02.28.11

Low Back Injury Prevention Tips

Posted in Spinal Hygiene at 1:34 PM by Dr. Greathouse

  1. Avoid lifting over head & shoulders.
  2. Avoid low lifts, especially off the ground.
  3. Stay mentally alert, (morning, lunch & end of shift).
  4. Get help moving or lifting bulky objects.
  5. 35 lb. begins high risk for back injury with repetitive lifting for females.
  6. 50 lb. begins high risk for back injury with repetitive lifting for males.
  7. When lifting any object, assess its size and weight first, establish a firm footing, prepare for the lift, bend at the back only slightly, bend at the knees, keep the load as close to the body as possible, avoid any turning or twisting with the lift, lift with the legs, keep the stomach muscles tight, and lift with a slow and smooth movement.
  8. Materials stored at least 20 inches off the ground reduced strain of the back by 50%.
  9. Use handling aids such as dollies and lift hoists for heavy items.
  10. With a load (carrying) avoid twisting the trunk of the body.
  11. Avoid reaching the over 16 inches with any job activity, especially lifting.
  12. Avoid prolonged bending or long periods of standing.
  13. Take breaks from sitting every 15 minutes.
  14. Pushing is better than pulling.
  15. Adjust just your work surface height to avoid bending.
  16. Make sure your work space is adequate.
  17. Make sure the lighting is adequate.
  18. Remember that injury occurs lowering objects as well as lifting.
  19. Reduce frequency of repetitive action of any body part.
  20. *Avoid sitting with an unsupported back if possible (no slump).
  21. Make sure you warm up before any physical activity, no matter how insignificant that might seem.


02.25.11

A Practical Guide to Reduce Problems Associated With Sitting

Posted in Spinal Hygiene at 3:34 PM by Dr. Greathouse

Common Problems Associated With Sitting
Low back pain, neck pain, headache, eye strain, headaches, shoulder and arm pain, wrist, hand and finger pain or symptoms, leg and foot symptoms, tired achy muscles and fatigue.
Practical Techniques To Reduce Stress
1.     **Take breaks, reverse posture and move at least every 20 minutes. Tissue integrity begins to weaken after about 15 to 20 minutes of load/stress from prolonged position.     Although this happens on a microscopic scale, the effect is cumulative over time and predisposes one to injury.
2.     *Avoid slumping; the use of a lumbar support pillow or a rolled towel adds significant low back support. Prolonged slumping is thought to produce disc protrusion, ligament and muscle fatigue.
3.     Prolonged positioning reduces circulation, thus, movement breaks re-circulate blood flow to the tissues.
4.     Forearm to upper arm angle is best maintained at 75 — 90 degrees.
5.     A footrest is required when the feet cannot be firmly placed on the floor.
6.     Thigh and trunk (body) angle should be at 90 degrees.
7.     Knee angle should be at 90 degrees.
8.     Make use of your swivel chair; avoid twisting your back when turning.
9.     Practice relaxation & movement techniques during a break.
10.  Computer screens are best situated 14 to 30 inches in distance from the face.
11.  The center of the computer monitor should be most comfortable at chin level.
12.  Materials on your desk, which are used at high frequency intervals, should be placed for easy access.
13.  Bracing a telephone between head and shoulder is a common cause of neck problems and should be avoided.
14.  Direct light from a window or lamp can cause visual interference/screen glare producing eyestrain.  Glare screens can reduce this problem.
15.  Too much heat from the sun through a window or too much cold from the AC can cause discomfort and muscular reactions.
16.  Excessive room noise can be stressful.  Modular room dividers can be very helpful at reducing this problem.
17.  Frequently changing your field vision will reduce eyestrain.
18.  Bifocal glasses requiring backward head tilting can precipitate neck pain.
19.  Leaning forward with an unsupported back will produce back pain.
20.  Constant one-sided twisting or leaning will produce muscular and spinal imbalance leading to pain and stiffness.
21.  Source documents should be at the same level as the screen if possible.
22.  A neutral wrist angle is best to avoid hand & wrist problems.
23.  Avoid resting your wrist on sharp edges.
24.  Your keyboard should be adjusted to compensate for wrist comfort.
25.  Your seat pan angle should be adjusted or changed to reduce pressure on your thighs.
26.  Sitting on a wallet will produce imbalance, poor circulation and sciatic nerve compression.
27.  Headaches are frequently produced from neck strain and/or eyestrain.
28.  Practice mini-breaks with desk exercises.
29.  Your desk chair should have adjusting capabilities for both vertical and horizontal changes for better back support.

02.24.11

Power of Positive Thinking Validated

Posted in Uncategorized at 10:49 AM by Dr. Greathouse

Website: http://www.normandoidge.com/normandoidge/MAIN.html

The result is this book, a riveting collection of case histories detailing the astonishing progress of people whose conditions had long been dismissed as hopeless. We see a woman born with half a brain that rewired itself to work as a whole, a woman labeled retarded who cured her deficits with brain exercises and now cures those of others, blind people learning to see, learning disorders cured, IQs raised, aging brains rejuvenated, painful phantom limbs erased, stroke patients recovering their faculties, children with cerebral palsy learning to move more gracefully, entrenched depression and anxiety disappearing, and lifelong character traits altered.

We learn that our thoughts can switch our genes on and off, altering our brain anatomy. Scientists have developed machines that can follow these physical changes in order to read people’s thoughts, allowing the paralyzed to control computers and electronics just by thinking. We learn how people of average intelligence can, with brain exercises, improve their cognition and perception in order to become savant calculators, develop muscle strength, or learn to play a musical instrument, simply by imagining doing so.

Using personal stories from the heart of this neuroplasticity revolution, Dr. Doidge explores the profound implications of the changing brain for understanding the mysteries of love, sexual attraction, taste, culture and education in an immensely moving, inspiring book that will permanently alter the way we look at human possibility and human nature.

02.22.11

Tune-ups

Posted in Spinal Hygiene, Uncategorized at 2:10 PM by Dr. Greathouse

Tune-Ups

Are Regular Interval Visits Good for You?

You Be The Judge

Dr. James E. Greathouse

What are tune-ups? A chiropractic tune-up may also be called palliative care, or wellness care, but in general it’s interval care on a regular basis, of variable frequency to work out the kinks that may be developing in your spine.

Supportive care is provided for those who, for various reasons, have recurrent problems and require care in order to prevent condition worsening.

This is a controversial subject within chiropractic as well as among lay people and other health care disciplines.

For a theoretical rational of why these tune-ups may actually be beneficial please see information below.

Spinal Problems Are Common If you haven’t experienced a back or neck problem yet, chances are you still will at some point. If you have suffered a back or neck problem, studies show you are likely to experience recurrent problems. The highest rate of incidence occurs between 30 and 50 years old, and typically does not involve a significant traumatic event. These are just a few statistical facts.

While chiropractic care isn’t the only effective way to treat spinal problems and it isn’t the end all to management; manual therapy may be a helpful component to prevention and management of problems once they do occur.

Ongoing Problems More Common Than Conventional Wisdom Reports: von Korff based his skepticism of low back pain’s benign natural history on his report that 69% of recent and 82% of non-recent onset patients were still experiencing back pain one year later (146). He later published that 33% of those contacted one year after their low back pain onset were still experiencing back pain with at least moderate intensity, 15% were still having severe back pain, and 25% continue to report substantial activity limitations (147).

In 1998, Croft et al. reported the results of interviews with 490 low back pain patients 3, 6, and 12 months after seeking care for their low back pain. (35) His results were similar to von Korff’s. Only 21% had completely recovered at 3 months. Interestingly however, just as in the 1996 Dillane study, 90% had stopped consulting with their doctors by three months, further discrediting care seeking as a surrogate for recovering. Even at 12 months, 75% of those surveyed indicated they were still not fully functional or without symptoms. A number of other studies also challenge the overly optimistic view of low back pain’s natural history. (26, 113, 142)

These data would seem to be a more accurate reflection of these patients natural history and also clearly portray a far less benign natural history than what guidelines continue to report.

Recoveries Followed by Recurrences Are Common: The second important characteristic of low back pain, and where there’s little controversy, is that it commonly recurs in the form of episodes; as many as 75% who experience their 1st episode of low back pain have a recurrence. (77, 119, 142) 
Croft: “the message from the figures is that, in any one year, recurrences, exacerbations, and persistence dominate the experience of low back pain in the community.” (35) 
Both Croft and van Korff’s data indicates that recurrent episodes often progressively worsen. (35, 147)

Waxman et al. conducted a three-year population based survey concluding that recurrent low back pain is “a mutable (variable) problem with acute episodes blending into longer periods resulting in more disability as time progresses.” (153) “Most persistent disabling back pain is preceded by episodes that, although they may resolve completely, may also increase in severity and duration overtime.”

Family physicians do notice this trend as well. A survey indicated there was nearly universal agreement as to the high rate of recurrences that commonly worsen overtime. (54)

Possible Contributing Factors To Spinal Pain

Sedentary or Inactive Lifestyles Lead to Spinal Stiffness: 
Experimental studies indicate that fixated (immobilized) joints eventually show signs of microscopic adhesions that limit flexibility and extensibility of the tissues. These fibrotic (scar) changes occur in the absence of trauma/injury. These changes result in a related loss of water (dehydration) necessary to lubricate the tissues. Furthermore, because movement affects the orientation of regular ongoing collagen synthesis, the collagen in the immobilized joints was found to be laid down in a more haphazard “Haystack” arrangement (non-conducive to movement). This orientation restricts tissue (and joint) mobility further by adhering to existing collagen fibers. (Maxey; Magnusson, Rehabilitation 2001, p 5)

Annotation: Although these studies are based on fixating joints, it’s reasonable to deduce, that over time, people who are more sedentary or do not regularly stretch or move the spine and maintain an active lifestyle will be prone to similar loss of joint mobility.

Spinal Stiffness & Degeneration Are Common Age Related Problems

It has been documented that the human spine shows signs of degeneration as early as four years old. This degeneration process continues in a linear pattern with varying degrees of severity, until death. It has been maintained that by age 30, there is no lumbar disc that does not show age related degenerative changes. (Ombregt, Bisschop & Veer: A System of Orthopedic Medicine; p729)

The spine stiffens as we age (Grieve).

Age related degeneration is not only due to inactivity but also from microtrauma (normal wear & tear) and repair, many times coupled with episodic, excessive, cumulative & repetitive stress and overload injury. Connective tissues do not regenerate if damaged, but are replaced by inferior fibrous scar tissue. (Evans 1980; Hardy 1989). Scar tissue is less flexible. 

The Stiffening Process is Slow and Insidious 
(Commentary) It’s likely that as gradual degeneration occurs and build-up of scar tissue takes place, the joints gradually become stiffer and joint movement is gradually reduced (hypomobility); which is a form of joint dysfunction.

As the process advances, it may become more evident on x-ray in the form of degenerative changes; ligament calcification and thinning joint spaces. It also becomes more self evident as stiffness and achiness is experienced.

The literature clearly recognizes that degenerative arthritis is a non-inflammatory process and commonly a non-painful, age related process. For example, it’s not uncommon for an individual to experience a painful back or neck, see a doctor, have x-rays taken, and discover that they have moderate to advanced degenerative arthritic changes, but never had prior episodes of pain.

Although a non-inflammatory condition, the stiffness of the tissues probably predisposes one to strains and sprains, which does lead to inflammation and pain to varying degrees.

Muscle Response

In stiffened joints, receptors (nerves that sense movement) can cause both abnormal facilitation (tightness) and inhibition (relaxation/weakness) of muscles (Liebenson, page 19). Thus, stiffened joints can potentially create muscle imbalances, which can lead to inappropriate or abnormal muscle responses to movement. Commentary: When muscular imbalance and joint dysfunction take place, strains and sprains are probably more likely to occur.

Supplementing With Hands On Joint Movement Possibly a Key Component

A key dynamic to getting things moving again is the passive (hands-on) component of spinal joint mobilization.

This is evidenced by x-ray stress studies, whereby it is demonstrated that when actively moving the spine, as in stretching or normal movement, the hypomobile (stiff) segments do not move. Consequently, actively stretching may not ensure all segments are re-establishing movement.

Passive forms of joint movement (hands-on), augments the movement that active stretching fails to achieve, ensuring that the hypomobile (stiff) segments are encouraged to regain movement and joint nourishment.

Remobilization: After repeated mobilizations, these joints gradually return to some degree of normalcy. (Maxey; Magnusson) Rehabilitation 2001, p 5)

Avert Back Problem With Spinal Hygiene

By combining passive joint and soft tissue mobility work (hands on manual therapy), on regular intervals, as well as regular active spinal movement exercises, it may be possible to preserve & improve joint and soft tissue mobility. Thus, in theory, this reduces the chances for acute episodes of pain or injury. In a sense, it’s very similar to dental hygiene.

Your Involvement Is Necessary

Regular active spinal movement exercise, as well as improved postural and body mechanic behaviors, continue to be a necessary continuum for optimal spinal joint and soft tissue health to maintain gains from passive procedures and to reduce the effects of daily stress on the joints. A more active lifestyle is necessary as well. Remember, moderation is a key!

You’ll Be Pleasantly Pleased With The Results!

You will be pleasantly pleased with how much better you feel after passive joint movement has been performed, especially when you are just feeling a little achy and stiff!

Our tune-ups typically include 10 minutes of moist heat, passive manual therapy, including muscle work; so it’s  much like a mini-massage with the extra component of spinal joint mobilization. Typically, these visits are very relaxing and relieving of aches & stiffness. A real feel good experience that likely helps preserve and improve joint & soft tissue flexibility and mobility.

“An ounce of Prevention”

Back Pain 1500 BC to Today

Posted in History at 11:38 AM by Dr. Greathouse

Scribes below.

(poor posture contributes to back pain)

Above left, the oldest surviving description of back pain. The Edwin Smith Papyrus (c. 1500 B.C.) written by an Egyptian scribe. Supposedly a prescription for treatment of some kind.

Cautery was used for sciatic pain as early as 100 AD and is still used in some cultures today.

<—- Yikes! Burning with a red hot iron(sciatic leg pain)!

We use Mineral Ice & Ben Gay today :)

Fuller (1852) concluded that ” the history of sciatica is, it must be confessed, the record of pathological ignorance and therapeutic failure.”

Greathouse (2011) concluded “not much has changed since 1852.”

We have approximately 22 different types of health care providers that treat back/sciatic pain, most of which have their own idea of cause and treatment type. In other words, diagnosis and treatment are practitioner training dependent, not valid diagnosis dependent. This is and always has been one of the biggest problems over the years in treating back pain. Currently our outcomes are still poor and the costs are outrageous! Science tells us 85% of all back pain is “Non-specific.” That means without a diagnosis. Without a diagnosis it’s anybody’s guess. And, therein lies the problem.

Good News! A small faction of health science is beginning to get it right! Next post, “Getting it Right.”

02.21.11

Choosing The Right Mattress

Posted in Spinal Hygiene at 5:50 PM by Dr. Greathouse

Because we spend an average of one third of our lifetime lying down or on a mattress, that’s on average 24 years, choosing a good mattress probably is important.  If we are not comfortable when we sleep obviously we do not get adequate and necessary rest.  Poor mattress design does produce musculoskeletal aches and pains, therefore  proper support is important.  Unfortunately there isn’t a lot of study on this topic.  Most medical references with regard to bedding is directed at reducing bedsores.

It is estimated that about half the population has experienced sleep difficulties.  Ergonomic study indicates that maintaining a natural shape of the spine while sleeping is important.  One study indicated that a regular bed versus an orthopedic mattress made no difference in sleep quality.  Air mattresses do provide better sleep quality than futon mattresses.  Another study suggested that our bodies just needed time to adjust to different sleep surfaces, and thus the complaints by travelers sleeping in different beds.  How hard or soft the mattress was did make a difference as it related to low back pain, soft was better.

There are three basic factors to look for in choosing a mattress.  First, choose a quality mattress that’s going to hold up over time.  The second thing to look for is a soft overlay, which is the top support surface of the mattress.  This is important because it reduces the amount of pressure on uneven body surfaces, conforms better to your body contours, allows for maintaining the natural shape of your spine and reduces restriction of circulation on pressure points.  The bed should also be firm under the overlay, so as to restrict sagging.  Sagging mattresses do not support the natural shape of the spine, therefore, placing more stress or load on ligaments, tendons and muscles.  This of course is more likely to produce aches and pains.

Additionally, there are other factors to consider. It’s important to provide yourself with a large sleep surface area.  We all toss in turn throughout the night and if this is restricted, prolonged load and reduced circulation occurs resulting in poor sleep quality or aches and pains.  A mattress should be designed to minimize the transfer movement from one sleeping partner to another and it  should have a perimeter edge support.

There’s a multitude of brands and types of beds that meet these requirements. The rest is up to you in finding the best buy for your money.

02.17.11

Tight Muscles & Stiff Joints

Posted in Spinal Hygiene at 2:13 PM by Dr. Greathouse

Science of  Flexibility (Alter) 1988

In patient care I’m often asked, “what’s causing the problem”? Back and neck problems are rarely the result of a single factor but rather multiple factors over time. Below is an explanation of how problems might develop.

What Makes Muscles Tight?

Science of  Flexibility (Alter) 1988 (page 5 — 6)

Prolonged muscular tension result in several negative effects.

  • Excessive muscular tension tends to decrease sensory awareness.
  • It also wastes energy; a contracting muscle requires more energy than a relaxed muscle, thus fatigues quicker with normal use.
  • Habitually tense muscles cut off  circulation, reducing blood supply resulting in lack of oxygen, essential nutrients and causes toxic waste products to accumulate in the cells. A source of discomfort and fatigue.
  • This process predisposes one to fatigue, aches, even pain.
  • When a muscle stays partially contracted, an abnormal state of shortening called contracture develops.  Contracture and chronic muscle tension not only shorten the muscle, but also make the muscle less supple, weaker, and unable to take the shock and stress of various types of movement.

Common activities of daily living that contribute to this process are; prolonged sitting, standing and poor sleep or recumbent positions.

Muscle contraction limits joint mobility.

Effects of Immobilization on Connective Tissue

Science of  Flexibility (Alter) 1988 (Page 54 – 55)

When joints are immobilized for a length of time, the connective tissue elements of the capsules, ligaments, tendons, muscles, and fascia lose their extensibility / flexibility.  Connective tissues will come in contact with each other and eventually stick, thereby encouraging the formation of abnormal cross-linking (adhesions). The joints become stiffer.

Commentary

Based on the above simple concepts you might better understand some of the mechanisms involved with back and neck pain. Tight muscles and stiff joints produce aches and pains as well as predisposing one to injury with increased use or even normal use in many instances.

You should not only understand these effects, but also where tension comes from, and some of the additional implications of muscle contracture.  Muscle contracture is not “muscle spasm”, and is called by other similar names such as muscle over-activity, muscle hypertonicity or hypertonic muscles, trigger points etc.

Muscles become tense for many reasons, probably the most common reasons are poor posture and emotional stress.  Sitting, standing and even lying with poor posture places tension or load on muscles.  When a muscle is loaded, it naturally resists the load by contracting just enough to overcome the demand.  Over time, no matter how seemingly insignificant, the effects of tension (load), as described above, come into play.  Eventually, the contracture or overactive response becomes learned behavior and the muscle stays contracted, even when the load is removed.

Muscles are our movement organs and therefore effect joints.  Without joints and muscles there’s no movement.  The joints & muscles communicate neurologically.  A tight muscle adversely affects joint mobility by restricting movement and causing off axis movement.

The partially immobilized joint and surrounding connective tissues adapt to this hypomobile state.

As indicated above, immobilized tissues lose extensibility.  The dense connective tissues ligaments, joint capsules etc. shorten.  This creates adaptive joint stiffness or what is commonly called articular (joint) dysfunction. Articular dysfunction not only harms the joint but also adversely affects the muscle as well.

Ironically, the neurologic sensors in the joints called mechanoreceptors can reflexively react to the stiffness and aberrant movement by signaling the muscles to respond or contract, thus further perpetuating the problem.

As you can imagine, in this state, the joints and muscles are very susceptible to injury.  Back and neck problems are very common and this process is probably a major contributing factor.  By the time you seek care for a problem, in many instances, this process has probably already established itself.  Many, if not most, patients experience strains and sprains of the back or neck because of pre-existing tight muscles and joints.  Just the right movement, twist or even prolonged positioning places a demand tissues that  have lower tolerance levels, thus injury or damage occurs.

The second component to this issue is the additional poor adaptation to injury with post trauma muscle spasm and scar tissue formation.

Manage the problem with joint mobilization, massage and exercise.

Prevent recurrent problems with good posture, frequent breaks, stress management and exercise.

Dr. James E. Greathouse Jr.

Chiropractic Physician

02.10.11

Pain & Anti-inflammatory Alternatives

Posted in Pain Management at 2:30 PM by Dr. Greathouse

Pain & Anti-inflammatory Alternatives

Inflammation is a primary source of pain

Disclaimer: This column is for information only and no part of its content should be construed as medical advice, diagnosis, recommendation or endorsement by Dr. Greathouse.

Always get clearance from your medical doctor before use!


Curcumin (Turmeric) An herb, a major ingredient in curry powder and also used in mustard. Curcumin dosage as anti-inflammatory, 200 to 400 mg, three times per day. To achieve similar amounts of curcumin using turmeric would require 4,000 to 40,000 mg. In combination with Bromelain (also an anti-inflammatory) increases absorption. Best taken on empty stomach 20 minutes before meal.

Quercetin 250 mg 3 times per day, between meals.

Bromelain 500 mg 3 times per day (pineapple enzyme).

Ginger, 2 grams per day in powdered form or 500 to 1000 mg per day in extract   form.

Omega-3, Essential fatty acids (EPA/DHA), 360 mg per day.

Comfrey Root Extract Ointment Relieves Back (topical).

Vitamin C, 3 to 4 grams per day.

Zinc, 50 mg per day, also promotes white blood cell production which clean-up the injured cellular debris.

Vitamin E, (D-Alpha-tocopheral), 600 IU.

Papain, 400mg.

Creatine & L-tryptophan suppress acute and chronic inflammation.

MSM (methylsulfonylmethane) If allergic to sulfur, do not use!  Dosage recommendations, 400 mg to 8,000 mg per day in divided doses for severe pain.

Green drinks, barley, wheat grass juice provide powerful anti-inflammatory and pain-relieving effects.

Magnesium 400-1000 mg / day

Increase water intake, and eat fruits and vegetables.

Avoid products (omega-6 fatty acid), such as safflower oil, corn oil &  sunflower oil.

Other Alternatives

Boswellia extract, from India medicine. Effective for arthritis; 100 mg daily in divided doses, with food.

Sea Cucumber: 200 mg daily. You can take as much as 1,000 mg per day and cut back as you feel better.

Penetran+Plus: a topical product sold in health food stores, works by re-establishing electrical balance in cell membranes. Studies show good effectiveness.

Magnets; some studies do support pain relief effectiveness.

Prolotherapy: Before you have surgery and when all else fails you may want to consider this approach. Basically it’s utilized for lax or loose joints (unstable). Injections are used to stimulate production of new collagen. Contact American Association of Orthopedic Medicine 800 992-2063, a $10 charge for info.

Acupuncture: plenty of evidence this helps. Like anything else though, works for some but not for others. Well worth a try.

Nerve Injury repair

Vitamin B6 (pyridoxine) utilized in almost all biochemical functions. Used for neurotransmitter (nerve) disorders, 250-mg/day safe dose. Scientific study indicates a possible causal relationship between carpal tunnel syndrome and B6 deficiency. A recommendation for additional supplementation of 50 to 100 mg/day, not to exceed 250mg/day, is suggested for carpal tunnel syndrome.

Joint Repair and Associated Pain Relief

Glucosamine sulfate beneficial for joint repair (500mg 3x per day) & Chondroitin sulfate 200 mg per day. These two are normally found in combination and have good supporting evidence in the literature. Still has data that’s not supportive as well.

Knox Gelatin, 2 ounces per 100 lb. body weight.

Always get clearance from your medical doctor before use!

02.09.11

What Causes Back Pain?

Posted in Uncategorized at 11:09 AM by Dr. Greathouse

When asked what causes back pain:

Dr. James N. Weinstein, editor of the medical journal Spine and chairman of the department of orthopedic surgery at Dartmouth-Hitchcock Medical Center said it quite honestly: “Probably the most common causes of back pain are just — what’s the best word? — Life’s events”.

Risk Of Chronic Pain

Posted in Back Facts (spine) at 11:02 AM by Dr. Greathouse

“There has been a lot of research in recent years to identify people at risk for long-term pain and disability. What may surprise you is that most of the warning signs are about what people feel and do, rather than medical findings.”

Gordon Waddell, MD  (Orthopedic Surgeon)

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