CHIROPRACTIC ADJUSTMENT, COORDINATION AND DEXTERITY

I have recently renewed my enthusiasm for digging into chiropractic basic sciences research, especially in the area of neurological efficiency, as my husband discovered the index to chiropractic literature as part of his fellowship in integrative medicine through the Weil Institute in Arizona.

There have been a series of research conducted using very sophisticated tools to measure the efficiency of intracranial signaling speed in patients receiving spinal manipulation. I am extremely grateful for a pioneer Canadian researcher who spent quite a bit of her research career in New Zealand and inspired a whole generation of younger researchers to expand on her earlier work using transcranial magnetic stimulation. To boil it down, the technology has allowed the use of an external magnetic device applied to the skull to modulate speed of transmission between incoming sensory output and outgoing muscular signaling. The technology also allows the researcher to very accurately measure the speed of transmission and the brain. As a general rule, faster transmission results in much more efficient human motor activities such as decreased response time (think athletic performance but also daily activities such as slamming on the brakes to avoid an oncoming vehicle), and overall improved speed and dexterity. This particular study was quite interesting in that it looked at how neck pain affected the speed at which an affected patient could type a series of letters (patients with neck pain were much lower than their counterparts without neck pain), and how a chiropractic adjustment not only restored typing speed to normal in patients with neck pain, but those adjusted individual actually outperformed the control group who had no neck pain and no adjustment.

We often talk about chiropractic for pain alone, but it's important to realize that pain is only a small fraction of our overall neurological functioning. Our earlier chiropractor pioneers were much more interested in the overall neurological function of their patients than pain alone. The study would certainly have reinforced their pursuits, reminding us that chiropractic can be a powerful tool to help humans perform their best, including much more efficient speed dexterity and coordination of the upper extremities for important modern human tasks such as typing.

https://www.researchgate.net/publication/323463302_Subclinical_recurrent_neck_pain_and_its_treatment_impacts_motor_training-induced_plasticity_of_the_cerebellum_and_motor_cortex

SCROLLING TENDINITIS (DE QUERVAIN'S TENOSYNOVITIS)

https://www.youtube.com/shorts/GCtCfrTNej8

I have seen several of these cases recently which then again prompts me to get behind the camera and record a short educational video. Wrist tendinitis can be caused by multiple types of activities, but the increasing number of repetitive strain injuries associated with the use of smart phones, especially single hand phone handling that relies on thumb scrolling, seems to be an increasing percentage. The thumb extensor tendon loops underneath a dorsal wrist ligament called the retinaculum, and the friction of the tendon underneath the retinaculum creates pretty significant inflammation and scarring over time, leading to pinpoint pain on the inside of the wrist during activities that involve wrist extension, holding and picking up objects, and rapidly moving your hand towards the outside of your wrist. When it's becoming an entrenched problem, we have to treat it obviously, but the proverbial ounce of prevention goes a long way in this case. Making sure you scroll with the opposite hand of your phone holding hand will virtually eliminate a lot of left-sided wrist tendinitis, which means that occasionally you have to put on your cup of coffee to use your right index to scroll. Better yet, get off your smart phone and start doing something more beneficial for yourself.

GLP-1 semiglutide medications, muscle and bone loss

Like any clinician working in 21st century American healthcare, over the last 12 months, I've come in contact with an explosion of patients taking GLP-1 semiglutide medications. While those medications were initially labeled for diabetic control, the vast majority of cases presenting in my office are for weight loss. And like many colleagues in the integrated space, balancing the facts about the benefits of a medication addressing severe persistent medically dangerous obesity with known and unknown side effects has been a fine balancing act.

Behind closed doors, when colleagues and I candidly discuss our experience with patients taking this new class of medication, we all wonder when the proverbial other shoe will fall off. There has been an unbridled enthusiasm about the potential for those medication to help curb the scourge of chronic population obesity, but probably a bit of a vacuum when it comes to discussing all of the pros and cons of the prolonged use of a class of medication that historically had been reserved for the patient with poorly controlled diabetes. After 30 years in practice, you acquire a little bit of healthy cynicism when it comes to new treatments of any sort, knowing that some downfalls are not readily available during the "honeymoon" period of a launch that can take months to years to unfold.

There may be a bit of the proverbial shoe starting to drop based on the most recent article published in Lancet (1 of the top dogs of straightforward published medical research). The speed at which patients can lose weight, it turns out, is not all about tissue that you would want to shed. A whopping 3rd of the weight loss comes from lean muscle tissue. This is in contrast to nonmedically induced weight loss from calorie restriction and physical activity, which has a much better track record at preserving lean muscle mass. The latter is quite important for long-term weight maintenance, since muscle tissue is much more metabolically active at burning calories at rest, acting as a blood sugar buffer, among other things.

From a neuromusculoskeletal provider standpoint, the research article hit a bit of a raw nerve because of the implications for our treatment plan. I had already started to suspect that patients on long-term GLP-1 exhibiting significant weight loss were also presenting with decreased overall muscle tone, bulk and endurance, complicating the stabilization phase of the typical spinal and extremity pain that were trying to treat. Another aspect of the rapid weight loss involving muscle tissue that is not brought up by Lancet but is a big concern to me is the concurrent potential impact on decreased bone mass. Lean muscle mass loss and bone loss tend to go hand in hand during significant weight loss.

The research article has reminded me of the importance of reviewing with patients 3 important mitigating strategies with patients on long-term GLP-1:

incorporate a sufficient amount of protein in the diet while on the medication, defined as a minimum of half a gram of protein per pound of body weight. This means that a 200 pound adult would need 100 g of protein. You have to be really intentional about reaching that goal every day through combination of protein dense foods with every meal, and potentially supplemental protein.

Engage in resistance training to 3 times a week that is sufficient to stimulate muscle growth. Just doing activities of daily living and walking is not going to preserve muscle mass.

Consider adding a good bone building support supplement, which is going to contain a combination of bioavailable calcium, magnesium, other bone building minerals, vitamin D3 and vitamin K 2.

3 technique pointers for a safer deadlift

3 TIPS FOR A SAFER DEADLIFT

I've found myself teaching those instructions to patients often enough that I decided to make a quick video about it so I can refer patients to view them again after the appointment. While I have not spent as much time as Dr. Steve in a traditional gym setting, I've done enough deadlifts in my own exercise time to know how quickly they can go wrong, especially if you happen to be recovering from a recent lumbar strain or any other lumbar injury. The main goal of the debt lift modification is to keep a stable flatback in maximum descent and muscular contraction. The 3 modifications, namely wide stance, slightly flexed knees, and firing up the good muscles ahead of time, facilitate maintaining a safe lumbar posture

(photo courtesy of Freepik)

https://www.youtube.com/watch?v=sFqTF5iy3WQ

What causes groin pain ?

It's a question that comes up periodically and since there is no easy answer that I can give to patient during a routine appointment slot, I decided to put my thoughts in writing so I can refer patients to it as a conversation starter.

The groin is a small piece of the body's real estate, that we tend to think of as private, but that can really control your life if it starts acting up.

It's a body area that is the intersection of several structures that can be pain producing, and you need a little bit of attentive detective work to determine the source of the problem.

The main structures that can be involved in producing groin pain:

– referred pain from the middle lumbar area, especially L2 and L3 segments. These would be things like a lumbar disc herniation causing pain to radiate along these dermatomes, or significant bony spurs. The lower lumbar segments such as L4 5 and L5 S1 definitely take the lines shares in terms of referred this pain, so that sometimes we tend to forget that mid lumbar areas can also be a source of referred pain. Patients with groin pain referred from these mid lumbar segments tend to have pain that is aggravated by lumbar movement.

– Referred pain from myofascial structures in the deep hip flexors, especially if involving some peripheral compression of the anterior peripheral nerves that exit that those levels: the femoral nerve, the ilio inguinal nerve, and the lateral femoral continues nerve. This pain can be really tricky to assess, since it will not readily show up on advanced imaging like MRI. During physical examination, deep lateral palpation of those structures can usually be pretty revealing, and the fact that very often activities involving hip flexion can be very triggering.

– The hip joint, or more precisely the acetabular femoral joint (AF joint) . This is the ball and socket joint between the socket in the pelvis (acetabulum) , and the femoral head. This is not usually a joint that is subject to primary misalignments due to its ball and socket nature, although it certainly can, but is subject to articular cartilage degeneration, and tearing and catching of the cartilage rim also known as the labrum. There are specific orthopedic testing that can help isolate the AF joint is the source of the problem, and in addition pain from imaging as well as advanced imaging like MRI can be very diagnostic of the problem starting in that structure. From a history standpoint, patient will often report the sensation of catching or clicking, and pain triggered by hip movement rather than lumbar movement.

– The sacroiliac joint. The sacroiliac is a rather large vertical/horizontal articulation at the base of the sacrum, and the anterior portion of the sacroiliac joint can refer pain to the groin. This would happen with misalignment of the sacroiliac joint internally, that will be often associated with deep pain in the buttocks, difficulty with flexibility in the affected side of the pelvis, and standing with a toe out position on the affected side.

So groin pain can come from many different sources, but it should not be a mystery and a good physical examination can usually point the patient and the treating doctor into the right direction.

Autism spectrum disorders and altered gut microbiome: new scientific diagnostic methods

https://www.nature.com/articles/s41564-024-01739-1?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=new%20study&utm_content=new%20study&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

With children going back to school this week, I was reminded of this article I first read earlier in the summer. Children with autism spectrum disorder (ASD) makeup and increasing percentage of our school population, with some debate about the real increasing incidence versus better diagnosis inflating the ranks.

Equally the subject of vigorous debate, is the cause of autism. Or more accurately, the causes, since it appears to be a multifactorial trigger that may be different in various affected individual.

This particular article focused on assessing the microbiome of neuro- typical children versus children with ASD. The integrative health community has long argued that neuro- divergent children almost always will exhibit significant functional G.I. markers abnormalities, which are likely the source of some retrograde brain functioning alteration. That same community has also argued that neuro- divergent children can see improvement in their brain functioning if we can improve their microbiota. This particular research article did not address that question, but clearly confirmed with advanced diagnostic techniques that is the children do indeed have some substantially and statistically significant differences in their digestive ecology. However it's pretty safe to operate on the hypothesis that G.I. intervention that will improve microbiota composition will indeed have a secondary positive effect on the function of the central nervous system. It's especially exciting for chiropractors in the integrative health community, since chiropractic adjustments alone have been shown to improve gut -brain axis signaling, further enhancing the effectiveness of any nutritional intervention.

Specific chiropractic adjustments versus random manual mobilization: why it really matters

https://www.researchgate.net/publication/377361433_A_randomized_controlled_trial_comparing_different_sites_of_high-velocity_low_amplitude_thrust_on_sensorimotor_integration_parameters

Over the last 30 years of practice I have often found myself answering the same question many times over. 1 of those questions is why I seem to only be adjusting only one side and only one very specific spot, when patients may have had previous experiences with chiropractors or other manual therapist that showed a much broader contact, and adjusting multiple areas of the spine on both sides. With the addition of Dr. Steve as my esteemed colleague and associate, I realize I'm not the only one answering that question. Dr. Steve and I have very similar approaches and background in manual adjusting, (more specifically we both had most of our training in the Gonstead technique and system), which means that on occasion we will both bemoan the drift of our profession away from specific and systematic manual adjustments based on a system of analysis that aims at isolating the main segment(s) of spinal dysfunction that should be adjusted, while leaving the rest alone.

There are good scientific rationales behind that approach: the spine is a very dynamic system of action and reaction based in gravity. What happens in one area of the spine will often lead to broad compensations in a different area, and it takes some clinical investigation to make sure you address the root cause rather than waste your time (and your body's limited healing energy) on areas of compensation.

There is also good and pretty solid research to validate the specific approach. I was thrilled to come across this wonderful paper by our colleagues from down under in New Zealand (especially Dr. Heidi Haavik who has been a workhorse of basic science chiropractic research for well over a decade). The nuts and bolts of the study was to measure the brain-based motor response of an adjustment in a randomly selected area of the spine across the test subjects, versus a specific spinal segment determined by chiropractic analysis including static palpation, palpatory tenderness, abnormal motion segment etc.). The results were statistically incredibly different between the 2 interventions.

The moral of the story is that chiropractic care is most likely to give you longer-lasting neurologically integrated results if your provider spends time to specifically isolating the main problem area and adjusting it according to best biomechanical correction principles.

How frequent is spinal pain in children?

https://www.sciencedirect.com/science/article/abs/pii/S1413355524000042

I continue to listen to a series of research podcasts, catching up from 2015 and on. All I can say is that we have some amazing colleagues doing serious research and enlightening our day to day practices.

This particular piece of research caught my attention because I've been thinking about children a lot recently. We have a crop of new babies coming in to the office, the children are back in school dragging heavy backpacks and happily crashing into each other in their fall sports.

Over the last 30 years of practice I feel that at times I have been fighting an uphill battle in the area of chiropractic pediatrics, trying to convince many parents and the community at large that children do develop spinal problems fairly early, fairly frequently, and that we are currently operating by a false narrative that back pain is not something that happens to children but rather to adults, and that if a child is complaining about pain, it is usually a psychological reason behind it. Up until recently we've not really had much research data to back this up.

This brand-new study (January 2024), from Brazil, indicates that a whopping 30% of adolescents may complain of spinal pain that could be at times disabling. What's most interesting looking through the fine print of the paper is that the pain pattern is really quite similar than adults already. (Objective factors, risk factors etc.) these numbers fly in the face of our current cultural understanding of spinal pain in children, much less our healthcare intervention resources. Having had the pleasure and privilege of working with individuals from birth to natural death over 30 years, I can say without a doubt that I have been shocked by the types of finding I've seen in rather young children over the year. But ultimately, as time goes by, I see the continuum of presentation between my adult patients and the history of their 1st trauma much more clearly now. When I see the children taking tumbles on the playground, falling down the stairs, and wrestling with the siblings I realize that none of us adults could do this and still get out of bed the next day. To be fair children's neuromusculoskeletal systems are more pliable and a little more resilient than ours, but they do not magically survive some of these injuries without some potential long-term residuals that will manifest episodically into adulthood.

I am most excited about another 10 year longitudinal initiative started in Denmark, currently underway. It will start screening a very large swath of schoolchildren starting in preschool and through high school, looking at a variety of metrics from pain to motor control to balance to visual efficiency. I think were going to get a wealth of data as to how children develop pain over time and what the risk factors are in their history, as well as what early signs in their other developmental milestones may be useful to flag them for early intervention. Those little people are genuinely our most precious resource and it's time we stop writing off their back pain as just something in their heads.