Food Reactions: How, Why, Pain, Wellness

https://www.gdx.net/product/igg-food-antibodies-food-sensitivity-test-blood

I have been fielding a lot of questions and requests recently from patients who are trying to pin down food reactions that they suspect are aggravating their chronic joint pain.

The umbrella of food reactions is complex and includes several categories including:

• Reactions mediated by the immune system and manifested as blood antibodies to common food proteins. Those can be tested using IgG antibody blood testing. We use Genova labs at the office and a basic panel costs around $100. Because some of those slow immune mediated food protein reactions can spread over 72 hours post ingestions, the test can be hugely helpful since the correlation to a specific food item is not always readily connected to ingestion.

• Reactions mediated by the interaction of some food macronutrient with the digestive tract: fat maldigestion, protein maldigestion, aggravation of dysbiosis, bacterial, and fungal overgrowth by simple sugars, fiber, FODMAP foods. In those instances, using a GI specific functional markers test will be the best way to work this up along with a good history.

• Reactions to certain chemical compounds found in a food such as MSG, histamines etc. Those can be much trickier to assess by lab or other diagnostics and may require food/ symptom journaling to correlate an ingredient list with a particular timing of symptoms.

SPONDYLOLISTHESIS IN YOUTH ATHLETICS

SPONDYLOLISTHESIS IN YOUTH ATHLETICS

https://www.isjonline.com/article.asp?issn=2589-5079;year=2021;volume=4;issue=1;spage=10;epage=17;aulast=Batra

I came across this article during a continuing education weekend lecture. I was all ears, since I had just been dealing with two very frustrating cases of youth athletics spondylolisthesis cases, which were not being taken seriously by their respective treating providers.

Most people may not have even heard of the term spondylolisthesis, which describes a stress fracture to the posterior elements of the lower lumbar spine. It happens in youth, between ages five and 16, and is not the result of a single trauma but repetitive axial loading with extension and is most commonly experienced with certain type of athletic activities in predisposed teenagers. The problem with youth athletics spondylolisthesis is that some of them will get better with rest and core strengthening, and some of them will not, but my experience as a referring provider is that there doesn't seem to be a very consistent way for the orthopedic system to differentiate between the cases and our youngsters often end up in a one-size-fits-all approach, not always with good results. As a provider who sees a variety of ages, I will often have to deal with the adult and mature adult results of a poorly treated spondylolisthesis in teenagers, long after the juvenile orthopedic system has seen them.

The very first problem is often that the spondylolisthesis is not picked up in the early stages, when the chances of it fully stabilizing and healing without permanent abnormal mechanical faults to the lumbosacral system is available. You can have a strong suspicion from the history, examination findings, and possibly plain film imaging, but ultimately you can only clearly diagnose it with advanced imaging such as MRI.

Assuming under the best of circumstances that advanced imaging has been done in the early stages, the next big issue is determining how likely it is to stabilize within 6 to 8 weeks of immobilization and strengthening. To that I would add obviously the chiropractic approach to look for any underlying mechanical inefficiencies they would add the chance of overloading the posterior elements such as the facets and the bony pars, such as strong pelvic girdle misalignment, short leg, ankle pronation, imbalances in the hip flexors and glutes, cervical facet syndrome with poor proprioception etc.

The research article in the Indian spine journal was really quite remarkable and that it looks at the very objective data to assess which patients are likely to progress to the point of needing surgical stabilization in which ones are not. It is based on total spine lateral weight-bearing plain film x-rays, measuring the angle of the sacrum, on which the spondylolisthesis segment normally rests, lumbar lordosis, and overall cervical to lumbar spine alignment. I had to chuckle since these are the types of mechanical things that chiropractors have been talking about for a long time, and I'm thinking my Indian chiropractic colleagues are probably enjoying a very close working relationship with their respective orthopedic surgeons.

At any rate, for those of you out there dealing with this tricky health issues, whether as a patient, as a parent, as a coach or athletic trainer, know that they are the resources to help you figure out which category you fall into, even if your current provider is not able to direct you with their own toolbox.

CRANIAL NERVE 5, TRIGEMINAL PAIN

CRANIAL NERVE 5, TRIGEMINAL PAIN

Facial pain can be really frustrating detective work to figure out for both patients and doctors alike. I was reminded of that recently with a patient that had been doctoring in multiple places for 18 months, with some unexplained tooth pain, to no avail. In this blog I would like to explore one source of facial pain that is often overlooked and that is trigeminal referred nerve pain from the cervical spine.

I still recall during human dissection in my first year of chiropractic school discovering that unlike most nerves, which were pretty small and elusive, the trigeminal nerve and its node were surprisingly large and easy to find. The trigeminal nerve is part of the 12 cranial nerves which exits through various openings in the skull, unlike the spinal nerves that exit at the level of the vertebral column below. It's a very large nerve with many sensory and motor functions. It affects a huge area over the lateral part of the face from the ear forward. In particular, the trigeminal nerve provides sensation to the upper and lower jaw and the base of the teeth.

What makes the trigeminal nerve unique from a chiropractic perspective is the following anatomical fact: the nerve cell that sends out its long nerve endings to the side of the face starts in the brainstem and dips all the way down in the spinal cord of the upper cervical spine, all the way down to the level of the second cervical vertebrae. As a result, any irritation to the upper cervical spinal cord has the potential to refer sensation to the side of the face. And very often this will localize over the jaw, and the lower teeth.

I'm certainly not suggesting that your first call when experiencing tooth pain should be to the chiropractor, but after a dental checkup, if you still have unexplained pain in the lower teeth especially, diffusely in the corner of the jaw or ear, it's certainly worth having a chiropractic evaluation. Not all upper cervical benign misalignments are likely to cause that, but functional lesions associated with enough torsion and extension can create some irritation of the upper cervical spinal cord and get the trigeminal nerve cells to misfire. This would result in vague unexplained pain in the above areas.

CHIROPRACTIC CARE AFTER SPINE SURGERY ?

That was a question posed to me earlier this week. I was going to refer the patient to some material that I had written about it, but to my great surprise and chagrin, I had done no such thing yet, and it was time to fill the gap.

The answer :

• Depending upon WHICH surgery you had, chiropractic care can resume close to normal after a waiting period of 8-12 weeks. Those surgeries include laminectomies, foratotomies, facet joint partial resection. You can adjust at that segment, obviously with some modification of depth and rotation. For DISC REPLACEMENTS, you need to stay away from the segment replaced but otherwise can adjust adjacent segments pretty normally (I tend to limit rotation and lower the depth threshhold as well).

• For SPINAL FUSION, using graft bone or metal hardware, no manual adjustment within 2 segments is the rule, and you have to wait a full 12 weeks and get confirmation from the treating surgeon that all hardware is secure before proceeding. There is still a lot you can do at other segments, as the fused segment is often a compensatory area in the first place.

• Soft tissue care is still readily available after any type of surgery, so long as the doc or the massage therapy can modify therapy technique to prevent compression of soft tissues onto the underlying bone. Not only is soft tissue care available I frankly think anyone with a prior spine surgery should be evaluated for the necessity of soft tissue care. Scar tissue and adhesions can be a major source of continued pain after surgery when all of the orthopedic imaging shows good results. I especially find cupping useful since it distracts and separates tethered myofascial layers , rather than compress.

• Acupuncture therapy can go on unrestricted, so long as the patient can be positioned comfortably for the duration of the treatment.

SITTING FOR DUMMIES

https://studio.youtube.com/video/4elMaXDAJcE/edit

The human body was not engineered for prolonged sitting as we are currently doing, but learning a few basic tricks can help you survive that necessity of modern life a whole lot better.

Why Does Everything Hurt on One Side of my Body ?

https://www.sciencedirect.com/topics/medicine-and-dentistry/periaqueductal-gray

It's a question that periodically gets brought up. Some patients have a striking tendency to develop recurrent injuries, pain patterns consistently or exclusively on one side of their body. They wonder if this is a coincidence, or if there may be a master mechanism driving that.

Short of being broadsided by a truck on one side of your body, you do need to look for reasons why patients continuously develop problems unilaterally. Here are some of the two most common mechanisms I have seen:

– from a mechanical standpoint, a chronic mechanical disruption or instability of the lower extremity can create stress on one side of the body. This is the case with undiagnosed or uncorrected short legs, which I have seen in a surprising number of adult patients who are told of it for the first time. The other mechanical issue that can affect one side of the body is significant upper cervical subluxation patterns, which affect utilization movement and coordination on one side of the body and leads to inefficiency injuries.

– Probably more commonly there is a neurological "glitch" in the central nervous system which affects sensory perception, motor response and coordination to one side of the body and leads to chronic recurrent pain and injuries unilaterally. A lot of people have the residuals of a very old mild traumatic brain injury causing these types of issues, although they are usually adamant they've never had such a thing. We can usually uncover that by doing a few subtle neurological testing for balance, vestibular function, and muscle tone symmetry between the right and the left side. There are several known neurological pathways descending from the brain that affect pain perception and modulation unilaterally in particular.

As always treatment depends upon correctly assessing what may be driving the issue, and trying to incorporate the right measures to correct it

Healthy All in one Fish Cakes

I am a bit proud of this recipe because of the unusual level of perseverance it took to get it right - 9 tries to be exact - all of which I ate in spite of the fact they were pretty nasty, because we do not waste food at our house. This version is a powerhouse of nutrition and still has some of the comfort food feeling you would expect from a good fish cake.

https://www.youtube.com/watch?v=TnRS5OAdNvU&t=6s

WHAT IS A FACET JOINT ?

Spinal discs are getting the lion’s share of the attention when it comes to painful structures of the spine. I often see the proverbial “deer in the headlight” look on patient’s faces when we discuss their imaging and what we think is causing their problem

Each spinal segment, except for the very first one in the upper cervical spine, is composed of a disc and two facet joints, one on the right and one on the left. The discs and facets are vastly different in their anatomy and their function. The discs are meant to be the primary weight bearing structures while the facet joints are meant to guide fine movement in rotation and lateral bending, This often in distorted in pathological states , when the facets start bearing extra weight that the discs should be shouldering - often the case with states of “swayback” or hyperlordosis.

Facet joints can be the source of a lot of pain, In a way that is very different from a spinal disc. The pain tends to be more local . Facet joints are less likely to cause pain into the arm or leg unless they have significant osteoarthritis and cause spurring into the spinal nerve opening from the posterior aspect.

https://www.youtube.com/watch?v=CZ86VzZOrGw

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