Physical Inactivity Leads to Chronic Pain

Here’s one more reason to exercise: Physical inactivity contributes to chronic musculo-skeletal pain, which affects the muscles, ligaments, tendons and bones. People with chronic conditions such as back pain, arthritis, or neck pain suffer daily through pain, fatigue, and even depression, and more people are falling victim every day. In fact, some experts have characterized the increasing prevalence of musculoskeletal conditions as an epidemic.

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According to a 2008 study published in BMC Musculoskeletal Disorders, a connection exists between physical inactivity and chronic musculoskeletal complaints (MSCs). Study participants responded to questions regarding their physical activity 11 years prior to experiencing any MSCs. The researchers concluded, “In this large-scale population-based study, physical exercise was associated with lower prevalence of chronic MSCs, in particular chronic widespread MSCs [>15 days during the last month]. Furthermore, consistent medium activity level [120-179 min./week] was associated with [a] more than 50% lower prevalence of chronic widespread MSCs.” (If you’d like to review the abstract of the BMC study, visit: www.biomedcentral.com/1471-2474/9/159.)

There you go – the latest in an ever-growing list of reasons to make exercise a part of your weekly routine. And remember, a consistent, balanced fitness program of cardio, muscle strengthening and stretching will do more than help in the prevention of chronic pain; it could also help prevent other serious conditions such as heart disease and hypertension.

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Don’t Let Back Pain Knock You Down

Have you missed work due to back pain? You’re not alone, according to the American Chiropractic Association; back pain is one of the most common reasons for missed days of work. However, several studies suggest vitamin D can help combat the pain.

One such study, published in the journal Pain Treatment Topics, found people with chronic musculoskeletal back pain had insufficient levels of vitamin D. However, when patients increased their intake of vitamin D, their pain decreased, and in some cases disappeared.

Experts involved in this study say vitamin D may be beneficial for pain because of its role in calcium absorption. Insufficient vitamin D / calcium absorption may cause bones to soften, leading to a condition known as ostomalacia (not to be confused with osteoporosis). As the Mayo Clinic explains, “Osteomalacia results from a defect in the bone-building process, while osteoporosis develops due to a weakening of previously constructed bone.” However, it’s important to note that insufficiencies in vitamin D / calcium can contribute to both conditions.

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Talk with your doctor for a recommendation on how much vitamin D you need to sustain healthy levels. Here are some suggestions on ways to increase vitamin D – supplements, healthy sun exposure (always wear sunblock) and vitamin D-rich foods. WebMD suggests these foods can help provide vitamin D:

  • Fatty fish, like tuna, mackerel, and salmon
  • Foods fortified with vitamin D, such as some dairy products, orange juice, soy milk, and cereals
  • Beef liver
  • Cheese
  • Egg yolks

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It’s Never Too Late to Exercise

Think you’re destined to die before your time because you’ve been sedentary (physically inactive) your entire life? Not so fast. While consistent exercise is associated with a host of health and wellness benefits including significant reductions in disease risk, new research suggests even middle-aged and older adults who haven’t been active their entire lives can benefit dramatically from a little more movement.

Researchers evaluated the exercise habits of more than 315,000 adults ages 50-71 by reviewing surveys each study participant had completed from adolescence, then tracked them for almost 15 years to see who passed away over that time period. Compared to participants who stayed essentially inactive throughout their lives (including the study period), participants who were not active previously, but became active from ages 40-61, were 35 percent less likely to die of all causes during the study period.

Interestingly, people who had been active from the start (youth through middle age) were only slightly less likely to die during the study period: 36 percent less likely compared to the permanently inactive group. In other words, the health benefits of physical activity (at least in terms of longevity) were essentially the same regardless of whether one exercised his/her entire life or became active starting in middle age or older.

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With respect to two of the major causes of death, cardiovascular disease and cancer, the risk reductions were also remarkably similar: 42 percent lower risk of death from heart disease and 14 percent lower risk of death from cancer for always exercisers (compared to people who stayed sedentary their entire lives), vs. 43 percent and 16 percent lower risks, respectively, for late exercise adopters. Study findings were published in JAMA Network Open.

The moral to this story: You’re never too old to start exercising – and reaping the longevity benefits. Talk to your doctor for more information on why exercise matters, and ask for help designing a consistent physical activity program suitable to your health and fitness needs.

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An Hour a Day Keeps OA Symptoms at Bay

Osteoarthritis (OA), the most common type of arthritis, is caused by excessive joint use, often due to aging. Also known as degenerative joint disease or “wear and tear” arthritis, OA can cause pain, stiffness and weakness at joint sites such as the neck, back, hip, elbows, knees and fingers / toes. These symptoms can limit movement and activities of daily living, two aspects of life people of all ages can appreciate, but particularly the elderly.

Fortunately, movement – the same thing limited by OA – is actually one of the keys to reducing symptoms, according to research. Published in the American Journal of Preventive Medicine, the study evaluated patients ages 49-83 with lower-extremity joint problems due to OA. All patients were considered disability-free (no walking or activity limitations) at the start of the study. During the six-year study period, researchers measured patients’ activity levels and interviewed them periodically to assess OA symptoms.

The results: OA patients who exercised moderately to vigorously at least one hour per week were significantly more likely to be disability-free after four years compared to patients who did not meet this exercise goal. In fact, patients who met or exceeded the goal were 86 percent less likely to have mobility limitations compared to other patients. Interestingly, total time spent participating in moderate-to-vigorous activity each week was more important than time spent in bouts of activity (e.g., 10  minutes vs. 15 minutes vs. 30 minutes at one time) when it came to reducing disability risk.

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A Poor Choice for Relieving Your Low Back Pain

Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it’s also the most likely to be taken inappropriately. In fact, improper use, coupled with the drug’s narrow safety margin, means “a large fraction of users [are] close to a toxic dose in the ordinary course of use,” according to the Food and Drug Administration.

But for the sake of discussion, let’s ignore the safety issues for a moment. Is acetaminophen an effective pain reliever in the first place? Not for low back pain and pain attributable to knee / hip osteoarthritis, conclude the authors of a recent meta-analysis. The just-published review of 13 randomized trials has yielded “high-quality evidence” that paracetamol (acetaminophen) does not reduce pain intensity or disability, and does not improve quality of life, in the short term for people experiencing LBP; and provides only “minimal, short-term benefit” for people suffering from hip or knee pain caused by OA, stating that “the small effects … are not likely to be meaningful for clinicians or patients.”

Back to the safety issues surrounding acetaminophen, which the meta-analysis did little to dilute. According to the review researchers, “high-quality” evidence suggests paracetamol use results in a fourfold risk of an abnormal liver function test. Not surprising, since acetaminophen misuse (overdose) is now the most common cause of acute liver failure (exceeding all other medications combined) and the second most common cause of liver failure requiring transplantation.

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In fact, the FDA has mandated that all acetaminophen-containing prescription products feature a “black box” warning (the administration’s strongest safety statement) noting an overdose can cause liver failure and even death; and have been urged to place similar language on OTC acetaminophen products.

How often do you use acetaminophen-containing over-the-counter and/or prescription medications for you LBP and OA pain, even as you pursue relief through chiropractic care? How often do you take these drugs for your spinal / OA pain instead of visiting a chiropractor? As this meta-analysis suggests, acetaminophen is ineffective for these types of pain. So give chiropractic a try – a proven natural pain reliever.

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Chiropractic for Low Back Pain: Your Best, First Recommendation

suffer low back pain at some point, many of whom will experience it on multiple occasions or even chronically.

Now here’s even better news: Evidence suggests chiropractic spinal manipulation is as effective as commonly recommended treatment options such as pain medication for LBP, which should make it your best, first recommendation, particularly in light of the prescription opioid crisis killing more than 100 Americans a day.

In a new review study, published in the British Medical Journal, researchers evaluated findings from 47 previous investigations involving more than 9,000 men and women (average age: 35-60 years). All studies compared the value of spinal manipulative therapy with recommended therapies including nonsteroidial anti-inflammatory drugs (NSAIDs; Aleve, Motrin, etc.), prescription painkillers and exercise. Spinal manipulation relieved LBP as effectively as the recommended therapies and was actually more effective in improving short-term function.

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Spinal manipulation still isn’t routinely recommended as a primary treatment for low back pain, despite evolving guidelines in the U.S. and worldwide. The opioid epidemic has opened eyes to the need for safer pain-relief options, but so far, the recommendations don’t go far enough. Why take pain medication and risk the side effects, some of which can be life-threatening, when you can enjoy the benefits of chiropractic spinal manipulation and achieve the same pain relief and functional improvements? Talk to your doctor to learn more.

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Why You Should Be Making Periodic Visits to Your Chiropractor

When you experience back pain, chiropractic care can help relieve the pain and identify the underlying cause. But your care shouldn’t stop once the pain stops (or comes back, which can frequently happen). A new study suggests maintenance chiropractic care (defined by the researchers as “treatment at regular intervals regardless of symptoms”) is more effective than symptomatic treatment (receiving chiropractic treatment only when you’re experiencing pain).

In the study, patients with recurrent / persistent low back pain who received maintenance care (scheduled every 1-3 months) after their initial treatment reported an average of 19.3 less days of “bothersome” low back pain over a 12-month period compared to patients who received only symptomatic chiropractic care. Overall, during the 12-month period, maintenance care patients made seven visits, on average, to their chiropractor, versus five visits, on average, for symptomatic patients.

So, if you’re suffering low back pain and your chiropractor suggests you come in periodically for treatment, you may want to heed his/her advice. It’s a research-supported suggestion that could dramatically reduce the amount of time you spend in pain.

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Foods That Fight Inflammation

In recent years, researchers have come to appreciate that our diet can substantially influence the inflammatory state within our body. This view of inflammation is different than the standard view that characterizes inflammation as a response to injury, such as a sprained ankle, which then heals naturally and the inflammation goes away.

The new view of inflammation, developed over the past 10 years, is that it is a generalized state within the circulatory and immune system perpetuated by poor diet. The outcome of this is the dietary promotion of arthritis, osteoporosis, heart disease, cancer, Alzheimer’s disease and most other chronic diseases. We should call this “dietary trauma,” as it leads to the development of biochemical changes similar to physical injury. The difference is that, for most people, dietary trauma occurs every time they eat, three or more times each day, every day. 

In most cases, the outcome of dietary trauma is not noticed for years. It takes years to develop arthritis and other chronic diseases, so we don’t usually associate a poor diet with disease expression. This allows us to easily deny such an association between diet, inflammation and disease. Thus, developing an awareness or mindfulness about eating is very important to help influence a behavioral change in our eating habits.

Foods That Promote Inflammation

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Refined carbohydrates in the form of sugar, sweeteners and flour produce inflammatory responses, as do refined oils and obese (fatty) meat. A surprise to many is that even whole grains and legumes (beans) can promote inflammation.

With the above in mind, consider that the average American consumes about 10 percent of calories from dairy products, 20 percent from refined sugar, 20 percent from refined grains, 20 percent from refined oils and 2 percent from alcohol. The biggest problems clearly are the sugar, grains and oils. Approximately another 20 percent of calories come from obese meat, which is the fatty meat from domestic animals that live a sedentary life in feedlots, where they are fed a tonnage of grains/corn instead of grass/pasture. The remaining 10 percent of calories might be fruits and vegetables.

Foods That Prevent Inflammation

Rather than listing all the foods and snacks that should be avoided, let’s focus on the foods that reduce inflammation. Researchers recently characterized a diet that offers preventive benefits for heart disease, called the “polymeal,” which is consistent with the PaleoDiet, the traditional low-starch Mediterranean diet and the anti-inflammatory diet.

A reasonable recommendation is for 80 percent to 100 percent of our calories to come from vegetables, fruit, raw nuts, potatoes, and either lean or omega-3 protein sources including fish, lean meat, skinless chicken, wild game, grass-fed animals and omega-3 eggs. Spices such as garlic, ginger, turmeric, oregano and the other popular spices are all anti-inflammatory. The best oils/fats to use in moderation are extra-virgin olive oil, coconut oil and butter.

Our focus should be on correcting the 80 percent of calories that come from sugar, refined grains, oils and obese meat. Worrying about yogurt, the occasional bran muffin, a cup of coffee, etc., has little influence compared to the tsunami of inflammation created by the 80 percent of calories derived from inflammatory foods.

Another key to reducing dietary trauma and inflammation is to eat appropriate amounts for your body. In general, overeating leads to an inflammatory response.

Avoid Dietary Extremism

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If you currently snack on bags of inflammation and regularly do “drive-through self-shootings” at fast-food restaurants, you likely will view a life of eating anti-inflammatory foods as somewhat extreme. In actuality, the anti-inflammatory foods described above are not extreme at all and are completely consistent with our biochemical and physiological needs.

If you’re eating 80 percent or more of your calories from sugar, flour/grains, refined oils and obese meat, you’re a dietary extremist. For many, the mere thought of giving up bread and pasta is too much to bear.

On the other hand, assuming 85 percent to 90 percent of your calories are anti-inflammatory, have fun with the remaining 10 percent to 15 percent of calories borne of foods from the dark side. Don’t become an anti-inflammatory diet extremist and make eating healthy a stressful event.

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By David Seaman, DC, MS, DABCN

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Make Your Body Stronger As You Age

Aging can bring on a variety of health issues, but one of the key problems that affect many is overall weakness. The body’s structural system tends to decline with age and muscle areas have been known to also cause a range of debilitating problems. Most people tend to see these changes as early as their 40s. So, what can you do to make sure your body stays strong as you age?

The key is in exercise by building up muscle strength, you can keep your body strong as you age.

When working out, focus on your upper body – strong trapezius, biceps and triceps muscles could someday make a difference doing basic tasks such as carrying groceries or your grandkids. And the weaker they are, the more prone you are to neck strain.

It is also good to focus on your core. By working out and focusing on your core, you could begin to build up strength can avoid placing extra strain on your lower back. A little prevention goes a long way for back pain, which makes even the most basic tasks, like sitting or bending over, excruciating. To target all the core muscles, activate them during a workout.

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Another body part that weakens dramatically with age are the knees. Knees not only provide overall stability, but they enable you to walk with balance and this is important as you age since you will need the most balance you can get.

When hitting the gym, remember your knees by doing some leg curls, and walking with a steady pace on the treadmill. This will also help your legs and other parts of your lower body.

Doing overall cardiovascular exercises will also help you work out your heart, which is also essential for aging.

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Common Knee Injuries, Uncommon Sense

How to Avoid Surgery and Stay in the Game

The growth of organized amateur sports over the past 30 years has spawned an unexpected and unwanted increase in sports-related injuries. Many young athletes suffer sports-related injuries that can turn into lifelong problems. Here are some basic facts about knee injuries and how they are handled in the world of modern medicine. I am not passing judgment – just pointing out some facts.

The American Academy of Orthopedic Surgeons reported that in 2003, 9.5 million people visited orthopedic surgeons because of knee problems. By now, this staggering number is probably even higher, considering a greater number of children and adults are participating in athletics every year. The most common recommendation regarding knee injuries is to avoid the activities that take place when the knee is injured, such as activities that require stopping and starting or quickly changing directions. It is thought that these extreme forces on the knee can result in torn ligaments; however, they don’t result in torn ligaments in everyone, which means there could be some pre-existing contributing factors.

To learn why our knees are injured so frequently, it’s important to know how the knee works. The knee joint is composed of four bones: the femur, the tibia, the fibula and the patella (see image on facing page). Cartilage covers the joint and provides a smooth, lubricated gliding surface so the knee can move. The shape of the knee joint is stable, but to function properly, the ligaments have to be in good shape, too! Those ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL).

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While the ACL works as the main stabilizer when the knee is bent, the PCL works as the main stabilizer when the knee is extended. The collateral ligaments are used when you move side to side. The medial and lateral menisci are located within the joint and act as “shock absorbers” and also influence knee stability. The most commonly injured parts of the knee are the ACL and the medial meniscus. Tears of the meniscus usually take place during twisting, pivoting, or decelerating movements, or as a result of direct impact.

When you look for information regarding treatment of knee injuries, you will see two basic categories of medical care: surgical and nonsurgical. Surgical intervention has certainly improved over the past 20 years and typically involves arthroscopic surgery for severely sprained or ruptured ligaments or torn cartilage. The new procedures are far less invasive than techniques used many years ago, resulting in less scar tissue and faster recovery time. Nonsurgical intervention typically involves improving the stability of the knee joint with rehabilitative exercises, focusing on the quadriceps (thigh) muscles and the hamstrings. Bracing is also a common practice to enhance stability by limiting motion in the knee joint.

To summarize, the way knee injuries are handled in today’s world is to stop doing things that tear ligaments, like running, jumping, twisting and stopping quickly. If you do want to continue doing those things, the common recommendation is to get surgery or do rehab and put on a brace to limit motion in the joint. The resulting lack of motion will likely cause degenerative arthritis over the next 20-40 years, which will result in the need for a knee joint replacement.

OK, so where’s the good news? Simply put, a chiropractor has the ability to do a better job than that! Their knowledge of the foot, knee, hip and spine connection, combined with practical experience, affords an alternative to the “shoot the dice and hope for the best” theory. The first thing to understand is that healthy knee function is not possible without healthy foot function. The medical model of health care does not take that into consideration because the foot rarely presents itself as being painful. Even if the foot does hurt, treatment only takes care of the symptom and does not address abnormal joint function.

A vast majority of people, young and old, excessively pronate. This means that when the foot hits the ground, it flattens out or unlocks, rolling inward and creating a twisting stress up the leg and into the knee. These twisting stresses do three things to the knees: stretch the ACL, stretch and twist the medial meniscus, and inhibit contraction of the quadriceps muscle.

Every time we take a step, jump, pivot, stop quickly and run, those three things take place. A torn knee ligament is not a one-injury event; it is a multiple micro-injury event. These abnormal forces take place perhaps thousands of times, creating microtrauma to the support structures of the lower leg until the ligament fails catastrophically.

If thigh muscle weakness is one of the results of excessive pronation, doesn’t it make sense that the muscle loses its tone to a point that it can no longer stabilize the joint efficiently? Remember, muscle is the primary stabilizer; ligaments are secondary. If you weaken the muscle and traumatize the ligament a few thousand times, you have all the ingredients for the classic knee injury.

Common sense tells us to prevent the excessive damaging motions by supporting the foundational structures (your feet) so they function within the functional range of motion.  Many chiropractors now evaluate the quality of the arches of the feet. If the arches aren’t supporting the legs and pelvis sufficiently, it can create stresses that lead to injury or joint wear and tear. It’s just like the foundation of your house; if it settles too much, it creates stress in other parts of the structure. 

Take a proactive step to avoiding injuries and preserving the health of your knees, hips and spine. After all, you know what they say about “an ounce of prevention.” Ask your doctor for a thorough foot evaluation, particularly if you’re experiencing knee pain or participate in activities that put you at risk for a knee injury.

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By Brian Jensen, DC

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