September is here!

The onset of September is usually the trigger for me to begin putting away summer clothes, trading Geraniums for cold-resistant Mums, and taking stock of whatever else needs to be done before the snow flies.  

I think that next to the smells and sensations of Fall, my favorite part about the end of Summer is that people begin to slow down a bit.  Vacations are over, the kids are back in school and you are able to bring some order and routine into your life.

Your mind and body love order and routine!

So, it might be that getting the kids back to school improves both your mental and physical health.  I am not sure if this is a planned phenomenon within the universe, but if it makes you healthier then I am for it.

This month I am going to bring you some articles and research that may help you to ease into Fall a little more comfortably.  

As always, I will try to provide you with information that will bring you direct benefit today and give you tools for future use.

The first two articles address the topic of true injury and symptoms versus mental health-related issues.  In other words, it's not 'all in your head'.  We live in a world of fast-food health care and paying a little better attention to physical problems will often erase the psychological complaints.

The third  article discusses why I  measure leg length imbalances on each patient during each visit.  This research-based analysis is even valid in medical circles.

Eileen's Corner brings you a wonderful old-fashioned cookie recipe that is both simple and tasty.

Finally, you have to read the last article.  It is a medical study that will change how you look at people on the street each and every day!

Dr. Frisch

Is This Pain All In My Head?

It has been contested for many decades that mental health issues can contribute to, if not directly cause chronic pain..  It has been proposed that people who suffer with depression, bipolar disorder, and other mental-related conditions are more susceptible to long-term pain and that they may use their injury to sustain their existing complaints.  Are they right?

A Proper Model of Investigation

If a patient is complaining of pain, the first thing that a doctor should do is investigate the pain.  If objective physical trauma is determined to exist through an examination and other advanced testing, then the patient's pain is validated.

If a patient's complaints of pain cannot be validated by physical testing, it does not mean that the pain doesn't exist, it just means that the doctor(s) can't find what is causing the distress!  Added testing and investigation are warranted.

When treatment of pain is administered, there needs to be a daily record of achievement or regression of the condition.  This will determine if the direction of care being administered is appropriate.  The severity of the injury will determine the direction of care, not just the level of pain.

A Restricted Model of Investigation

With the ever-continuing changes in health care, a restricted model of investigation seems to be more common than rare.  It often looks like this:

A patient enters a clinic complaining of pain and they are immediately seen by someone other than a doctor who then makes a determination of their condition.  That determination is often made with little or no physical examination or advanced testing.  The determination of trauma is made by someone who is too busy to investigate the injury/pain further and who may not recognize what they are actually looking at.  

This is the flow chart method of treatment that categorizes the patient by their complaint, simple objective measures and minimal treatment allotment.  This patient is often given a prescription for pain medication and sent home with instructions to rest, use ice/heat, and call if the problem worsens.  If this sounds familiar, then you have likely been the victim of simple, flow chart care.

The Problem

The problem arises when the person who is suffering with the injury and pain can't deal with the pain anymore.  They begin to 'shop around' as they try to find answers for what they feel on a daily basis.  Each failed investigation generates a record of their self-efforts.  This should be commended, but it often isn't.  

Their self-treatment efforts often get them labeled as a 'doctor shopper' who only wants drugs to curb their 'habit', when in fact, what they really want is someone who will listen to their complaints, do the proper testing, and tell them what's wrong.  Even if the outcome was bad, at least they could put a face to what they live with on a daily basis!

Most people's pain is not 'all in their head'.  

"Unresolved trauma and pain can cause mental distress, which may lead to mental health problems.  Mental health problems, however, do not lead to physical injury or pain.  It is NOT a two way street!

Does 'Pre-Existing' Mental Distress Contribute to Chronic Pain?

This article adds credibility to my opinion that Mental Health problems are exclusive and unrelated in causing physical complaints of pain.  This study conveniently crossed my desk on the same day that I determined the direction of this newsletter!

This study investigated the relationship between coping techniques and whiplash injury outcomes.¹

Prior research studies have investigated the hypothesis that 'coping' skills may play a roll in the successful treatment and outcome of trauma after an automobile crash, but it was not proven if there was any actual relationship between mental distress and the injury in the first place.

This study investigated 91 Emergency Room patients who had been involved in a motor vehicle crash within 1 week prior to the ER visit.  Each patient was given a standardized Coping Strategies Questionnaire (CSQ) after they had been examined.  

The same 91 patients were again given a CSQ one year after their crash with the following findings:

• 34% still had neck pain from the crash one year later.

• 71% of patients with pain were women.

• Women, more than men, used coping strategies, but there was no relationship of the coping strategies and the chronic pain.

• The only indicator of future neck pain was if the person in the crash had suffered with neck pain in the month prior to the crash.  Their risk for chronic pain was 5X's greater than the others.

The authors concluded,

"Illness Behaviour after a whiplash injury does not appear to be related to the patient's perception of the severity of the accident or their concern about the illness or disability.

This means that coping skills and prior mental health problems are unrelated to chronic pain and the long-term outcome of trauma. 

You may also remember from reading prior ENewsletters that there are added reasons why women sustain greater damage during a vehicle crash than men.  2 reasons are:

• Seat, head rest, and belt height during impact.

• Women have less muscle mass than men and they are less able to handle the 'shearing forces' generated during the crash.

• There are more reasons for trauma than just these two examples!  That is why I leave past ENewsletters on my web site.  You can review them when you need them!

1. Kivioja J.,  Jensen, I., Lindgren, U. Early coping strategies do not influence the prognosis after whiplash injuries.  Injury, 2005. 36:935-940.

Why Does the Chiropractor Measure My Legs?

The Deerfield Leg Length Analysis has been used  for many years as a valid, accurate, and reproducible tool with which to measure physical imbalance in the body.

Differences in leg lengths are due to:

• A True Short Leg.  This occurs in less than 10% of cases.  This may occur by way of a fracture, a genetic condition, a growth problem and any other condition that causes the leg bone to stop growing.

• A Functional Short Leg.  This occurs in more than 90% of cases.  A functional short leg means that  the leg is not structurally short, but rather, the imbalance exists due to trauma and a resulting muscle spasm.  Remember... muscles move bones!

Can someone have a True Short Leg and still have a Functional Short Leg too?  

Sure, why not?  The Functional shortness means that there is an imbalance that exists due to protective measures, even if a bone is truly short. 

For Example, a patient who suffers from cerebral palsy or a damaged bony growth plate may have a structurally short leg, but when trauma or imbalance exists, that 'normal' short leg worsens and the physical appearance changes.  If left untreated, this imbalance becomes trauma to the body and the arthritic and degenerative process begins.

Osteoarthritis is simply the body's attempt at trying to stabilize itself!

(It just doesn't do it very well!)

Measuring leg length inequality is more than an art, it is a skill that must be practiced until it becomes instinctive to the doctor.  Chiropractors who practice the Research-based, Activator Technique are tested regularly on their knowledge of the analysis and their ability to perform it.  There are also skill testing levels associated with the analysis

The Activator Technique analysis does not stop at the legs.  The analysis is used to evaluate 'structure and function' problems throughout the whole body.

Over the past 50 years, the Activator Technique has proven itself in research laboratories, clinical care and even during spinal surgery.  

The leg length imbalance is not just a phenomenon that some people get and others don't, but rather, it is an accurate measure of the body's self-protective mechanism.  

Using a leg length analysis provides the patient an accurate, 'full body' analysis with minimal risk of error.  The analysis is objective.  A protective mechanism is either present or it is not.

Leg length inequality is an important tool to help insure that patients are given the best analysis possible.  Leg length analysis is also an effective aid in determining problem areas that someone may not have previously been aware of.  It also helps in the objective analysis of chronic pain that  "No one else seems to be able to find".

Eileen's Corner

"This is still a regular cookie in my Mom's house and these are nearly 'no-fail' cookies.

When I tell Glenn 'Mom sent cookies', he knows what to expect!

I think that you will like these too!"

Enjoy!

Eileen

Lets' Talk About Death!

I know that this is a morbid topic, but let's face it, it will happen to all of us! It may even happen to me when Eileen sees it next to her great recipe! (Just kidding)  This study, however, is too important to pass up!

This interesting research was published late last year in the Journal of the American Geriatric Society (Vol. 52, Issue 10, Oct. 2004).

The investigation studied the association of hyperkyphotic posture and cause-specific mortality in the elderly.  In plain English, they were trying to determine if body structure causes us to die early.  This study wasn't a Chiropractic study, but the end results will likely influence how elderly people care for themselves.

The upper back curve that we all have is called a kyphosis.  This is complimented by the neck curve (lordosis) and the low back curve (lordosis).  We are all born with a kyphosis.  It is the fetal position. 

The neck curve develops as the neck muscles strengthen to the point that a baby can easily lift its head.  This is followed by a developing low back curve as the child begins to walk.  For the most part, we are one big spring that bounces up and down in resistance to gravity.  Without the 'spinal spring'  we would not live as long because we would sustain too many bony fractures.  The spring makes us more resilient to the world.

As we age, the upper back curve (kyphosis) can begin to increase in size because of restriction of normal vertebra motion, fractures, disc and cartilage dehydration, and a general loss of supporting muscle mass.  We have all seen the 'little old lady or man' ambling down the street, but I wonder how many people ever questioned why they look that way?  

OLD AGE is not the right answer! 

If the spinal problems listed above are not fixed, it will result in spinal degeneration and breakdown.  The resulting structural demands for compensation increases the size of the upper back kyphosis and the individual loses height and becomes physically impaired.  As the curve increases with time (this is why it is age-related), the impairment becomes greater.  This is called a hyperkyphosis.

The published study measured 1353 senior participants.  Taking into account demographics, clinical characteristics and behaviors, each participant was assessed and then followed for an average of 4.2 years.  The results were striking and unexpected:

• Hyperkyphosis dramatically increased the risk of dying early from atherosclerotic disease.  This means that an increased upper back curve as we age increases our risk of dying from heart disease.

• Men (44%) had a greater incidence of hyperkyphosis than did women (22%).  Clinically, we were always taught that women had a greater incidence of hyperkyphosis than did men.  Women even have a name for it (Dowager's Hump).

• In these seniors, the greater the degree of kyphosis, the higher the death rate.  These findings are an accurate predictor of who and when!

I think that Chiropractic has just been validated for its claims over the past 100+ years.  Spinal health is important and if it is neglected, impairment, disability and early death may be the result!  I couldn't have said it better or clearer than this study!

Have a great month!

Dr. Frisch