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"Bridge the gap between injury and performance"

The Functionally Unstable Spine

8/15/2023

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A functionally unstable spine may be the cause of a person's back pain. It is a painful disorder thought to result from a loss of the spine’s ability to maintain appropriate mechanical stiffness throughout it's NORMAL range of movements. In biomechanical terms, spinal stiffness refers to the spine’s ability to prevent unwanted movement or buckling. People often think of stiffness as a bad thing. It isn't always. When a muscle contracts, it creates both force and stiffness. Spinal stiffness is necessary to perform basic daily movements. With minimal amount of force, muscles around the spine act as guy wires, a tensioned cable designed to add stability to a free-standing structure.

It is important to note that a functionally unstable spine is not synonymous with hypermobility or radiographic instability. Hypermobility and radiographic instability is where spinal joint motion is excessive BEYOND normal joint movement. This is typically demonstrated on appropriate imaging.

Some indicators that 
a functionally unstable spine may be the cause of a person's back pain often include:
  • Multiple unpredictable episodes triggered by sudden or trivial movements or sustained postures
  • Reports of catching or locking associated with a feeling of giving way or consistent clicking or clunking noises which may be followed by a minor aching for a few days
  • Immediate pain with transitional movements like sit to stand
  • Temporary response to adjustments
  • Decreased response to adjustments over time

40-60% of typical back pain patients experience recurrence or low level chronic symptoms, but a pattern of sudden flare ups caused by minimal loading events may be linked in this instability phenomena. The theory behind this is that poor stability increases the risk of a “spinal buckling” under minimal weight, often just bodyweight movements, and triggers episodes. This accumulative repetitive buckling makes it difficult for the patient to truly feel a healing of their back pain. 

The safest and most effective conservative treatment for patients with a functionally unstable spine is through an effective spine stabilization exercise routine. Stabilization exercises are designed to improve spinal stability, relieve pain and increase movement performance. A large number of muscles cross the spine, and all contribute to the modulation of lumbar stability and movement to some extent. Multiple imaging studies have demonstrated muscle atrophy in patients with chronic back pain. A stabilization exercise routine is designed to target these areas of muscle atrophy to improve strength and reduce muscle fatigue over time.

Some of the muscles that are most commonly weakened and atrophied in patients with a functionally unstable spine are:
  • Multifidus
  • Quadratus lumborum
  • Transverse Abdominis
  • Internal and External Abdominal Obliques
  • Gluteus Maximus
  • Gluteus Medius
  • Diaphragm

Most people are surprised to learn that the diaphragm, which is mainly involved in breathing, is a key muscle in creating spinal stability. As the roof of the cylinder of muscles that surround the spine and assist with stability, the diaphragm is a major contributor to intraabdominal pressure and therefore lumbar stability. The diaphragm contributes to this spinal stiffness before the initiation of large limb movements to assist with spinal stability and greater strength of the arms or legs.

Some of the most effective stabilization exercises studied include:
  • Learning to find and maintain a neutral spinal position
  • Isometric contractions of the multifidus and transverse abdominis
  • Dead bug
  • Supine pelvic bridge
  • Side bridge
  • Bird dog
  • Bear crawl
  • Reverse Hyperextension
  • Planking with variations

Once these exercises are mastered, a person suffering from a functionally unstable spine can gradually progress to various bodyweight loading strategies that would ordinarily be seen a training weight training environment. This type of training of the spine will carry over into the performance of functional activities, daily living activities, and work ultimately resulting in reduced episodes of functionally unstable back pain.

If you feel your back pain is the result of a functionally unstable spine, please click the link below to request an appointment!
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Back Pack Ergonomics: A guide to proper back pack use for children

8/9/2023

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Incorrect use of a proper back pack can be just as damaging as using an improper back pack. Our growing children use their back packs for many years. Repetitive loading of heavy back packs combined with poor ergonomics can be a source of dysfunction in their body and can lead to chronic back and shoulder pain. Smart choices now are important to your child's health long after their school days are gone.

Signs that your child's back pack is inappropriate for them or that they are wearing the pack incorrectly include:
  • Headaches at the base of their skull
  • Neck pain or pain between their shoulder blades
  • Red marks on their shoulders
  • Shoulders rolled forward
  • Stomach sticking out 
  • Hips rolled forward
  • Numbness in their arms or hands

When purchasing a new back pack one should look for:
  • A lightweight bag which is the same length as your child's torso.
  • A back pack that sits no higher than the top of your child's shoulders and no lower than the hip bones.
  • Wide (at least 2") adjustable padded straps that do not cut into their arms or armpits.
  • Chest strap
  • Waist strap
  • A padded back with many compartments to evenly distribute the weight

Maintain regular adjustments with your chiropractor to detect and correct spinal problems before they cause pain and dysfunction in your growing child.

Additional tips for proper back pack ergonomics:
  • Place heavy items closest to their back.
  • Place odd shaped items outside to prevent poking into their back.
  • Elementary students should no exceed 10% of their body weight.
  • Junior and Senior High students should not exceed 15% of their body weight.
  • Place the back pack on their back from a table height or lift properly with the knees.
  • Adjust the straps so the bottom of the back pack lies in the curve of their low back.
  • Check the back pack regularly for unnecessary items.
  • Carry extra books or lunches in hand.
  • Use the waist strap to redistribute 50-70% of the bag's weight off their upper body and onto their pelvis.
  • Have their back pack assessed with your local chiropractor for appropriateness.
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Treatment of lumbar disc herniation: Evidence-based practice

8/1/2023

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When a patient is diagnosed with a lumbar disc herniation, what is the best treatment?

Best Answer: Both conservative and surgical options are backed by research. Though the ultimate decision of which route to choose should be made by the patient based on their individual goals and needs after an honest discussion with their surgeon.

Now let's talk!

Lumbar disc herniations are a very common condition affecting the spine of young and middle-aged folks. The incidence of lumbar disc herniations within certain populations has been estimated to be greater than 50% though often the disc herniations is asymptomatic, meaning without symptoms. A disc “injury” quite often happens in the absence of any pain and you don’t even know about it. Medicare estimates that spending on lumbar discectomy procedure, a surgery to remove disc material, exceeds $300 million annually. Back pain related disorders may or may not always be the result of a disc herniation but are a common cause of disability nonetheless. The American health care system spends over $1 billion annually to address back pain conditions. 

The structure of the disc is composed of circular, basket woven-like annular fibers made of collagen, proteoglycans, and a variety of regenerative cells that surround a gel like structure called the nucleus pulposus. The disc serves to dissipate forces exerted on the spine as well as give space between the vertebra above and below the disc so the nerves have room to exit the spine. As we age, the disc tends to lose water content and height. This loss of hydration and disc collapse can increase strain on the annular fibers which may lead to bulging, a protrusion or extrusion of disc material that would be seen as a herniation. The joint made up between the two vertebral bones and disc is called the intervertebral joint. It is classified as a fibrocartilage joint and can also be referred to as a symphysis joint, similar to the pubic symphysis of the pelvis. If you know anything about symphysis joints, you know that they are EXTREMELY STRONG and they certainly don't slip out of place, giving the impression that discs are inherently weak. It takes about 740lbs of force to compress the disc height 1mm in young subjects and 460lbs of force to compress the disc height 1mm in older subjects. End story is that discs are VERY strong. 

With all that said, back pain may still occur due to disc bulging without pressure on the spinal canal or nerve roots. However back pain with radiculopathy can occur when pressure or irritation of the extruded disc material contacts the thecal sac or lumbar nerve roots. The pain commonly felt with radiculopathy can be felt as electrical, shooting, pins and needles, numbness, tingling, or weakness into the leg. Often patients will experience this as "Sciatica". Sciatica is a description of any of the symptoms above felt in the leg as a result of pressure or irritation of the specific nerve roots levels of L4, L5, or S1. The good news is that 90% of patients with lumbar disc herniations will improve without substantial medical intervention like surgery. Too many people think that once you have a disc herniation (or disc bulge), that you’ve got it for life. Discs have the ability to heal. A patient should not be fearsome of low back pain, even if pain is caused by a disc injury.

Regarding treatment, the research supports both conservative management and surgical intervention as viable options for the treatment of lumbar disc herniation even when radiculopathy is present. Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results studies show similar outcomes regardless of type of management. It should be noted that contrary to popular belief of some including surgeons, the size of a lumbar disc herniation does not predict outcomes or the need for surgery. Research indicates from many studies, multiple medical association position statements, and my own clinical experience treating these disorders validates this notion. This is consistent with findings from a 2010 study which found that even massive disc herniations can successfully be treated conservatively. In fact, on several occasions patients with nearly complete spinal canal narrowing were successfully managed without surgery, some as great as 85.1%. Literature suggests that less than 10% of disc herniation cases ultimately require surgery.

The typical patient with lumbar disc related pain will often present to their primary care physician first. However research supports chiropractors being a great first contact for these patients. In fact, medical costs may significantly be reduced when a patient visits a chiropractor first. Initial management of these disorders should include regular movement within a patient's tolerance, exercise guidance, manipulation of the spine, proper nutrition and supplementation, and adequate sleep. A patient should not be told to completely rest. Many of these patients are able to continue lifting. In most instances, radicular symptoms will go away within six weeks. Patients with symptoms that persist beyond six weeks will often be referred for advanced imaging like magnetic resonance imaging (MRI) in order to identify the area of disc pathology and to determine if they are also candidates for more invasive treatments like  injection or surgery.

If you are suffering from back pain, please click the link below to request an appointment!
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Benefits of Chiropractic

7/26/2023

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Thirty-one million Americans have low back pain at any given time.1 One half of all working Americans admit to having back symptoms each year. 2 One third of all Americans over age 18 had a back problem in the past five years severe enough for them to seek professional help. 3  And the cost of this care is estimated to be a staggering $50 Billion yearly–and that’s just for the more easily identified costs!4
These are just some of the astounding facts about Americans and their miserable backs! Is there any wonder why some experts estimate that as many as 80% of all of us will experience a back problem at some time in our lives?5
Because back problems are this common it’s probably going to happen to you too! Shouldn’t you find out what to do about it before it happens rather than after? Why wait until you’re hurting to learn about your treatment options?
When you’re hurting you may not give this important decision the time and attention it needs to make the best choice. Here are the facts about manipulation as a treatment for back problems:
Manipulation is one of several established forms of treatment used for back problems. Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today’s growing emphasis on treatment and cost effectiveness, manipulation is receiving much more widespread attention. In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research–a federal government research organization–recommended that low back pain suffers choose the most conservative care first. And it recommended spinal manipulation as the ONLY safe and effective, DRUGLESS form of initial professional treatment for acute low back problems in adults!6 Chiropractic manipulation, also frequently called the chiropractic adjustment, is the form of manipulation that has been most extensively used by Americans for the last one hundred years.7 Satisfied chiropractic patients already know that DCs are uniquely trained and experienced in diagnosing back problems and are the doctors most skilled in using manipulation for the treatment of back pain and related disorders.8 As a public service, the American Chiropractic Association (ACA) urges you to make an informed choice about your back care. To learn more about the federal government’s recommendations and how chiropractic manipulation may help you, contact a Doctor of Chiropractic in your area.
References:1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.
2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
3. Finding from a national study conducted for the American Chiropractic Association. Risher P. Americans’ Perception of Practitioners and Treatments for Back Problems. Louis Harris and Associates, Inc. New York: August, 1994.
4.This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
5.In Vallfors B, previously cited.
6.Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.
7.The RAND Corporation reported from its analysis of spinal manipulation research literature that 94% of all spinal manipulation is performed by chiropractors, 4% by osteopaths, and the remainder by medical doctors.
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Ankle sprain? A bit of understanding and rehab strategies.

1/27/2021

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Did you just sprain your ankle? I did recently. It hurts! Ankle sprains occur so often that sometimes it can be easy to overlook helpful treatment strategies to accelerate the healing because, well, they will heal on their own, right?

Ankle sprains are the most common lower extremity injury in sport. The most common is an inversion sprain where the foot rolls under the inside portion of the ankle. There are eversion sprains and diastasis (aka "high ankle") sprains, but these are less common. ​

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4 ways to naturally boost the immune system that doesn't involve diet and nutrition.

12/18/2020

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Now more than ever it seems the world wants effective means by which to naturally boost the immune system. We've already learned a lot about what strengthen our immunity before this pandemic and even more afterwards.

What we know is that functional impairment of antigen-specific T cells is a hallmark of chronic infections and viral disease. 

There are many considerations for boosting immunity and T cell function. Supplements most notable for this are:
  • Vitamin D3 with K2
  • magnesium
  • zinc
  • selenium
  • melatonin
In addition to supplementation, staying hydrated and eating well are usually the first things people think about when wanting to boost their immune system. I mean, you are what you eat right. But what ways naturally boost the immune system that goes beyond what you put in your mouth? Here are 4 ways to boost the immune system naturally that doesn't involve diet and nutrition:

  1. Reduce stress - when your mental health is attacked, inflammation is seen throughout the body because of your hormonal response to cortisol. Chronic inflammation causes an imbalance in cell function and can lead to illness and disease. Managing your stress levels by practicing mindfulness techniques, speaking to a licensed counselor, journaling your thoughts, socializing with friends, receiving a massage, reading a book, reducing screen time,  or enjoying a favorite activity can all help keep your immune system functioning properly.(1,2,3)
  2. Restful sleep - most of us have experienced a time in our life when we consistently got less and less sleep and were more prone to getting sick. Adequate rest will significantly impact the ability to fight illness and infections. Our bodies need sleep to recover from everyday stressors, whether that be mental or physical. Aim for 7 hours of actual sleep time if you are an adult, 8-10 hours for adolescents, and 14 hours for young children and infants. (4,5,6)
  3. Exercise - moderate intensity exercise will place a healthy amount of oxidative stress on your body that causing your immune system to adapt over time to this stress and slowly strength immune cellular function. It can be tricky because chronic high-intensity exercise can also cause enough stress to the immune system resulting in an unfavorable outcome of suppressing the immune system. Brisk walking regularly is one of the most often studied forms of exercise that shows consistent results for boosting the immune system. (7,8,9)
  4. Chiropractic adjustments - okay this one I'm certain I will need research to support. Last thing I need is someone saying I said Chiropractic adjustments cure COVID-19. I am not saying that. In no way shape or form am I suggesting that chiropractic can cure, treat, prevent, or mitigate COVID-19 because the evidence to substantiate such a claim does not exist. The practice of chiropractic however focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health.  There is a growing body of evidence showing a positive relationship between the chiropractic adjustments, the nervous system and the immune system. (10,11,12,13,14,15)

​Want more tips and tricks on keeping your body healthy and strong? Hit us up at Gaitway Chiropractic @ Spokane Wellness in Spokane, Wa. 509-466-1366
Request an appointment now!
References:
  1. ​​Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014 May;58(2-3):193-210. doi: 10.1007/s12026-014-8517-0. PMID: 24798553.
  2. Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012 Apr 17;109(16):5995-9. doi: 10.1073/pnas.1118355109. Epub 2012 Apr 2. PMID: 22474371; PMCID: PMC3341031.
  3. ​Carlsson E, Frostell A, Ludvigsson J, Faresjö M. Psychological stress in children may alter the immune response. J Immunol. 2014 Mar 1;192(5):2071-81. doi: 10.4049/jimmunol.1301713. Epub 2014 Feb 5. PMID: 24501202.
  4. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015 Sep 1;38(9):1353-9. doi: 10.5665/sleep.4968. PMID: 26118561; PMCID: PMC4531403.
  5. Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019 Jul 1;99(3):1325-1380. doi: 10.1152/physrev.00010.2018. PMID: 30920354; PMCID: PMC6689741.
  6. Nagai N, Ayaki M, Yanagawa T, Hattori A, Negishi K, Mori T, Nakamura TJ, Tsubota K. Suppression of Blue Light at Night Ameliorates Metabolic Abnormalities by Controlling Circadian Rhythms. Invest Ophthalmol Vis Sci. 2019 Sep 3;60(12):3786-3793. doi: 10.1167/iovs.19-27195. PMID: 31504080.
  7. ​Simpson RJ, Kunz H, Agha N, Graff R. Exercise and the Regulation of Immune Functions. Prog Mol Biol Transl Sci. 2015;135:355-80. doi: 10.1016/bs.pmbts.2015.08.001. Epub 2015 Sep 5. PMID: 26477922.
  8. Abd El-Kader SM, Al-Shreef FM. Inflammatory cytokines and immune system modulation by aerobic versus resisted exercise training for elderly. Afr Health Sci. 2018 Mar;18(1):120-131. doi: 10.4314/ahs.v18i1.16. PMID: 29977265; PMCID: PMC6016983.
  9. ​Khosravi N, Stoner L, Farajivafa V, Hanson ED. Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain Behav Immun. 2019 Oct;81:92-104. doi: 10.1016/j.bbi.2019.08.187. Epub 2019 Aug 24. PMID: 31454519.
  10. Fidelibus, J.C., An overview of neuroimmunomodulation and a possible correlation with musculoskeletal system function. J Manipulative Physiol Ther, 1989. 12(4): p. 289-92.
  11. Teodorczyk-Injeyan, J.A., H.S. Injeyan, and R. Ruegg, Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther, 2006. 29(1): p. 14-21.
  12. Lohman, E.B., et al., The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther, 2019. 27(4): p. 186-196.
  13. Teodorczyk-Injeyan, J.A., et al., Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation: A Nonrandomized Clinical Trial. Clin J Pain, 2018. 34(1): p. 68-75.
  14. Kovanur-Sampath, K., et al., Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis. Musculoskelet Sci Pract, 2017. 29: p. 120-131.
  15. Teodorczyk-Injeyan, J.A., et al., Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008. 16: p. 5. 
​Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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What conservative treatments for pain do Chiropractors and physical therapist typically use?

12/18/2020

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Effective conservative treatments for musculoskeletal related pain that you will most often find in the chiropractic or physical therapy clinic include:
  • Spinal manipulative therapy (AKA "an adjustment") - this involves the application of accurately determined and specifically directed manual forces to the body with the intent to improve mobility in areas that are restricted whether the restrictions are within joints, in connective tissues, or in skeletal muscles. 
  • Soft tissue therapy (AKA "massage") - though massage is commonly interchanged with soft tissue therapy the two are not synonymous. This involves some form of hands on or instrument-assisted means of improving the flexibility of soft tissues; things like, muscles, tendons, ligaments, fascia, skin, etc.
  • Traction - this involves mechanical stretching apart of two structures over either a short or long period of time with the intent to decrease contracture, improve disc fluid absorption, reduce muscle spasm, increase nerve root canal size, and increase circulation to the nerve root and spine.
  • Hydrotherapy (AKA "hot and cold") - this involves the direct application of heat or cold, usually ice,  to allow for pain relief, blood vessel changes, reduced inflammation and increase relaxation. The clinical effectiveness of operating temperatures for heat is 140°-160° Fahrenheit and for cold is 50°-60° Fahrenheit.
  • Functional Strength Training (AKA "FST") - this is the means of engaging the body in a variety of strength challenges in multiple positions to effective train the small stabilization muscles as well as the large primary movement muscles to improve movement patterns, increase tissue load capacity making them more resilient to injury, and reduce muscle imbalances.
  • Low Level Light Therapy (AKA "laser" or LLLT) - this is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Typical it is achieved using red and near-infrared wavelengths.
  • Ultrasound - this incorporates soundwaves through a patient's skin and tissues to reduce adhesions, fibrosis, and increase molecular and fluid movement. It can also be used to administer therapeutic topical agents to deliver benefits directly to the local injured tissue.
  • Electrotherapy - this can include a variety of treatments such as electrical muscle stimulation (EMS), transcutaneous electrical nerve stimulation (TENS), diathermy (microwave), interferential electrical currents, low volt and high volt galvanic currents, and microcurrents. All of these have different clinical outcome goals in mind but generally the target goal is increased tissue healing, pain relief, muscle relaxation, decreased swelling, and decreased inflammation.
Of course, there exists other conservative treatment options like nutritional needs analysis, topical analgesics, acupuncture, brain based therapy, hypobaric oxygen therapy, etc. However, the list above is what most often what a Chiropractor or physical therapist might recommend to you. Before you decide which treatment or combination of treatments you decide to go with, it is important for you to be an equal team member in the decision making process of your own health.

Want tips and tricks on getting rid of headaches, back pain, neck pain, shoulder pain, hip pain, knee pain for good?
​
Hit us up at Gaitway Chiropractic at Spokane Wellness in Spokane, Wa.
509-466-1366
Request an appointment now!
Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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What is deep referred pain?

12/17/2020

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Deep referred pain is also called "scleratogenous" referred pain and is far more likely a cause of symptoms referring down a patient's arms or legs than is a true nerve root or "radicular" problem. We also call deep referred pain "somatic referred pain" where the "soma" or body tissues like muscles, bone, joint, ligaments, skin and fascia.

Once a trained clinician in the area of pain has ruled out central and peripheral nerve damage, their consideration of a patient's pain source causing referral should be that of joints, ligaments, or muscles. This is the most common scenario. The cause of this type of referred pain comes from our understanding of a patient's modulation of pain perception. There are several proposed theories for referred pain including:
  1. pain signaling received at the spinal cord - this includes concepts such as the Convergent-Projection Theory, the Convergent-Facilitation Theory (AKA central sensitization), the Axon-Reflex Theory, and the Hyperexcitability Theory. In these cases pain can be perceived and inhibited or excited at the level of the backside of the spinal cord.  This can alter the pathway of pain that an individual feels in response in a painful stimulus.
  2. pain signaling received in the brain - prevailing theories here include the Gate Control Theory, Central Modulation Theory and the Thalamic-Convergence Theory where pain can be modified by higher cortical centers in the  brain allowing for either inhibition or excited pain pathways to an individual's response to pain.

Examples of a patient's deep referred, "somatic" or "scleratogenous", referred pain that is most commonly seen with spinal related complaints could be from things like:
  • Facet syndrome - joints of the spine are often called the facet joint. They may be injured by trauma, be that small or large, sustained postural loads, or simple activities of daily living that overload the facet load capacity. This can lead to pain inputs affecting some of the theories explained above, especially in chronic examples of facet syndrome. 
  • Intervertebral disc injury - common causes of pain, especially in the region of the low back, is annular fiber tears of the intervertebral discs. This can occur even if there is no herniation into the spinal canal. Tears or local swelling can stimulate pain receptors in the spine and brain that, once again, can affect the theory of referred pain as explained above.
  • Joint Dysfunction - because of their relationship to facets and discs, joints are considered capable of creating local and radiating symptoms similar to described above. Pain referral patterns in the thoracic spine and between the shoulder blades have often referred pain into the chest especially during activities in which the hands are held out in front of the body.
  • Myofascial pain syndromes - trigger points can cause referred pain, numbness, or even paresthesia (a change in the normal sensation one feels in the skin) along the arm and legs. For instance, a common deep referred pain like this is seen in the shoulder. Trigger points in the rotator cuff muscles (e.g., supraspinatus, infraspinatus, subscapularis, and teres minor) can project pain into the arms.

Though describing the concept of deep referred pain as above may make it sound simple and easy to comprehend, the truth is that deep referred pain can overlap considerably with other clinical pain presentations and differentiation may be difficult. A way to remember "scleratogenous" pain is that it may be:
  • Deep
  • Dull
  • Achy
  • Hard to localize
  • Diffuse

Want tips and tricks on getting rid of deep referred pain for good? Request an appointment now.
​
Request an appointment now!
Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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82.2% of COVID-19 patients tested were found to be deficient in...

11/9/2020

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The research linking Vitamin D deficiency and the effects of COVID-19 along with the severity of COVID-19 outcomes and treatment with vitamin D is mounting up.

We told you about a pilot study a while back that was released in August 2020 to assess the clinical effectiveness of treatment of patients hospitalized for COVID-19 with calcifediol (25-hydroxyvitamin D3).

The highlights of this study indicated that the vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression and that the administration of calcifediol or 25-hydroxyvitamin D to hospitalized COVID-19 patients significantly reduced their need for Intensive Care United admission. (Castillo et al 2020).

Vitamin D seems to be able to reduce severity of the disease.

But wait, there's more.

Researchers in Spain found that 82.2% of COVID-19 patients tested were found to be deficient in vitamin D. (Hernández et al 2020)

Aside from the impact of insulin resistance on the severity of COVID-19 outcomes, Vitamin D deficiency is emerging as a primary risk factor for the severity of COVID-19 infections. 

It would be foolish to not consider assessing one's current serum 25-hydroxyvitamin D (25OHD) and determining the best supplementation to address increasing that level over time. 

For instance, for an individual weighing 185 lbs that was categorized at a high risk for viral infection with low vitamin D levels in the blood measuring at 10 ng/ml and wished to increase their amount to a high vitamin D level of 60 ng/ml in order to lower their risk of infection, that person would need a supplementation amount of: 10000 IU* per day (more than their current intake) to be sufficient  to achieve the recommended target serum level of 60 ng/ml. *Values rounded to the nearest 1000 IU

Vitamin D plays a significant role in our health. It can reduce the survival and replication of viruses, reduce cellular inflammation, maintain vascular integrity by effecting vascular inflammation and clotting factors, reduce blood pressure by it's role in the conversion of angiotensin-converting enzyme 2, lower cancer risk, improve bone and connective tissue healing, decrease risk of autoimmune disease, and more.

To optimize vitamin D absorption and utilization, be sure to take your vitamin D with vitamin K2 and magnesium. A person supplementing Vitamin D for the hope to raise serum blood levels should retest their serum 25-hydroxyvitamin D (25OHD) every three to four months. 

References:
Castillo M.E., Entrenas Costa L.M., Vaquero Barrios J.M., Alcalá Díaz J.F., Miranda J.L., Bouillon R., Quesada Gomez J.M. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J. Steroid Biochem. Mol. Biol. 2020;203:105751. doi: 10.1016/j.jsbmb.2020.105751

José L Hernández, Daniel Nan, Marta Fernandez-Ayala, Mayte García-Unzueta, Miguel A Hernández-Hernández, Marcos López-Hoyos, Pedro Muñoz Cacho, José M Olmos, Manuel Gutiérrez-Cuadra, Juan J Ruiz-Cubillán, Javier Crespo, Víctor M Martínez-Taboada, Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection, The Journal of Clinical Endocrinology & Metabolism, , dgaa733, https://doi.org/10.1210/clinem/dgaa733
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​Immune Health – Cold and Flu Support

10/22/2020

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With COVID-19 still on the table and the upcoming seasonal occurrences of cold and flu, targeting the immune system and improving one's overall wellness is critical. The right vitality and nutrition plan during this time has the potential to help decrease the frequency, severity, or duration of cold and flu symptoms.

We can decrease this risk with:
  1. nutrition
  2. supplementation
  3. sleep
  4. exercise
  5. stress management

This is even more important for high-risk populations, such as the elderly, those who are overweight, those with diabetes and other comorbidities causing compromised immune systems.

Want tips and tricks on keeping your body strong during this upcoming cold and flu season? Are you sick now and wish you were more prepared to fight off the cold or flu virus so you can more quickly return to what you enjoy? Then follow along with this protocol developed using only quality evidence.

The following protocol and ingredients below are a reflection of what current research findings show support for when trying to prevent or treat the immune system affecting by cold and flu viruses.

Vitamin C

Adults: 1 g daily as an ongoing maintenance dose3,4, or 3 to 4 g daily at the onset of symptoms and for the duration of illness2,4
Children: 1 to 2 g daily as an ongoing maintenance dose4,2
  • Reduces the duration of the common cold by approximately a half-day2, or by 8% in adults and by 14-18% in children4
  • Reduces time of confinement by approximately six hours and fever duration by approximately a half-day, relieves chest pain and chills by approximately eight hours when given an extra therapeutic dose at the time of onset of cold2
  • Improves antimicrobial and natural killer (NK) cell activities, lymphocyte levels, chemotaxis, delayed T cell responses, sympathetic nervous response, and induces anti-reactive oxygen species activity2
  • Decreased duration of cold by 59% and increased weekly activity levels by 39.5% when compared to placebo in otherwise healthy adult males3

Zinc
75-100 mg of elemental zinc as zinc acetate or zinc gluconate lozenges, once per day, within 24 hours of the onset of common cold symptoms, minimum 1 to 2 weeks cold15,16,17,18,19
  • Reduces cold duration by 33%15, or by approximately 1.65 to 3 days in healthy adults cold16,17,18,20,21
  • Zinc acetate equivalently reduces the duration by 40% and zinc gluconate reduces the duration by 28%15, while other sources indicate greater efficacy with zinc acetate in healthy adults20 
  • Reduces the incidence of cold symptoms after 5-7 days in healthy adults and children19,21
  • Reduces the duration of muscle soreness by 54%, cough by 46%, voice hoarseness by 43%, nasal congestion by 37%, nasal discharge by 34%, scratchy throat by 33%, sneezing by 22%, and sore throat by 18% in healthy adults19,21
  • Reduces the incidence of common cold development, absence from school, and antibiotic use in children1,17
  • Improves anti-inflammatory and antioxidant profile via reductions in plasma interleukin-1 receptor antagonist (IL-1ra), intercellular adhesion molecule-1 (ICAM-1), TNF-ɑ, MDA, HAE, and 8-oHdG, and increases in IL-2 mRNA in mononuclear cells in healthy adults21,22
  • Reduces duration of symptoms particularly when given within the first 24 hours of symptom onset1,23

Probiotics
Probiotics may reduce the incidence of colds with minor effects on prevention, as well as improve influenza vaccination efficacy for A/H1N1, A/H3N2, and B strains, but is dependent on strain and population.24,25,26
Pediatric: 
Common Cold
  • 5 billion CFU of Lactobacillus acidophilus NCFM (ATCC 700396), twice per day, minimum 6 months27
    • Reduces the incidence of fever by 53%, cough by 41%, and antibiotic use by 68%
    • Reduces the duration of fever, coughing, and rhinorrhea by 32%
    • Reduces days absent from childcare by 32%
Influenza
  • 10 billion CFU of Bifidobacterium animalis subs. lactis Bi-07 (ATCC PTA-4802) & Lactobacillus acidophilus NCFM (ATCC 700396), twice per day for 6 months27
    • Reduces the incidence of fever by 73%, rhinorrhea by 73%, cough by 62%, and antibiotic use by 84%
    • Reduces the duration of fever, coughing, and rhinorrhea by 48%
    • Reduces days absent from childcare by 28%
Adult:
Common Cold
  • 1 billion CFU of Lactobacillus paracasei 8700:2 (DSM 13434) & Lactobacillus plantarum HEAL 9 (DSM 15312), once per day for 3 months28
    • Reduces the incidence of developing more than one common cold episode and number of days with a cold
    • Reduces total symptom scores & pharyngeal symptoms of cold
    • Reduces B lymphocyte proliferation
Influenza
  • 10 billion CFU of Lactobacillus fermentum CECT5716, once per day for 2 weeks before influenza vaccination and two weeks after29
    • Reduces the incidence of influenza 5-months after vaccination compared to vaccine alone
    • Increases natural killer cells, T-helper response, and IgA levels
  • 10 billion CFU of Lactobacillus rhamnosus GG, twice per day for 4 weeks after influenza vaccination30
    • Increases seroprotection for the H3N2 strain during the supplementation period
  • 500 mg of Saccharomyces cerevisiae (EpiCor®), once per day for 12 weeks31,32
    • Reduces the incidence of cold/flu symptoms with or without prior vaccination
    • Reduces the duration of symptoms with prior vaccination

Echinacea purpurea
Prevention: 0.9 mL, three times per day (equivalent to 2400 mg of extract), minimum 4 months9 
Acute: Up to 4.5 mL liquid extract (equivalent to 4000 mg), once per day at the first stage of cold development9
  • Reduces the relative risk of cold development by 10-58%10,11
  • Reduces days with symptoms by 26% (1.4 days)9,12 and symptom scores by 23%13
  • 52% fewer patients requiring concomitant use of aspirin, paracetamol, or ibuprofen9
  • Reduces the incidence of cumulative viral infections by 26% and recurring infections by 59%, including influenza virus and parainfluenza virus9
  • Increases associated counts for white blood cells, monocytes, neutrophils, and natural killer cells, and suppresses superoxide production in the later-phase of the cold by neutrophils14

American ginseng (Panax quinquefolius)
​
400 mg, once per day, minimum 8-16 weeks in healthy adults as a preventative measure5,6,7
  • Reduces the duration of colds or acute respiratory infections by approximately 5-6 days5,7
  • Reduces the incidence of colds by 25%4, the incidence of influenza and respiratory syncytial virus, and the relative risk of respiratory symptoms by 48%6,8,7
  • Reduces total symptom severity score for sore throat, runny nose, sneezing, nasal congestion, malaise, fever, headache, hoarseness, earaches, and cough6
Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Did you know we have a supplement protocol designed with the above cold and flu support topic discussed above. Check it out!

https://us.fullscript.com/protocols/spokane-wellness-immune-health-cold-and-flu-support

References
​1https://www.ncbi.nlm.nih.gov/pubmed/30069463
2https://www.ncbi.nlm.nih.gov/pubmed/23440782
3https://www.ncbi.nlm.nih.gov/pubmed/19592479
4https://www.ncbi.nlm.nih.gov/pubmed/16247099
5https://www.ncbi.nlm.nih.gov/pubmed/16566675
6https://www.ncbi.nlm.nih.gov/pubmed/14687309/
7https://www.ncbi.nlm.nih.gov/pubmed/23024696
8https://www.ncbi.nlm.nih.gov/pubmed/24554461
9https://www.ncbi.nlm.nih.gov/pubmed/16678640
10https://www.ncbi.nlm.nih.gov/pubmed/17597571
11https://www.ncbi.nlm.nih.gov/pubmed/14748902
12https://www.ncbi.nlm.nih.gov/pubmed/16177972
13https://www.ncbi.nlm.nih.gov/pubmed/28515951
14https://www.ncbi.nlm.nih.gov/pubmed/22566526
15https://www.ncbi.nlm.nih.gov/pubmed/27378206
16https://www.ncbi.nlm.nih.gov/pubmed/23775705
17https://www.ncbi.nlm.nih.gov/pubmed/28480298
18https://www.ncbi.nlm.nih.gov/pubmed/25888289
19https://www.ncbi.nlm.nih.gov/pubmed/18279051
20https://www.ncbi.nlm.nih.gov/pubmed/17344507
21https://www.ncbi.nlm.nih.gov/pubmed/23372900
22https://www.ncbi.nlm.nih.gov/pubmed/29416317
23https://www.ncbi.nlm.nih.gov/pubmed/29077061
24https://www.ncbi.nlm.nih.gov/pubmed/19651563
25https://www.ncbi.nlm.nih.gov/pubmed/20803023
26https://www.ncbi.nlm.nih.gov/pubmed/17352961
27https://www.ncbi.nlm.nih.gov/pubmed/21285968
28https://www.ncbi.nlm.nih.gov/pubmed/20180695
29https://www.ncbi.nlm.nih.gov/pubmed/18335698
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    Dr. Jared Wilson, DC, MS

    Dr. Jared Wilson blogs about chiropractic health and other relevant health news.  He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters degree in Exercise and Sports Science.

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