Four Ways to Avoid the Back Pain Epidemic

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The Case of Little Sarah: Stimulating the Brain With Chiropractic Care
 

By Edgar Romero, DC, DACNB
 

Little Sarah, 5 years old and with the biggest blue eyes you have ever seen, presented to the office with a history of seizures that had started at the age of 3. According to her parents, Sarah, without any other previous predisposing signs or symptoms, had her first seizure while falling asleep one otherwise normal day.
 

Since that event, she had suffered, on average, five such episodes per week, and at one point as many as five per day. These seizures always began just as she was about to fall asleep, and took the form of muscle contractions that began on the left side of her body and sometimes affected the right side of her body as well. They would sometimes start in the left leg, sometimes in the left arm, but always on the left side of the body first.
 

At the time of her evaluation, she was on two medications that her parents felt were helping somewhat, although the seizures continued.  She had been through a plethora of tests, as you can imagine; I was touched by her nonchalance at meeting another "scary" doctor when she was first introduced to me. She had been through so many tests at that point that she had essentially been desensitized to anything even remotely resembling a doctor's office.
 

Anatomy of a Seizure
 

We can define a seizure as a spontaneous firing of cortical cells, such that activity is produced where otherwise there should be none. Depending on the area of the brain that fires, the seizures can present as visual, emotional, auditory or motor. It can focus in one area or it can spread to other areas. It can present without loss of consciousness or present as a tonic-clonic (grand mal) seizure characterized by a generalized motor response and loss of consciousness.
 

We could have discussions of tumors and a plethora of various other pathologies and disorders that all could have and should have been part of her differential. And it would be right to discuss these scenarios because we are, after all, primary care physicians and we have to know about these other conditions. You can look up all this information in any good textbook (e.g., Beck's Functional Neurology). However, as I have stated emphatically before, who cares what you call something if you cannot fix it?
 

Searching for Clues
 

As most of you have experienced in your own practices, this little angel had been brought to my office by somewhat scared and skeptical parents.  I was the doctor of "last resort." Neither parent had ever been adjusted, so you can understand their trepidation at what this chiropractor would do or say. Sarah had undergone every test in the book (and probably some more), and everything was negative. The medical perspective on her condition was simple: seizures of unknown origin, medication to control them and the hope they would not worsen as she aged. Knowing that all her tests were negative actually opened the door to what all other physicians had not assessed, of course, which was the central integrative state of Sarah's nervous system.
 

Due to certain signs and symptoms that are commonly seen with a transneurally degenerated brain, her evaluation was rather straightforward. Her right pupil was somewhat constricted initially, but started to present with hippus with repeated pupillary challenges. The right pupil then dilated dramatically after about four light flashes, revealing a brain that was craving oxygen. Her signs and symptoms almost always started on the left side of her body, and then sometimes proceeded to the right side. (The right cortex has a somatic presentation on both sides of the body and thus, can present with motor disorders that can in some cases become bilateral.)
 

Most importantly, Sarah's seizures primarily only occurred when she was about to fall asleep. This is significant because a brain that is not firing well will reflexogenically fire more when faced with the possibility of not waking up later. In other words, if the brain were so deficient that it doubted its own viability to continue to function, it would fire to a greater extent than it should to maintain function.
 

We can extrapolate this to many conditions. Some, like dystonia, can sometimes be treated, not by trying our hardest to turn off the movement disorder, but in fact by supplying the body with some alternate stimulus to promote natural inhibition of an overly stimulated system.  This can translate into a whole other form of treatment for our offices.  Instead of trying to turn off a painful spasm, for example, perhaps we can learn why it was there to begin with and stimulate some other system to prevent the continued reaction. In fact, this is what we do with a really good adjustment.
 

Stimulate the Brain

The brain is in and of itself primarily inhibitory in nature. Thus, when the brain is not firing properly, an increased level of tone is the greater probability of symptoms that would present. This could include spastic paralysis after a stroke, aura from migraines, tics from Tourette's syndrome, or stimming from an autistic patient. The treatment should not be to overmedicate these patients to slow down the brain more, since that would only be more likely to perpetuate the deficiency leading to the imbalances. The best treatment is to stimulate that deficient brain, and thus stabilize central neurons such that spontaneous firing from a sick cortex ceases. There are many, many ways to do this, and the approaches are way beyond the scope of this article.
 

Sarah was stimulated for her diseased right cortex, which showed transneurally degenerative signs. She stopped having her "normal" seizures from the very first adjustment. The first period lasted three days, then eight days, then two weeks. As of this writing, she is no longer on medication and is seizure-free following approximately six visits. Her parents, as you may guess, are no longer afraid of chiropractors.
 

Dr. Edgar Romero practices in Miami. He is a diplomate of the American Chiropractic Neurology Board.
 

The Long-Term Benefits of Chiropractic Care
 

By Charles Masarsky, DC
 

Many patients come in for their initial visit with a clear short-term goal: pain relief. Unfortunately, if that remains their only goal, they miss out on some of the benefits of chiropractic care beyond pain relief. The following patient education article is designed to assist you in discussing long-term goals of chiropractic care. Please feel free to use it on your bulletin board, as a front-desk handout or for lay lectures.
 

No one thinks it's odd when their dentist recommends regular visits to maintain good oral health for as long as possible, nor do they find it peculiar when their optometrist suggests regular visits to maintain good visual health for as long as possible. And yet many people are puzzled  when their doctor of chiropractic recommends regular visits to maintain good spinal health for as long as possible.
 

Of course, when you are suffering with low back pain, neck pain or tension headache, it is completely understandable that you have one overriding goal - stop the pain. However, once this short-term goal has been accomplished, it is time to consider your long-term spinal health goals. In formulating your long-term goals, it is essential to understand that spinal health is about more than getting rid of pain.  Spinal health has a long-term impact on every function affected by the spinal nerves, which influence every organ system in your body.
 

Breathing is a good example of a function most people do not associate with spinal health. A case published in the 1980s involved a 53-year-old man with a 20-year history of chronic obstructive pulmonary disease (1). More than 14 months after starting chiropractic care, the amount of air he was able to forcibly exhale in one complete breath (a measure called                 "forced vital capacity") and the amount of air he could move in the first second of that complete breath (called "forced expiratory volume in one second") had both improved substantially (1 liter and 0.3 liters, respectively). This case is part of a growing body of literature indicating that improved spinal health through chiropractic care is often accompanied by improved lung volumes (2).
 

The long-term implications of the link between chiropractic care and lung volumes cannot be overemphasized. In most adults, even those without pulmonary disease, lung volumes do not improve over time. In fact, lung volumes generally decline with age. Lower than normal lung volumes are associated with shorter lifespans.(3) More specifically, depressed lung volumes have recently been linked to increased risk of stroke, heart attack, and other potentially life-shortening cardiovascular problems.(4,5,6) Conversely, the better your lung volumes, the longer your lifespan is expected to be. Additional biological functions that seem to benefit from improved spinal health include reaction time (7), balance and vision (8).
 

In the short run, it would be great to get out of pain. Chiropractic care can help most people achieve this short-term goal of spinal health.  In the long run, it would be great to retain as much lung capacity, visual acuity, reaction time, balance, and cardiovascular health as possible. Emerging research strongly suggests spinal health has a role to play in these long-term goals as well. Consider this when your doctor of chiropractic recommends regular follow-up visits.
 

References:
 

               1. Masarsky CS, Weber M. Chiropractic management of  chronic obstructive pulmonary disease. JMPT, December 1988;11(6):505-10.
               2. Masarsky CS, Weber M. Somatic dyspnea and the orthopedics of respiration. Chiropractic Technique, 1991;3:26.
               3. Beatty TH, et al. Effects of pulmonary function on morbidity. J Chron Dis, 1985;38:703.
               4. Van Der Palen J, Rea TD, et al. Respiratory muscle strength and the risk of incident cardiovascular events. Thorax, 2004;59:1063-7.
               5. Hozawa A, Billings JL, et al. Lung function and ischemic stroke                 incidence: the Atherosclerosis Risk in Communities Study. Chest, December 2006;130(6):1642-9.
               6. Guo X, Pantoni L, et al. Midlife respiratory function related to white matter lesions and lacunar infarcts in late life: the Prospective Population Study of Women in Gothenburg, Sweden. Stroke, July 2006;37(7):1658-162.
               7. Lauro A, Mouch B. Chiropractic effects on athletic ability.                 Chiropractic: The Journal of Research and Chiropractic Clinical Investigation, 1991;6:84.
               8. Kessinger R, Boneva D. Changes in visual acuity in patients receiving upper cervical chiropractic care. Journal of Vertebral Subluxation Research, 1998;2(1):43. 

Physical Causes of Subluxation in Kids
 

By Claudia Anrig, DC
 

As doctors of chiropractic, we truly are the original health care professionals who have embraced the truth that wellness is achieved through a healthier lifestyle. The family wellness chiropractor also recognizes and acknowledges three stressors that may work against a child's personal well-being by causing subluxation and interfering with nervous system function. It is only through lifestyle education that a patient can begin to recognize these three common stressors and minimize or eliminate them from their life. Who better to choose as their advocate for change than a family wellness chiropractor? As the leader in the area of wellness, you can be a lifestyle coach with every visit, encouraging and educating younger patients and their parents in their journey toward wellness.
 

What Parents Need to Know
 

There are many physical stressors in the life of a child. These stressors may be seen first in the last trimester of the pregnancy when the fetus is in a malposition causing in-utero constraint. The infant in a breech position is 50 percent more likely to have a hip dislocation, mandibular asymmetry and postural distortion. The transverse lie increases the child's chance of postural scoliosis, and the brow or facial presentation can lead to upper cervical, upper thoracic and lumbopelvic strain (microtrauma), causing potential areas of subluxation.  All of these malpositions rarely resolve prior to birth and lead to C-sections.
 

In the United States, birth trauma is estimated to be one of the top 10 causes of infant mortality. Many in the developing field of sensory integration disorder management are stating that birth trauma is a major cause of the disorder. In 2006, 31.1 percent of U.S. births were by C-section, a dramatic 50 percent increase from the previous 10 years.  With the increased rate of C-sections, the rise in pregnancy-associated deaths should be noted.
 

The first year of life is not without trauma, either. Approximately 50 percent of all children have fallen head-first from a high place.  Furthermore, baby walkers contribute to 3,000 annual injuries in children under 15 months. There are other staggering statistics:
 

                * More than 1 million children under the age of 5 visit hospital emergency rooms each year.
               * Almost 200,000 children are injured in car accidents and more than 1,000 children die annually as a result of those accidents.
               * The beloved trampoline causes approximately 88,000 visits to the emergency room each year, and playground equipment accounts for another 200,000 visits.
               * In the United States, 3.5 million children under the  age of 14 receive medical treatment for sports injuries each year.
 

Looking at repetitive stress (microtrauma) syndrome, it is very easy to see that it may start with parents incorrectly holding their newborn or changing their diaper without providing proper spinal stability. Infant bouncers or activity centers require youngsters to stand on joints that  are unable to normally support their own weight. Mastering walking is not easy. The art of balancing on two feet will mean hundreds of falls, with the child often landing on their bottom. This can cause repetitive microtrauma to the sacrum and other surrounding joints. 

Children learning to walk also are often seen with bruises on their brow from running into something low. This hyper-extension trauma may lead to cervical and upper thoracic spine subluxation. As the child gets older, repetitive stress continues with the use of backpacks at early ages and the asymmetry it brings to the child during their developmental years.
 

The Wellness Lifestyle
 

As a family wellness chiropractor, you cannot single-handedly eliminate all causes of micro- or macro-trauma, but you can see yourself as the wellness advocate on behalf of the child. Introduce healthier or safer lifestyle habits by conducting in-office workshops and providing handouts, articles and in-room advice. Parents who are told that their child's spine and nervous system are developing, and that there is only a window of time for true prevention care, normally choose wellness care for their child.
 

Checkups vs. Adjustments
 

My recommendation for colleagues who have developed or would like to develop a family practice is to create a schedule for regular checkups of all child patients. Depending on your technique and the needs of the child, this schedule will vary, but a good rule of thumb is a twice-a-month evaluation of the child's spine to see if an adjustment is warranted.  Not all visits may turn into an adjustment; however, parents value your opinion. If they are aware that between checkups, their children will experience normal physical stressors that may lead to vertebral subluxation, we can expand our professional role as prevention advocates.  
 

Irritable Bowel and the Subluxated Spine
 

By Joseph D. Kurnik, DC
 

Traditional nondrug treatments for irritable bowel syndrome (IBS) include proper food selection and supplementation. These approaches can be useful to some degree or may even completely solve the problem.  Medications may be necessary in extreme cases, especially if significant inflammation or infection is involved. However, the usefulness of medications always must be evaluated in relation to the unwanted effects.
 

Another potential factor that can cause or effect IBS is spinal integrity. This is a subject that is poorly represented in practice and in literature, and appears to be a topic that is avoided. However, the subject of manipulation and IBS or pseudo IBS has been presented in a practical manner by Dr. Robert Maigne, a French physician and manipulative practitioner. In his text on spinal manipulation, Diagnosis and Treatment of Pain of Vertebral Origin, he makes specific references to the thoracolumbar syndrome (aka Maigne's syndrome). The syndrome involves the mechanical dysfunction of the thoracolumbar junction, typically the T12/L1 and L1/L2 spinal levels. This may broaden to include T11/12 and L2/3 levels in some individuals.
 

Dysfunction and/or irritability to nerve roots of those levels (mainly T12 and L1 roots) can cause low back, hip, groin, thigh and pelvic complaints. One of the pelvic complaints reported by Dr. Maigne as a result of his research and practical observations is an irritable bowel  disorder, which he referred to as a pseudo disorder secondary to nerve root disturbances. Often, genetourinary complaints were observed. Most  often, the pelvic complaints ended up being examined and treated as primary complaints, unsuccessfully.
 

When a cause of such complaints was spinal, there was rarely any complaint or mention of back pain, soreness or other back complaints in the thoracolumbar region. Treatment by manipulation to the thoraco-lumbar region when dysfunction was recognized often resulted in improvement or alleviation of the complaints.
 

I have noticed a high percentage of gastrointestinal complaints when examining patients with low back pain related to thoracolumbar dysfunction. My method for identifying a T/L dysfunction is motion palpation in the prone position. A manipulable dysfunction would be a hypomobile dysfunction (fixation). Most such dysfunctions have restrictions in extension (or P-to-A glide), rotation and lateral bending. Flexion restriction also may be a component. Non-manipulable hypermobility may be a factor at times, and disc pathology and arthritis may be factors.
 

The use of X-ray or MRI analysis may show pathologies such as DJD, Schmorl's nodes and disc disorders. One such example was a case featuring chronic intestinal and digestive disorders of more than 20 years in duration. Also associated with these complaints were shortness of breath, such as in climbing stairs; and an episode of shingles in the T12 dermatomal pattern. An MRI showed the existence of a T12 disc herniation with mild flattening of the cord.
 

In this case, adjusting the extension and rotation restrictions of T12/L1 proved very useful in combination with eating restrictions/guidelines, nutritional supplementation and exercise (Treatment of the shingles involved the addition of a short course of an anti-herpes viral medication.) Most cases can be managed with a combination approach, but in my opinion should include spinal evaluation for subluxation, dysfunction and pathological disorders, which may cause neurological irritations.
 

As Dr. Maigne pointed out in his text, however, radiological analysis often proved to show no pathology at the thoraco-lumbar junction. Local thoraco-lumbar symptoms, such as T/L back pain, also were not present.  What was present was segmental dysfunction at T12/L1 and L1/L2. The thoraco-lumbar junction syndrome may also be associated with abdominal pain, bursitis-type pain at the hip, pubic pain, and iliac crest nodular disorders. A dermatomal skin-rolling examination also tests positive.
 

Traumatic compression injuries may occur at T11, T12 and L1, with subsequent pathology developing. It is interesting to note, however, that seldom are degenerative complaints seen (in contrast to the lumbosacral region) in the absence of trauma. Patients presenting with lesions characterized by Scheurman's disease, Schmorl's nodes or other degenerative processes at the thoracolumbar region appear to be more vulnerable, according to Dr. Maigne.
 

The low back pain associated with thoracolumbar syndrome usually is more predominant on one side, but may be on both sides. It can easily be confused with lower lumbar and sacroiliac pain, and may manifest as iliac crest pain, buttock, hip or lateral thigh pain. In most cases it is described as deep, rather than superficial.

My point is that taking the above into consideration, the treatment of IBS should include spinal evaluation and manipulation if called for. Manipulation can be done manually or using instrumentation. I use both approaches in my treatment of spinal disorders.