June 17, 2003 [Volume 4, Issue 13]
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In this issue of To Your Health:
The Best of the Best
Exercise
therapy is highly effective for treating chronic low-back pain - but that
doesn't necessarily mean there isn't an even better treatment out there.
A recent study in the scientific journal Spine provides further
evidence of the power of spinal manipulation for back pain.
In the study, approximately 50 patients with chronic low-back pain who had been sick-listed for between eight weeks and six months received either exercise therapy or manual therapy. The patients, ages 20-60, were administered sixteen 45-minute treatments over eight weeks; patient improvement was measured before and after treatment and at four weeks, six months and one year after treatment.
Patients in the manual-therapy group received mobilization and high-velocity, low-amplitude manipulation from trained physiotherapists (a form of treatment chiropractors also utilize) and performed general exercises for the trunk, spine and legs. Exercise-group patients trained with a 35-minute focus on the trunk and legs following 10 minutes of warm-up on an exercise bicycle.
Both groups showed significant improvements; however, the manual-therapy group experienced much greater improvements than the exercise group in all areas of improvement (pain, functional status, etc.) at every point in follow-up. For example, average reduction in pain was doubled for manual-therapy patients, compared to exercise patients. Also, immediately following the treatment period, the manual-therapy group was significantly more likely to have returned to work (67%, vs. 27% for the exercise group). One year later, exercise-therapy patients were over three times more likely to still be sick-listed than manual-therapy patients.
If you suffer from low-back pain, spinal manipulation may be the best form of treatment. Talk to your local chiropractor about the benefits of spinal adjustments. For more information on back pain, visit www.chiroweb.com/find/tellmeabout/backpain.html.
Reference: Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: A randomized, controlled trial with 1-year follow-up. Spine 2003:28(6), pp. 525-532.
Rest Easier
Frequent headaches have been linked to an assortment of sleep disorders. Up to 4% of adults suffer from chronic daily headache (CDH), or headaches 15 or more days each month (that's over 180 headache days per year). Some types of CDH generally last over four hours per episode, including chronic migraines and tension-type headaches.
Recently, researchers sought information about a possible link between CDH and snoring. Using a randomly generated list of telephone numbers in the Atlanta, Philadelphia and Baltimore areas, nearly 3,000 adults with CDH and over 50,000 others with less-frequent headaches (anywhere from none to about 100 days each year) were questioned about sleep and lifestyle habits. Participants also reported on the frequency of snoring in this study in the journal Neurology: never, less than half of nights, more than half of nights, always or unknown.
Habitual snoring, as defined by answering "always" on the snoring-frequency survey, appeared in 24% of CDH sufferers compared to only 14% of nonsufferers. In fact, individuals suffering from chronic daily headache were almost three times more likely to be habitual snorers than non-sufferers, after ruling out other factors associated with snoring.
Do headaches cause sleep disorders, or do sleep disorders cause headaches? We still don't have all the answers. But the researchers cited one preventable cause of CDH: overuse of medications, specifically sedatives for pain and depression. Go easy on the medications, find a safe way to prevent snoring and try to sleep more hours, and maybe you'll have fewer headaches and better sleep. Talk to your chiropractor for more information.
Scher AI, Lipton RB, Stewart WF. Habitual snoring as a risk factor for chronic daily headache. Neurology 2003:60, pp. 1366-1368.
For more general health studies, head to www.chiroweb.com/find/archives/general.
Fibromyalgia May Be Overdiagnosed
In the past decade, fibromyalgia has become a well-known ailment that causes reduced pain tolerance, musculoskeletal pain, sleep disturbances, fatigue and morning stiffness in sufferers. The estimated prevalence of fibromyalgia has been determined to be around 2%, with 10 times more women affected than men. Recent information suggests that this syndrome may be overreported as a "fashionable diagnosis," however, while other medical conditions are overlooked.
To examine fibromyalgia diagnostic accuracy, researchers evaluated all 76 new patients referred to a rheumatology clinic over a six-month period with an initial diagnosis of fibromyalgia, or a final diagnosis of fibromyalgia after ruling out a previously incorrect diagnosis.
At final evaluation, diagnostic accuracy for fibromyalgia at a patient's initial visit was correct in only one-third of cases. Of the patients initially (but incorrectly) diagnosed with fibromyalgia, 59% suffered from other inflammatory conditions, such as rheumatoid arthritis. True fibromyalgia sufferers tended to have many more tender points and were more fatigued than those suffering from other conditions. The authors of this study from Rheumatology concluded that there is a "disturbing inaccuracy" in the diagnosis of fibromyalgia, which might in part explain the current high rates reported for this condition. By accepting an incorrect diagnosis of fibromyalgia, many people may be inadvertently overlooking other inflammatory conditions. If you have been diagnosed with fibromyalgia and don't seem to be responding to treatment, you may want to get a second opinion.
Reference: Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: Analysis of referrals. Rheumatology 2003:42(2), pp. 263-267.
To read more about different types of common body aches and pains, go to www.chiroweb.com/find/archives/musculoskeletal.
DON'T Keep Your Head Above Water
That lifeguard may be able to save you from drowning, but he or she probably can't protect you from a swimming injury. Shoulder overuse injuries in particular are the main culprit in swimmers - accounting for approximately one-third of all injuries in competitive swimmers each year. These injuries are common even in many recreational swimmers who think they are using the proper freestyle stroke technique.
An overview of swimming injuries, published in The Physician and Sportsmedicine, dispels some widely accepted techniques used by freestyle swimmers, such as keeping your head up out of the water. Some tips are offered to help you avoid pain in the pool:
- Begin each stroke with your hand entering the water finger- or pinky-first (not thumb-first).
- Continue your stroke downward in a straight line.
- Roll your body equally to each side approximately 45 degrees during strokes.
- Keep your head down in the water for proper spinal alignment (not "eyes forward" as many coaches have encouraged).
Paddling on a surfboard can help you develop the proper stroke. If you have existing shoulder pain, have a chiropractor examine you for rotator-cuff injury, shoulder impingement or other causes. Core strength (of the back, stomach and upper legs) and shoulder strength are necessary for proper stroke technique. Shoulder flexibility is also important. Yoga, abdominal strengthening exercises, and shoulder strengthening exercises (push-ups, rowing and overhead presses) can be combined with chest and shoulder stretches to keep you swimming like a fish.
Reference: Johnson JN, Gauvin J, Fredericson M. Swimming biomechanics and injury prevention. The Physician and Sportsmedicine 2003:31(1).
For additional information on exercise and sports, go to www.chiroweb.com/find/tellmeabout/sports.html.
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