermometer is essential to accurately determine the degree of heat injury. An oral, ear or forehead thermometer doesn’t provide an accurate temperature reading for this purpose. In cases of heatstroke, due to confusion and mental status changes, you won’t be able to treat yourself and you’ll require emergency medical care. The most effective way of rapid cooling is immersion of your body in a cold- or ice-water tub.

In cases of heat exhaustion, remove extra clothing or sports equipment. Make sure you are around people who can help you and assist in your care. If possible, fan your body or wet down your body with cool water.

You may place cool, wet towels or ice packs on your neck, forehead and under your arms, spray yourself with water from a hose or shower, or sit in a tub filled with cold water. Drink fluids such as water or a sports drink. If you don’t feel better within about 20 minutes, seek emergency medical care.

IF YOU HAVE SIGNS OF HEAT STROKE- SEEK MEDICAL TREATMENT RIGHT AWAY

If your core temperature is less than 104° F, but it doesn’t come down quickly, you’ll also need urgent medical attention. In some cases, you may need fluids through intravenous (IV) tubes if you’re not able to drink fluids, or not able to drink enough fluids.

Get cleared by your doctor before you return to exercise if you’ve had heatstroke. Your doctor will likely recommend that you wait to return to exercise or sports until you’re not experiencing symptoms. If you’ve had a heatstroke, you may require many weeks before you are able to exercise at a high level. Once your doctor clears you for exercise, you may begin to exercise for short periods of time and gradually exercise for longer periods as you adjust to the heat.

When you exercise in hot weather, keep these precautions in mind:

  • Watch the temperature.Pay attention to weather forecasts and heat alerts. Know what the temperature is expected to be for the duration of your planned outdoor activity. In running events, there are “flag” warnings that correspond to the degree of heat and humidity. For example, a yellow flag requires careful monitoring, and races are canceled in black flag conditions.
  • Get acclimated.If you’re used to exercising indoors or in cooler weather, take it easy at first when you exercise in the heat. It can take at least one to two weeks to adapt to the heat. As your body adapts to the heat over time, gradually increase the length and intensity of your workouts.
  • Know your fitness level.If you’re unfit or new to exercise, be extra cautious when working out in the heat. Your body may have a lower tolerance to the heat. Reduce your exercise intensity and take frequent breaks.
  • Drink plenty of fluids.Dehydration is a key factor in heat illness. Help your body sweat and cool down by staying well-hydrated with water. Don’t wait until you’re thirsty to drink fluids. If you plan to exercise intensely, consider a sports drink instead of water. Sports drinks can replace the sodium, chloride and potassium you lose through sweating. Avoid alcoholic drinks because they can actually promote fluid loss.
  • Dress appropriately.Lightweight, loose fitting clothing helps sweat evaporate and keeps you cooler. Avoid dark colors, which can absorb heat. If possible, wear a light-colored, wide-brimmed hat.
  • Avoid midday sun.Exercise in the morning or evening, when it’s likely to be cooler outdoors. If possible, exercise in shady areas, or do a water workout in a pool.
  • Wear sunscreen.A sunburn decreases your body’s ability to cool itself and increases the risk of skin cancer.
  • Have a backup plan.If you’re concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building.
  • Understand your medical risks.Certain medical conditions or medications can increase your risk of a heat-related illness. If you plan to exercise in the heat, talk to your doctor about precautions.
  • Choose and alternative form of exercise. If you are a runner – maybe try cycling as you create your own cooling effect by moving air over your body – or maybe give swimming a go – but beware of swimming laps in a hot (> 84° F) pool – as you can quickly overheat swimming in water that warm.

I do recommend that you continue to exercise on a regular basis even through this hot month of August, just be smart about it by following these recommendations.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com

 

Share This With Your PCP!

Unfortunately the following saga is way too typical in our office. Last month I saw a new patient who had severe low back pain (LBP) for over 2 years. The pain was so severe she was living on pain meds, going right home from work and going to bed. She was not participating in life and was extremely frustrated. She had seen her Primary Care Physician (PCP) from the onset of her pain. She was referred to multiple specialists for advanced testing, injections and more medications, none of which gave her any real relief or hope.

Finally after two (2) years, at the repeated encouragement of Lyn Rome, her hair stylist, she came into my office, explained in detail all she had been through and the frustration of living with pain. My exam ruled out all the “red flags” or pathological causes of her pain. My diagnosis was dysfunction of her left Sacro-iliac joint and sciatic nerve entrapment. Simply put, the largest joint in her body (in the butt area) was stuck and the longest and thickest nerve in the body which goes from the low back to the toes was not gliding properly. Of course she also had muscles spasms because her muscles were short and tight to protect the joint that was not moving, setting up a visors cycle of pain that kept perpetuating itself.

I felt confident I could help her, but since she was skeptical and nervous from her prior medical treatments I recommended a 2 week trial of chiropractic care to see how she would respond. I wish all of my patients responded so quickly, but after 2 treatments she had significant decrease in pain, stopped the pain meds and didn’t have to go right to bed after work. Obviously the trial of care was successful and she is on the road to recovery.

Two (2) years of her life was wasted because of ignorance (or bias) on the part of her PCP. Unfortunately this is a scenario I see all the time at our office, but it shouldn’t be that way. Any competent medical doctor who keeps up with the literature should know that chiropractic care has been well documented as an effective treatment for LBP. (It is not the only condition we treat, but the most researched). There really is no excuse for collaboration between your PCP and the chiropractic profession for the best interest of the patient, especially for the treatment of LBP.

Now there is even more proof! In the May 2018, on-line edition of the JAMA (Journal of the American Medical Association), a new studies found that “usual medical care plus chiropractic care reported a statistically significant improvement in low back pain intensity and disability at 6 weeks compared with those who received usual care alone.” In a study of 750 people, from the ages of 18-50, the addition of including chiropractic care documented statistically significant improvement included less reported pain, less disability, more patient satisfaction and less pain medications used. Across the board including chiropractic care reduced pain and suffering.The conclusion of this study states, “this trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines”. Note the words…as currently recommended in existing guidelines.

The number one cause of disability worldwide is LBP! At least 20% of Americans will have LBP lasting at least 1 day over the next 3 months. LBP is the 2nd reason why patients visit their PCP. The direct cost of LBP in 2010 was $34 billion, and adding in lost work and productivity costs the US economy up to $200 Billion. At the present time only 8-14% of the US population receives chiropractic care annually. So why aren’t PCPs referring to chiropractors. Getting historical, there have been excellent studies validating chiropractic care and multiple government reports recommend a greater utilization of chiropractic care.

As far back as 1993 the Ontario Ministry of Health published what is called the Manga Report. The Manga Report’s conclusion was to make chiropractors the gatekeepers for treating LBP for many reasons concluding: “On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate; there is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain; and there is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”

Then in 1994, the US Agency on Health Care Policy and Research (AHCPR) released Clinical Guidelines for Management of Acute Low Back Pain. These Guidelines were created an expert panel to provide PCPs with recommendations on the assessment and treatment of LBP. Again the conclusions included:
• Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

The benefits of chiropractic care both in human suffering level and economic savings is well documented and recommended by multiple government agencies. I still don’t understand why the chiropractic profession is not getting more referrals from the medical profession. Going back to the patient in the first paragraph, in her words she lost 2 years of her life and had lost hope of ever being able to function and doing the most basic activities like walking with her husband or sitting in a restaurant. My bias is that she should have been referred for chiropractic care after the pain lasted for 2 weeks while following her PCPs advice. When the pain persisted and multiple therapies failed, at the very least her PCP could have said I don’t know much about chiropractic health care, but since you are not feeling better why don’t you give it a try.

I don’t fault the present generation of medical doctors. Chiropractic care is not part of their educational curriculum. I have seen this first hand. For eight (8) years family practice residents first at University of Vermont and then Tufts had a one (1) day rotation at my office. I asked each resident in all your years of medical school and residency how much did they learn about chiropractic health care. The answer across the board was “nothing”. Then I’d ask how much did they learn about the musculoskeletal system? The answer across the board this time was “not much”. Then I’d ask my final question which was how many vertebrae are in the spine? In 8 years only 1 Family Practice Resident was able to rattle off the correct answer which is 24.

Then the medical resident spent the day with me watching me interact and treat my patients. At the end of the day across the residents would say how impressed they were. They didn’t realize the scope of chiropractic practice and the benefits of manipulation. My advice was always the same. When you finish your residencies and hang up your shingle to practice, meet a few chiropractors in your community, find one or two that you feel comfortable with and refer your patients to them. Unfortunately this type of rotation at a chiropractic office was and still is a rare event in the training of medical residents.

Hopefully you have read down this far. The only way your PCP is going to know about this new study (and historical guidelines) is if you share this article with them. Please email your PCP and attach this article. Ask if he/she has read the new JAMA study on the significant benefits of including chiropractic care in collaboration with “usual medical care” for patients with low back pain? If not the link is here: Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial

Sharing this article with your PCP this will help build bridges between the two professions and the winner is you, the consumer of health care.

For more information please contact me at drbradweiss@performancehealthcenter.com

“Rest and Relax” vs “Fight or Flight”

“Rest and Relax” (PNS) vs “Fight or Flight” (SNS)…. I am writing this Blog the week before Super Bowl LII, while most sports fans are thinking AFC vs NFC and which is stronger and who will over power the other.  Well, I want you to consider in your own mind which system in your body is overpowering the other?

What do I mean by that?  Well, we all have both a Parasympathetic nervous system (PNS) and Sympathetic nervous system (SNS), both of which are regulated by our Central Nervous System (CNS).  Which ever one is dominant in you may influence your overall health.  People who are more SNS dominant may have trouble relaxing, they may have hypertension, muscle tension, irritability, and difficulty with digestion and/or elimination.  There are a host of health-related problems from being too SNS dominant, but for the sake of this blog I will highlight how it effects our overall nutritional intake and absorption.

Have you ever switched your focus from what you are eating to how you are digesting? Are you really absorbing all the nutrients from your foods?

The parasympathetic nerves come from the cranial nerves and include the vagus nerve. The PNS nerves perform the following digestive functions:

  • Stimulate the activity of the stomach
  • Inhibit the release of glucose
  • Stimulate the release of the gallbladder to release bile needed to digest fat
  • Stimulate the activity of the intestines
  • Trigger peristalsis, which helps prevent constipation
  • Trigger enzyme production in the pancreas (pancreatic enzymes to break down carbs, protein and fats)
  • Signal if satiated
  • Signal if hungry
  • Need for more stomach acid (HCL), enzymes, bile and peristalsis

The sympathetic nerves do the opposite, including:

  • Inhibit the activity of the stomach
  • Stimulate the release of glucose (increasing blood sugar levels)
  • Inhibit gallbladder function (inhibiting the release of bile for fat digestion)
  • Inhibit the activity of the intestines

Stress impairs our digestive process. Digestion is a parasympathetic nervous system process (PNS) also known as the “rest, digest and repair” nervous system. For maximum health we should be in the PNS 80 percent of the time and the other 20 percent of the day we should be in the sympathetic nervous system (SNS), also known as the “fight or flight” nervous system. Now what percentage of the day do you think you are in PNS versus SNS? What about when you are eating? Resting? Sleeping? We should be in the parasympathetic nervous system when eating but rarely do we sit, relax and focus on eating a meal as they do in most areas of Europe.

If you are a typical type-A personality, over-doer in life, then you may struggle with taking time out of your weekday for a relaxing meal and unplugging. What is the difference? Eating in the parasympathetic nervous system versus the sympathetic nervous system. Digestion is turned off when you are in the sympathetic nervous system. Many of us are living life as a race leading us to be in the sympathetic nervous system 80 percent of the day instead of 20 percent, causing a domino effect of health problems.

So, we know the vagus nerve highly influences the PNS so our vagus nerve needs to be strong in order to help in the digestion process. Remember, we get our amino acids, essential fatty acids, vitamins and minerals from the food we digest and break down, which helps build enzymes, hormones, muscles, bones, blood and our gut biome.

We need to support our vagus nerve and (PNS) to improve our digestion and gut health if we want to be healthier, since good digestion leads to a healthy gut, which results in reduced inflammation and an improved immune system (70% of our immune system is in the gut!).

Stop, pause, slow inhales, long exhales and reset. Take some deep breathes in and out, focus and unplug. Other techniques to boost your PNS: gargling, humming, singing, cold showers, meditation, mindful yoga, and connecting with loved ones.

Our digestion is as important as our diet. To nourish ourselves, we must support our digestion, but also our brain, as the brain communicates to the gut and the gut communicates back to the brain. Anti-inflammation is key to our bodies’ repair, recovery and regeneration, but it doesn’t happen if we are not in the parasympathetic nervous system more often during the day and all night.

Chiropractic adjustments can strengthen your PNS since it deals directly with your nervous system.  Every function of your body is controlled by your central nervous system, and these functions can be disrupted by misalignments in your spine. These are called subluxations. A subluxation creates interference in the function of your spinal nerves, and this can result in impaired functioning of your organs and endocrine system.

So, slow down, take some deep breaths and get regular chiropractic adjustments to keep your vagus nerve and your PNS strong and healthy.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com