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Why Chiropractic or Physical Therapy before Opioids?

Opioid prescriptions have skyrocketed over the last 25 years. Originally they were intended for post surgical patients and those in the end stages of cancer. In 1991 there were around 76 million prescriptions but by 2013 that number had risen to almost 207 million prescriptions.

There are strong ties in rises of opioid use and heroin use.

As prescriptions have risen, so have abuses. According to the CDC more than 1000 people a day are treated in emergency rooms for inappropriate opioid use.  As many as 1 in 4 people using opioids long term struggle with addiction. In 2015 there were nearly 60,000 drug overdose deaths, nearly half of those were from opioid drugs and opioid prescriptions frequently lead to other narcotic abuse. The economic costs of opioid abuse is estimated to be$75 billion a year. On top of all of that, there is no research to suggest that the amount of opioids has had any impact on people suffering from chronic pain. Patients who take opioids for even 1 day have a 6% chance of using them a year later, a 13% chance if they are used more than 8 days and a 30% chance if they are used for a month.

This year the American College of Physicians updated its guidelines for the treatment of acute and chronic back pain to recommend first using non-invasive, non-drug treatments before resorting to drug therapies.

The Joint Commission (the organization that accredits hospitals) has also added chiropractic treatment to its pain management recommendations. The guidelines were published in the Annals of Internal Medicine and based on reviews of randomized controlled trials and observational studies, and recommend spinal manipulation, massage and therapeutic exercise as first treatments for low back pain. Multiple studies support manual therapies and exercise to both resolve acute and chronic pain, but also for conditions you might not expect to see a chiropractor or physical therapist for: Parkinson’s, balance disorders, arthritis, and many others.

Chiropractors and physical therapists have excellent patient satisfaction scores.

A typical treatment plan for a chiropractor or a physical therapist costs less than an MRI.  Chiropractors and physical therapists are neuromusculoskeletal experts, and do far more than just pain relief, they create treatment plans that correct problems. You’ll be stronger, have better range of motion, and in general be more functional and be better able to do the things you love and your chance of recurrence will be lower. Do you have pain? Give us a call and see how we can help!

More Than Just a Bump on the Head

Concussions have become more and more “hot topic” in sports in the United States over the last decade. They have been put in the spotlight by the media and even become the subject of major Hollywood films. According to the International Symposia of Concussion in sport, a concussion is defined traumatic brain injury induced by biomechanical forces. That’s right, a concussion is now considered a traumatic brain injury which represents the seriousness of the condition.

Concussions occur in many different ways ranging from sports related impact to car accidents. Many people do not understand that a concussion can occur by either contact with the head or contact with the body causing head movement (whiplash from a car accident). Sports concussions will be expanded on in the rest of this blog post, but remember they can occur in a variety of ways.

Sports concussions are of particular concern in the present day. Athletes in higher level athletics are becoming bigger, faster, and stronger. This increase in athletic ability has allowed the games to move at a higher pace than in the past. This has led an increased risk for injury for athletes because of the decreased amount of time to brace and react before being hit.

Although helmets are designed to aid in the risk reduction for concussion, their main function is to prevent skull fractures not concussions. Even with improvement in helmet padding through innovation, concussion rates continue to increase. This increase in occurrence is partially related to both the increase in athletic ability and an improvement of sideline diagnosis of the condition. Football continues to be the sport that puts athletes at the highest risk for concussion. To the right is a graph representing concussions by sport in both high school and collegiate players.

 

What to Watch For

Symptoms of concussion vary from person to person. To the left is a list of symptoms that are commonly associated with concussions. If you are a coach, parent, athlete, or spectator and notice a player that present any of these symptoms following a hit, the trainer should be notified and the player should be removed from the game. It is important to get the athlete out of the game to prevent a second contact from happening. If a second contact happens during the same game or if the person is returned to sport before the injury has had time to fully heal, brain damage or even sudden death can occur. This has been seen a number of times in high school and collegiate sports. It is better to be more conservative and keep the athlete out of the game, than to return them too soon and risk injury or death.

 

What to do If you think you or someone else has experienced a concussion?

Get that person to a medical professional ASAP! Getting an examination by a medical professional allows for early diagnosis and treatment. Early treatment generally consists of mental rest. This means time away from the TV, computer, cell phones, work, and school. This usually lasts for 1-3 days until symptoms resolve and then these activities can be reintroduced gradually as symptoms allow. Most concussions resolve within 10 days for the majority of people.

Sometimes symptoms may last past the first 1-2 weeks following the injury. When symptoms present past a week or two, the person should seek out additional support to treat possible symptoms stemming from the cervical spine or vestibular system. With treatment of these areas, symptoms generally resolve within the first month of treatment.

In summary, concussions are a serious condition and are now classified as a mild traumatic brain injury. When someone is suspected of having a concussion, medical assistance should be sought out immediately for prompt diagnosis and counseling on appropriate rest procedures. Do not hesitate to reach out for help if a concussion is suspected. It is more important to protect the brain for the future than to stay in the game and risk further damage!

Healthy Snacking

It is back to school time! That means busy schedules, last minute plan changes and sleeping in to the last possible minute. Nutrition and healthy meals can easily slip through the cracks. Having healthy meals and snacks planned can greatly help you and your family work through this busy and transitional time. Having a nutritious snack in between meals is a great way to incorporate nutrient dense foods into your day. Often we are so busy during the day and either we ignore our hunger cues and inhale our lunch or dinner or we go visit our receptionist friend and get some candy from their basket. There is nothing wrong with the occasional candy, it is just that candy is not going to give you the nutrition you need to stay focused, have energy or be satisfied. Snacks are just as important for our kiddos. Let’s be real, kids are not worried about their nutrition or what type of snack they are eating. Their priority is not being late for their next class, their pop quiz that they are totally unprepared for, or the game they are playing at recess.

snacks for healthy snackingSo what makes a nutritious snack? Snacks need to be a combination of both protein and healthy carbohydrates. Carbohydrates give our bodies energy, provide fiber and help raise our blood sugar levels. Proteins also give us energy, though not as quickly, makes enzymes and hormones and also keeps our blood sugar levels from crashing. The combination of both protein and carbohydrates is critical to keep your blood sugar levels stable to give you sustained energy.

Below is a list of some great snacks that you can easily bring with you to work or pack in your kiddos bag.

  • Half nut butter sandwich on whole wheat bread
  • Fruit + handful of nuts
  • Cheese stick + fruit
  • Small salad with beans
  • Plain whole fat greek yogurt
  • Roasted chick peas or soy beans
  • Cottage cheese + fruit

Happy snacking!

Guest BloggerAmanda Terillo, is a Registered Dietitian Nutritionist (RDN) who specializes in integrative practices.

How To Fit a Backpack

Back to school is right around the corner, which means it’s time to break out the shopping lists and load the carts up with pens, folders, notebooks, crayons, glue sticks and – of course – the backpack. To help your little (or not so little!) one carry that load, it’s important to have the right size pack. We’re here to help!

 

 

The first consideration for a good fit will be the the torso sizing. To measure the torso, start from the base of their neck and bring the tape to their hip bones:

  • From a standing position, have your child tilt their head forward and look down. At the base of the neck there will be a big bump (totally normal, called C7). Measure vertically from there to the top of their hip bones. Have them put their hands on their hips and draw an imaginary line across their back – from thumb to thumb. This distance from this line to that C7 bump is your measurement. You want to find a back pack with that length. A few extra inches longer to accommodate growth is fine.

The second consideration will be the multitude of features. You’ll want to be sure whichever backpack you choose has the following elements:

  • Adjustable straps
  • Hip belt
  • Chest strap
  • If your child will carry any electronic devices, you may also want to examine options that include a padded laptop compartment with a waterproof feature

Once you’ve identified the appropriate features, and measured your child’s torso, you’re ready for the fitting to make your final selection. Have your child put on the back pack, and follow these steps:

  • Adjust the waist belt – it should sit up on top of the hip bones, and shouldn’t be so tight that it pinches or so loose that it slides down onto their hips.
  • Adjust the chest strap – it should feel snug, but not so tight that it makes it hard to breathe.  When your child is wearing the full back pack (with books in it), they should not feel any pinching in their low back, or burning between the shoulder blades. They also shouldn’t feel straps digging into them.  If they feel any of those things, you need to keep making small adjustments.
  • Check to be sure your child is able to carry the pack standing up right, without it pulling them backward or forcing them to lean forward.

Be sure to steer clear of these ‘don’ts’:

  • Don’t – drag the bag on the ground
  • Don’t – wear only one strap
  • Don’t – use the chest strap but not the hip belt
  • Don’t – choose a messenger bag
  • Don’t- put more than 20% of the child’s weight in the back pack.

So, if you’ve selected a backpack that fits the torso, has all of the right features, and has been adjusted to a good, comfortable fit, you’re ready to go. DO have a fun and safe return to school!

Summer Fitness: 4 Injury Warning Signs

Summer is here again, and with it comes the feeling of needing to get into shape. We want to look our best, so naturally our activity levels increase drastically. This isn’t necessarily a bad thing – as exercise is one way to ensure a long and healthy life. Unfortunately, for a lot of us, a large increase in activity level without a sufficient ramp-up period can spell injury trouble. The good news is there are warning signs your body sends prior to actually sustaining an injury.

Warning Signs 

Our body does a great job of helping us know whether something is harming us. There are many checks and balances within the body that allow this to happen.  For one, the level of pain does not necessarily equal the level of tissue damage. A little ache in the knees could be osteoarthritis or a torn meniscus. Sharp pain may represent only a minor ligament sprain or inflammation. So, how do you know if you’re over-doing it?

Here are the warning signs to watch out for:
  1. Pain during your warm-up: Warm-ups should not be painful! They get the body primed to work. If it is painful while priming, there is likely something underlying that needs to be take care of. Think of a car “warming up” for a trip on the highway; if it is shuddering, stalling, and a lot of warning lights come on before you make it to the highway, you’re in trouble before you even start the trip.
  2. Soreness that lasts more than 2 days: Soreness following a run or session at the gym – even into the next 24-48 hours – is OK. But, when it lasts for more than three days, something’s wrong. Take a step back and see what can be done differently. Did you push too hard or forget to include a proper warm-up? Our tissue needs to be exposed to demands that it can handle before loading too much. A proper ramp-up period will allow the tissues to adapt and respond to the demands placed on them.
  3. Inability to do as much work as the previous session: We’re always on the go, but our bodies do need REST. If you notice that your performance on workouts is declining, it might be a good time to give your body a rest. When we exercise, our muscles experience small micro tears. Healing these tears allows our muscles to build up and adapt to increased weight, distance, or other demands on your body. Your body needs time to heal before exposure to the same demands that lead to the damage. This doesn’t mean exercise needs to be stopped, but it may be a good idea to target a different part of your body or different muscular subsystem. For example – if you’re a runner, take a day off from running and add strength training on off days. If you’re lifting weights, try alternating days between upper and lower body exercises. Our bodies need variety to adapt. Without it, a decline in performance is likely follow.
  4. When in doubt, listen to your body: This one is relatively straight forward. If you refuse to listen to your body, and continue experiencing pain, it’s likely you’ll suffer an injury. The ‘no-pain, no-gain’ cliche is out. There is a difference between pain stemming from muscular fatigue, buildup of lactic acid and depletion of energy supplies and pain experienced when tissue damage is occurring. Know the difference and respond appropriately to the signals your brain is sending.

Getting back into shape for the summer can be extremely rewarding to just about everyone. But, a phase-in period to safely ease into your programs will help to ensure your body has enough time to adapt. Remember – listen to your body, learn from your mistakes, and build on the progress that you have already made. Stay healthy my friends!

Bryan Esherick PT, DPT

Posture Perfect

With the increase in technological devices of late, posture has been a recurring theme in physical health news more and more. You may have even heard the term “text neck”. If you’ve ever been to a physical therapist or a chiropractor you may have even heard more sophisticated terms like “Upper Cross Syndrome” and “Lower Cross Syndrome.” If you’ve been to Pilates, yoga or barre classes you’ve also probably heard about pelvic tilts and “tucking.”

We know that a good posture is healthy for us. But, you may be asking yourself – what exactly is good posture, and how can I maintain it?

Good posture looks like this. 

Your ears should be in the middle of your shoulders – and your shoulders directly over your hips – and all of that in-line directly over your ankles. Be sure and keep your shoulders down and back, too – not rounded forward. When you’re in a good posture position, you should notice:

  • Your spine should make a gentle ‘S’ curve.
  • Your pelvis should be level and your weight should be evenly distributed through your feet.
  • You experience no pinching in your lower back.
  • You feel no discomfort or excess weight in your heels or the balls of your feet.

 

The affects of not maintaining correct posture can be significant. Bad posture can lead to pain, injury and even degeneration of the spine. So, take heed and be mindful of your posture in during everyday activities – including how you are holding your head and neck while texting.

Stay tuned for more in our series on posture – the positive, and negative, affects it can have on your health.

Break the Injury Cycle

You’ve recently recovered from an injury, so you started a new workout program, and now you’ve just suffered another injury. Sound familiar? You’re not alone. It’s a common problem that lots of people face. The trick to breaking the cycle is in understanding the cause.

Exercise and rehabilitation is predicated on the SAID principle. This refers to the Specific Adaptation to Imposed Demand. Let’s break it down. We all have our own unique stress line – that limit within each of us that, if breached, will result in injury. This holds true for each system in our body – cardiovascular (heart, blood vessels, lungs) and musculoskeletal (bones, joints, muscles, ligaments, tendons). When we start a new exercise program, we start stressing these two systems. We push too hard and we suffer injury, don’t push hard enough and we don’t gain any results. So how do you overcome this conundrum? Strike a balance on exertion load over time.

When we safely exert ourselves up to the point of our unique stress line, our bodies adapt over time to tolerate increased levels of strain – elevating our individual limits. Think of it like this – you get winded while walking to get the mail, but you keep doing the activity for a week and in the end, you’re less winded over time. On the flip side, exerting yourself below your systems’ stress line, and your body has no reason to adapt and adjust. The key is to operate between the lines.

Here are a few injury risk signs that indicate need for increased recovery time:
  • Experiencing pain during your activity
  • Experiencing pain after your activity
  • Muscle stiffness the next day

It’s important to listen to your body and not overdo it. The concept of “no pain, no gain” is a fallacy. When starting a new program, it’s a good idea to meet with your chiropractor or physical therapist. They should evaluate your fitness, sleep patterns, and diet – and can help you learn the best movements for your fitness level to avoid risk and injury.

Food Can Make Us Strong

In honor of National Nutrition Month, I’d like to share a few thoughts on one of trickier health subjects – food.

Food is, at its core, emotional. It’s tied to all kinds of emotions. Emotions can be positive, happy, warm and fuzzy. But they can also be negative, sad, guilt-ridden and bring about compulsive behavior. The science on nutrition is very difficult, because it has so many factors and variables involved. Not to mention, it’s a very popular topic, and just one new study can launch a myriad of commentary from wellness blogs to news publications, and everything in between. What gets lost in the mix is that the new study is just that – one new study – but sometimes it is treated like the latest, broadly accepted scientific opinion. Remember when carbs were good for you… and then they weren’t… and then they were good again?

With so many different types of dietary models: Paleo, Atkins, Vegan, etc., it can be hard to figure out what’s right for you. There are merits behind so many of them, but the way we think about what we eat is what’s most critical.

Too often we think of food in black and white – as bad for you (but delicious and wonderful) and good for you (but so unappetizing).  A few weeks ago, I enjoyed opportunity to discuss nutrition with a patient in the office. Her name is Christa Bennett, and something she said really struck a chord with me.  She was telling me that she doesn’t talk about food with her children in terms of good or bad. Instead she frames it like this: “is it strong food or weak food?” It made me think – will this food make me strong or make me weak. I really liked it.

When we think of food in terms of good or bad, we are placing an emotional value on it. This isn’t always a healthy thing for our bodies, our minds, or our hearts. Let’s take a note from Christa. As we sit down to our next meal, consider what’s on the plate. “Will this make me strong? Will it make me weak?”

Try to incorporate a few of these foods and tips into your meal prep routine:
  • Fish or poultry three or more times per week
  • Whole grains and fruits daily
  • Vegetables – lots and lots of vegetables
  • Healthy fats, like olive oil
  • Pair proteins with fats
  • Design meals that feature a variety of rich, vibrant colors

We want to eat better so we can feel better, and we want to eat food that tastes good. But we can do without the calorie counting, countless hours preparing in the kitchen, and ultimately feeling deprived and hungry. With a little bit of will power and some slight adjustments to how we think about food, we can feel strong and fuel our bodies right. I have been getting ready for a new jiu-jitsu belt test lately and eating a lot of strong foods, because I want to feel strong. And thanks to Christa, I do. I hope you do to!

 

Healthy Sleep Habits, Happy Back

Sleep is important. Yet, despite our awareness of sleep benefits, we often don’t make getting enough of it a priority. Sleep loss costs the U.S. $4.2 billion dollars a year – an equivalent of 1.2 million work days a year. But there is more to sleep than getting enough. How you sleep can be just as important to your health.

Stomach sleeping.

Many people sleep on their stomachs. And while stomach sleeping can help with snoring, it can also exacerbate and prolong neck and shoulder pain from a recent or recurring injury.

Side sleeping.

Side sleeping – with your arms below chest  level – is better. But, also brings risk of waking with numbness and tingling in your arms from having them in the wrong spot. I recommend sleeping on your side with your arms down, and your legs almost straight, with a pillow between your knees. Many people have a tendency to bring their chin toward their chest in this position. Try to keep your neck straight, and be sure your pillow is thick enough to keep your spine straight. Side sleeping requires a thicker pillow than sleeping on your back.

So, what’s the best sleep position to cover by best?

Back sleeping.

As a chiropractor, I like back sleeping with your arms down best. It keeps your spine straight and level. This is the ideal position for back health and injury recovery. Tucking a pillow below underneath your knees can be a good extra measure as well. However, if you snore or have sleep apnea, this may not be the best position for you.

So, be sure to get your sleep – and be mindful about how your body is feeling when you wake up – you might need to make some adjustments. If you have pain or stiffness when you wake that’s a good sign that you’ve some adjusting to do. When we wake we should feel our best.

Healthy Life, Healthy Back

Patients often ask: “What caused my problem and how do I keep it from returning?” The origin of a condition may be easily identified as an accident or injury. However, more than half the time, the exact cause is more difficult to pinpoint – because the problem was generated by a series of seemingly harmless events and circumstances (e.g. your posture; increased activity; mild repetitive strains; etc). In fact, most conditions are started by a “recipe” of irritants rather than any single “ingredient”. From a slight increase in your daily exercise routine coupled with less than ideal posture in an old office chair, to a few extra trips up and down the stairs and layering on the Spring chores, all add up to: “Ouch, my back…!”

When life’s physical demands exceed your body’s tolerance for those challenges, muscle, bone, joint and nerve problems begin. So, how do you prevent recurring injury?

Here are five tips to help keep the back strain away.

  1. Lift with your legs. The strongest among us are still at risk of back injury when we lift heavy objects incorrectly. Be sure to squat down, grab the item and use your leg muscles to lift up.
  2. Exercise your core. Your core muscles are key to supporting your lower back. Low-impact activities, like walking, will get your heart-rate up, deliver increased oxygen to your spine, and help keep your middle fit.
  3. Practice your good posture. Much like poor posture can lead to painful back problems, good posture can help prevent injury and strain. Set reminders for yourself throughout the day to check your posture – get up and walk around from time to time – and avoid slouching.
  4. Reduce your stress. We hold tension in our back muscles, and this type of constant stress can cause back pain. Try introducing stress-relieving activities into your daily routine – meditation, yoga, tai chi – the list of options is long. The trick is finding something that works for you.
  5. Be the healthiest You that you can be. Think of your spine as an indicator of your body’s overall health and well-being. So, practicing activities that have a positive affect on your health will also have a positive impact on your back. Drink lots of water; minimize alcohol; avoid nicotine; and limit inflammatory foods (sugar, flour, dairy, processed meats, fried and saturated fats).

Of course, prevention is always the best measure to keep your body pain-free. But, if you do encounter a mishap, partnering with your physical therapist and employing these measures to help increase strength and flexibility can also help increase your threshold for future injury.