BLOG – Page 158 – Chiropractic Resource Organization

Comparison of Outcomes in Neck Pain Patients With and Without Dizziness

By Frank M. Painter|January 8, 2013|Chiropractic Care, Dizziness, Spinal Manipulation, Whiplash|

Comparison of Outcomes in Neck Pain Patients With and Without Dizziness

Chiropractic & Manual Therapies 2013 (Jan 7); 21: 3

B Kim Humphreys and Cynthia Peterson

University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

Background The symptom ‘dizziness’ is common in patients with chronic whiplash related disorders. However, little is known about dizziness in neck pain patients who have not suffered whiplash. Therefore, the purposes of this study are to compare baseline factors and clinical outcomes of neck pain patients with and without dizziness undergoing chiropractic treatment and to compare outcomes based on gender.

Methods This prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.

Results Females accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).

Conclusions Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.

There are many more articles like this @ our:

Vertigo and Chiropractic Page and our:

Whiplash and Chiropractic Page

Introduction

The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime prevalence of 26-71% and a yearly prevalence of 30-50%. [1, 2] Most concerning is that many patients, particularly those in the working population or who have suffered whiplash trauma, will become chronic and continue to report pain and disability for greater than 6-months. [3-6] In terms of symptoms, dizziness and unsteadiness are the most frequent complaints following pain for chronic whiplash sufferers with up to 70% of patients reporting these problems. [7, 8] Apart from whiplash trauma, little is known about dizziness in the chronic neck pain population and much remains unknown about the etiology of chronic neck pain in general. [9]

Gender differences in reporting pain intensity is currently a topic of debate. Recent research suggests that females report more pain because they feel pain more intensely than males over a variety of musculoskeletal complaints. [10, 11] Furthermore, LeResche suggests that these differences may not be taken into account by health care providers, leading to less than optimal pain management for females. [12] However gender differences in neck pain patients with or without dizziness have not been described with respect to clinical outcomes over time.

Therefore, the purposes of this study on neck pain patients receiving chiropractic care are twofold:

to compare baseline variables and the clinical outcomes of neck pain patients with and without dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables over a 6-month period;

to evaluate gender differences for neck pain patients with dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables in a longitudinal study.

(more…)

0

Clinical Biomechanics: Mechanical Concepts and Terms

By Frank M. Painter|January 6, 2013|Chiropractic Care, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Spinal Manipulation|

Clinical Biomechanics: Mechanical Concepts and Terms

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 2 from RC’s best-selling book:

“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 2: Mechanical Concepts and Terms

All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.

Energy and Mass

Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.

Energy

Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.

Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.

The Center of Mass

The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.

The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).

Newton’s Laws of Mechanics

(more…)

0

Clinical Biomechanics: General Spinal Biomechanics

By Frank M. Painter|January 3, 2013|Chiropractic Care, Clinical Decision-making, Education|

Clinical Biomechanics: General Spinal Biomechanics

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 6 from RC’s best-selling book:

“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 6: General Spinal Biomechanics

This chapter discusses the vertebral column as a whole and serves as a foundation for the following three chapters that consider the regional aspects of the spine and pelvis. Emphasis here is on gross structure, function, spinal kinematics, and other general biomechanical implications.

Background

The vertebral column is a mechanical marvel in that it must afford both rigidity and flexibility.

The Spine as a Whole

The segmental design of the vetebral column allows adequate motion among the head, trunk, and pelvis; affords protection of the spinal cord; transfers weight forces and bending moments of the upper body to the pelvis; offers a shockabsorbing apparatus; and serves as a pivot for the head. Without stabilization from the spine, the head and upper limbs could not move evenly, smoothly, or support the loads imposed upon them (Fig. 6.1).

Essentially because of its various adult curvatures, the bony spine is anatomically divided into the seven cervical vertebrae, the twelve thoracic vertebrae, the five lumbar vertebrae, and the ossified five sacral and four coccygeal segments. From C1 to S1, the articulating parts of these vertebrae are the vertebral bodies, which are separated by intervertebral discs (IVD’s), and the posterior facet joints. The IVD’s tend to be static weight-bearing joints, while the facets function as dynamic sliding and gliding joints.

WEIGHT DISTRIBUTION

The flexible vertebral column is balanced upon its base, the sacrum. In the erect position, weight is transferred across the sacroiliac joints to the ilia, then to the hips, and then to the lower extremities. In the sitting position, weight is transferred from the sacroiliac joints to the ilia, and then to the ischial tuberosities.

SPINAL LENGTH

About 75% of spinal length is contributed by the vertebral bodies, while 25% of its length is composed of disc material. The contribution by the discs, however, is not spread evenly throughout the spine. About 20% of cervical and thoracic length is from disc height, while approximately 30% of lumbar length is from disc height. In all regions, the contribution by the discs diminishes with age.

Development of the Spine

In brief, development occurs in three stages: mesenchymal, chondrification, and ossification.

MESENCHYMAL AND CHONDRIFICATION ORIGINS

Just prior to the 4th week of embryonic development, a vertebral segment begins to develop as paired condensations of mesenchyme (somites) around the longitudinal notochord and dorsal neural tube. One or usually two chondrification centers appear (6 weeks) in the centrum and begin to form a cartilaginous model surrounded by anterior and posterior longitudinal ligaments which are complete by 7-8 weeks. Chondrification centers also form in the neural arches and costal processes. A thick ring of nonchrondrous cells establishes the model IVD around the longitudinal string of beaded notochordal segments (Fig. 6.2). (more…)

1

How a drug went from $50 to $28,000 a vial

By John Wiens DC|December 30, 2012|Health Care|

Source NY Times

The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.

The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.

“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.

How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers. (more…)

3

Could High Insulin Make You Fat? Mouse Study Says Yes

By John Wiens DC|December 30, 2012|Nutrition|

Source Science Daily

Animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet.

When we eat too much, obesity may develop as a result of chronically high insulin levels, not the other way around. That’s according to new evidence in mice reported in the December 4th Cell Metabolism, a Cell Press publication, which challenges the widespread view that rising insulin is a secondary consequence of obesity and insulin resistance.

The new study helps to solve this chicken-or-the-egg dilemma by showing that animals with persistently lower insulin stay trim even as they indulge themselves on a high-fat, all-you-can-eat buffet. The findings come as some of the first direct evidence in mammals that circulating insulin itself drives obesity, the researchers say.

The results are also consistent with clinical studies showing that long-term insulin use by people with diabetes tends to come with weight gain, says James Johnson of the University of British Columbia.

“We are very inclined to think of insulin as either good or bad, but it’s neither,” Johnson said. “This doesn’t mean anyone should stop taking insulin; there are nuances and ranges at which insulin levels are optimal.” (more…)

2

Too Sweet to Be Good? The Potential Health Hazards of Artificial Sweeteners

By Frank M. Painter|December 27, 2012|Artificial Sweeteners, Attention Deficit, Chemical Sensitivity, Environmental Sensitivity, Food Sensitivity, Headache, Obesity, Pediatrics|

Too Sweet to Be Good? The Potential Health Hazards of Artificial Sweeteners

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Claudia Anrig, DC

With worldwide obesity rates doubling in the past three decades, is it any surprise that artificial sweeteners have been gaining popularity? Beginning with the creation of saccharin, “sugar substitutes” have become the supposed answer to a dieter’s prayer – and part of the daily diet of many of our children.

Let’s review the various sugar substitutes on the market today to appreciate what they are and why they may not be the best option in terms of your patients’ – and your – health.

Aspartame: NutraSweet or Equal

This sugar substitute was discovered in 1965 by accident while chemist James Schlatter was testing an anti-ulcer drug. [1] Aspartame gained FDA approval in 1981 and was approved in 1983 for use in carbonated beverages, where it is most commonly found now as the primary sweetener for most diet sodas. [2]

Aspartame accounts for over 75 percent of the adverse reactions to food additives reported to the FDA and has been linked to serious medical reactions. [3, 4] Researchers and physicians studying these reactions have concluded that the following chronic illnesses can worsen when ingesting aspartame: brain tumors, multiple sclerosis, epilepsy, chronic fatigue syndrome, Parkinson’s disease, Alzheimer’s, mental retardation, lymphoma, birth defects, fibromyalgia, and diabetes. [4] (more…)

3